hospital_name,last_updated_on,version,location_name,hospital_address,license_number|CA,type_2_npi,,,"To the best of its knowledge and belief, this 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 in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.",attester_name,general_contract_provisions,,,,,,,,,,,,,,,,
CULLMAN REGIONAL MEDICAL CENTER,1/19/2026,3.0.0,Cullman Regional Hospital|Hartselle Health Park Emergency Department|CRMC Medical Group LLC,"1912 AL Hwy 157, Cullman, AL 35056|1549 US Hwy 31, Hartselle, AL 35640",H2201,1114919339|1710640305|1467083675,,,TRUE,Tammy Parris,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,code|4,code|4|type,modifiers,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,payer_name,plan_name,standard_charge|negotiated_dollar,standard_charge|negotiated_percentage,standard_charge|negotiated_algorithm,median_amount,10th_percentile,90th_percentile,count,standard_charge|methodology,standard_charge|min,standard_charge|max,additional_generic_notes
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,1,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,229563.94,,,,,,,Fee Schedule,2300,229563.9421,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,2,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,92826.93,,,,,,,Fee Schedule,2300,92826.9327,
"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",3,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,173870.9,,,,,,,Fee Schedule,2300,173870.8953,
"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",4,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,113466.79,,,,,,,Fee Schedule,2300,113466.7904,
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,5,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,84460.73,,,,,,,Fee Schedule,2300,84460.72906,
LIVER TRANSPLANT WITHOUT MCC,6,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,37985.01,,,,,,,Fee Schedule,2300,37985.00564,
LUNG TRANSPLANT,7,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,106084.41,,,,,,,Fee Schedule,2300,106084.4123,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,8,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,45911.31,,,,,,,Fee Schedule,2300,45911.31391,
PANCREAS TRANSPLANT,10,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,25147.76,,,,,,,Fee Schedule,2300,25147.76123,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",11,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,44678.46,,,,,,,Fee Schedule,2300,44678.46005,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",12,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,34536.29,,,,,,,Fee Schedule,2300,34536.29152,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",13,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,23606.9,,,,,,,Fee Schedule,2300,23606.8987,
ALLOGENEIC BONE MARROW TRANSPLANT,14,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,98447.27,,,,,,,Fee Schedule,2300,98447.27179,
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,16,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,48574.44,,,,,,,Fee Schedule,2300,48574.44208,
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,17,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,39634,,,,,,,Fee Schedule,2300,39633.99888,
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,18,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,353741.41,,,,,,,Fee Schedule,2300,353741.4064,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,19,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,54288.17,,,,,,,Fee Schedule,2300,54288.16678,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,20,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,64459.01,,,,,,,Fee Schedule,2300,64459.00634,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,21,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,43365.33,,,,,,,Fee Schedule,2300,43365.32734,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,22,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,25190.36,,,,,,,Fee Schedule,2300,25190.35817,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,23,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,46941.01,,,,,,,Fee Schedule,2300,46941.01312,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,24,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,32045.19,,,,,,,Fee Schedule,2300,32045.18947,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,25,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,37245.29,,,,,,,Fee Schedule,2300,37245.29332,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,26,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,25469.7,,,,,,,Fee Schedule,2300,25469.69582,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,27,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,20666.89,,,,,,,Fee Schedule,2300,20666.89039,
SPINAL PROCEDURES WITH MCC,28,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,49218.31,,,,,,,Fee Schedule,2300,49218.31128,
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,29,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,27946.87,,,,,,,Fee Schedule,2300,27946.87195,
SPINAL PROCEDURES WITHOUT CC/MCC,30,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17982.46,,,,,,,Fee Schedule,2300,17982.46374,
VENTRICULAR SHUNT PROCEDURES WITH MCC,31,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,36703,,,,,,,Fee Schedule,2300,36703.00146,
VENTRICULAR SHUNT PROCEDURES WITH CC,32,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17456.56,,,,,,,Fee Schedule,2300,17456.55532,
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,33,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13622.01,,,,,,,Fee Schedule,2300,13879,
CAROTID ARTERY STENT PROCEDURES WITH MCC,34,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,31707.69,,,,,,,Fee Schedule,2300,31707.6906,
CAROTID ARTERY STENT PROCEDURES WITH CC,35,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,19582.31,,,,,,,Fee Schedule,2300,19582.30666,
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,36,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15914.87,,,,,,,Fee Schedule,2300,15914.87362,
EXTRACRANIAL PROCEDURES WITH MCC,37,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,26967.96,,,,,,,Fee Schedule,2300,26967.96141,
EXTRACRANIAL PROCEDURES WITH CC,38,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13291.88,,,,,,,Fee Schedule,2300,13291.88487,
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,39,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9629.37,,,,,,,Fee Schedule,2300,9629.36686,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",40,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,31629.87,,,,,,,Fee Schedule,2300,31629.86926,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",41,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,18011.13,,,,,,,Fee Schedule,2300,18011.13476,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",42,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14152.83,,,,,,,Fee Schedule,2300,14152.83464,
SPINAL DISORDERS AND INJURIES WITH CC/MCC,52,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14587.81,,,,,,,Fee Schedule,2300,14587.81498,
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,53,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8021.33,,,,,,,Fee Schedule,2300,8021.332224,
NERVOUS SYSTEM NEOPLASMS WITH MCC,54,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12507.94,,,,,,,Fee Schedule,2300,12507.93727,
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,55,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8352.28,,,,,,,Fee Schedule,2300,8352.277712,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,56,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,19030.18,,,,,,,Fee Schedule,2300,19030.18473,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,57,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10613.19,,,,,,,Fee Schedule,2300,10613.19243,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,58,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14003.75,,,,,,,Fee Schedule,2300,14003.74534,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,59,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10165.11,,,,,,,Fee Schedule,2300,10165.10535,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,60,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7534.74,,,,,,,Fee Schedule,2300,7534.744056,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",61,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,22585.39,,,,,,,Fee Schedule,2300,22585.39121,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",62,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14394.49,,,,,,,Fee Schedule,2300,14394.49038,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",63,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11499.54,,,,,,,Fee Schedule,2300,11499.53654,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,64,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,16473.55,,,,,,,Fee Schedule,2300,16473.54892,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,65,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8276.09,,,,,,,Fee Schedule,2300,8276.094716,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,66,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5606.41,,,,,,,Fee Schedule,2300,5606.413168,
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,67,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12031.18,,,,,,,Fee Schedule,2300,12031.17916,
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,68,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7080.92,,,,,,,Fee Schedule,2300,7080.922768,
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,69,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6543.55,,,,,,,Fee Schedule,2300,6543.545936,
OTHER CEREBROVASCULAR DISORDERS WITH MCC,70,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13637.58,,,,,,,Fee Schedule,2300,13637.57546,
OTHER CEREBROVASCULAR DISORDERS WITH CC,71,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8404.7,,,,,,,Fee Schedule,2300,8404.70472,
OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,72,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6194.58,,,,,,,Fee Schedule,2300,6194.578664,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,73,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13141.98,,,,,,,Fee Schedule,2300,13141.9764,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,74,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8444.02,,,,,,,Fee Schedule,2300,8444.024976,
VIRAL MENINGITIS WITH CC/MCC,75,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15707.62,,,,,,,Fee Schedule,2300,15707.6231,
VIRAL MENINGITIS WITHOUT CC/MCC,76,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6133.96,,,,,,,Fee Schedule,2300,6133.959936,
NONTRAUMATIC STUPOR AND COMA WITH MCC,80,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14827.01,,,,,,,Fee Schedule,2300,14827.0132,
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,81,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7336.5,,,,,,,Fee Schedule,2300,7336.504432,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,82,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,18723,,,,,,,Fee Schedule,2300,18722.99523,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,83,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11434,,,,,,,Fee Schedule,2300,11434.00278,
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,84,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7829.65,,,,,,,Fee Schedule,2300,7829.645976,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,85,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,18610.77,,,,,,,Fee Schedule,2300,18610.76867,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,86,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10671.35,,,,,,,Fee Schedule,2300,10671.35364,
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,87,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7492.97,,,,,,,Fee Schedule,2300,7492.966284,
CONCUSSION WITH MCC,88,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11073.57,,,,,,,Fee Schedule,2300,11073.5671,
CONCUSSION WITH CC,89,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8999.42,,,,,,,Fee Schedule,2300,8999.423592,
CONCUSSION WITHOUT CC/MCC,90,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6743.42,,,,,,,Fee Schedule,2300,6743.423904,
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,91,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14386.3,,,,,,,Fee Schedule,2300,14386.29866,
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,92,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8380.13,,,,,,,Fee Schedule,2300,8380.12956,
OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,93,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6523.07,,,,,,,Fee Schedule,2300,6523.066636,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,94,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,28829.94,,,,,,,Fee Schedule,2300,28829.93937,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,95,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,21128.08,,,,,,,Fee Schedule,2300,21128.08422,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,96,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,21128.08,,,,,,,Fee Schedule,2300,21128.08422,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,97,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,29586.85,,,,,,,Fee Schedule,2300,29586.8543,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,98,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,18799.18,,,,,,,Fee Schedule,2300,18799.17823,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,99,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11160.4,,,,,,,Fee Schedule,2300,11160.39933,
SEIZURES WITH MCC,100,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15865.72,,,,,,,Fee Schedule,2300,15865.7233,
SEIZURES WITHOUT MCC,101,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7393.85,,,,,,,Fee Schedule,2300,7393.846472,
HEADACHES WITH MCC,102,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9182.1,,,,,,,Fee Schedule,2300,9182.098948,
HEADACHES WITHOUT MCC,103,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6850.74,,,,,,,Fee Schedule,2300,6850.735436,
ORBITAL PROCEDURES WITH CC/MCC,113,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,19259.55,,,,,,,Fee Schedule,2300,19259.55289,
ORBITAL PROCEDURES WITHOUT CC/MCC,114,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11083.4,,,,,,,Fee Schedule,2300,11083.39716,
EXTRAOCULAR PROCEDURES EXCEPT ORBIT,115,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12573.47,,,,,,,Fee Schedule,2300,12573.47103,
INTRAOCULAR PROCEDURES WITH CC/MCC,116,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14811.45,,,,,,,Fee Schedule,2300,14811.44893,
INTRAOCULAR PROCEDURES WITHOUT CC/MCC,117,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8887.2,,,,,,,Fee Schedule,2300,8887.197028,
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,121,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9529.43,,,,,,,Fee Schedule,2300,9529.427876,
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,122,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6437.05,,,,,,,Fee Schedule,2300,6437.053576,
NEUROLOGICAL EYE DISORDERS,123,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6541.91,,,,,,,Fee Schedule,2300,6541.907592,
OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT,124,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10838.46,,,,,,,Fee Schedule,2300,10838.46473,
OTHER DISORDERS OF THE EYE WITHOUT MCC,125,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6289.6,,,,,,,Fee Schedule,2300,6289.602616,
SINUS AND MASTOID PROCEDURES WITH CC/MCC,135,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17327.13,,,,,,,Fee Schedule,2300,17327.12614,
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,136,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8317.05,,,,,,,Fee Schedule,2300,8327,
MOUTH PROCEDURES WITH CC/MCC,137,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12231.88,,,,,,,Fee Schedule,2300,12231.8763,
MOUTH PROCEDURES WITHOUT CC/MCC,138,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7259.5,,,,,,,Fee Schedule,2300,7259.502264,
SALIVARY GLAND PROCEDURES,139,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9900.51,,,,,,,Fee Schedule,2300,9900.512792,
MAJOR HEAD AND NECK PROCEDURES WITH MCC,140,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,34940.14,,,,,,,Fee Schedule,2300,34940.14332,
MAJOR HEAD AND NECK PROCEDURES WITH CC,141,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17866.96,,,,,,,Fee Schedule,2300,17866.96049,
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,142,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13077.26,,,,,,,Fee Schedule,2300,13879,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,30691.1,,,,,,,Fee Schedule,2300,30691.09815,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14195.43,,,,,,,Fee Schedule,2300,14195.43159,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9848.9,,,,,,,Fee Schedule,2300,9848.904956,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17345.15,,,,,,,Fee Schedule,2300,17345.14793,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",147,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10415.77,,,,,,,Fee Schedule,2300,10415.77198,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",148,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6529.62,,,,,,,Fee Schedule,2300,6529.620012,
DYSEQUILIBRIUM,149,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6156.9,,,,,,,Fee Schedule,2300,6156.896752,
EPISTAXIS WITH MCC,150,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10907.28,,,,,,,Fee Schedule,2300,10907.27518,
EPISTAXIS WITHOUT MCC,151,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6012.72,,,,,,,Fee Schedule,2300,6012.72248,
OTITIS MEDIA AND URI WITH MCC,152,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9684.25,,,,,,,Fee Schedule,2300,9684.251384,
OTITIS MEDIA AND URI WITHOUT MCC,153,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6047.13,,,,,,,Fee Schedule,2300,6047.127704,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12807.75,,,,,,,Fee Schedule,2300,12807.75422,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7507.71,,,,,,,Fee Schedule,2300,7507.71138,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5661.3,,,,,,,Fee Schedule,2300,5661.297692,
DENTAL AND ORAL DISEASES WITH MCC,157,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14063.54,,,,,,,Fee Schedule,2300,14063.5449,
DENTAL AND ORAL DISEASES WITH CC,158,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7452.83,,,,,,,Fee Schedule,2300,7452.826856,
DENTAL AND ORAL DISEASES WITHOUT CC/MCC,159,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5803.83,,,,,,,Fee Schedule,2300,5803.83362,
MAJOR CHEST PROCEDURES WITH MCC,163,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,36713.65,,,,,,,Fee Schedule,2300,36713.6507,
MAJOR CHEST PROCEDURES WITH CC,164,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,20675.9,,,,,,,Fee Schedule,2300,20675.90128,
MAJOR CHEST PROCEDURES WITHOUT CC/MCC,165,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15680.59,,,,,,,Fee Schedule,2300,15680.59042,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,166,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,30618.19,,,,,,,Fee Schedule,2300,30618.19184,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,167,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14772.95,,,,,,,Fee Schedule,2300,14772.94785,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,168,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11193.17,,,,,,,Fee Schedule,2300,11193.16621,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM,173,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,24381.84,,,,,,,Fee Schedule,2300,24381.83541,
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,175,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11252.15,,,,,,,Fee Schedule,2300,11252.14659,
PULMONARY EMBOLISM WITHOUT MCC,176,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6594.33,,,,,,,Fee Schedule,2300,6594.3346,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,177,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12801.2,,,,,,,Fee Schedule,2300,12801.20084,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,178,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7995.12,,,,,,,Fee Schedule,2300,7995.11872,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,179,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6184.75,,,,,,,Fee Schedule,2300,6184.7486,
RESPIRATORY NEOPLASMS WITH MCC,180,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14466.58,,,,,,,Fee Schedule,2300,14466.57752,
RESPIRATORY NEOPLASMS WITH CC,181,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8773.33,,,,,,,Fee Schedule,2300,8773.33212,
RESPIRATORY NEOPLASMS WITHOUT CC/MCC,182,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6094.64,,,,,,,Fee Schedule,2300,6094.63968,
MAJOR CHEST TRAUMA WITH MCC,183,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12532.51,,,,,,,Fee Schedule,2300,12532.51243,
MAJOR CHEST TRAUMA WITH CC,184,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8716.81,,,,,,,Fee Schedule,2300,8716.809252,
MAJOR CHEST TRAUMA WITHOUT CC/MCC,185,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6442.79,,,,,,,Fee Schedule,2300,6442.78778,
PLEURAL EFFUSION WITH MCC,186,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12766.8,,,,,,,Fee Schedule,2300,12766.79562,
PLEURAL EFFUSION WITH CC,187,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8102.43,,,,,,,Fee Schedule,2300,8102.430252,
PLEURAL EFFUSION WITHOUT CC/MCC,188,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5875.1,,,,,,,Fee Schedule,2300,5875.101584,
PULMONARY EDEMA AND RESPIRATORY FAILURE,189,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10120.05,,,,,,,Fee Schedule,2300,10120.05089,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,190,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9073.97,,,,,,,Fee Schedule,2300,9073.968244,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,191,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6905.62,,,,,,,Fee Schedule,2300,6905.61996,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,192,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5259.08,,,,,,,Fee Schedule,2300,5259.08424,
SIMPLE PNEUMONIA AND PLEURISY WITH MCC,193,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10767.2,,,,,,,Fee Schedule,2300,10767.19677,
SIMPLE PNEUMONIA AND PLEURISY WITH CC,194,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6601.71,,,,,,,Fee Schedule,2300,6601.707148,
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,195,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5148.5,,,,,,,Fee Schedule,2300,5148.49602,
INTERSTITIAL LUNG DISEASE WITH MCC,196,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15459.41,,,,,,,Fee Schedule,2300,15459.41398,
INTERSTITIAL LUNG DISEASE WITH CC,197,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7774.76,,,,,,,Fee Schedule,2300,7774.761452,
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,198,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5866.91,,,,,,,Fee Schedule,2300,5866.909864,
PNEUMOTHORAX WITH MCC,199,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14451.01,,,,,,,Fee Schedule,2300,14451.01325,
PNEUMOTHORAX WITH CC,200,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9005.16,,,,,,,Fee Schedule,2300,9005.157796,
PNEUMOTHORAX WITHOUT CC/MCC,201,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5857.9,,,,,,,Fee Schedule,2300,5857.898972,
BRONCHITIS AND ASTHMA WITH CC/MCC,202,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7955.8,,,,,,,Fee Schedule,2300,7955.798464,
BRONCHITIS AND ASTHMA WITHOUT CC/MCC,203,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5488.45,,,,,,,Fee Schedule,2300,5488.4524,
RESPIRATORY SIGNS AND SYMPTOMS,204,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6613.99,,,,,,,Fee Schedule,2300,6613.994728,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,205,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14999.04,,,,,,,Fee Schedule,2300,14999.03932,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,206,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7709.23,,,,,,,Fee Schedule,2300,7709.227692,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,207,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,52711.26,,,,,,,Fee Schedule,2300,52711.26068,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,208,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,22516.58,,,,,,,Fee Schedule,2300,22516.58076,
COMPLEX AORTIC ARCH PROCEDURES,209,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,92720.44,,,,,,,Fee Schedule,2300,92720.44034,
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES,212,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,89077.58,,,,,,,Fee Schedule,2300,89077.58245,
ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES,213,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,46749.33,,,,,,,Fee Schedule,2300,46749.32687,
OTHER HEART ASSIST SYSTEM IMPLANT,215,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,81564.96,,,,,,,Fee Schedule,2300,81564.95604,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,216,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,80137.96,,,,,,,Fee Schedule,2300,80137.95842,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,217,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,53863.02,,,,,,,Fee Schedule,2300,53863.01652,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,218,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,53863.02,,,,,,,Fee Schedule,2300,53863.01652,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,219,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,62898.48,,,,,,,Fee Schedule,2300,62898.48368,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,220,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,43684.8,,,,,,,Fee Schedule,2300,43684.80442,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,221,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,41287.91,,,,,,,Fee Schedule,2300,41287.90714,
OTHER CARDIOTHORACIC PROCEDURES WITH MCC,228,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,40527.72,,,,,,,Fee Schedule,2300,40527.71553,
OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,229,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,25799.82,,,,,,,Fee Schedule,2300,25799.82214,
CORONARY BYPASS WITH PTCA WITH MCC,231,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,69055.38,,,,,,,Fee Schedule,2300,69055.38043,
CORONARY BYPASS WITH PTCA WITHOUT MCC,232,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,49663.12,,,,,,,Fee Schedule,2300,49663.12167,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,233,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,62627.34,,,,,,,Fee Schedule,2300,62627.33774,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,234,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,44748.91,,,,,,,Fee Schedule,2300,44748.90884,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,235,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,48073.93,,,,,,,Fee Schedule,2300,48073.92799,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,236,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,34313.48,,,,,,,Fee Schedule,2300,34313.47674,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,239,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,40317.19,,,,,,,Fee Schedule,2300,40317.18832,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,240,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,23350.5,,,,,,,Fee Schedule,2300,23350.49786,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,241,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11340.62,,,,,,,Fee Schedule,2300,11340.61717,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,242,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,26154.52,,,,,,,Fee Schedule,2300,26154.52362,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,243,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17455.74,,,,,,,Fee Schedule,2300,17455.73615,
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,244,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14806.53,,,,,,,Fee Schedule,2300,14806.5339,
AICD GENERATOR PROCEDURES,245,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,37373.9,,,,,,,Fee Schedule,2300,37373.90333,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC,250,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17878.43,,,,,,,Fee Schedule,2300,17878.4289,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC,251,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12242.53,,,,,,,Fee Schedule,2300,13879,
OTHER VASCULAR PROCEDURES WITH MCC,252,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,28575.18,,,,,,,Fee Schedule,2300,28575.17688,
OTHER VASCULAR PROCEDURES WITH CC,253,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,21262.43,,,,,,,Fee Schedule,2300,21262.42843,
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,254,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14595.19,,,,,,,Fee Schedule,2300,14595.18752,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,255,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,22096.35,,,,,,,Fee Schedule,2300,22096.34553,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,256,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13908.72,,,,,,,Fee Schedule,2300,13908.72139,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,257,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8947,,,,,,,Fee Schedule,2300,8946.996584,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,258,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,25739.2,,,,,,,Fee Schedule,2300,25739.20341,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,259,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,16564.48,,,,,,,Fee Schedule,2300,16564.47701,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,260,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,26646.03,,,,,,,Fee Schedule,2300,26646.02682,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,261,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15486.45,,,,,,,Fee Schedule,2300,15486.44666,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,262,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13351.68,,,,,,,Fee Schedule,2300,13351.68443,
VEIN LIGATION AND STRIPPING,263,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,25045.36,,,,,,,Fee Schedule,2300,25045.36473,
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,264,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,27365.26,,,,,,,Fee Schedule,2300,27365.25983,
AICD LEAD PROCEDURES,265,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,29639.28,,,,,,,Fee Schedule,2300,29639.2813,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,266,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,50202.14,,,,,,,Fee Schedule,2300,50202.13685,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,267,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,38999.14,,,,,,,Fee Schedule,2300,38999.14058,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,268,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,56341.83,,,,,,,Fee Schedule,2300,56341.83099,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,269,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,34595.27,,,,,,,Fee Schedule,2300,34595.2719,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,270,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,43221.97,,,,,,,Fee Schedule,2300,43221.97224,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,271,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,29132.21,,,,,,,Fee Schedule,2300,29132.21384,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,272,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,20913.46,,,,,,,Fee Schedule,2300,20913.46116,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,273,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,33794.94,,,,,,,Fee Schedule,2300,33794.94086,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,274,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,26964.68,,,,,,,Fee Schedule,2300,26964.68472,
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC,275,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,58410.24,,,,,,,Fee Schedule,2300,58410.24029,
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR,276,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,49204.39,,,,,,,Fee Schedule,2300,49204.38535,
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC,277,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,37833.46,,,,,,,Fee Schedule,2300,37833.45882,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC,278,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,45596.75,,,,,,,Fee Schedule,2300,45596.75186,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC,279,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,29542.62,,,,,,,Fee Schedule,2300,29542.61901,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",280,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13140.34,,,,,,,Fee Schedule,2300,13140.33805,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",281,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7529.01,,,,,,,Fee Schedule,2300,7529.009852,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",282,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5923.43,,,,,,,Fee Schedule,2300,5923.432732,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",283,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,16226.16,,,,,,,Fee Schedule,2300,16226.15898,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",284,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5670.31,,,,,,,Fee Schedule,2300,5670.308584,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",285,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,4906.02,,,,,,,Fee Schedule,2300,4972,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",286,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,18126.64,,,,,,,Fee Schedule,2300,18126.63802,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",287,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8765.96,,,,,,,Fee Schedule,2300,8765.959572,
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,288,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,22168.43,,,,,,,Fee Schedule,2300,22168.43266,
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,289,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13982.45,,,,,,,Fee Schedule,2300,13982.44687,
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,290,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7615.84,,,,,,,Fee Schedule,2300,7615.842084,
HEART FAILURE AND SHOCK WITH MCC,291,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10516.53,,,,,,,Fee Schedule,2300,10516.53014,
HEART FAILURE AND SHOCK WITH CC,292,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6954.77,,,,,,,Fee Schedule,2300,6954.77028,
HEART FAILURE AND SHOCK WITHOUT CC/MCC,293,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,4636.51,,,,,,,Fee Schedule,2300,4636.51352,
"CARDIAC ARREST, UNEXPLAINED WITH MCC",296,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12794.65,,,,,,,Fee Schedule,2300,12794.64747,
"CARDIAC ARREST, UNEXPLAINED WITH CC",297,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5107.54,,,,,,,Fee Schedule,2300,6184,
"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",298,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,3728.05,,,,,,,Fee Schedule,2300,4972,
PERIPHERAL VASCULAR DISORDERS WITH MCC,299,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13374.62,,,,,,,Fee Schedule,2300,13374.62124,
PERIPHERAL VASCULAR DISORDERS WITH CC,300,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8744.66,,,,,,,Fee Schedule,2300,8744.6611,
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,301,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5895.58,,,,,,,Fee Schedule,2300,5895.580884,
ATHEROSCLEROSIS WITH MCC,302,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9802.21,,,,,,,Fee Schedule,2300,9802.212152,
ATHEROSCLEROSIS WITHOUT MCC,303,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5514.67,,,,,,,Fee Schedule,2300,5514.665904,
HYPERTENSION WITH MCC,304,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9748.15,,,,,,,Fee Schedule,2300,9748.1468,
HYPERTENSION WITHOUT MCC,305,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6185.57,,,,,,,Fee Schedule,2300,6185.567772,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,306,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12908.51,,,,,,,Fee Schedule,2300,12908.51238,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,307,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7480.68,,,,,,,Fee Schedule,2300,7480.678704,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,308,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9862.83,,,,,,,Fee Schedule,2300,9862.83088,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,309,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6026.65,,,,,,,Fee Schedule,2300,6026.648404,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,310,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,4637.33,,,,,,,Fee Schedule,2300,4637.332692,
ANGINA PECTORIS,311,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5749.77,,,,,,,Fee Schedule,2300,5749.768268,
SYNCOPE AND COLLAPSE,312,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7139.9,,,,,,,Fee Schedule,2300,7139.903152,
CHEST PAIN,313,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5898.04,,,,,,,Fee Schedule,2300,5898.0384,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,314,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17081.37,,,,,,,Fee Schedule,2300,17081.37454,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,315,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7891.08,,,,,,,Fee Schedule,2300,7891.083876,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,316,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5587.57,,,,,,,Fee Schedule,2300,5587.572212,
CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION,317,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,54773.94,,,,,,,Fee Schedule,2300,54773.93578,
PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE,318,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,19841.98,,,,,,,Fee Schedule,2300,19841.98418,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,319,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,36558.83,,,,,,,Fee Schedule,2300,36558.82719,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,320,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,19703.54,,,,,,,Fee Schedule,2300,19703.54412,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES,321,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,22288.03,,,,,,,Fee Schedule,2300,22288.03178,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC,322,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14442,,,,,,,Fee Schedule,2300,14442.00236,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC,323,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,35448.85,,,,,,,Fee Schedule,2300,35448.84913,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC,324,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,25812.11,,,,,,,Fee Schedule,2300,25812.10972,
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE,325,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,26298.7,,,,,,,Fee Schedule,2300,26298.69789,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,40855.38,,,,,,,Fee Schedule,2300,40855.38433,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,20022.2,,,,,,,Fee Schedule,2300,20022.20202,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13125.59,,,,,,,Fee Schedule,2300,13125.59296,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,329,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,37653.24,,,,,,,Fee Schedule,2300,37653.24098,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,330,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,19637.19,,,,,,,Fee Schedule,2300,19637.19118,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,331,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13785.85,,,,,,,Fee Schedule,2300,13785.84559,
RECTAL RESECTION WITH MCC,332,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,29659.76,,,,,,,Fee Schedule,2300,29659.7606,
RECTAL RESECTION WITH CC,333,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,19186.65,,,,,,,Fee Schedule,2300,19186.64658,
RECTAL RESECTION WITHOUT CC/MCC,334,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13417.22,,,,,,,Fee Schedule,2300,13417.21819,
PERITONEAL ADHESIOLYSIS WITH MCC,335,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,29251.81,,,,,,,Fee Schedule,2300,29251.81295,
PERITONEAL ADHESIOLYSIS WITH CC,336,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17273.88,,,,,,,Fee Schedule,2300,17273.87996,
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,337,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12574.29,,,,,,,Fee Schedule,2300,12574.2902,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,344,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,21157.57,,,,,,,Fee Schedule,2300,21157.57442,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,345,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12326.08,,,,,,,Fee Schedule,2300,12326.08108,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,346,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9717.02,,,,,,,Fee Schedule,2300,9717.018264,
ANAL AND STOMAL PROCEDURES WITH MCC,347,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,18804.91,,,,,,,Fee Schedule,2300,18804.91243,
ANAL AND STOMAL PROCEDURES WITH CC,348,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10721.32,,,,,,,Fee Schedule,2300,10721.32314,
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,349,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7131.71,,,,,,,Fee Schedule,2300,7131.711432,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,350,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,20412.95,,,,,,,Fee Schedule,2300,20412.94707,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,351,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12488.28,,,,,,,Fee Schedule,2300,12488.27714,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,352,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9566.29,,,,,,,Fee Schedule,2300,9566.290616,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,353,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,23772.37,,,,,,,Fee Schedule,2300,23772.37144,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,354,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13781.75,,,,,,,Fee Schedule,2300,13781.74973,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,355,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11017.86,,,,,,,Fee Schedule,2300,11017.8634,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,356,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,35984.59,,,,,,,Fee Schedule,2300,35984.58762,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,357,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,19049.84,,,,,,,Fee Schedule,2300,19049.84486,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,358,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11451.21,,,,,,,Fee Schedule,2300,11451.20539,
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC,359,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,28168.05,,,,,,,Fee Schedule,2300,28168.04839,
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC,360,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,19777.27,,,,,,,Fee Schedule,2300,19777.2696,
MAJOR ESOPHAGEAL DISORDERS WITH MCC,368,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13040.4,,,,,,,Fee Schedule,2300,13040.39907,
MAJOR ESOPHAGEAL DISORDERS WITH CC,369,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8193.36,,,,,,,Fee Schedule,2300,8193.358344,
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,370,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5740.76,,,,,,,Fee Schedule,2300,5740.757376,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,371,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14524.74,,,,,,,Fee Schedule,2300,14524.73873,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,372,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8363.75,,,,,,,Fee Schedule,2300,8363.74612,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,373,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5958.66,,,,,,,Fee Schedule,2300,5958.657128,
DIGESTIVE MALIGNANCY WITH MCC,374,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17519.63,,,,,,,Fee Schedule,2300,17519.63156,
DIGESTIVE MALIGNANCY WITH CC,375,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9908.7,,,,,,,Fee Schedule,2300,9908.704512,
DIGESTIVE MALIGNANCY WITHOUT CC/MCC,376,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7571.61,,,,,,,Fee Schedule,2300,7571.606796,
GASTROINTESTINAL HEMORRHAGE WITH MCC,377,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14974.46,,,,,,,Fee Schedule,2300,14974.46416,
GASTROINTESTINAL HEMORRHAGE WITH CC,378,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8033.62,,,,,,,Fee Schedule,2300,8033.619804,
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,379,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5164.06,,,,,,,Fee Schedule,2300,5164.060288,
COMPLICATED PEPTIC ULCER WITH MCC,380,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,16073.79,,,,,,,Fee Schedule,2300,16073.79298,
COMPLICATED PEPTIC ULCER WITH CC,381,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8875.73,,,,,,,Fee Schedule,2300,8875.72862,
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,382,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6558.29,,,,,,,Fee Schedule,2300,6558.291032,
UNCOMPLICATED PEPTIC ULCER WITH MCC,383,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11310.31,,,,,,,Fee Schedule,2300,11310.3078,
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,384,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7002.28,,,,,,,Fee Schedule,2300,7002.282256,
INFLAMMATORY BOWEL DISEASE WITH MCC,385,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12961.76,,,,,,,Fee Schedule,2300,12961.75856,
INFLAMMATORY BOWEL DISEASE WITH CC,386,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7997.58,,,,,,,Fee Schedule,2300,7997.576236,
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,387,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5581.02,,,,,,,Fee Schedule,2300,5581.018836,
GASTROINTESTINAL OBSTRUCTION WITH MCC,388,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12097.53,,,,,,,Fee Schedule,2300,12097.5321,
GASTROINTESTINAL OBSTRUCTION WITH CC,389,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6469.82,,,,,,,Fee Schedule,2300,6469.820456,
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,390,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,4456.3,,,,,,,Fee Schedule,2300,4456.29568,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10389.56,,,,,,,Fee Schedule,2300,10389.55848,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6386.26,,,,,,,Fee Schedule,2300,6386.264912,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,393,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13101.02,,,,,,,Fee Schedule,2300,13101.0178,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,394,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7664.99,,,,,,,Fee Schedule,2300,7664.992404,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,395,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5316.43,,,,,,,Fee Schedule,2300,5316.42628,
APPENDIX PROCEDURES WITH MCC,397,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,19618.35,,,,,,,Fee Schedule,2300,19618.35023,
APPENDIX PROCEDURES WITH CC,398,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12398.99,,,,,,,Fee Schedule,2300,12398.98739,
APPENDIX PROCEDURES WITHOUT CC/MCC,399,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9377.06,,,,,,,Fee Schedule,2300,9377.061884,
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL,402,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,32934.81,,,,,,,Fee Schedule,2300,32934.81026,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",405,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,44812.8,,,,,,,Fee Schedule,2300,44812.80426,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",406,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,23757.63,,,,,,,Fee Schedule,2300,23757.62634,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",407,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,18182.34,,,,,,,Fee Schedule,2300,18182.34171,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,408,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,29208.4,,,,,,,Fee Schedule,2300,29208.39683,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,409,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17835.83,,,,,,,Fee Schedule,2300,17835.83196,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,410,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13005.99,,,,,,,Fee Schedule,2300,13005.99384,
CHOLECYSTECTOMY WITH C.D.E. WITH MCC,411,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,27059.71,,,,,,,Fee Schedule,2300,27059.70868,
CHOLECYSTECTOMY WITH C.D.E. WITH CC,412,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17223.09,,,,,,,Fee Schedule,2300,17223.0913,
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,413,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13602.35,,,,,,,Fee Schedule,2300,13602.35106,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,414,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,29183.82,,,,,,,Fee Schedule,2300,29183.82167,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,415,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,16929.83,,,,,,,Fee Schedule,2300,16929.82772,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,416,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11167.77,,,,,,,Fee Schedule,2300,11167.77188,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,417,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,19548.72,,,,,,,Fee Schedule,2300,19548.72061,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,418,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13857.11,,,,,,,Fee Schedule,2300,13857.11355,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,419,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11188.25,,,,,,,Fee Schedule,2300,11188.25118,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,420,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,27910.01,,,,,,,Fee Schedule,2300,27910.00921,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,421,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14233.11,,,,,,,Fee Schedule,2300,14233.1135,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,422,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11464.31,,,,,,,Fee Schedule,2300,11464.31214,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,423,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,34020.21,,,,,,,Fee Schedule,2300,34020.21316,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,424,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17922.66,,,,,,,Fee Schedule,2300,17922.66419,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,425,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12290.04,,,,,,,Fee Schedule,2300,12290.03752,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,426,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,90282.58,,,,,,,Fee Schedule,2300,90282.58446,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC,427,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,59132.75,,,,,,,Fee Schedule,2300,59132.74999,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC,428,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,46053.85,,,,,,,Fee Schedule,2300,46053.84984,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC,429,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,73804.12,,,,,,,Fee Schedule,2300,73804.12051,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC,430,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,47242.47,,,,,,,Fee Schedule,2300,47242.46841,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,432,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,16122.94,,,,,,,Fee Schedule,2300,16122.9433,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,433,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8652.09,,,,,,,Fee Schedule,2300,8652.094664,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,434,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5836.6,,,,,,,Fee Schedule,2300,5836.6005,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,435,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15045.73,,,,,,,Fee Schedule,2300,15045.73212,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,436,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9265.65,,,,,,,Fee Schedule,2300,9265.654492,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,437,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6989.99,,,,,,,Fee Schedule,2300,6989.994676,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,438,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13354.14,,,,,,,Fee Schedule,2300,13354.14194,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,439,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6890.87,,,,,,,Fee Schedule,2300,6890.874864,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,440,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5090.33,,,,,,,Fee Schedule,2300,5090.334808,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14701.68,,,,,,,Fee Schedule,2300,14701.67988,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7907.47,,,,,,,Fee Schedule,2300,7907.467316,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5731.75,,,,,,,Fee Schedule,2300,5731.746484,
DISORDERS OF THE BILIARY TRACT WITH MCC,444,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13687.54,,,,,,,Fee Schedule,2300,13687.54495,
DISORDERS OF THE BILIARY TRACT WITH CC,445,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8965.02,,,,,,,Fee Schedule,2300,8965.018368,
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,446,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6777.01,,,,,,,Fee Schedule,2300,6777.009956,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,447,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,54733.8,,,,,,,Fee Schedule,2300,54733.79635,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,448,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,34739.45,,,,,,,Fee Schedule,2300,34739.44618,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,450,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,43658.59,,,,,,,Fee Schedule,2300,43658.59091,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,451,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,26462.53,,,,,,,Fee Schedule,2300,26462.53229,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",456,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,68838.3,,,,,,,Fee Schedule,2300,68838.29985,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",457,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,48848.05,,,,,,,Fee Schedule,2300,48848.04553,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",458,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,34180.77,,,,,,,Fee Schedule,2300,34180.77087,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,461,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,43912.53,,,,,,,Fee Schedule,2300,43912.53423,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,462,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,21789.98,,,,,,,Fee Schedule,2300,21789.9752,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,463,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,46688.71,,,,,,,Fee Schedule,2300,46688.70814,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,464,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,25514.75,,,,,,,Fee Schedule,2300,25514.75028,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,465,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14939.24,,,,,,,Fee Schedule,2300,14939.23976,
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,466,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,42641.18,,,,,,,Fee Schedule,2300,42641.17929,
REVISION OF HIP OR KNEE REPLACEMENT WITH CC,467,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,28888.92,,,,,,,Fee Schedule,2300,28888.91975,
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,468,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,22510.85,,,,,,,Fee Schedule,2300,22510.84656,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,469,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,24847.13,,,,,,,Fee Schedule,2300,24847.1251,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,470,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15801.01,,,,,,,Fee Schedule,2300,15801.00871,
CERVICAL SPINAL FUSION WITH MCC,471,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,39555.36,,,,,,,Fee Schedule,2300,39555.35836,
CERVICAL SPINAL FUSION WITH CC,472,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,24133.63,,,,,,,Fee Schedule,2300,24133.62629,
CERVICAL SPINAL FUSION WITHOUT CC/MCC,473,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,19998.45,,,,,,,Fee Schedule,2300,19998.44604,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,474,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,35166.23,,,,,,,Fee Schedule,2300,35166.23479,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,475,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,18641.9,,,,,,,Fee Schedule,2300,18641.8972,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,476,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9667.87,,,,,,,Fee Schedule,2300,9667.867944,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,477,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,28299.12,,,,,,,Fee Schedule,2300,28299.11591,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,478,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,20145.08,,,,,,,Fee Schedule,2300,20145.07782,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,479,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15227.59,,,,,,,Fee Schedule,2300,15227.58831,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,480,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,23856.75,,,,,,,Fee Schedule,2300,23856.74616,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,481,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17157.56,,,,,,,Fee Schedule,2300,17157.55754,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,482,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13360.7,,,,,,,Fee Schedule,2300,13360.69532,
MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,483,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,22706.63,,,,,,,Fee Schedule,2300,22706.62867,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,485,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,26435.5,,,,,,,Fee Schedule,2300,26435.49961,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,486,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17129.71,,,,,,,Fee Schedule,2300,17129.70569,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,487,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12829.87,,,,,,,Fee Schedule,2300,12829.87186,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,488,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12480.9,,,,,,,Fee Schedule,2300,12480.90459,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,489,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9148.51,,,,,,,Fee Schedule,2300,13879,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",492,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,30076.72,,,,,,,Fee Schedule,2300,30076.71915,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",493,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,20775.02,,,,,,,Fee Schedule,2300,20775.02109,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",494,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,16436.69,,,,,,,Fee Schedule,2300,16436.68618,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,495,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,29700.72,,,,,,,Fee Schedule,2300,29700.7192,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,496,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14777.04,,,,,,,Fee Schedule,2300,14777.04371,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,497,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9434.4,,,,,,,Fee Schedule,2300,9434.403924,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,498,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,24712.78,,,,,,,Fee Schedule,2300,24712.7809,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,499,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,16504.68,,,,,,,Fee Schedule,2300,16504.67746,
SOFT TISSUE PROCEDURES WITH MCC,500,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,25925.16,,,,,,,Fee Schedule,2300,25925.15546,
SOFT TISSUE PROCEDURES WITH CC,501,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14319.95,,,,,,,Fee Schedule,2300,14319.94573,
SOFT TISSUE PROCEDURES WITHOUT CC/MCC,502,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11025.24,,,,,,,Fee Schedule,2300,11025.23595,
FOOT PROCEDURES WITH MCC,503,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,22863.91,,,,,,,Fee Schedule,2300,22863.90969,
FOOT PROCEDURES WITH CC,504,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15311.96,,,,,,,Fee Schedule,2300,15311.96302,
FOOT PROCEDURES WITHOUT CC/MCC,505,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14686.12,,,,,,,Fee Schedule,2300,14686.11562,
MAJOR THUMB OR JOINT PROCEDURES,506,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9826.79,,,,,,,Fee Schedule,2300,9826.787312,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,507,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14797.52,,,,,,,Fee Schedule,2300,14797.52301,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,508,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12405.54,,,,,,,Fee Schedule,2300,12405.54077,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,24743.09,,,,,,,Fee Schedule,2300,24743.09026,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17033.86,,,,,,,Fee Schedule,2300,17033.86257,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13560.57,,,,,,,Fee Schedule,2300,13879,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12896.22,,,,,,,Fee Schedule,2300,12896.2248,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8374.4,,,,,,,Fee Schedule,2300,8374.395356,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,515,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,26106.19,,,,,,,Fee Schedule,2300,26106.19247,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,516,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17023.21,,,,,,,Fee Schedule,2300,17023.21333,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,517,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12588.22,,,,,,,Fee Schedule,2300,13879,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,518,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,30614.92,,,,,,,Fee Schedule,2300,30614.91516,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,519,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,16385.08,,,,,,,Fee Schedule,2300,16385.07834,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,520,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12237.61,,,,,,,Fee Schedule,2300,12237.61051,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,521,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,23511.87,,,,,,,Fee Schedule,2300,23511.87474,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,522,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17347.61,,,,,,,Fee Schedule,2300,17347.60544,
FRACTURES OF FEMUR WITH MCC,533,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12842.16,,,,,,,Fee Schedule,2300,12842.15944,
FRACTURES OF FEMUR WITHOUT MCC,534,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6603.35,,,,,,,Fee Schedule,2300,6603.345492,
FRACTURES OF HIP AND PELVIS WITH MCC,535,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10501.79,,,,,,,Fee Schedule,2300,10501.78504,
FRACTURES OF HIP AND PELVIS WITHOUT MCC,536,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6615.63,,,,,,,Fee Schedule,2300,6615.633072,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",537,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7817.36,,,,,,,Fee Schedule,2300,7817.358396,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",538,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5900.5,,,,,,,Fee Schedule,2300,5900.495916,
OSTEOMYELITIS WITH MCC,539,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,16135.23,,,,,,,Fee Schedule,2300,16135.23088,
OSTEOMYELITIS WITH CC,540,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10618.93,,,,,,,Fee Schedule,2300,10618.92664,
OSTEOMYELITIS WITHOUT CC/MCC,541,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6319.91,,,,,,,Fee Schedule,2300,6319.91198,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,542,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14470.67,,,,,,,Fee Schedule,2300,14470.67338,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,543,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8421.09,,,,,,,Fee Schedule,2300,8421.08816,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,544,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6181.47,,,,,,,Fee Schedule,2300,6181.471912,
CONNECTIVE TISSUE DISORDERS WITH MCC,545,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,20329.39,,,,,,,Fee Schedule,2300,20329.39152,
CONNECTIVE TISSUE DISORDERS WITH CC,546,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9448.33,,,,,,,Fee Schedule,2300,9448.329848,
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,547,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6849.92,,,,,,,Fee Schedule,2300,6849.916264,
SEPTIC ARTHRITIS WITH MCC,548,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15817.39,,,,,,,Fee Schedule,2300,15817.39215,
SEPTIC ARTHRITIS WITH CC,549,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9889.04,,,,,,,Fee Schedule,2300,9889.044384,
SEPTIC ARTHRITIS WITHOUT CC/MCC,550,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7160.38,,,,,,,Fee Schedule,2300,7160.382452,
MEDICAL BACK PROBLEMS WITH MCC,551,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13730.14,,,,,,,Fee Schedule,2300,13730.14189,
MEDICAL BACK PROBLEMS WITHOUT MCC,552,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7874.7,,,,,,,Fee Schedule,2300,7874.700436,
BONE DISEASES AND ARTHROPATHIES WITH MCC,553,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10618.93,,,,,,,Fee Schedule,2300,10618.92664,
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,554,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6799.95,,,,,,,Fee Schedule,2300,6799.946772,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,555,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10827.82,,,,,,,Fee Schedule,2300,10827.8155,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,556,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6804.04,,,,,,,Fee Schedule,2300,6804.042632,
"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12180.27,,,,,,,Fee Schedule,2300,12180.26847,
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7316.84,,,,,,,Fee Schedule,2300,7316.844304,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15276.74,,,,,,,Fee Schedule,2300,15276.73863,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9224.7,,,,,,,Fee Schedule,2300,9224.695892,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6585.32,,,,,,,Fee Schedule,2300,6585.323708,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11671.56,,,,,,,Fee Schedule,2300,11671.56266,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7335.69,,,,,,,Fee Schedule,2300,7335.68526,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,564,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12644.74,,,,,,,Fee Schedule,2300,12644.73899,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,565,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7982.01,,,,,,,Fee Schedule,2300,7982.011968,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,566,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6138.06,,,,,,,Fee Schedule,2300,6138.055796,
SKIN DEBRIDEMENT WITH MCC,570,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,24092.67,,,,,,,Fee Schedule,2300,24092.66769,
SKIN DEBRIDEMENT WITH CC,571,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13839.91,,,,,,,Fee Schedule,2300,13839.91094,
SKIN DEBRIDEMENT WITHOUT CC/MCC,572,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9390.17,,,,,,,Fee Schedule,2300,9390.168636,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,573,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,53667.23,,,,,,,Fee Schedule,2300,53667.23441,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,574,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,28436.74,,,,,,,Fee Schedule,2300,28436.73681,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,575,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13381.99,,,,,,,Fee Schedule,2300,13381.99379,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,576,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,40149.26,,,,,,,Fee Schedule,2300,40149.25806,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,577,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,21713.79,,,,,,,Fee Schedule,2300,21713.7922,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,578,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13159.18,,,,,,,Fee Schedule,2300,13159.17901,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,26528.89,,,,,,,Fee Schedule,2300,26528.88522,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14155.29,,,,,,,Fee Schedule,2300,14155.29216,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11821.47,,,,,,,Fee Schedule,2300,11821.47113,
MASTECTOMY FOR MALIGNANCY WITH CC/MCC,582,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15782.17,,,,,,,Fee Schedule,2300,15782.16775,
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,583,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14125.8,,,,,,,Fee Schedule,2300,14125.80197,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17536.02,,,,,,,Fee Schedule,2300,17536.015,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15802.65,,,,,,,Fee Schedule,2300,15802.64705,
SKIN ULCERS WITH MCC,592,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15853.44,,,,,,,Fee Schedule,2300,15853.43572,
SKIN ULCERS WITH CC,593,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9717.84,,,,,,,Fee Schedule,2300,9717.837436,
SKIN ULCERS WITHOUT CC/MCC,594,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7100.58,,,,,,,Fee Schedule,2300,7100.582896,
MAJOR SKIN DISORDERS WITH MCC,595,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17372.18,,,,,,,Fee Schedule,2300,17372.1806,
MAJOR SKIN DISORDERS WITHOUT MCC,596,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8867.54,,,,,,,Fee Schedule,2300,8867.5369,
MALIGNANT BREAST DISORDERS WITH MCC,597,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13656.42,,,,,,,Fee Schedule,2300,13656.41641,
MALIGNANT BREAST DISORDERS WITH CC,598,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9267.29,,,,,,,Fee Schedule,2300,9267.292836,
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,599,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6006.17,,,,,,,Fee Schedule,2300,6006.169104,
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,600,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8532.5,,,,,,,Fee Schedule,2300,8532.495552,
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,601,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,4955.99,,,,,,,Fee Schedule,2300,4955.9906,
CELLULITIS WITH MCC,602,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11642.89,,,,,,,Fee Schedule,2300,11642.89164,
CELLULITIS WITHOUT MCC,603,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7134.17,,,,,,,Fee Schedule,2300,7134.168948,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12059.03,,,,,,,Fee Schedule,2300,12059.03101,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7503.62,,,,,,,Fee Schedule,2300,7503.61552,
MINOR SKIN DISORDERS WITH MCC,606,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12395.71,,,,,,,Fee Schedule,2300,12395.7107,
MINOR SKIN DISORDERS WITHOUT MCC,607,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7424.98,,,,,,,Fee Schedule,2300,7424.975008,
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,614,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17954.61,,,,,,,Fee Schedule,2300,17954.6119,
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,615,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11462.67,,,,,,,Fee Schedule,2300,11462.6738,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,28567.8,,,,,,,Fee Schedule,2300,28567.80433,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15320.97,,,,,,,Fee Schedule,2300,15320.97392,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",618,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11618.32,,,,,,,Fee Schedule,2300,11618.31648,
O.R. PROCEDURES FOR OBESITY WITH MCC,619,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,23652.77,,,,,,,Fee Schedule,2300,23652.77233,
O.R. PROCEDURES FOR OBESITY WITH CC,620,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13109.21,,,,,,,Fee Schedule,2300,13879,
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,621,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12356.39,,,,,,,Fee Schedule,2300,13879,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,29155.97,,,,,,,Fee Schedule,2300,29155.96982,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14695.13,,,,,,,Fee Schedule,2300,14695.12651,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",624,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10255.21,,,,,,,Fee Schedule,2300,10255.21427,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,24739.81,,,,,,,Fee Schedule,2300,24739.81357,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12282.66,,,,,,,Fee Schedule,2300,13879,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10881.06,,,,,,,Fee Schedule,2300,10881.06168,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,30528.9,,,,,,,Fee Schedule,2300,30528.9021,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17848.12,,,,,,,Fee Schedule,2300,17848.11954,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11955.82,,,,,,,Fee Schedule,2300,13879,
DIABETES WITH MCC,637,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11769.04,,,,,,,Fee Schedule,2300,11769.04412,
DIABETES WITH CC,638,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7341.42,,,,,,,Fee Schedule,2300,7341.419464,
DIABETES WITHOUT CC/MCC,639,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5088.7,,,,,,,Fee Schedule,2300,5088.696464,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10940.86,,,,,,,Fee Schedule,2300,10940.86123,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6374.8,,,,,,,Fee Schedule,2300,6374.796504,
INBORN AND OTHER DISORDERS OF METABOLISM,642,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11649.45,,,,,,,Fee Schedule,2300,11649.44501,
ENDOCRINE DISORDERS WITH MCC,643,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13484.39,,,,,,,Fee Schedule,2300,13484.39029,
ENDOCRINE DISORDERS WITH CC,644,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8396.51,,,,,,,Fee Schedule,2300,8396.513,
ENDOCRINE DISORDERS WITHOUT CC/MCC,645,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6293.7,,,,,,,Fee Schedule,2300,6293.698476,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,650,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,38512.55,,,,,,,Fee Schedule,2300,38512.55241,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,651,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,30356.88,,,,,,,Fee Schedule,2300,30356.87598,
KIDNEY TRANSPLANT,652,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,26455.16,,,,,,,Fee Schedule,2300,26455.15974,
MAJOR BLADDER PROCEDURES WITH MCC,653,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,42567.45,,,,,,,Fee Schedule,2300,42567.45381,
MAJOR BLADDER PROCEDURES WITH CC,654,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,22931.08,,,,,,,Fee Schedule,2300,22931.0818,
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,655,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17338.59,,,,,,,Fee Schedule,2300,17338.59455,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,656,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,26080.8,,,,,,,Fee Schedule,2300,26080.79814,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,657,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14990.85,,,,,,,Fee Schedule,2300,14990.8476,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,658,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12711.91,,,,,,,Fee Schedule,2300,12711.9111,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,659,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,20814.34,,,,,,,Fee Schedule,2300,20814.34135,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,660,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10827,,,,,,,Fee Schedule,2300,10826.99632,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,661,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8481.71,,,,,,,Fee Schedule,2300,8481.706888,
MINOR BLADDER PROCEDURES WITH MCC,662,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,25078.95,,,,,,,Fee Schedule,2300,25078.95078,
MINOR BLADDER PROCEDURES WITH CC,663,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12453.05,,,,,,,Fee Schedule,2300,12453.05274,
MINOR BLADDER PROCEDURES WITHOUT CC/MCC,664,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8575.91,,,,,,,Fee Schedule,2300,8575.911668,
PROSTATECTOMY WITH MCC,665,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,25568,,,,,,,Fee Schedule,2300,25567.99646,
PROSTATECTOMY WITH CC,666,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14329.78,,,,,,,Fee Schedule,2300,14329.7758,
PROSTATECTOMY WITHOUT CC/MCC,667,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9061.68,,,,,,,Fee Schedule,2300,9061.680664,
TRANSURETHRAL PROCEDURES WITH MCC,668,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,23919.82,,,,,,,Fee Schedule,2300,23919.8224,
TRANSURETHRAL PROCEDURES WITH CC,669,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12713.55,,,,,,,Fee Schedule,2300,12713.54944,
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,670,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8005.77,,,,,,,Fee Schedule,2300,8327,
URETHRAL PROCEDURES WITH CC/MCC,671,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14704.14,,,,,,,Fee Schedule,2300,14704.1374,
URETHRAL PROCEDURES WITHOUT CC/MCC,672,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8842.96,,,,,,,Fee Schedule,2300,8842.96174,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,673,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,34418.33,,,,,,,Fee Schedule,2300,34418.33075,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,674,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,19157.16,,,,,,,Fee Schedule,2300,19157.15639,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,675,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13445.89,,,,,,,Fee Schedule,2300,13445.88921,
RENAL FAILURE WITH MCC,682,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12131.94,,,,,,,Fee Schedule,2300,12131.93732,
RENAL FAILURE WITH CC,683,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7174.31,,,,,,,Fee Schedule,2300,7174.308376,
RENAL FAILURE WITHOUT CC/MCC,684,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,4917.49,,,,,,,Fee Schedule,2300,4917.489516,
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,686,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14775.41,,,,,,,Fee Schedule,2300,14775.40536,
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,687,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8583.28,,,,,,,Fee Schedule,2300,8583.284216,
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,688,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6473.92,,,,,,,Fee Schedule,2300,6473.916316,
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,689,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9504.85,,,,,,,Fee Schedule,2300,9504.852716,
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,690,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6631.2,,,,,,,Fee Schedule,2300,6631.19734,
URINARY STONES WITH MCC,693,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11013.77,,,,,,,Fee Schedule,2300,11013.76754,
URINARY STONES WITHOUT MCC,694,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6403.47,,,,,,,Fee Schedule,2300,6403.467524,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,695,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9369.69,,,,,,,Fee Schedule,2300,9369.689336,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,696,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5644.1,,,,,,,Fee Schedule,2300,5644.09508,
URETHRAL STRICTURE,697,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8829.04,,,,,,,Fee Schedule,2300,8829.035816,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,698,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13552.38,,,,,,,Fee Schedule,2300,13552.38157,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,699,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8314.6,,,,,,,Fee Schedule,2300,8314.5958,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,700,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5651.47,,,,,,,Fee Schedule,2300,5651.467628,
MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,707,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,16385.9,,,,,,,Fee Schedule,2300,16385.89752,
MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,708,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12567.74,,,,,,,Fee Schedule,2300,13879,
PENIS PROCEDURES WITH CC/MCC,709,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,19062.95,,,,,,,Fee Schedule,2300,19062.95161,
PENIS PROCEDURES WITHOUT CC/MCC,710,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11478.24,,,,,,,Fee Schedule,2300,13879,
TESTES PROCEDURES WITH CC/MCC,711,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17069.91,,,,,,,Fee Schedule,2300,17069.90614,
TESTES PROCEDURES WITHOUT CC/MCC,712,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9008.43,,,,,,,Fee Schedule,2300,9008.434484,
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,713,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12315.43,,,,,,,Fee Schedule,2300,12315.43185,
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,714,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8661.92,,,,,,,Fee Schedule,2300,8661.924728,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,715,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,18327.34,,,,,,,Fee Schedule,2300,18327.33516,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,716,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12050.02,,,,,,,Fee Schedule,2300,12050.02012,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,717,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15486.45,,,,,,,Fee Schedule,2300,15486.44666,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,718,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11002.3,,,,,,,Fee Schedule,2300,11002.29913,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14824.56,,,,,,,Fee Schedule,2300,14824.55568,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9360.68,,,,,,,Fee Schedule,2300,9360.678444,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",724,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5010.88,,,,,,,Fee Schedule,2300,5010.875124,
BENIGN PROSTATIC HYPERTROPHY WITH MCC,725,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9585.95,,,,,,,Fee Schedule,2300,9585.950744,
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,726,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5914.42,,,,,,,Fee Schedule,2300,5914.42184,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,727,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12147.5,,,,,,,Fee Schedule,2300,12147.50159,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,728,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6645.12,,,,,,,Fee Schedule,2300,6645.123264,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,729,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8672.57,,,,,,,Fee Schedule,2300,8672.573964,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,730,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5504.84,,,,,,,Fee Schedule,2300,5504.83584,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17448.36,,,,,,,Fee Schedule,2300,17448.3636,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",735,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11021.96,,,,,,,Fee Schedule,2300,13879,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,736,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,29281.3,,,,,,,Fee Schedule,2300,29281.30314,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,737,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,16879.86,,,,,,,Fee Schedule,2300,16879.85823,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,738,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12029.54,,,,,,,Fee Schedule,2300,12029.54082,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,739,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,28886.46,,,,,,,Fee Schedule,2300,28886.46224,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,740,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14823.74,,,,,,,Fee Schedule,2300,14823.73651,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,741,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11682.21,,,,,,,Fee Schedule,2300,13879,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,742,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15030.17,,,,,,,Fee Schedule,2300,15030.16786,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,743,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10163.47,,,,,,,Fee Schedule,2300,10163.467,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,16785.65,,,,,,,Fee Schedule,2300,16785.65345,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9318.08,,,,,,,Fee Schedule,2300,9318.0815,
"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14229.84,,,,,,,Fee Schedule,2300,14229.83681,
"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6876.95,,,,,,,Fee Schedule,2300,8327,
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,748,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11364.37,,,,,,,Fee Schedule,2300,13879,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,749,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,21033.06,,,,,,,Fee Schedule,2300,21033.06027,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,750,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12089.34,,,,,,,Fee Schedule,2300,12089.34038,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15086.69,,,,,,,Fee Schedule,2300,15086.69072,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8910.95,,,,,,,Fee Schedule,2300,8910.953016,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",756,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7868.15,,,,,,,Fee Schedule,2300,7868.14706,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11729.72,,,,,,,Fee Schedule,2300,11729.72387,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8019.69,,,,,,,Fee Schedule,2300,8019.69388,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5436.03,,,,,,,Fee Schedule,2300,5436.025392,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,760,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8253.16,,,,,,,Fee Schedule,2300,8253.1579,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,761,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,4666,,,,,,,Fee Schedule,2300,4666.003712,
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,768,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8778.25,,,,,,,Fee Schedule,2300,8778.247152,
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,769,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13842.37,,,,,,,Fee Schedule,2300,13842.36846,
"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8213.84,,,,,,,Fee Schedule,2300,8213.837644,
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,776,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5363.12,,,,,,,Fee Schedule,2300,5363.119084,
ABORTION WITHOUT D&C,779,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5841.52,,,,,,,Fee Schedule,2300,5841.515532,
CESAREAN SECTION WITH STERILIZATION WITH MCC,783,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,20111.49,,,,,,,Fee Schedule,2300,20111.49177,
CESAREAN SECTION WITH STERILIZATION WITH CC,784,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8684.04,,,,,,,Fee Schedule,2300,8684.042372,
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,785,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7846.03,,,,,,,Fee Schedule,2300,7846.029416,
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,786,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13512.24,,,,,,,Fee Schedule,2300,13512.24214,
CESAREAN SECTION WITHOUT STERILIZATION WITH CC,787,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9148.51,,,,,,,Fee Schedule,2300,9148.512896,
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,788,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7854.22,,,,,,,Fee Schedule,2300,7854.221136,
"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14763.12,,,,,,,Fee Schedule,1184,14763.11778,
"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,48687.49,,,,,,,Fee Schedule,2300,48687.48782,
PREMATURITY WITH MAJOR PROBLEMS,791,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,33250.19,,,,,,,Fee Schedule,2300,33250.19148,
PREMATURITY WITHOUT MAJOR PROBLEMS,792,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,20063.16,,,,,,,Fee Schedule,2300,20063.16062,
FULL TERM NEONATE WITH MAJOR PROBLEMS,793,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,34156.2,,,,,,,Fee Schedule,2300,34156.19571,
NEONATE WITH OTHER SIGNIFICANT PROBLEMS,794,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12090.16,,,,,,,Fee Schedule,1184,12090.15955,
NORMAL NEWBORN,795,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,1636.71,,,,,,,Fee Schedule,530,2786,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,796,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9559.74,,,,,,,Fee Schedule,2300,9559.73724,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,797,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8195,,,,,,,Fee Schedule,2300,8194.996688,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,798,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7840.3,,,,,,,Fee Schedule,2300,7840.295212,
SPLENIC PROCEDURES WITH MCC,799,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,37099.48,,,,,,,Fee Schedule,2300,37099.48071,
SPLENIC PROCEDURES WITH CC,800,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,23013.82,,,,,,,Fee Schedule,2300,23013.81817,
SPLENIC PROCEDURES WITHOUT CC/MCC,801,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15637.17,,,,,,,Fee Schedule,2300,15637.17431,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,802,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,32636.63,,,,,,,Fee Schedule,2300,32636.63165,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,803,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15227.59,,,,,,,Fee Schedule,2300,15227.58831,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,804,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11107.97,,,,,,,Fee Schedule,2300,11107.97232,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,805,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8840.5,,,,,,,Fee Schedule,2300,8840.504224,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,806,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6176.56,,,,,,,Fee Schedule,2300,6176.55688,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,807,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5522.86,,,,,,,Fee Schedule,2300,5522.857624,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,808,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,18086.5,,,,,,,Fee Schedule,2300,18086.49859,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,809,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10369.9,,,,,,,Fee Schedule,2300,10369.89835,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,810,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8573.45,,,,,,,Fee Schedule,2300,8573.454152,
RED BLOOD CELL DISORDERS WITH MCC,811,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11503.63,,,,,,,Fee Schedule,2300,11503.6324,
RED BLOOD CELL DISORDERS WITHOUT MCC,812,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7521.64,,,,,,,Fee Schedule,2300,7521.637304,
COAGULATION DISORDERS,813,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12494.83,,,,,,,Fee Schedule,2300,12494.83052,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,814,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17421.33,,,,,,,Fee Schedule,2300,17421.33092,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,815,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8306.4,,,,,,,Fee Schedule,2300,8306.40408,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,816,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5177.17,,,,,,,Fee Schedule,2300,5177.16704,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,817,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13827.62,,,,,,,Fee Schedule,2300,13827.62336,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,818,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8635.71,,,,,,,Fee Schedule,2300,8635.711224,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,819,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7044.06,,,,,,,Fee Schedule,2300,8327,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,820,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,48042.8,,,,,,,Fee Schedule,2300,48042.79946,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,821,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,18337.98,,,,,,,Fee Schedule,2300,18337.98439,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,822,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9862.83,,,,,,,Fee Schedule,2300,9862.83088,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,823,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,37557.4,,,,,,,Fee Schedule,2300,37557.39786,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,824,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,18559.16,,,,,,,Fee Schedule,2300,18559.16083,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,825,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11053.91,,,,,,,Fee Schedule,2300,11053.90697,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,826,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,38319.23,,,,,,,Fee Schedule,2300,38319.22782,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,827,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,18932.7,,,,,,,Fee Schedule,2300,18932.70326,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,828,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13957.05,,,,,,,Fee Schedule,2300,13957.05254,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,829,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,25885.84,,,,,,,Fee Schedule,2300,25885.8352,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,830,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12328.54,,,,,,,Fee Schedule,2300,13879,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,831,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9850.54,,,,,,,Fee Schedule,2300,9850.5433,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,832,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5911.15,,,,,,,Fee Schedule,2300,5911.145152,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,833,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,4283.45,,,,,,,Fee Schedule,2300,4283.450388,
ACUTE LEUKEMIA WITH MCC,834,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,44971.72,,,,,,,Fee Schedule,2300,44971.72363,
ACUTE LEUKEMIA WITH CC,835,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17086.29,,,,,,,Fee Schedule,2300,17086.28958,
ACUTE LEUKEMIA WITHOUT CC/MCC,836,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9989.8,,,,,,,Fee Schedule,2300,9989.80254,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,837,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,39355.48,,,,,,,Fee Schedule,2300,39355.4804,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,838,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17099.4,,,,,,,Fee Schedule,2300,17099.39633,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,839,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11828.02,,,,,,,Fee Schedule,2300,11828.02451,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,840,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,26499.4,,,,,,,Fee Schedule,2300,26499.39503,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,841,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13363.97,,,,,,,Fee Schedule,2300,13363.97201,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,842,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8276.91,,,,,,,Fee Schedule,2300,8276.913888,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,843,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,16340.84,,,,,,,Fee Schedule,2300,16340.84306,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,844,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9972.6,,,,,,,Fee Schedule,2300,9972.599928,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,845,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6976.07,,,,,,,Fee Schedule,2300,6976.068752,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,846,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,21237.03,,,,,,,Fee Schedule,2300,21237.0341,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,847,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10716.41,,,,,,,Fee Schedule,2300,10716.4081,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,848,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6958.05,,,,,,,Fee Schedule,2300,6958.046968,
RADIOTHERAPY,849,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,22195.47,,,,,,,Fee Schedule,2300,22195.46534,
ACUTE LEUKEMIA WITH OTHER PROCEDURES,850,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,70936.2,,,,,,,Fee Schedule,2300,70936.19934,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,853,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,40455.63,,,,,,,Fee Schedule,2300,40455.62839,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,854,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,16367.88,,,,,,,Fee Schedule,2300,16367.87573,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,855,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12264.64,,,,,,,Fee Schedule,2300,12264.64318,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,856,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,37261.68,,,,,,,Fee Schedule,2300,37261.67676,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,857,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17542.57,,,,,,,Fee Schedule,2300,17542.56838,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,858,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11410.25,,,,,,,Fee Schedule,2300,11410.24679,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,862,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14939.24,,,,,,,Fee Schedule,2300,14939.23976,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,863,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8174.52,,,,,,,Fee Schedule,2300,8174.517388,
FEVER AND INFLAMMATORY CONDITIONS,864,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7271.79,,,,,,,Fee Schedule,2300,7271.789844,
VIRAL ILLNESS WITH MCC,865,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12273.65,,,,,,,Fee Schedule,2300,12273.65408,
VIRAL ILLNESS WITHOUT MCC,866,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7123.52,,,,,,,Fee Schedule,2300,7123.519712,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,867,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17146.91,,,,,,,Fee Schedule,2300,17146.9083,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,868,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8446.48,,,,,,,Fee Schedule,2300,8446.482492,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,869,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5977.5,,,,,,,Fee Schedule,2300,5977.498084,
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,870,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,56619.53,,,,,,,Fee Schedule,2300,56619.5303,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,871,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15912.42,,,,,,,Fee Schedule,2300,15912.4161,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,872,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8382.59,,,,,,,Fee Schedule,2300,8382.587076,
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,876,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,31660.18,,,,,,,Fee Schedule,850,31660.17863,
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,880,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7865.69,,,,,,,Fee Schedule,850,7865.689544,
DEPRESSIVE NEUROSES,881,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7707.59,,,,,,,Fee Schedule,850,7707.589348,
NEUROSES EXCEPT DEPRESSIVE,882,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8796.27,,,,,,,Fee Schedule,850,8796.268936,
DISORDERS OF PERSONALITY AND IMPULSE CONTROL,883,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,16107.38,,,,,,,Fee Schedule,850,16107.37904,
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,884,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13179.66,,,,,,,Fee Schedule,850,13179.65831,
PSYCHOSES,885,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11442.19,,,,,,,Fee Schedule,850,11442.1945,
BEHAVIORAL AND DEVELOPMENTAL DISORDERS,886,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,17000.28,,,,,,,Fee Schedule,850,17000.27652,
OTHER MENTAL DISORDER DIAGNOSES,887,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8772.51,,,,,,,Fee Schedule,850,8772.512948,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5053.47,,,,,,,Fee Schedule,850,5053.472068,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11596.2,,,,,,,Fee Schedule,850,11596.19883,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14295.37,,,,,,,Fee Schedule,850,14295.37057,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7231.65,,,,,,,Fee Schedule,850,7231.650416,
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,901,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,34377.37,,,,,,,Fee Schedule,2300,34377.37215,
WOUND DEBRIDEMENTS FOR INJURIES WITH CC,902,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,15683.05,,,,,,,Fee Schedule,2300,15683.04794,
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,903,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9581.04,,,,,,,Fee Schedule,2300,9581.035712,
SKIN GRAFTS FOR INJURIES WITH CC/MCC,904,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,30089.01,,,,,,,Fee Schedule,2300,30089.00673,
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,905,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,11728.9,,,,,,,Fee Schedule,2300,11728.9047,
HAND PROCEDURES FOR INJURIES,906,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14437.09,,,,,,,Fee Schedule,2300,14437.08733,
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,907,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,31450.47,,,,,,,Fee Schedule,2300,31450.4706,
OTHER O.R. PROCEDURES FOR INJURIES WITH CC,908,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,16344.12,,,,,,,Fee Schedule,2300,16344.11974,
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,909,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10753.27,,,,,,,Fee Schedule,2300,10753.27084,
TRAUMATIC INJURY WITH MCC,913,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13390.19,,,,,,,Fee Schedule,2300,13390.18551,
TRAUMATIC INJURY WITHOUT MCC,914,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7253.77,,,,,,,Fee Schedule,2300,7253.76806,
ALLERGIC REACTIONS WITH MCC,915,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13775.2,,,,,,,Fee Schedule,2300,13775.19635,
ALLERGIC REACTIONS WITHOUT MCC,916,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5458.14,,,,,,,Fee Schedule,2300,5458.143036,
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,917,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12847.89,,,,,,,Fee Schedule,2300,12847.89365,
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,918,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7021.12,,,,,,,Fee Schedule,2300,7021.123212,
COMPLICATIONS OF TREATMENT WITH MCC,919,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14997.4,,,,,,,Fee Schedule,2300,14997.40098,
COMPLICATIONS OF TREATMENT WITH CC,920,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8210.56,,,,,,,Fee Schedule,2300,8210.560956,
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,921,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5639.18,,,,,,,Fee Schedule,2300,5639.180048,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14330.59,,,,,,,Fee Schedule,2300,14330.59497,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,8336.71,,,,,,,Fee Schedule,2300,8336.713444,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,927,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,150975.04,,,,,,,Fee Schedule,2300,150975.0379,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,928,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,58756.75,,,,,,,Fee Schedule,2300,58756.75004,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,929,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,26383.89,,,,,,,Fee Schedule,2300,26383.89178,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,933,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,31265.34,,,,,,,Fee Schedule,2300,31265.33772,
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,934,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,18108.62,,,,,,,Fee Schedule,2300,18108.61623,
NON-EXTENSIVE BURNS,935,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,16874.94,,,,,,,Fee Schedule,2300,16874.9432,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,939,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,29723.66,,,,,,,Fee Schedule,2300,29723.65602,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,940,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,19143.23,,,,,,,Fee Schedule,2300,19143.23047,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,941,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,16610.35,,,,,,,Fee Schedule,2300,16610.35064,
REHABILITATION WITH CC/MCC,945,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12685.7,,,,,,,Fee Schedule,2300,12685.69759,
REHABILITATION WITHOUT CC/MCC,946,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9394.26,,,,,,,Fee Schedule,2300,9394.264496,
SIGNS AND SYMPTOMS WITH MCC,947,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10398.57,,,,,,,Fee Schedule,2300,10398.56937,
SIGNS AND SYMPTOMS WITHOUT MCC,948,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,6557.47,,,,,,,Fee Schedule,2300,6557.47186,
AFTERCARE WITH CC/MCC,949,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9745.69,,,,,,,Fee Schedule,2300,9745.689284,
AFTERCARE WITHOUT CC/MCC,950,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,5141.94,,,,,,,Fee Schedule,2300,5141.942644,
OTHER FACTORS INFLUENCING HEALTH STATUS,951,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,4554.6,,,,,,,Fee Schedule,2300,4972,
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,955,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,55139.29,,,,,,,Fee Schedule,2300,55139.28649,
"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,30825.44,,,,,,,Fee Schedule,2300,30825.44236,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,957,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,62420.09,,,,,,,Fee Schedule,2300,62420.08723,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,958,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,34519.09,,,,,,,Fee Schedule,2300,34519.08891,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,959,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,24117.24,,,,,,,Fee Schedule,2300,24117.24285,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,963,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,22394.52,,,,,,,Fee Schedule,2300,22394.52414,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,964,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,12554.63,,,,,,,Fee Schedule,2300,12554.63007,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,965,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7704.31,,,,,,,Fee Schedule,2300,7704.31266,
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,969,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,50143.98,,,,,,,Fee Schedule,2300,50143.97564,
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,970,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,21604.84,,,,,,,Fee Schedule,2300,21604.84233,
HIV WITH MAJOR RELATED CONDITION WITH MCC,974,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,23641.3,,,,,,,Fee Schedule,2300,23641.30392,
HIV WITH MAJOR RELATED CONDITION WITH CC,975,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10608.28,,,,,,,Fee Schedule,2300,10608.2774,
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,976,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,7327.49,,,,,,,Fee Schedule,2300,7327.49354,
HIV WITH OR WITHOUT OTHER RELATED CONDITION,977,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,10383.82,,,,,,,Fee Schedule,2300,10383.82427,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,981,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,38433.91,,,,,,,Fee Schedule,2300,38433.9119,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,982,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,20139.34,,,,,,,Fee Schedule,2300,20139.34362,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,983,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,14040.61,,,,,,,Fee Schedule,2300,14040.60808,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,987,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,28084.49,,,,,,,Fee Schedule,2300,28084.49285,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,988,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,13463.91,,,,,,,Fee Schedule,2300,13463.91099,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,989,MS-DRG,,,,,,,,inpatient,,,,,Aetna Med ADV,Aetna Med ADV,9823.51,,,,,,,Fee Schedule,2300,9823.510624,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,1,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,229563.94,,,,,,,Fee Schedule,2300,229563.9421,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,2,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,92826.93,,,,,,,Fee Schedule,2300,92826.9327,
"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",3,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,173870.9,,,,,,,Fee Schedule,2300,173870.8953,
"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",4,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,113466.79,,,,,,,Fee Schedule,2300,113466.7904,
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,5,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,84460.73,,,,,,,Fee Schedule,2300,84460.72906,
LIVER TRANSPLANT WITHOUT MCC,6,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,37985.01,,,,,,,Fee Schedule,2300,37985.00564,
LUNG TRANSPLANT,7,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,106084.41,,,,,,,Fee Schedule,2300,106084.4123,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,8,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,45911.31,,,,,,,Fee Schedule,2300,45911.31391,
PANCREAS TRANSPLANT,10,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,25147.76,,,,,,,Fee Schedule,2300,25147.76123,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",11,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,44678.46,,,,,,,Fee Schedule,2300,44678.46005,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",12,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,34536.29,,,,,,,Fee Schedule,2300,34536.29152,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",13,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,23606.9,,,,,,,Fee Schedule,2300,23606.8987,
ALLOGENEIC BONE MARROW TRANSPLANT,14,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,98447.27,,,,,,,Fee Schedule,2300,98447.27179,
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,16,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,48574.44,,,,,,,Fee Schedule,2300,48574.44208,
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,17,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,39634,,,,,,,Fee Schedule,2300,39633.99888,
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,18,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,353741.41,,,,,,,Fee Schedule,2300,353741.4064,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,19,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,54288.17,,,,,,,Fee Schedule,2300,54288.16678,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,20,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,64459.01,,,,,,,Fee Schedule,2300,64459.00634,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,21,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,43365.33,,,,,,,Fee Schedule,2300,43365.32734,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,22,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,25190.36,,,,,,,Fee Schedule,2300,25190.35817,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,23,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,46941.01,,,,,,,Fee Schedule,2300,46941.01312,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,24,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,32045.19,,,,,,,Fee Schedule,2300,32045.18947,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,25,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,37245.29,,,,,,,Fee Schedule,2300,37245.29332,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,26,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,25469.7,,,,,,,Fee Schedule,2300,25469.69582,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,27,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,20666.89,,,,,,,Fee Schedule,2300,20666.89039,
SPINAL PROCEDURES WITH MCC,28,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,49218.31,,,,,,,Fee Schedule,2300,49218.31128,
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,29,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,27946.87,,,,,,,Fee Schedule,2300,27946.87195,
SPINAL PROCEDURES WITHOUT CC/MCC,30,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17982.46,,,,,,,Fee Schedule,2300,17982.46374,
VENTRICULAR SHUNT PROCEDURES WITH MCC,31,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,36703,,,,,,,Fee Schedule,2300,36703.00146,
VENTRICULAR SHUNT PROCEDURES WITH CC,32,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17456.56,,,,,,,Fee Schedule,2300,17456.55532,
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,33,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13622.01,,,,,,,Fee Schedule,2300,13879,
CAROTID ARTERY STENT PROCEDURES WITH MCC,34,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,31707.69,,,,,,,Fee Schedule,2300,31707.6906,
CAROTID ARTERY STENT PROCEDURES WITH CC,35,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,19582.31,,,,,,,Fee Schedule,2300,19582.30666,
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,36,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15914.87,,,,,,,Fee Schedule,2300,15914.87362,
EXTRACRANIAL PROCEDURES WITH MCC,37,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,26967.96,,,,,,,Fee Schedule,2300,26967.96141,
EXTRACRANIAL PROCEDURES WITH CC,38,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13291.88,,,,,,,Fee Schedule,2300,13291.88487,
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,39,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9629.37,,,,,,,Fee Schedule,2300,9629.36686,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",40,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,31629.87,,,,,,,Fee Schedule,2300,31629.86926,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",41,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,18011.13,,,,,,,Fee Schedule,2300,18011.13476,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",42,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14152.83,,,,,,,Fee Schedule,2300,14152.83464,
SPINAL DISORDERS AND INJURIES WITH CC/MCC,52,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14587.81,,,,,,,Fee Schedule,2300,14587.81498,
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,53,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8021.33,,,,,,,Fee Schedule,2300,8021.332224,
NERVOUS SYSTEM NEOPLASMS WITH MCC,54,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12507.94,,,,,,,Fee Schedule,2300,12507.93727,
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,55,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8352.28,,,,,,,Fee Schedule,2300,8352.277712,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,56,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,19030.18,,,,,,,Fee Schedule,2300,19030.18473,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,57,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10613.19,,,,,,,Fee Schedule,2300,10613.19243,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,58,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14003.75,,,,,,,Fee Schedule,2300,14003.74534,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,59,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10165.11,,,,,,,Fee Schedule,2300,10165.10535,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,60,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7534.74,,,,,,,Fee Schedule,2300,7534.744056,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",61,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,22585.39,,,,,,,Fee Schedule,2300,22585.39121,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",62,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14394.49,,,,,,,Fee Schedule,2300,14394.49038,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",63,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11499.54,,,,,,,Fee Schedule,2300,11499.53654,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,64,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,16473.55,,,,,,,Fee Schedule,2300,16473.54892,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,65,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8276.09,,,,,,,Fee Schedule,2300,8276.094716,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,66,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5606.41,,,,,,,Fee Schedule,2300,5606.413168,
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,67,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12031.18,,,,,,,Fee Schedule,2300,12031.17916,
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,68,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7080.92,,,,,,,Fee Schedule,2300,7080.922768,
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,69,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6543.55,,,,,,,Fee Schedule,2300,6543.545936,
OTHER CEREBROVASCULAR DISORDERS WITH MCC,70,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13637.58,,,,,,,Fee Schedule,2300,13637.57546,
OTHER CEREBROVASCULAR DISORDERS WITH CC,71,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8404.7,,,,,,,Fee Schedule,2300,8404.70472,
OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,72,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6194.58,,,,,,,Fee Schedule,2300,6194.578664,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,73,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13141.98,,,,,,,Fee Schedule,2300,13141.9764,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,74,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8444.02,,,,,,,Fee Schedule,2300,8444.024976,
VIRAL MENINGITIS WITH CC/MCC,75,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15707.62,,,,,,,Fee Schedule,2300,15707.6231,
VIRAL MENINGITIS WITHOUT CC/MCC,76,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6133.96,,,,,,,Fee Schedule,2300,6133.959936,
NONTRAUMATIC STUPOR AND COMA WITH MCC,80,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14827.01,,,,,,,Fee Schedule,2300,14827.0132,
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,81,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7336.5,,,,,,,Fee Schedule,2300,7336.504432,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,82,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,18723,,,,,,,Fee Schedule,2300,18722.99523,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,83,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11434,,,,,,,Fee Schedule,2300,11434.00278,
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,84,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7829.65,,,,,,,Fee Schedule,2300,7829.645976,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,85,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,18610.77,,,,,,,Fee Schedule,2300,18610.76867,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,86,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10671.35,,,,,,,Fee Schedule,2300,10671.35364,
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,87,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7492.97,,,,,,,Fee Schedule,2300,7492.966284,
CONCUSSION WITH MCC,88,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11073.57,,,,,,,Fee Schedule,2300,11073.5671,
CONCUSSION WITH CC,89,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8999.42,,,,,,,Fee Schedule,2300,8999.423592,
CONCUSSION WITHOUT CC/MCC,90,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6743.42,,,,,,,Fee Schedule,2300,6743.423904,
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,91,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14386.3,,,,,,,Fee Schedule,2300,14386.29866,
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,92,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8380.13,,,,,,,Fee Schedule,2300,8380.12956,
OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,93,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6523.07,,,,,,,Fee Schedule,2300,6523.066636,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,94,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,28829.94,,,,,,,Fee Schedule,2300,28829.93937,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,95,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,21128.08,,,,,,,Fee Schedule,2300,21128.08422,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,96,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,21128.08,,,,,,,Fee Schedule,2300,21128.08422,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,97,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,29586.85,,,,,,,Fee Schedule,2300,29586.8543,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,98,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,18799.18,,,,,,,Fee Schedule,2300,18799.17823,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,99,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11160.4,,,,,,,Fee Schedule,2300,11160.39933,
SEIZURES WITH MCC,100,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15865.72,,,,,,,Fee Schedule,2300,15865.7233,
SEIZURES WITHOUT MCC,101,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7393.85,,,,,,,Fee Schedule,2300,7393.846472,
HEADACHES WITH MCC,102,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9182.1,,,,,,,Fee Schedule,2300,9182.098948,
HEADACHES WITHOUT MCC,103,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6850.74,,,,,,,Fee Schedule,2300,6850.735436,
ORBITAL PROCEDURES WITH CC/MCC,113,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,19259.55,,,,,,,Fee Schedule,2300,19259.55289,
ORBITAL PROCEDURES WITHOUT CC/MCC,114,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11083.4,,,,,,,Fee Schedule,2300,11083.39716,
EXTRAOCULAR PROCEDURES EXCEPT ORBIT,115,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12573.47,,,,,,,Fee Schedule,2300,12573.47103,
INTRAOCULAR PROCEDURES WITH CC/MCC,116,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14811.45,,,,,,,Fee Schedule,2300,14811.44893,
INTRAOCULAR PROCEDURES WITHOUT CC/MCC,117,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8887.2,,,,,,,Fee Schedule,2300,8887.197028,
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,121,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9529.43,,,,,,,Fee Schedule,2300,9529.427876,
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,122,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6437.05,,,,,,,Fee Schedule,2300,6437.053576,
NEUROLOGICAL EYE DISORDERS,123,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6541.91,,,,,,,Fee Schedule,2300,6541.907592,
OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT,124,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10838.46,,,,,,,Fee Schedule,2300,10838.46473,
OTHER DISORDERS OF THE EYE WITHOUT MCC,125,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6289.6,,,,,,,Fee Schedule,2300,6289.602616,
SINUS AND MASTOID PROCEDURES WITH CC/MCC,135,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17327.13,,,,,,,Fee Schedule,2300,17327.12614,
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,136,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8317.05,,,,,,,Fee Schedule,2300,8327,
MOUTH PROCEDURES WITH CC/MCC,137,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12231.88,,,,,,,Fee Schedule,2300,12231.8763,
MOUTH PROCEDURES WITHOUT CC/MCC,138,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7259.5,,,,,,,Fee Schedule,2300,7259.502264,
SALIVARY GLAND PROCEDURES,139,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9900.51,,,,,,,Fee Schedule,2300,9900.512792,
MAJOR HEAD AND NECK PROCEDURES WITH MCC,140,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,34940.14,,,,,,,Fee Schedule,2300,34940.14332,
MAJOR HEAD AND NECK PROCEDURES WITH CC,141,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17866.96,,,,,,,Fee Schedule,2300,17866.96049,
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,142,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13077.26,,,,,,,Fee Schedule,2300,13879,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,30691.1,,,,,,,Fee Schedule,2300,30691.09815,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14195.43,,,,,,,Fee Schedule,2300,14195.43159,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9848.9,,,,,,,Fee Schedule,2300,9848.904956,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17345.15,,,,,,,Fee Schedule,2300,17345.14793,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",147,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10415.77,,,,,,,Fee Schedule,2300,10415.77198,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",148,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6529.62,,,,,,,Fee Schedule,2300,6529.620012,
DYSEQUILIBRIUM,149,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6156.9,,,,,,,Fee Schedule,2300,6156.896752,
EPISTAXIS WITH MCC,150,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10907.28,,,,,,,Fee Schedule,2300,10907.27518,
EPISTAXIS WITHOUT MCC,151,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6012.72,,,,,,,Fee Schedule,2300,6012.72248,
OTITIS MEDIA AND URI WITH MCC,152,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9684.25,,,,,,,Fee Schedule,2300,9684.251384,
OTITIS MEDIA AND URI WITHOUT MCC,153,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6047.13,,,,,,,Fee Schedule,2300,6047.127704,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12807.75,,,,,,,Fee Schedule,2300,12807.75422,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7507.71,,,,,,,Fee Schedule,2300,7507.71138,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5661.3,,,,,,,Fee Schedule,2300,5661.297692,
DENTAL AND ORAL DISEASES WITH MCC,157,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14063.54,,,,,,,Fee Schedule,2300,14063.5449,
DENTAL AND ORAL DISEASES WITH CC,158,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7452.83,,,,,,,Fee Schedule,2300,7452.826856,
DENTAL AND ORAL DISEASES WITHOUT CC/MCC,159,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5803.83,,,,,,,Fee Schedule,2300,5803.83362,
MAJOR CHEST PROCEDURES WITH MCC,163,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,36713.65,,,,,,,Fee Schedule,2300,36713.6507,
MAJOR CHEST PROCEDURES WITH CC,164,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,20675.9,,,,,,,Fee Schedule,2300,20675.90128,
MAJOR CHEST PROCEDURES WITHOUT CC/MCC,165,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15680.59,,,,,,,Fee Schedule,2300,15680.59042,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,166,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,30618.19,,,,,,,Fee Schedule,2300,30618.19184,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,167,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14772.95,,,,,,,Fee Schedule,2300,14772.94785,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,168,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11193.17,,,,,,,Fee Schedule,2300,11193.16621,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM,173,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,24381.84,,,,,,,Fee Schedule,2300,24381.83541,
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,175,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11252.15,,,,,,,Fee Schedule,2300,11252.14659,
PULMONARY EMBOLISM WITHOUT MCC,176,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6594.33,,,,,,,Fee Schedule,2300,6594.3346,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,177,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12801.2,,,,,,,Fee Schedule,2300,12801.20084,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,178,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7995.12,,,,,,,Fee Schedule,2300,7995.11872,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,179,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6184.75,,,,,,,Fee Schedule,2300,6184.7486,
RESPIRATORY NEOPLASMS WITH MCC,180,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14466.58,,,,,,,Fee Schedule,2300,14466.57752,
RESPIRATORY NEOPLASMS WITH CC,181,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8773.33,,,,,,,Fee Schedule,2300,8773.33212,
RESPIRATORY NEOPLASMS WITHOUT CC/MCC,182,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6094.64,,,,,,,Fee Schedule,2300,6094.63968,
MAJOR CHEST TRAUMA WITH MCC,183,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12532.51,,,,,,,Fee Schedule,2300,12532.51243,
MAJOR CHEST TRAUMA WITH CC,184,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8716.81,,,,,,,Fee Schedule,2300,8716.809252,
MAJOR CHEST TRAUMA WITHOUT CC/MCC,185,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6442.79,,,,,,,Fee Schedule,2300,6442.78778,
PLEURAL EFFUSION WITH MCC,186,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12766.8,,,,,,,Fee Schedule,2300,12766.79562,
PLEURAL EFFUSION WITH CC,187,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8102.43,,,,,,,Fee Schedule,2300,8102.430252,
PLEURAL EFFUSION WITHOUT CC/MCC,188,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5875.1,,,,,,,Fee Schedule,2300,5875.101584,
PULMONARY EDEMA AND RESPIRATORY FAILURE,189,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10120.05,,,,,,,Fee Schedule,2300,10120.05089,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,190,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9073.97,,,,,,,Fee Schedule,2300,9073.968244,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,191,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6905.62,,,,,,,Fee Schedule,2300,6905.61996,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,192,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5259.08,,,,,,,Fee Schedule,2300,5259.08424,
SIMPLE PNEUMONIA AND PLEURISY WITH MCC,193,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10767.2,,,,,,,Fee Schedule,2300,10767.19677,
SIMPLE PNEUMONIA AND PLEURISY WITH CC,194,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6601.71,,,,,,,Fee Schedule,2300,6601.707148,
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,195,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5148.5,,,,,,,Fee Schedule,2300,5148.49602,
INTERSTITIAL LUNG DISEASE WITH MCC,196,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15459.41,,,,,,,Fee Schedule,2300,15459.41398,
INTERSTITIAL LUNG DISEASE WITH CC,197,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7774.76,,,,,,,Fee Schedule,2300,7774.761452,
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,198,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5866.91,,,,,,,Fee Schedule,2300,5866.909864,
PNEUMOTHORAX WITH MCC,199,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14451.01,,,,,,,Fee Schedule,2300,14451.01325,
PNEUMOTHORAX WITH CC,200,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9005.16,,,,,,,Fee Schedule,2300,9005.157796,
PNEUMOTHORAX WITHOUT CC/MCC,201,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5857.9,,,,,,,Fee Schedule,2300,5857.898972,
BRONCHITIS AND ASTHMA WITH CC/MCC,202,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7955.8,,,,,,,Fee Schedule,2300,7955.798464,
BRONCHITIS AND ASTHMA WITHOUT CC/MCC,203,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5488.45,,,,,,,Fee Schedule,2300,5488.4524,
RESPIRATORY SIGNS AND SYMPTOMS,204,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6613.99,,,,,,,Fee Schedule,2300,6613.994728,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,205,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14999.04,,,,,,,Fee Schedule,2300,14999.03932,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,206,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7709.23,,,,,,,Fee Schedule,2300,7709.227692,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,207,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,52711.26,,,,,,,Fee Schedule,2300,52711.26068,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,208,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,22516.58,,,,,,,Fee Schedule,2300,22516.58076,
COMPLEX AORTIC ARCH PROCEDURES,209,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,92720.44,,,,,,,Fee Schedule,2300,92720.44034,
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES,212,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,89077.58,,,,,,,Fee Schedule,2300,89077.58245,
ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES,213,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,46749.33,,,,,,,Fee Schedule,2300,46749.32687,
OTHER HEART ASSIST SYSTEM IMPLANT,215,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,81564.96,,,,,,,Fee Schedule,2300,81564.95604,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,216,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,80137.96,,,,,,,Fee Schedule,2300,80137.95842,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,217,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,53863.02,,,,,,,Fee Schedule,2300,53863.01652,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,218,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,53863.02,,,,,,,Fee Schedule,2300,53863.01652,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,219,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,62898.48,,,,,,,Fee Schedule,2300,62898.48368,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,220,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,43684.8,,,,,,,Fee Schedule,2300,43684.80442,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,221,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,41287.91,,,,,,,Fee Schedule,2300,41287.90714,
OTHER CARDIOTHORACIC PROCEDURES WITH MCC,228,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,40527.72,,,,,,,Fee Schedule,2300,40527.71553,
OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,229,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,25799.82,,,,,,,Fee Schedule,2300,25799.82214,
CORONARY BYPASS WITH PTCA WITH MCC,231,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,69055.38,,,,,,,Fee Schedule,2300,69055.38043,
CORONARY BYPASS WITH PTCA WITHOUT MCC,232,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,49663.12,,,,,,,Fee Schedule,2300,49663.12167,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,233,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,62627.34,,,,,,,Fee Schedule,2300,62627.33774,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,234,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,44748.91,,,,,,,Fee Schedule,2300,44748.90884,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,235,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,48073.93,,,,,,,Fee Schedule,2300,48073.92799,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,236,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,34313.48,,,,,,,Fee Schedule,2300,34313.47674,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,239,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,40317.19,,,,,,,Fee Schedule,2300,40317.18832,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,240,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,23350.5,,,,,,,Fee Schedule,2300,23350.49786,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,241,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11340.62,,,,,,,Fee Schedule,2300,11340.61717,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,242,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,26154.52,,,,,,,Fee Schedule,2300,26154.52362,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,243,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17455.74,,,,,,,Fee Schedule,2300,17455.73615,
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,244,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14806.53,,,,,,,Fee Schedule,2300,14806.5339,
AICD GENERATOR PROCEDURES,245,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,37373.9,,,,,,,Fee Schedule,2300,37373.90333,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC,250,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17878.43,,,,,,,Fee Schedule,2300,17878.4289,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC,251,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12242.53,,,,,,,Fee Schedule,2300,13879,
OTHER VASCULAR PROCEDURES WITH MCC,252,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,28575.18,,,,,,,Fee Schedule,2300,28575.17688,
OTHER VASCULAR PROCEDURES WITH CC,253,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,21262.43,,,,,,,Fee Schedule,2300,21262.42843,
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,254,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14595.19,,,,,,,Fee Schedule,2300,14595.18752,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,255,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,22096.35,,,,,,,Fee Schedule,2300,22096.34553,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,256,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13908.72,,,,,,,Fee Schedule,2300,13908.72139,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,257,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8947,,,,,,,Fee Schedule,2300,8946.996584,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,258,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,25739.2,,,,,,,Fee Schedule,2300,25739.20341,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,259,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,16564.48,,,,,,,Fee Schedule,2300,16564.47701,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,260,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,26646.03,,,,,,,Fee Schedule,2300,26646.02682,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,261,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15486.45,,,,,,,Fee Schedule,2300,15486.44666,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,262,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13351.68,,,,,,,Fee Schedule,2300,13351.68443,
VEIN LIGATION AND STRIPPING,263,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,25045.36,,,,,,,Fee Schedule,2300,25045.36473,
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,264,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,27365.26,,,,,,,Fee Schedule,2300,27365.25983,
AICD LEAD PROCEDURES,265,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,29639.28,,,,,,,Fee Schedule,2300,29639.2813,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,266,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,50202.14,,,,,,,Fee Schedule,2300,50202.13685,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,267,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,38999.14,,,,,,,Fee Schedule,2300,38999.14058,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,268,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,56341.83,,,,,,,Fee Schedule,2300,56341.83099,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,269,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,34595.27,,,,,,,Fee Schedule,2300,34595.2719,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,270,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,43221.97,,,,,,,Fee Schedule,2300,43221.97224,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,271,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,29132.21,,,,,,,Fee Schedule,2300,29132.21384,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,272,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,20913.46,,,,,,,Fee Schedule,2300,20913.46116,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,273,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,33794.94,,,,,,,Fee Schedule,2300,33794.94086,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,274,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,26964.68,,,,,,,Fee Schedule,2300,26964.68472,
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC,275,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,58410.24,,,,,,,Fee Schedule,2300,58410.24029,
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR,276,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,49204.39,,,,,,,Fee Schedule,2300,49204.38535,
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC,277,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,37833.46,,,,,,,Fee Schedule,2300,37833.45882,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC,278,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,45596.75,,,,,,,Fee Schedule,2300,45596.75186,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC,279,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,29542.62,,,,,,,Fee Schedule,2300,29542.61901,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",280,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13140.34,,,,,,,Fee Schedule,2300,13140.33805,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",281,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7529.01,,,,,,,Fee Schedule,2300,7529.009852,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",282,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5923.43,,,,,,,Fee Schedule,2300,5923.432732,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",283,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,16226.16,,,,,,,Fee Schedule,2300,16226.15898,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",284,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5670.31,,,,,,,Fee Schedule,2300,5670.308584,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",285,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,4906.02,,,,,,,Fee Schedule,2300,4972,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",286,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,18126.64,,,,,,,Fee Schedule,2300,18126.63802,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",287,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8765.96,,,,,,,Fee Schedule,2300,8765.959572,
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,288,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,22168.43,,,,,,,Fee Schedule,2300,22168.43266,
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,289,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13982.45,,,,,,,Fee Schedule,2300,13982.44687,
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,290,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7615.84,,,,,,,Fee Schedule,2300,7615.842084,
HEART FAILURE AND SHOCK WITH MCC,291,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10516.53,,,,,,,Fee Schedule,2300,10516.53014,
HEART FAILURE AND SHOCK WITH CC,292,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6954.77,,,,,,,Fee Schedule,2300,6954.77028,
HEART FAILURE AND SHOCK WITHOUT CC/MCC,293,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,4636.51,,,,,,,Fee Schedule,2300,4636.51352,
"CARDIAC ARREST, UNEXPLAINED WITH MCC",296,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12794.65,,,,,,,Fee Schedule,2300,12794.64747,
"CARDIAC ARREST, UNEXPLAINED WITH CC",297,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5107.54,,,,,,,Fee Schedule,2300,6184,
"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",298,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,3728.05,,,,,,,Fee Schedule,2300,4972,
PERIPHERAL VASCULAR DISORDERS WITH MCC,299,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13374.62,,,,,,,Fee Schedule,2300,13374.62124,
PERIPHERAL VASCULAR DISORDERS WITH CC,300,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8744.66,,,,,,,Fee Schedule,2300,8744.6611,
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,301,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5895.58,,,,,,,Fee Schedule,2300,5895.580884,
ATHEROSCLEROSIS WITH MCC,302,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9802.21,,,,,,,Fee Schedule,2300,9802.212152,
ATHEROSCLEROSIS WITHOUT MCC,303,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5514.67,,,,,,,Fee Schedule,2300,5514.665904,
HYPERTENSION WITH MCC,304,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9748.15,,,,,,,Fee Schedule,2300,9748.1468,
HYPERTENSION WITHOUT MCC,305,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6185.57,,,,,,,Fee Schedule,2300,6185.567772,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,306,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12908.51,,,,,,,Fee Schedule,2300,12908.51238,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,307,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7480.68,,,,,,,Fee Schedule,2300,7480.678704,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,308,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9862.83,,,,,,,Fee Schedule,2300,9862.83088,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,309,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6026.65,,,,,,,Fee Schedule,2300,6026.648404,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,310,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,4637.33,,,,,,,Fee Schedule,2300,4637.332692,
ANGINA PECTORIS,311,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5749.77,,,,,,,Fee Schedule,2300,5749.768268,
SYNCOPE AND COLLAPSE,312,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7139.9,,,,,,,Fee Schedule,2300,7139.903152,
CHEST PAIN,313,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5898.04,,,,,,,Fee Schedule,2300,5898.0384,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,314,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17081.37,,,,,,,Fee Schedule,2300,17081.37454,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,315,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7891.08,,,,,,,Fee Schedule,2300,7891.083876,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,316,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5587.57,,,,,,,Fee Schedule,2300,5587.572212,
CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION,317,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,54773.94,,,,,,,Fee Schedule,2300,54773.93578,
PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE,318,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,19841.98,,,,,,,Fee Schedule,2300,19841.98418,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,319,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,36558.83,,,,,,,Fee Schedule,2300,36558.82719,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,320,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,19703.54,,,,,,,Fee Schedule,2300,19703.54412,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES,321,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,22288.03,,,,,,,Fee Schedule,2300,22288.03178,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC,322,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14442,,,,,,,Fee Schedule,2300,14442.00236,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC,323,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,35448.85,,,,,,,Fee Schedule,2300,35448.84913,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC,324,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,25812.11,,,,,,,Fee Schedule,2300,25812.10972,
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE,325,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,26298.7,,,,,,,Fee Schedule,2300,26298.69789,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,40855.38,,,,,,,Fee Schedule,2300,40855.38433,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,20022.2,,,,,,,Fee Schedule,2300,20022.20202,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13125.59,,,,,,,Fee Schedule,2300,13125.59296,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,329,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,37653.24,,,,,,,Fee Schedule,2300,37653.24098,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,330,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,19637.19,,,,,,,Fee Schedule,2300,19637.19118,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,331,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13785.85,,,,,,,Fee Schedule,2300,13785.84559,
RECTAL RESECTION WITH MCC,332,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,29659.76,,,,,,,Fee Schedule,2300,29659.7606,
RECTAL RESECTION WITH CC,333,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,19186.65,,,,,,,Fee Schedule,2300,19186.64658,
RECTAL RESECTION WITHOUT CC/MCC,334,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13417.22,,,,,,,Fee Schedule,2300,13417.21819,
PERITONEAL ADHESIOLYSIS WITH MCC,335,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,29251.81,,,,,,,Fee Schedule,2300,29251.81295,
PERITONEAL ADHESIOLYSIS WITH CC,336,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17273.88,,,,,,,Fee Schedule,2300,17273.87996,
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,337,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12574.29,,,,,,,Fee Schedule,2300,12574.2902,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,344,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,21157.57,,,,,,,Fee Schedule,2300,21157.57442,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,345,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12326.08,,,,,,,Fee Schedule,2300,12326.08108,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,346,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9717.02,,,,,,,Fee Schedule,2300,9717.018264,
ANAL AND STOMAL PROCEDURES WITH MCC,347,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,18804.91,,,,,,,Fee Schedule,2300,18804.91243,
ANAL AND STOMAL PROCEDURES WITH CC,348,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10721.32,,,,,,,Fee Schedule,2300,10721.32314,
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,349,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7131.71,,,,,,,Fee Schedule,2300,7131.711432,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,350,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,20412.95,,,,,,,Fee Schedule,2300,20412.94707,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,351,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12488.28,,,,,,,Fee Schedule,2300,12488.27714,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,352,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9566.29,,,,,,,Fee Schedule,2300,9566.290616,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,353,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,23772.37,,,,,,,Fee Schedule,2300,23772.37144,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,354,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13781.75,,,,,,,Fee Schedule,2300,13781.74973,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,355,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11017.86,,,,,,,Fee Schedule,2300,11017.8634,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,356,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,35984.59,,,,,,,Fee Schedule,2300,35984.58762,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,357,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,19049.84,,,,,,,Fee Schedule,2300,19049.84486,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,358,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11451.21,,,,,,,Fee Schedule,2300,11451.20539,
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC,359,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,28168.05,,,,,,,Fee Schedule,2300,28168.04839,
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC,360,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,19777.27,,,,,,,Fee Schedule,2300,19777.2696,
MAJOR ESOPHAGEAL DISORDERS WITH MCC,368,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13040.4,,,,,,,Fee Schedule,2300,13040.39907,
MAJOR ESOPHAGEAL DISORDERS WITH CC,369,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8193.36,,,,,,,Fee Schedule,2300,8193.358344,
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,370,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5740.76,,,,,,,Fee Schedule,2300,5740.757376,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,371,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14524.74,,,,,,,Fee Schedule,2300,14524.73873,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,372,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8363.75,,,,,,,Fee Schedule,2300,8363.74612,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,373,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5958.66,,,,,,,Fee Schedule,2300,5958.657128,
DIGESTIVE MALIGNANCY WITH MCC,374,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17519.63,,,,,,,Fee Schedule,2300,17519.63156,
DIGESTIVE MALIGNANCY WITH CC,375,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9908.7,,,,,,,Fee Schedule,2300,9908.704512,
DIGESTIVE MALIGNANCY WITHOUT CC/MCC,376,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7571.61,,,,,,,Fee Schedule,2300,7571.606796,
GASTROINTESTINAL HEMORRHAGE WITH MCC,377,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14974.46,,,,,,,Fee Schedule,2300,14974.46416,
GASTROINTESTINAL HEMORRHAGE WITH CC,378,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8033.62,,,,,,,Fee Schedule,2300,8033.619804,
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,379,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5164.06,,,,,,,Fee Schedule,2300,5164.060288,
COMPLICATED PEPTIC ULCER WITH MCC,380,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,16073.79,,,,,,,Fee Schedule,2300,16073.79298,
COMPLICATED PEPTIC ULCER WITH CC,381,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8875.73,,,,,,,Fee Schedule,2300,8875.72862,
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,382,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6558.29,,,,,,,Fee Schedule,2300,6558.291032,
UNCOMPLICATED PEPTIC ULCER WITH MCC,383,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11310.31,,,,,,,Fee Schedule,2300,11310.3078,
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,384,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7002.28,,,,,,,Fee Schedule,2300,7002.282256,
INFLAMMATORY BOWEL DISEASE WITH MCC,385,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12961.76,,,,,,,Fee Schedule,2300,12961.75856,
INFLAMMATORY BOWEL DISEASE WITH CC,386,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7997.58,,,,,,,Fee Schedule,2300,7997.576236,
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,387,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5581.02,,,,,,,Fee Schedule,2300,5581.018836,
GASTROINTESTINAL OBSTRUCTION WITH MCC,388,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12097.53,,,,,,,Fee Schedule,2300,12097.5321,
GASTROINTESTINAL OBSTRUCTION WITH CC,389,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6469.82,,,,,,,Fee Schedule,2300,6469.820456,
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,390,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,4456.3,,,,,,,Fee Schedule,2300,4456.29568,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10389.56,,,,,,,Fee Schedule,2300,10389.55848,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6386.26,,,,,,,Fee Schedule,2300,6386.264912,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,393,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13101.02,,,,,,,Fee Schedule,2300,13101.0178,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,394,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7664.99,,,,,,,Fee Schedule,2300,7664.992404,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,395,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5316.43,,,,,,,Fee Schedule,2300,5316.42628,
APPENDIX PROCEDURES WITH MCC,397,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,19618.35,,,,,,,Fee Schedule,2300,19618.35023,
APPENDIX PROCEDURES WITH CC,398,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12398.99,,,,,,,Fee Schedule,2300,12398.98739,
APPENDIX PROCEDURES WITHOUT CC/MCC,399,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9377.06,,,,,,,Fee Schedule,2300,9377.061884,
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL,402,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,32934.81,,,,,,,Fee Schedule,2300,32934.81026,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",405,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,44812.8,,,,,,,Fee Schedule,2300,44812.80426,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",406,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,23757.63,,,,,,,Fee Schedule,2300,23757.62634,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",407,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,18182.34,,,,,,,Fee Schedule,2300,18182.34171,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,408,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,29208.4,,,,,,,Fee Schedule,2300,29208.39683,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,409,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17835.83,,,,,,,Fee Schedule,2300,17835.83196,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,410,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13005.99,,,,,,,Fee Schedule,2300,13005.99384,
CHOLECYSTECTOMY WITH C.D.E. WITH MCC,411,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,27059.71,,,,,,,Fee Schedule,2300,27059.70868,
CHOLECYSTECTOMY WITH C.D.E. WITH CC,412,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17223.09,,,,,,,Fee Schedule,2300,17223.0913,
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,413,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13602.35,,,,,,,Fee Schedule,2300,13602.35106,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,414,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,29183.82,,,,,,,Fee Schedule,2300,29183.82167,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,415,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,16929.83,,,,,,,Fee Schedule,2300,16929.82772,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,416,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11167.77,,,,,,,Fee Schedule,2300,11167.77188,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,417,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,19548.72,,,,,,,Fee Schedule,2300,19548.72061,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,418,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13857.11,,,,,,,Fee Schedule,2300,13857.11355,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,419,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11188.25,,,,,,,Fee Schedule,2300,11188.25118,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,420,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,27910.01,,,,,,,Fee Schedule,2300,27910.00921,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,421,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14233.11,,,,,,,Fee Schedule,2300,14233.1135,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,422,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11464.31,,,,,,,Fee Schedule,2300,11464.31214,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,423,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,34020.21,,,,,,,Fee Schedule,2300,34020.21316,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,424,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17922.66,,,,,,,Fee Schedule,2300,17922.66419,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,425,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12290.04,,,,,,,Fee Schedule,2300,12290.03752,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,426,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,90282.58,,,,,,,Fee Schedule,2300,90282.58446,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC,427,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,59132.75,,,,,,,Fee Schedule,2300,59132.74999,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC,428,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,46053.85,,,,,,,Fee Schedule,2300,46053.84984,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC,429,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,73804.12,,,,,,,Fee Schedule,2300,73804.12051,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC,430,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,47242.47,,,,,,,Fee Schedule,2300,47242.46841,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,432,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,16122.94,,,,,,,Fee Schedule,2300,16122.9433,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,433,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8652.09,,,,,,,Fee Schedule,2300,8652.094664,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,434,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5836.6,,,,,,,Fee Schedule,2300,5836.6005,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,435,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15045.73,,,,,,,Fee Schedule,2300,15045.73212,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,436,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9265.65,,,,,,,Fee Schedule,2300,9265.654492,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,437,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6989.99,,,,,,,Fee Schedule,2300,6989.994676,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,438,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13354.14,,,,,,,Fee Schedule,2300,13354.14194,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,439,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6890.87,,,,,,,Fee Schedule,2300,6890.874864,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,440,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5090.33,,,,,,,Fee Schedule,2300,5090.334808,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14701.68,,,,,,,Fee Schedule,2300,14701.67988,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7907.47,,,,,,,Fee Schedule,2300,7907.467316,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5731.75,,,,,,,Fee Schedule,2300,5731.746484,
DISORDERS OF THE BILIARY TRACT WITH MCC,444,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13687.54,,,,,,,Fee Schedule,2300,13687.54495,
DISORDERS OF THE BILIARY TRACT WITH CC,445,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8965.02,,,,,,,Fee Schedule,2300,8965.018368,
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,446,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6777.01,,,,,,,Fee Schedule,2300,6777.009956,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,447,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,54733.8,,,,,,,Fee Schedule,2300,54733.79635,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,448,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,34739.45,,,,,,,Fee Schedule,2300,34739.44618,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,450,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,43658.59,,,,,,,Fee Schedule,2300,43658.59091,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,451,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,26462.53,,,,,,,Fee Schedule,2300,26462.53229,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",456,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,68838.3,,,,,,,Fee Schedule,2300,68838.29985,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",457,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,48848.05,,,,,,,Fee Schedule,2300,48848.04553,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",458,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,34180.77,,,,,,,Fee Schedule,2300,34180.77087,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,461,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,43912.53,,,,,,,Fee Schedule,2300,43912.53423,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,462,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,21789.98,,,,,,,Fee Schedule,2300,21789.9752,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,463,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,46688.71,,,,,,,Fee Schedule,2300,46688.70814,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,464,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,25514.75,,,,,,,Fee Schedule,2300,25514.75028,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,465,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14939.24,,,,,,,Fee Schedule,2300,14939.23976,
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,466,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,42641.18,,,,,,,Fee Schedule,2300,42641.17929,
REVISION OF HIP OR KNEE REPLACEMENT WITH CC,467,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,28888.92,,,,,,,Fee Schedule,2300,28888.91975,
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,468,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,22510.85,,,,,,,Fee Schedule,2300,22510.84656,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,469,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,24847.13,,,,,,,Fee Schedule,2300,24847.1251,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,470,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15801.01,,,,,,,Fee Schedule,2300,15801.00871,
CERVICAL SPINAL FUSION WITH MCC,471,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,39555.36,,,,,,,Fee Schedule,2300,39555.35836,
CERVICAL SPINAL FUSION WITH CC,472,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,24133.63,,,,,,,Fee Schedule,2300,24133.62629,
CERVICAL SPINAL FUSION WITHOUT CC/MCC,473,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,19998.45,,,,,,,Fee Schedule,2300,19998.44604,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,474,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,35166.23,,,,,,,Fee Schedule,2300,35166.23479,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,475,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,18641.9,,,,,,,Fee Schedule,2300,18641.8972,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,476,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9667.87,,,,,,,Fee Schedule,2300,9667.867944,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,477,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,28299.12,,,,,,,Fee Schedule,2300,28299.11591,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,478,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,20145.08,,,,,,,Fee Schedule,2300,20145.07782,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,479,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15227.59,,,,,,,Fee Schedule,2300,15227.58831,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,480,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,23856.75,,,,,,,Fee Schedule,2300,23856.74616,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,481,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17157.56,,,,,,,Fee Schedule,2300,17157.55754,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,482,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13360.7,,,,,,,Fee Schedule,2300,13360.69532,
MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,483,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,22706.63,,,,,,,Fee Schedule,2300,22706.62867,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,485,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,26435.5,,,,,,,Fee Schedule,2300,26435.49961,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,486,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17129.71,,,,,,,Fee Schedule,2300,17129.70569,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,487,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12829.87,,,,,,,Fee Schedule,2300,12829.87186,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,488,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12480.9,,,,,,,Fee Schedule,2300,12480.90459,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,489,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9148.51,,,,,,,Fee Schedule,2300,13879,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",492,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,30076.72,,,,,,,Fee Schedule,2300,30076.71915,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",493,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,20775.02,,,,,,,Fee Schedule,2300,20775.02109,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",494,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,16436.69,,,,,,,Fee Schedule,2300,16436.68618,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,495,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,29700.72,,,,,,,Fee Schedule,2300,29700.7192,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,496,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14777.04,,,,,,,Fee Schedule,2300,14777.04371,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,497,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9434.4,,,,,,,Fee Schedule,2300,9434.403924,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,498,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,24712.78,,,,,,,Fee Schedule,2300,24712.7809,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,499,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,16504.68,,,,,,,Fee Schedule,2300,16504.67746,
SOFT TISSUE PROCEDURES WITH MCC,500,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,25925.16,,,,,,,Fee Schedule,2300,25925.15546,
SOFT TISSUE PROCEDURES WITH CC,501,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14319.95,,,,,,,Fee Schedule,2300,14319.94573,
SOFT TISSUE PROCEDURES WITHOUT CC/MCC,502,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11025.24,,,,,,,Fee Schedule,2300,11025.23595,
FOOT PROCEDURES WITH MCC,503,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,22863.91,,,,,,,Fee Schedule,2300,22863.90969,
FOOT PROCEDURES WITH CC,504,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15311.96,,,,,,,Fee Schedule,2300,15311.96302,
FOOT PROCEDURES WITHOUT CC/MCC,505,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14686.12,,,,,,,Fee Schedule,2300,14686.11562,
MAJOR THUMB OR JOINT PROCEDURES,506,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9826.79,,,,,,,Fee Schedule,2300,9826.787312,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,507,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14797.52,,,,,,,Fee Schedule,2300,14797.52301,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,508,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12405.54,,,,,,,Fee Schedule,2300,12405.54077,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,24743.09,,,,,,,Fee Schedule,2300,24743.09026,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17033.86,,,,,,,Fee Schedule,2300,17033.86257,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13560.57,,,,,,,Fee Schedule,2300,13879,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12896.22,,,,,,,Fee Schedule,2300,12896.2248,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8374.4,,,,,,,Fee Schedule,2300,8374.395356,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,515,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,26106.19,,,,,,,Fee Schedule,2300,26106.19247,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,516,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17023.21,,,,,,,Fee Schedule,2300,17023.21333,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,517,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12588.22,,,,,,,Fee Schedule,2300,13879,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,518,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,30614.92,,,,,,,Fee Schedule,2300,30614.91516,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,519,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,16385.08,,,,,,,Fee Schedule,2300,16385.07834,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,520,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12237.61,,,,,,,Fee Schedule,2300,12237.61051,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,521,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,23511.87,,,,,,,Fee Schedule,2300,23511.87474,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,522,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17347.61,,,,,,,Fee Schedule,2300,17347.60544,
FRACTURES OF FEMUR WITH MCC,533,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12842.16,,,,,,,Fee Schedule,2300,12842.15944,
FRACTURES OF FEMUR WITHOUT MCC,534,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6603.35,,,,,,,Fee Schedule,2300,6603.345492,
FRACTURES OF HIP AND PELVIS WITH MCC,535,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10501.79,,,,,,,Fee Schedule,2300,10501.78504,
FRACTURES OF HIP AND PELVIS WITHOUT MCC,536,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6615.63,,,,,,,Fee Schedule,2300,6615.633072,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",537,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7817.36,,,,,,,Fee Schedule,2300,7817.358396,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",538,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5900.5,,,,,,,Fee Schedule,2300,5900.495916,
OSTEOMYELITIS WITH MCC,539,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,16135.23,,,,,,,Fee Schedule,2300,16135.23088,
OSTEOMYELITIS WITH CC,540,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10618.93,,,,,,,Fee Schedule,2300,10618.92664,
OSTEOMYELITIS WITHOUT CC/MCC,541,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6319.91,,,,,,,Fee Schedule,2300,6319.91198,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,542,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14470.67,,,,,,,Fee Schedule,2300,14470.67338,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,543,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8421.09,,,,,,,Fee Schedule,2300,8421.08816,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,544,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6181.47,,,,,,,Fee Schedule,2300,6181.471912,
CONNECTIVE TISSUE DISORDERS WITH MCC,545,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,20329.39,,,,,,,Fee Schedule,2300,20329.39152,
CONNECTIVE TISSUE DISORDERS WITH CC,546,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9448.33,,,,,,,Fee Schedule,2300,9448.329848,
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,547,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6849.92,,,,,,,Fee Schedule,2300,6849.916264,
SEPTIC ARTHRITIS WITH MCC,548,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15817.39,,,,,,,Fee Schedule,2300,15817.39215,
SEPTIC ARTHRITIS WITH CC,549,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9889.04,,,,,,,Fee Schedule,2300,9889.044384,
SEPTIC ARTHRITIS WITHOUT CC/MCC,550,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7160.38,,,,,,,Fee Schedule,2300,7160.382452,
MEDICAL BACK PROBLEMS WITH MCC,551,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13730.14,,,,,,,Fee Schedule,2300,13730.14189,
MEDICAL BACK PROBLEMS WITHOUT MCC,552,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7874.7,,,,,,,Fee Schedule,2300,7874.700436,
BONE DISEASES AND ARTHROPATHIES WITH MCC,553,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10618.93,,,,,,,Fee Schedule,2300,10618.92664,
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,554,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6799.95,,,,,,,Fee Schedule,2300,6799.946772,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,555,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10827.82,,,,,,,Fee Schedule,2300,10827.8155,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,556,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6804.04,,,,,,,Fee Schedule,2300,6804.042632,
"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12180.27,,,,,,,Fee Schedule,2300,12180.26847,
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7316.84,,,,,,,Fee Schedule,2300,7316.844304,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15276.74,,,,,,,Fee Schedule,2300,15276.73863,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9224.7,,,,,,,Fee Schedule,2300,9224.695892,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6585.32,,,,,,,Fee Schedule,2300,6585.323708,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11671.56,,,,,,,Fee Schedule,2300,11671.56266,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7335.69,,,,,,,Fee Schedule,2300,7335.68526,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,564,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12644.74,,,,,,,Fee Schedule,2300,12644.73899,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,565,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7982.01,,,,,,,Fee Schedule,2300,7982.011968,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,566,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6138.06,,,,,,,Fee Schedule,2300,6138.055796,
SKIN DEBRIDEMENT WITH MCC,570,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,24092.67,,,,,,,Fee Schedule,2300,24092.66769,
SKIN DEBRIDEMENT WITH CC,571,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13839.91,,,,,,,Fee Schedule,2300,13839.91094,
SKIN DEBRIDEMENT WITHOUT CC/MCC,572,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9390.17,,,,,,,Fee Schedule,2300,9390.168636,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,573,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,53667.23,,,,,,,Fee Schedule,2300,53667.23441,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,574,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,28436.74,,,,,,,Fee Schedule,2300,28436.73681,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,575,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13381.99,,,,,,,Fee Schedule,2300,13381.99379,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,576,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,40149.26,,,,,,,Fee Schedule,2300,40149.25806,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,577,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,21713.79,,,,,,,Fee Schedule,2300,21713.7922,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,578,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13159.18,,,,,,,Fee Schedule,2300,13159.17901,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,26528.89,,,,,,,Fee Schedule,2300,26528.88522,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14155.29,,,,,,,Fee Schedule,2300,14155.29216,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11821.47,,,,,,,Fee Schedule,2300,11821.47113,
MASTECTOMY FOR MALIGNANCY WITH CC/MCC,582,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15782.17,,,,,,,Fee Schedule,2300,15782.16775,
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,583,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14125.8,,,,,,,Fee Schedule,2300,14125.80197,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17536.02,,,,,,,Fee Schedule,2300,17536.015,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15802.65,,,,,,,Fee Schedule,2300,15802.64705,
SKIN ULCERS WITH MCC,592,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15853.44,,,,,,,Fee Schedule,2300,15853.43572,
SKIN ULCERS WITH CC,593,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9717.84,,,,,,,Fee Schedule,2300,9717.837436,
SKIN ULCERS WITHOUT CC/MCC,594,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7100.58,,,,,,,Fee Schedule,2300,7100.582896,
MAJOR SKIN DISORDERS WITH MCC,595,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17372.18,,,,,,,Fee Schedule,2300,17372.1806,
MAJOR SKIN DISORDERS WITHOUT MCC,596,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8867.54,,,,,,,Fee Schedule,2300,8867.5369,
MALIGNANT BREAST DISORDERS WITH MCC,597,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13656.42,,,,,,,Fee Schedule,2300,13656.41641,
MALIGNANT BREAST DISORDERS WITH CC,598,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9267.29,,,,,,,Fee Schedule,2300,9267.292836,
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,599,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6006.17,,,,,,,Fee Schedule,2300,6006.169104,
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,600,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8532.5,,,,,,,Fee Schedule,2300,8532.495552,
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,601,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,4955.99,,,,,,,Fee Schedule,2300,4955.9906,
CELLULITIS WITH MCC,602,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11642.89,,,,,,,Fee Schedule,2300,11642.89164,
CELLULITIS WITHOUT MCC,603,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7134.17,,,,,,,Fee Schedule,2300,7134.168948,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12059.03,,,,,,,Fee Schedule,2300,12059.03101,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7503.62,,,,,,,Fee Schedule,2300,7503.61552,
MINOR SKIN DISORDERS WITH MCC,606,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12395.71,,,,,,,Fee Schedule,2300,12395.7107,
MINOR SKIN DISORDERS WITHOUT MCC,607,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7424.98,,,,,,,Fee Schedule,2300,7424.975008,
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,614,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17954.61,,,,,,,Fee Schedule,2300,17954.6119,
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,615,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11462.67,,,,,,,Fee Schedule,2300,11462.6738,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,28567.8,,,,,,,Fee Schedule,2300,28567.80433,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15320.97,,,,,,,Fee Schedule,2300,15320.97392,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",618,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11618.32,,,,,,,Fee Schedule,2300,11618.31648,
O.R. PROCEDURES FOR OBESITY WITH MCC,619,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,23652.77,,,,,,,Fee Schedule,2300,23652.77233,
O.R. PROCEDURES FOR OBESITY WITH CC,620,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13109.21,,,,,,,Fee Schedule,2300,13879,
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,621,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12356.39,,,,,,,Fee Schedule,2300,13879,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,29155.97,,,,,,,Fee Schedule,2300,29155.96982,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14695.13,,,,,,,Fee Schedule,2300,14695.12651,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",624,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10255.21,,,,,,,Fee Schedule,2300,10255.21427,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,24739.81,,,,,,,Fee Schedule,2300,24739.81357,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12282.66,,,,,,,Fee Schedule,2300,13879,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10881.06,,,,,,,Fee Schedule,2300,10881.06168,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,30528.9,,,,,,,Fee Schedule,2300,30528.9021,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17848.12,,,,,,,Fee Schedule,2300,17848.11954,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11955.82,,,,,,,Fee Schedule,2300,13879,
DIABETES WITH MCC,637,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11769.04,,,,,,,Fee Schedule,2300,11769.04412,
DIABETES WITH CC,638,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7341.42,,,,,,,Fee Schedule,2300,7341.419464,
DIABETES WITHOUT CC/MCC,639,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5088.7,,,,,,,Fee Schedule,2300,5088.696464,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10940.86,,,,,,,Fee Schedule,2300,10940.86123,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6374.8,,,,,,,Fee Schedule,2300,6374.796504,
INBORN AND OTHER DISORDERS OF METABOLISM,642,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11649.45,,,,,,,Fee Schedule,2300,11649.44501,
ENDOCRINE DISORDERS WITH MCC,643,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13484.39,,,,,,,Fee Schedule,2300,13484.39029,
ENDOCRINE DISORDERS WITH CC,644,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8396.51,,,,,,,Fee Schedule,2300,8396.513,
ENDOCRINE DISORDERS WITHOUT CC/MCC,645,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6293.7,,,,,,,Fee Schedule,2300,6293.698476,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,650,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,38512.55,,,,,,,Fee Schedule,2300,38512.55241,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,651,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,30356.88,,,,,,,Fee Schedule,2300,30356.87598,
KIDNEY TRANSPLANT,652,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,26455.16,,,,,,,Fee Schedule,2300,26455.15974,
MAJOR BLADDER PROCEDURES WITH MCC,653,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,42567.45,,,,,,,Fee Schedule,2300,42567.45381,
MAJOR BLADDER PROCEDURES WITH CC,654,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,22931.08,,,,,,,Fee Schedule,2300,22931.0818,
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,655,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17338.59,,,,,,,Fee Schedule,2300,17338.59455,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,656,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,26080.8,,,,,,,Fee Schedule,2300,26080.79814,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,657,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14990.85,,,,,,,Fee Schedule,2300,14990.8476,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,658,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12711.91,,,,,,,Fee Schedule,2300,12711.9111,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,659,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,20814.34,,,,,,,Fee Schedule,2300,20814.34135,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,660,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10827,,,,,,,Fee Schedule,2300,10826.99632,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,661,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8481.71,,,,,,,Fee Schedule,2300,8481.706888,
MINOR BLADDER PROCEDURES WITH MCC,662,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,25078.95,,,,,,,Fee Schedule,2300,25078.95078,
MINOR BLADDER PROCEDURES WITH CC,663,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12453.05,,,,,,,Fee Schedule,2300,12453.05274,
MINOR BLADDER PROCEDURES WITHOUT CC/MCC,664,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8575.91,,,,,,,Fee Schedule,2300,8575.911668,
PROSTATECTOMY WITH MCC,665,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,25568,,,,,,,Fee Schedule,2300,25567.99646,
PROSTATECTOMY WITH CC,666,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14329.78,,,,,,,Fee Schedule,2300,14329.7758,
PROSTATECTOMY WITHOUT CC/MCC,667,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9061.68,,,,,,,Fee Schedule,2300,9061.680664,
TRANSURETHRAL PROCEDURES WITH MCC,668,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,23919.82,,,,,,,Fee Schedule,2300,23919.8224,
TRANSURETHRAL PROCEDURES WITH CC,669,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12713.55,,,,,,,Fee Schedule,2300,12713.54944,
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,670,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8005.77,,,,,,,Fee Schedule,2300,8327,
URETHRAL PROCEDURES WITH CC/MCC,671,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14704.14,,,,,,,Fee Schedule,2300,14704.1374,
URETHRAL PROCEDURES WITHOUT CC/MCC,672,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8842.96,,,,,,,Fee Schedule,2300,8842.96174,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,673,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,34418.33,,,,,,,Fee Schedule,2300,34418.33075,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,674,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,19157.16,,,,,,,Fee Schedule,2300,19157.15639,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,675,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13445.89,,,,,,,Fee Schedule,2300,13445.88921,
RENAL FAILURE WITH MCC,682,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12131.94,,,,,,,Fee Schedule,2300,12131.93732,
RENAL FAILURE WITH CC,683,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7174.31,,,,,,,Fee Schedule,2300,7174.308376,
RENAL FAILURE WITHOUT CC/MCC,684,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,4917.49,,,,,,,Fee Schedule,2300,4917.489516,
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,686,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14775.41,,,,,,,Fee Schedule,2300,14775.40536,
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,687,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8583.28,,,,,,,Fee Schedule,2300,8583.284216,
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,688,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6473.92,,,,,,,Fee Schedule,2300,6473.916316,
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,689,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9504.85,,,,,,,Fee Schedule,2300,9504.852716,
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,690,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6631.2,,,,,,,Fee Schedule,2300,6631.19734,
URINARY STONES WITH MCC,693,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11013.77,,,,,,,Fee Schedule,2300,11013.76754,
URINARY STONES WITHOUT MCC,694,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6403.47,,,,,,,Fee Schedule,2300,6403.467524,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,695,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9369.69,,,,,,,Fee Schedule,2300,9369.689336,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,696,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5644.1,,,,,,,Fee Schedule,2300,5644.09508,
URETHRAL STRICTURE,697,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8829.04,,,,,,,Fee Schedule,2300,8829.035816,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,698,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13552.38,,,,,,,Fee Schedule,2300,13552.38157,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,699,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8314.6,,,,,,,Fee Schedule,2300,8314.5958,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,700,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5651.47,,,,,,,Fee Schedule,2300,5651.467628,
MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,707,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,16385.9,,,,,,,Fee Schedule,2300,16385.89752,
MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,708,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12567.74,,,,,,,Fee Schedule,2300,13879,
PENIS PROCEDURES WITH CC/MCC,709,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,19062.95,,,,,,,Fee Schedule,2300,19062.95161,
PENIS PROCEDURES WITHOUT CC/MCC,710,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11478.24,,,,,,,Fee Schedule,2300,13879,
TESTES PROCEDURES WITH CC/MCC,711,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17069.91,,,,,,,Fee Schedule,2300,17069.90614,
TESTES PROCEDURES WITHOUT CC/MCC,712,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9008.43,,,,,,,Fee Schedule,2300,9008.434484,
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,713,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12315.43,,,,,,,Fee Schedule,2300,12315.43185,
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,714,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8661.92,,,,,,,Fee Schedule,2300,8661.924728,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,715,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,18327.34,,,,,,,Fee Schedule,2300,18327.33516,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,716,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12050.02,,,,,,,Fee Schedule,2300,12050.02012,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,717,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15486.45,,,,,,,Fee Schedule,2300,15486.44666,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,718,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11002.3,,,,,,,Fee Schedule,2300,11002.29913,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14824.56,,,,,,,Fee Schedule,2300,14824.55568,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9360.68,,,,,,,Fee Schedule,2300,9360.678444,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",724,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5010.88,,,,,,,Fee Schedule,2300,5010.875124,
BENIGN PROSTATIC HYPERTROPHY WITH MCC,725,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9585.95,,,,,,,Fee Schedule,2300,9585.950744,
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,726,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5914.42,,,,,,,Fee Schedule,2300,5914.42184,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,727,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12147.5,,,,,,,Fee Schedule,2300,12147.50159,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,728,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6645.12,,,,,,,Fee Schedule,2300,6645.123264,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,729,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8672.57,,,,,,,Fee Schedule,2300,8672.573964,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,730,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5504.84,,,,,,,Fee Schedule,2300,5504.83584,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17448.36,,,,,,,Fee Schedule,2300,17448.3636,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",735,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11021.96,,,,,,,Fee Schedule,2300,13879,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,736,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,29281.3,,,,,,,Fee Schedule,2300,29281.30314,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,737,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,16879.86,,,,,,,Fee Schedule,2300,16879.85823,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,738,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12029.54,,,,,,,Fee Schedule,2300,12029.54082,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,739,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,28886.46,,,,,,,Fee Schedule,2300,28886.46224,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,740,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14823.74,,,,,,,Fee Schedule,2300,14823.73651,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,741,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11682.21,,,,,,,Fee Schedule,2300,13879,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,742,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15030.17,,,,,,,Fee Schedule,2300,15030.16786,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,743,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10163.47,,,,,,,Fee Schedule,2300,10163.467,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,16785.65,,,,,,,Fee Schedule,2300,16785.65345,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9318.08,,,,,,,Fee Schedule,2300,9318.0815,
"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14229.84,,,,,,,Fee Schedule,2300,14229.83681,
"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6876.95,,,,,,,Fee Schedule,2300,8327,
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,748,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11364.37,,,,,,,Fee Schedule,2300,13879,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,749,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,21033.06,,,,,,,Fee Schedule,2300,21033.06027,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,750,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12089.34,,,,,,,Fee Schedule,2300,12089.34038,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15086.69,,,,,,,Fee Schedule,2300,15086.69072,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8910.95,,,,,,,Fee Schedule,2300,8910.953016,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",756,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7868.15,,,,,,,Fee Schedule,2300,7868.14706,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11729.72,,,,,,,Fee Schedule,2300,11729.72387,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8019.69,,,,,,,Fee Schedule,2300,8019.69388,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5436.03,,,,,,,Fee Schedule,2300,5436.025392,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,760,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8253.16,,,,,,,Fee Schedule,2300,8253.1579,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,761,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,4666,,,,,,,Fee Schedule,2300,4666.003712,
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,768,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8778.25,,,,,,,Fee Schedule,2300,8778.247152,
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,769,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13842.37,,,,,,,Fee Schedule,2300,13842.36846,
"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8213.84,,,,,,,Fee Schedule,2300,8213.837644,
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,776,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5363.12,,,,,,,Fee Schedule,2300,5363.119084,
ABORTION WITHOUT D&C,779,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5841.52,,,,,,,Fee Schedule,2300,5841.515532,
CESAREAN SECTION WITH STERILIZATION WITH MCC,783,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,20111.49,,,,,,,Fee Schedule,2300,20111.49177,
CESAREAN SECTION WITH STERILIZATION WITH CC,784,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8684.04,,,,,,,Fee Schedule,2300,8684.042372,
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,785,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7846.03,,,,,,,Fee Schedule,2300,7846.029416,
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,786,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13512.24,,,,,,,Fee Schedule,2300,13512.24214,
CESAREAN SECTION WITHOUT STERILIZATION WITH CC,787,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9148.51,,,,,,,Fee Schedule,2300,9148.512896,
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,788,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7854.22,,,,,,,Fee Schedule,2300,7854.221136,
"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14763.12,,,,,,,Fee Schedule,1184,14763.11778,
"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,48687.49,,,,,,,Fee Schedule,2300,48687.48782,
PREMATURITY WITH MAJOR PROBLEMS,791,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,33250.19,,,,,,,Fee Schedule,2300,33250.19148,
PREMATURITY WITHOUT MAJOR PROBLEMS,792,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,20063.16,,,,,,,Fee Schedule,2300,20063.16062,
FULL TERM NEONATE WITH MAJOR PROBLEMS,793,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,34156.2,,,,,,,Fee Schedule,2300,34156.19571,
NEONATE WITH OTHER SIGNIFICANT PROBLEMS,794,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12090.16,,,,,,,Fee Schedule,1184,12090.15955,
NORMAL NEWBORN,795,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,1636.71,,,,,,,Fee Schedule,530,2786,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,796,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9559.74,,,,,,,Fee Schedule,2300,9559.73724,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,797,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8195,,,,,,,Fee Schedule,2300,8194.996688,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,798,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7840.3,,,,,,,Fee Schedule,2300,7840.295212,
SPLENIC PROCEDURES WITH MCC,799,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,37099.48,,,,,,,Fee Schedule,2300,37099.48071,
SPLENIC PROCEDURES WITH CC,800,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,23013.82,,,,,,,Fee Schedule,2300,23013.81817,
SPLENIC PROCEDURES WITHOUT CC/MCC,801,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15637.17,,,,,,,Fee Schedule,2300,15637.17431,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,802,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,32636.63,,,,,,,Fee Schedule,2300,32636.63165,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,803,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15227.59,,,,,,,Fee Schedule,2300,15227.58831,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,804,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11107.97,,,,,,,Fee Schedule,2300,11107.97232,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,805,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8840.5,,,,,,,Fee Schedule,2300,8840.504224,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,806,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6176.56,,,,,,,Fee Schedule,2300,6176.55688,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,807,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5522.86,,,,,,,Fee Schedule,2300,5522.857624,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,808,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,18086.5,,,,,,,Fee Schedule,2300,18086.49859,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,809,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10369.9,,,,,,,Fee Schedule,2300,10369.89835,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,810,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8573.45,,,,,,,Fee Schedule,2300,8573.454152,
RED BLOOD CELL DISORDERS WITH MCC,811,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11503.63,,,,,,,Fee Schedule,2300,11503.6324,
RED BLOOD CELL DISORDERS WITHOUT MCC,812,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7521.64,,,,,,,Fee Schedule,2300,7521.637304,
COAGULATION DISORDERS,813,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12494.83,,,,,,,Fee Schedule,2300,12494.83052,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,814,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17421.33,,,,,,,Fee Schedule,2300,17421.33092,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,815,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8306.4,,,,,,,Fee Schedule,2300,8306.40408,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,816,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5177.17,,,,,,,Fee Schedule,2300,5177.16704,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,817,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13827.62,,,,,,,Fee Schedule,2300,13827.62336,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,818,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8635.71,,,,,,,Fee Schedule,2300,8635.711224,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,819,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7044.06,,,,,,,Fee Schedule,2300,8327,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,820,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,48042.8,,,,,,,Fee Schedule,2300,48042.79946,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,821,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,18337.98,,,,,,,Fee Schedule,2300,18337.98439,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,822,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9862.83,,,,,,,Fee Schedule,2300,9862.83088,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,823,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,37557.4,,,,,,,Fee Schedule,2300,37557.39786,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,824,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,18559.16,,,,,,,Fee Schedule,2300,18559.16083,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,825,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11053.91,,,,,,,Fee Schedule,2300,11053.90697,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,826,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,38319.23,,,,,,,Fee Schedule,2300,38319.22782,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,827,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,18932.7,,,,,,,Fee Schedule,2300,18932.70326,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,828,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13957.05,,,,,,,Fee Schedule,2300,13957.05254,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,829,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,25885.84,,,,,,,Fee Schedule,2300,25885.8352,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,830,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12328.54,,,,,,,Fee Schedule,2300,13879,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,831,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9850.54,,,,,,,Fee Schedule,2300,9850.5433,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,832,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5911.15,,,,,,,Fee Schedule,2300,5911.145152,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,833,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,4283.45,,,,,,,Fee Schedule,2300,4283.450388,
ACUTE LEUKEMIA WITH MCC,834,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,44971.72,,,,,,,Fee Schedule,2300,44971.72363,
ACUTE LEUKEMIA WITH CC,835,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17086.29,,,,,,,Fee Schedule,2300,17086.28958,
ACUTE LEUKEMIA WITHOUT CC/MCC,836,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9989.8,,,,,,,Fee Schedule,2300,9989.80254,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,837,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,39355.48,,,,,,,Fee Schedule,2300,39355.4804,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,838,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17099.4,,,,,,,Fee Schedule,2300,17099.39633,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,839,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11828.02,,,,,,,Fee Schedule,2300,11828.02451,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,840,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,26499.4,,,,,,,Fee Schedule,2300,26499.39503,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,841,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13363.97,,,,,,,Fee Schedule,2300,13363.97201,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,842,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8276.91,,,,,,,Fee Schedule,2300,8276.913888,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,843,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,16340.84,,,,,,,Fee Schedule,2300,16340.84306,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,844,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9972.6,,,,,,,Fee Schedule,2300,9972.599928,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,845,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6976.07,,,,,,,Fee Schedule,2300,6976.068752,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,846,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,21237.03,,,,,,,Fee Schedule,2300,21237.0341,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,847,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10716.41,,,,,,,Fee Schedule,2300,10716.4081,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,848,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6958.05,,,,,,,Fee Schedule,2300,6958.046968,
RADIOTHERAPY,849,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,22195.47,,,,,,,Fee Schedule,2300,22195.46534,
ACUTE LEUKEMIA WITH OTHER PROCEDURES,850,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,70936.2,,,,,,,Fee Schedule,2300,70936.19934,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,853,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,40455.63,,,,,,,Fee Schedule,2300,40455.62839,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,854,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,16367.88,,,,,,,Fee Schedule,2300,16367.87573,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,855,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12264.64,,,,,,,Fee Schedule,2300,12264.64318,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,856,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,37261.68,,,,,,,Fee Schedule,2300,37261.67676,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,857,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17542.57,,,,,,,Fee Schedule,2300,17542.56838,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,858,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11410.25,,,,,,,Fee Schedule,2300,11410.24679,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,862,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14939.24,,,,,,,Fee Schedule,2300,14939.23976,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,863,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8174.52,,,,,,,Fee Schedule,2300,8174.517388,
FEVER AND INFLAMMATORY CONDITIONS,864,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7271.79,,,,,,,Fee Schedule,2300,7271.789844,
VIRAL ILLNESS WITH MCC,865,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12273.65,,,,,,,Fee Schedule,2300,12273.65408,
VIRAL ILLNESS WITHOUT MCC,866,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7123.52,,,,,,,Fee Schedule,2300,7123.519712,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,867,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17146.91,,,,,,,Fee Schedule,2300,17146.9083,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,868,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8446.48,,,,,,,Fee Schedule,2300,8446.482492,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,869,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5977.5,,,,,,,Fee Schedule,2300,5977.498084,
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,870,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,56619.53,,,,,,,Fee Schedule,2300,56619.5303,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,871,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15912.42,,,,,,,Fee Schedule,2300,15912.4161,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,872,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8382.59,,,,,,,Fee Schedule,2300,8382.587076,
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,876,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,31660.18,,,,,,,Fee Schedule,850,31660.17863,
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,880,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7865.69,,,,,,,Fee Schedule,850,7865.689544,
DEPRESSIVE NEUROSES,881,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7707.59,,,,,,,Fee Schedule,850,7707.589348,
NEUROSES EXCEPT DEPRESSIVE,882,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8796.27,,,,,,,Fee Schedule,850,8796.268936,
DISORDERS OF PERSONALITY AND IMPULSE CONTROL,883,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,16107.38,,,,,,,Fee Schedule,850,16107.37904,
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,884,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13179.66,,,,,,,Fee Schedule,850,13179.65831,
PSYCHOSES,885,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11442.19,,,,,,,Fee Schedule,850,11442.1945,
BEHAVIORAL AND DEVELOPMENTAL DISORDERS,886,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,17000.28,,,,,,,Fee Schedule,850,17000.27652,
OTHER MENTAL DISORDER DIAGNOSES,887,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8772.51,,,,,,,Fee Schedule,850,8772.512948,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5053.47,,,,,,,Fee Schedule,850,5053.472068,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11596.2,,,,,,,Fee Schedule,850,11596.19883,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14295.37,,,,,,,Fee Schedule,850,14295.37057,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7231.65,,,,,,,Fee Schedule,850,7231.650416,
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,901,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,34377.37,,,,,,,Fee Schedule,2300,34377.37215,
WOUND DEBRIDEMENTS FOR INJURIES WITH CC,902,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,15683.05,,,,,,,Fee Schedule,2300,15683.04794,
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,903,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9581.04,,,,,,,Fee Schedule,2300,9581.035712,
SKIN GRAFTS FOR INJURIES WITH CC/MCC,904,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,30089.01,,,,,,,Fee Schedule,2300,30089.00673,
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,905,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,11728.9,,,,,,,Fee Schedule,2300,11728.9047,
HAND PROCEDURES FOR INJURIES,906,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14437.09,,,,,,,Fee Schedule,2300,14437.08733,
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,907,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,31450.47,,,,,,,Fee Schedule,2300,31450.4706,
OTHER O.R. PROCEDURES FOR INJURIES WITH CC,908,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,16344.12,,,,,,,Fee Schedule,2300,16344.11974,
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,909,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10753.27,,,,,,,Fee Schedule,2300,10753.27084,
TRAUMATIC INJURY WITH MCC,913,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13390.19,,,,,,,Fee Schedule,2300,13390.18551,
TRAUMATIC INJURY WITHOUT MCC,914,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7253.77,,,,,,,Fee Schedule,2300,7253.76806,
ALLERGIC REACTIONS WITH MCC,915,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13775.2,,,,,,,Fee Schedule,2300,13775.19635,
ALLERGIC REACTIONS WITHOUT MCC,916,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5458.14,,,,,,,Fee Schedule,2300,5458.143036,
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,917,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12847.89,,,,,,,Fee Schedule,2300,12847.89365,
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,918,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7021.12,,,,,,,Fee Schedule,2300,7021.123212,
COMPLICATIONS OF TREATMENT WITH MCC,919,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14997.4,,,,,,,Fee Schedule,2300,14997.40098,
COMPLICATIONS OF TREATMENT WITH CC,920,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8210.56,,,,,,,Fee Schedule,2300,8210.560956,
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,921,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5639.18,,,,,,,Fee Schedule,2300,5639.180048,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14330.59,,,,,,,Fee Schedule,2300,14330.59497,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,8336.71,,,,,,,Fee Schedule,2300,8336.713444,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,927,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,150975.04,,,,,,,Fee Schedule,2300,150975.0379,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,928,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,58756.75,,,,,,,Fee Schedule,2300,58756.75004,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,929,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,26383.89,,,,,,,Fee Schedule,2300,26383.89178,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,933,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,31265.34,,,,,,,Fee Schedule,2300,31265.33772,
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,934,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,18108.62,,,,,,,Fee Schedule,2300,18108.61623,
NON-EXTENSIVE BURNS,935,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,16874.94,,,,,,,Fee Schedule,2300,16874.9432,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,939,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,29723.66,,,,,,,Fee Schedule,2300,29723.65602,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,940,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,19143.23,,,,,,,Fee Schedule,2300,19143.23047,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,941,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,16610.35,,,,,,,Fee Schedule,2300,16610.35064,
REHABILITATION WITH CC/MCC,945,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12685.7,,,,,,,Fee Schedule,2300,12685.69759,
REHABILITATION WITHOUT CC/MCC,946,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9394.26,,,,,,,Fee Schedule,2300,9394.264496,
SIGNS AND SYMPTOMS WITH MCC,947,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10398.57,,,,,,,Fee Schedule,2300,10398.56937,
SIGNS AND SYMPTOMS WITHOUT MCC,948,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,6557.47,,,,,,,Fee Schedule,2300,6557.47186,
AFTERCARE WITH CC/MCC,949,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9745.69,,,,,,,Fee Schedule,2300,9745.689284,
AFTERCARE WITHOUT CC/MCC,950,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,5141.94,,,,,,,Fee Schedule,2300,5141.942644,
OTHER FACTORS INFLUENCING HEALTH STATUS,951,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,4554.6,,,,,,,Fee Schedule,2300,4972,
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,955,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,55139.29,,,,,,,Fee Schedule,2300,55139.28649,
"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,30825.44,,,,,,,Fee Schedule,2300,30825.44236,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,957,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,62420.09,,,,,,,Fee Schedule,2300,62420.08723,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,958,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,34519.09,,,,,,,Fee Schedule,2300,34519.08891,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,959,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,24117.24,,,,,,,Fee Schedule,2300,24117.24285,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,963,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,22394.52,,,,,,,Fee Schedule,2300,22394.52414,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,964,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,12554.63,,,,,,,Fee Schedule,2300,12554.63007,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,965,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7704.31,,,,,,,Fee Schedule,2300,7704.31266,
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,969,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,50143.98,,,,,,,Fee Schedule,2300,50143.97564,
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,970,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,21604.84,,,,,,,Fee Schedule,2300,21604.84233,
HIV WITH MAJOR RELATED CONDITION WITH MCC,974,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,23641.3,,,,,,,Fee Schedule,2300,23641.30392,
HIV WITH MAJOR RELATED CONDITION WITH CC,975,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10608.28,,,,,,,Fee Schedule,2300,10608.2774,
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,976,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,7327.49,,,,,,,Fee Schedule,2300,7327.49354,
HIV WITH OR WITHOUT OTHER RELATED CONDITION,977,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,10383.82,,,,,,,Fee Schedule,2300,10383.82427,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,981,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,38433.91,,,,,,,Fee Schedule,2300,38433.9119,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,982,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,20139.34,,,,,,,Fee Schedule,2300,20139.34362,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,983,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,14040.61,,,,,,,Fee Schedule,2300,14040.60808,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,987,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,28084.49,,,,,,,Fee Schedule,2300,28084.49285,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,988,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,13463.91,,,,,,,Fee Schedule,2300,13463.91099,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,989,MS-DRG,,,,,,,,inpatient,,,,,Humana,Humana,9823.51,,,,,,,Fee Schedule,2300,9823.510624,
"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8121.87,,,,,,,Case Rate,2300,8213.837644,
ABORTION WITHOUT D&C,779,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5776.11,,,,,,,Case Rate,2300,5841.515532,
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,880,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7777.62,,,,,,,Case Rate,850,7865.689544,
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,289,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13825.89,,,,,,,Case Rate,2300,13982.44687,
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,288,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,21920.22,,,,,,,Case Rate,2300,22168.43266,
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,290,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7530.57,,,,,,,Case Rate,2300,7615.842084,
ACUTE LEUKEMIA WITH CC,835,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16894.98,,,,,,,Case Rate,2300,17086.28958,
ACUTE LEUKEMIA WITH MCC,834,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,44468.19,,,,,,,Case Rate,2300,44971.72363,
ACUTE LEUKEMIA WITH OTHER PROCEDURES,850,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,70141.95,,,,,,,Case Rate,2300,70936.19934,
ACUTE LEUKEMIA WITHOUT CC/MCC,836,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9877.95,,,,,,,Case Rate,2300,9989.80254,
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,121,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9422.73,,,,,,,Case Rate,2300,9529.427876,
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,122,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6364.98,,,,,,,Case Rate,2300,6437.053576,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",281,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7444.71,,,,,,,Case Rate,2300,7529.009852,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",280,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12993.21,,,,,,,Case Rate,2300,13140.33805,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",282,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5857.11,,,,,,,Case Rate,2300,5923.432732,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",284,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5606.82,,,,,,,Case Rate,2300,5670.308584,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",283,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16044.48,,,,,,,Case Rate,2300,16226.15898,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",285,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,4851.09,,,,,,,Case Rate,2300,4972,
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,614,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17753.58,,,,,,,Case Rate,2300,17954.6119,
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,615,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11334.33,,,,,,,Case Rate,2300,11462.6738,
AFTERCARE WITH CC/MCC,949,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9636.57,,,,,,,Case Rate,2300,9745.689284,
AFTERCARE WITHOUT CC/MCC,950,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5084.37,,,,,,,Case Rate,2300,5141.942644,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9121.41,,,,,,,Case Rate,2300,9224.695892,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15105.69,,,,,,,Case Rate,2300,15276.73863,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6511.59,,,,,,,Case Rate,2300,6585.323708,
AICD GENERATOR PROCEDURES,245,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,36955.44,,,,,,,Case Rate,2300,37373.90333,
AICD LEAD PROCEDURES,265,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,29307.42,,,,,,,Case Rate,2300,29639.2813,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11466.36,,,,,,,Case Rate,850,11596.19883,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14135.31,,,,,,,Case Rate,850,14295.37057,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7150.68,,,,,,,Case Rate,850,7231.650416,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,4996.89,,,,,,,Case Rate,850,5053.472068,
ALLERGIC REACTIONS WITH MCC,915,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13620.96,,,,,,,Case Rate,2300,13775.19635,
ALLERGIC REACTIONS WITHOUT MCC,916,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5397.03,,,,,,,Case Rate,2300,5458.143036,
ALLOGENEIC BONE MARROW TRANSPLANT,14,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,97344.99,,,,,,,Case Rate,2300,98447.27179,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,240,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,23089.05,,,,,,,Case Rate,2300,23350.49786,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,239,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,39865.77,,,,,,,Case Rate,2300,40317.18832,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,241,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11213.64,,,,,,,Case Rate,2300,11340.61717,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,475,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,18433.17,,,,,,,Case Rate,2300,18641.8972,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,474,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,34772.49,,,,,,,Case Rate,2300,35166.23479,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,476,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9559.62,,,,,,,Case Rate,2300,9667.867944,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15149.43,,,,,,,Case Rate,2300,15320.97392,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,28247.94,,,,,,,Case Rate,2300,28567.80433,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",618,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11488.23,,,,,,,Case Rate,2300,11618.31648,
ANAL AND STOMAL PROCEDURES WITH CC,348,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10601.28,,,,,,,Case Rate,2300,10721.32314,
ANAL AND STOMAL PROCEDURES WITH MCC,347,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,18594.36,,,,,,,Case Rate,2300,18804.91243,
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,349,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7051.86,,,,,,,Case Rate,2300,7131.711432,
ANGINA PECTORIS,311,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5685.39,,,,,,,Case Rate,2300,5749.768268,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,268,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,55710.99,,,,,,,Case Rate,2300,56341.83099,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,269,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,34207.92,,,,,,,Case Rate,2300,34595.2719,
APPENDIX PROCEDURES WITH CC,398,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12260.16,,,,,,,Case Rate,2300,12398.98739,
APPENDIX PROCEDURES WITH MCC,397,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,19398.69,,,,,,,Case Rate,2300,19618.35023,
APPENDIX PROCEDURES WITHOUT CC/MCC,399,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9272.07,,,,,,,Case Rate,2300,9377.061884,
ATHEROSCLEROSIS WITH MCC,302,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9692.46,,,,,,,Case Rate,2300,9802.212152,
ATHEROSCLEROSIS WITHOUT MCC,303,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5452.92,,,,,,,Case Rate,2300,5514.665904,
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,16,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,48030.57,,,,,,,Case Rate,2300,48574.44208,
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,17,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,39190.23,,,,,,,Case Rate,2300,39633.99888,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,519,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16201.62,,,,,,,Case Rate,2300,16385.07834,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,518,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,30272.13,,,,,,,Case Rate,2300,30614.91516,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,520,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12100.59,,,,,,,Case Rate,2300,12237.61051,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,95,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,20891.52,,,,,,,Case Rate,2300,21128.08422,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,94,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,28507.14,,,,,,,Case Rate,2300,28829.93937,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,96,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,20891.52,,,,,,,Case Rate,2300,21128.08422,
BEHAVIORAL AND DEVELOPMENTAL DISORDERS,886,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16809.93,,,,,,,Case Rate,850,17000.27652,
BENIGN PROSTATIC HYPERTROPHY WITH MCC,725,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9478.62,,,,,,,Case Rate,2300,9585.950744,
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,726,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5848.2,,,,,,,Case Rate,2300,5914.42184,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,461,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,43420.86,,,,,,,Case Rate,2300,43912.53423,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,462,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,21546,,,,,,,Case Rate,2300,21789.9752,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,409,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17636.13,,,,,,,Case Rate,2300,17835.83196,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,408,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,28881.36,,,,,,,Case Rate,2300,29208.39683,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,410,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12860.37,,,,,,,Case Rate,2300,13005.99384,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,478,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,19919.52,,,,,,,Case Rate,2300,20145.07782,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,477,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,27982.26,,,,,,,Case Rate,2300,28299.11591,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,479,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15057.09,,,,,,,Case Rate,2300,15227.58831,
BONE DISEASES AND ARTHROPATHIES WITH MCC,553,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10500.03,,,,,,,Case Rate,2300,10618.92664,
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,554,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6723.81,,,,,,,Case Rate,2300,6799.946772,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17339.67,,,,,,,Case Rate,2300,17536.015,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15625.71,,,,,,,Case Rate,2300,15802.64705,
BRONCHITIS AND ASTHMA WITH CC/MCC,202,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7866.72,,,,,,,Case Rate,2300,7955.798464,
BRONCHITIS AND ASTHMA WITHOUT CC/MCC,203,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5427,,,,,,,Case Rate,2300,5488.4524,
"CARDIAC ARREST, UNEXPLAINED WITH CC",297,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5050.35,,,,,,,Case Rate,2300,6184,
"CARDIAC ARREST, UNEXPLAINED WITH MCC",296,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12651.39,,,,,,,Case Rate,2300,12794.64747,
"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",298,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,3686.31,,,,,,,Case Rate,2300,4972,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,309,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5959.17,,,,,,,Case Rate,2300,6026.648404,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,308,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9752.4,,,,,,,Case Rate,2300,9862.83088,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,310,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,4585.41,,,,,,,Case Rate,2300,4637.332692,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,306,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12763.98,,,,,,,Case Rate,2300,12908.51238,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,307,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7396.92,,,,,,,Case Rate,2300,7480.678704,
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC,275,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,57756.24,,,,,,,Case Rate,2300,58410.24029,
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR,276,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,48653.46,,,,,,,Case Rate,2300,49204.38535,
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC,277,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,37409.85,,,,,,,Case Rate,2300,37833.45882,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,258,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,25451.01,,,,,,,Case Rate,2300,25739.20341,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,259,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16379.01,,,,,,,Case Rate,2300,16564.47701,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,261,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15313.05,,,,,,,Case Rate,2300,15486.44666,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,260,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,26347.68,,,,,,,Case Rate,2300,26646.02682,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,262,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13202.19,,,,,,,Case Rate,2300,13351.68443,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,217,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,53259.93,,,,,,,Case Rate,2300,53863.01652,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,216,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,79240.68,,,,,,,Case Rate,2300,80137.95842,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,218,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,53259.93,,,,,,,Case Rate,2300,53863.01652,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,220,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,43195.68,,,,,,,Case Rate,2300,43684.80442,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,219,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,62194.23,,,,,,,Case Rate,2300,62898.48368,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,221,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,40825.62,,,,,,,Case Rate,2300,41287.90714,
CAROTID ARTERY STENT PROCEDURES WITH CC,35,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,19363.05,,,,,,,Case Rate,2300,19582.30666,
CAROTID ARTERY STENT PROCEDURES WITH MCC,34,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,31352.67,,,,,,,Case Rate,2300,31707.6906,
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,36,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15736.68,,,,,,,Case Rate,2300,15914.87362,
CELLULITIS WITH MCC,602,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11512.53,,,,,,,Case Rate,2300,11642.89164,
CELLULITIS WITHOUT MCC,603,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7054.29,,,,,,,Case Rate,2300,7134.168948,
CERVICAL SPINAL FUSION WITH CC,472,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,23863.41,,,,,,,Case Rate,2300,24133.62629,
CERVICAL SPINAL FUSION WITH MCC,471,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,39112.47,,,,,,,Case Rate,2300,39555.35836,
CERVICAL SPINAL FUSION WITHOUT CC/MCC,473,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,19774.53,,,,,,,Case Rate,2300,19998.44604,
CESAREAN SECTION WITH STERILIZATION WITH CC,784,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8586.81,,,,,,,Case Rate,2300,8684.042372,
CESAREAN SECTION WITH STERILIZATION WITH MCC,783,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,19886.31,,,,,,,Case Rate,2300,20111.49177,
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,785,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7758.18,,,,,,,Case Rate,2300,7846.029416,
CESAREAN SECTION WITHOUT STERILIZATION WITH CC,787,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9046.08,,,,,,,Case Rate,2300,9148.512896,
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,786,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13360.95,,,,,,,Case Rate,2300,13512.24214,
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,788,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7766.28,,,,,,,Case Rate,2300,7854.221136,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,837,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,38914.83,,,,,,,Case Rate,2300,39355.4804,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,838,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16907.94,,,,,,,Case Rate,2300,17099.39633,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,839,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11695.59,,,,,,,Case Rate,2300,11828.02451,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,847,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10596.42,,,,,,,Case Rate,2300,10716.4081,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,846,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,20999.25,,,,,,,Case Rate,2300,21237.0341,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,848,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6880.14,,,,,,,Case Rate,2300,6958.046968,
CHEST PAIN,313,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5832,,,,,,,Case Rate,2300,5898.0384,
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,18,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,349780.68,,,,,,,Case Rate,2300,353741.4064,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,415,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16740.27,,,,,,,Case Rate,2300,16929.82772,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,414,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,28857.06,,,,,,,Case Rate,2300,29183.82167,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,416,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11042.73,,,,,,,Case Rate,2300,11167.77188,
CHOLECYSTECTOMY WITH C.D.E. WITH CC,412,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17030.25,,,,,,,Case Rate,2300,17223.0913,
CHOLECYSTECTOMY WITH C.D.E. WITH MCC,411,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,26756.73,,,,,,,Case Rate,2300,27059.70868,
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,413,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13450.05,,,,,,,Case Rate,2300,13602.35106,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,191,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6828.3,,,,,,,Case Rate,2300,6905.61996,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,190,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8972.37,,,,,,,Case Rate,2300,9073.968244,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,192,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5200.2,,,,,,,Case Rate,2300,5259.08424,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",286,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17923.68,,,,,,,Case Rate,2300,18126.63802,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",287,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8667.81,,,,,,,Case Rate,2300,8765.959572,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,433,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8555.22,,,,,,,Case Rate,2300,8652.094664,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,432,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15942.42,,,,,,,Case Rate,2300,16122.9433,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,434,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5771.25,,,,,,,Case Rate,2300,5836.6005,
COAGULATION DISORDERS,813,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12354.93,,,,,,,Case Rate,2300,12494.83052,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC,429,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,72977.76,,,,,,,Case Rate,2300,73804.12051,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC,430,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,46713.51,,,,,,,Case Rate,2300,47242.46841,
COMPLEX AORTIC ARCH PROCEDURES,209,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,91682.28,,,,,,,Case Rate,2300,92720.44034,
COMPLICATED PEPTIC ULCER WITH CC,381,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8776.35,,,,,,,Case Rate,2300,8875.72862,
COMPLICATED PEPTIC ULCER WITH MCC,380,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15893.82,,,,,,,Case Rate,2300,16073.79298,
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,382,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6484.86,,,,,,,Case Rate,2300,6558.291032,
COMPLICATIONS OF TREATMENT WITH CC,920,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8118.63,,,,,,,Case Rate,2300,8210.560956,
COMPLICATIONS OF TREATMENT WITH MCC,919,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14829.48,,,,,,,Case Rate,2300,14997.40098,
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,921,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5576.04,,,,,,,Case Rate,2300,5639.180048,
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES,212,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,88080.21,,,,,,,Case Rate,2300,89077.58245,
CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION,317,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,54160.65,,,,,,,Case Rate,2300,54773.93578,
CONCUSSION WITH CC,89,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8898.66,,,,,,,Case Rate,2300,8999.423592,
CONCUSSION WITH MCC,88,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10949.58,,,,,,,Case Rate,2300,11073.5671,
CONCUSSION WITHOUT CC/MCC,90,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6667.92,,,,,,,Case Rate,2300,6743.423904,
CONNECTIVE TISSUE DISORDERS WITH CC,546,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9342.54,,,,,,,Case Rate,2300,9448.329848,
CONNECTIVE TISSUE DISORDERS WITH MCC,545,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,20101.77,,,,,,,Case Rate,2300,20329.39152,
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,547,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6773.22,,,,,,,Case Rate,2300,6849.916264,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,233,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,61926.12,,,,,,,Case Rate,2300,62627.33774,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,234,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,44247.87,,,,,,,Case Rate,2300,44748.90884,
CORONARY BYPASS WITH PTCA WITH MCC,231,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,68282.19,,,,,,,Case Rate,2300,69055.38043,
CORONARY BYPASS WITH PTCA WITHOUT MCC,232,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,49107.06,,,,,,,Case Rate,2300,49663.12167,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,235,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,47535.66,,,,,,,Case Rate,2300,48073.92799,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,236,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,33929.28,,,,,,,Case Rate,2300,34313.47674,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC,323,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,35051.94,,,,,,,Case Rate,2300,35448.84913,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC,324,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,25523.1,,,,,,,Case Rate,2300,25812.10972,
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE,325,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,26004.24,,,,,,,Case Rate,2300,26298.69789,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,73,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12994.83,,,,,,,Case Rate,2300,13141.9764,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,74,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8349.48,,,,,,,Case Rate,2300,8444.024976,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,26,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,25184.52,,,,,,,Case Rate,2300,25469.69582,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,25,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,36828.27,,,,,,,Case Rate,2300,37245.29332,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,27,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,20435.49,,,,,,,Case Rate,2300,20666.89039,
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,955,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,54521.91,,,,,,,Case Rate,2300,55139.28649,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,23,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,46415.43,,,,,,,Case Rate,2300,46941.01312,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,24,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,31686.39,,,,,,,Case Rate,2300,32045.18947,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16597.71,,,,,,,Case Rate,2300,16785.65345,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9213.75,,,,,,,Case Rate,2300,9318.0815,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,56,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,18817.11,,,,,,,Case Rate,2300,19030.18473,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,57,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10494.36,,,,,,,Case Rate,2300,10613.19243,
DENTAL AND ORAL DISEASES WITH CC,158,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7369.38,,,,,,,Case Rate,2300,7452.826856,
DENTAL AND ORAL DISEASES WITH MCC,157,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13906.08,,,,,,,Case Rate,2300,14063.5449,
DENTAL AND ORAL DISEASES WITHOUT CC/MCC,159,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5738.85,,,,,,,Case Rate,2300,5803.83362,
DEPRESSIVE NEUROSES,881,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7621.29,,,,,,,Case Rate,850,7707.589348,
DIABETES WITH CC,638,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7259.22,,,,,,,Case Rate,2300,7341.419464,
DIABETES WITH MCC,637,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11637.27,,,,,,,Case Rate,2300,11769.04412,
DIABETES WITHOUT CC/MCC,639,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5031.72,,,,,,,Case Rate,2300,5088.696464,
DIGESTIVE MALIGNANCY WITH CC,375,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9797.76,,,,,,,Case Rate,2300,9908.704512,
DIGESTIVE MALIGNANCY WITH MCC,374,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17323.47,,,,,,,Case Rate,2300,17519.63156,
DIGESTIVE MALIGNANCY WITHOUT CC/MCC,376,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7486.83,,,,,,,Case Rate,2300,7571.606796,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7818.93,,,,,,,Case Rate,2300,7907.467316,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14537.07,,,,,,,Case Rate,2300,14701.67988,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5667.57,,,,,,,Case Rate,2300,5731.746484,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,439,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6813.72,,,,,,,Case Rate,2300,6890.874864,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,438,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13204.62,,,,,,,Case Rate,2300,13354.14194,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,440,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5033.34,,,,,,,Case Rate,2300,5090.334808,
DISORDERS OF PERSONALITY AND IMPULSE CONTROL,883,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15927.03,,,,,,,Case Rate,850,16107.37904,
DISORDERS OF THE BILIARY TRACT WITH CC,445,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8864.64,,,,,,,Case Rate,2300,8965.018368,
DISORDERS OF THE BILIARY TRACT WITH MCC,444,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13534.29,,,,,,,Case Rate,2300,13687.54495,
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,446,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6701.13,,,,,,,Case Rate,2300,6777.009956,
DYSEQUILIBRIUM,149,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6087.96,,,,,,,Case Rate,2300,6156.896752,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",147,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10299.15,,,,,,,Case Rate,2300,10415.77198,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17150.94,,,,,,,Case Rate,2300,17345.14793,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",148,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6456.51,,,,,,,Case Rate,2300,6529.620012,
"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",3,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,171924.12,,,,,,,Case Rate,2300,173870.8953,
ENDOCRINE DISORDERS WITH CC,644,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8302.5,,,,,,,Case Rate,2300,8396.513,
ENDOCRINE DISORDERS WITH MCC,643,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13333.41,,,,,,,Case Rate,2300,13484.39029,
ENDOCRINE DISORDERS WITHOUT CC/MCC,645,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6223.23,,,,,,,Case Rate,2300,6293.698476,
ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES,213,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,46225.89,,,,,,,Case Rate,2300,46749.32687,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,266,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,49640.04,,,,,,,Case Rate,2300,50202.13685,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,267,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,38562.48,,,,,,,Case Rate,2300,38999.14058,
EPISTAXIS WITH MCC,150,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10785.15,,,,,,,Case Rate,2300,10907.27518,
EPISTAXIS WITHOUT MCC,151,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5945.4,,,,,,,Case Rate,2300,6012.72248,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10273.23,,,,,,,Case Rate,2300,10389.55848,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6314.76,,,,,,,Case Rate,2300,6386.264912,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,927,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,149284.62,,,,,,,Case Rate,2300,150975.0379,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,933,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,30915.27,,,,,,,Case Rate,2300,31265.33772,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,982,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,19913.85,,,,,,,Case Rate,2300,20139.34362,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,981,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,38003.58,,,,,,,Case Rate,2300,38433.9119,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,983,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13883.4,,,,,,,Case Rate,2300,14040.60808,
EXTRACRANIAL PROCEDURES WITH CC,38,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13143.06,,,,,,,Case Rate,2300,13291.88487,
EXTRACRANIAL PROCEDURES WITH MCC,37,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,26666.01,,,,,,,Case Rate,2300,26967.96141,
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,39,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9521.55,,,,,,,Case Rate,2300,9629.36686,
EXTRAOCULAR PROCEDURES EXCEPT ORBIT,115,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12432.69,,,,,,,Case Rate,2300,12573.47103,
"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,48142.35,,,,,,,Case Rate,2300,48687.48782,
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,748,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11237.13,,,,,,,Case Rate,2300,13879,
FEVER AND INFLAMMATORY CONDITIONS,864,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7190.37,,,,,,,Case Rate,2300,7271.789844,
FOOT PROCEDURES WITH CC,504,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15140.52,,,,,,,Case Rate,2300,15311.96302,
FOOT PROCEDURES WITH MCC,503,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,22607.91,,,,,,,Case Rate,2300,22863.90969,
FOOT PROCEDURES WITHOUT CC/MCC,505,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14521.68,,,,,,,Case Rate,2300,14686.11562,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11540.88,,,,,,,Case Rate,2300,11671.56266,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7253.55,,,,,,,Case Rate,2300,7335.68526,
FRACTURES OF FEMUR WITH MCC,533,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12698.37,,,,,,,Case Rate,2300,12842.15944,
FRACTURES OF FEMUR WITHOUT MCC,534,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6529.41,,,,,,,Case Rate,2300,6603.345492,
FRACTURES OF HIP AND PELVIS WITH MCC,535,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10384.2,,,,,,,Case Rate,2300,10501.78504,
FRACTURES OF HIP AND PELVIS WITHOUT MCC,536,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6541.56,,,,,,,Case Rate,2300,6615.633072,
FULL TERM NEONATE WITH MAJOR PROBLEMS,793,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,33773.76,,,,,,,Case Rate,2300,34156.19571,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,928,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,58098.87,,,,,,,Case Rate,2300,58756.75004,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,929,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,26088.48,,,,,,,Case Rate,2300,26383.89178,
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,934,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17905.86,,,,,,,Case Rate,2300,18108.61623,
GASTROINTESTINAL HEMORRHAGE WITH CC,378,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7943.67,,,,,,,Case Rate,2300,8033.619804,
GASTROINTESTINAL HEMORRHAGE WITH MCC,377,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14806.8,,,,,,,Case Rate,2300,14974.46416,
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,379,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5106.24,,,,,,,Case Rate,2300,5164.060288,
GASTROINTESTINAL OBSTRUCTION WITH CC,389,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6397.38,,,,,,,Case Rate,2300,6469.820456,
GASTROINTESTINAL OBSTRUCTION WITH MCC,388,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11962.08,,,,,,,Case Rate,2300,12097.5321,
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,390,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,4406.4,,,,,,,Case Rate,2300,4456.29568,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12751.83,,,,,,,Case Rate,2300,12896.2248,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8280.63,,,,,,,Case Rate,2300,8374.395356,
HAND PROCEDURES FOR INJURIES,906,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14275.44,,,,,,,Case Rate,2300,14437.08733,
HEADACHES WITH MCC,102,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9079.29,,,,,,,Case Rate,2300,9182.098948,
HEADACHES WITHOUT MCC,103,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6774.03,,,,,,,Case Rate,2300,6850.735436,
HEART FAILURE AND SHOCK WITH CC,292,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6876.9,,,,,,,Case Rate,2300,6954.77028,
HEART FAILURE AND SHOCK WITH MCC,291,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10398.78,,,,,,,Case Rate,2300,10516.53014,
HEART FAILURE AND SHOCK WITHOUT CC/MCC,293,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,4584.6,,,,,,,Case Rate,2300,4636.51352,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,1,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,226993.59,,,,,,,Case Rate,2300,229563.9421,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,2,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,91787.58,,,,,,,Case Rate,2300,92826.9327,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,421,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14073.75,,,,,,,Case Rate,2300,14233.1135,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,420,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,27597.51,,,,,,,Case Rate,2300,27910.00921,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,422,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11335.95,,,,,,,Case Rate,2300,11464.31214,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,354,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13627.44,,,,,,,Case Rate,2300,13781.74973,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,353,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,23506.2,,,,,,,Case Rate,2300,23772.37144,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,355,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10894.5,,,,,,,Case Rate,2300,11017.8634,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,481,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16965.45,,,,,,,Case Rate,2300,17157.55754,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,480,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,23589.63,,,,,,,Case Rate,2300,23856.74616,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,482,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13211.1,,,,,,,Case Rate,2300,13360.69532,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,521,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,23248.62,,,,,,,Case Rate,2300,23511.87474,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,522,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17153.37,,,,,,,Case Rate,2300,17347.60544,
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,969,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,49582.53,,,,,,,Case Rate,2300,50143.97564,
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,970,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,21362.94,,,,,,,Case Rate,2300,21604.84233,
HIV WITH MAJOR RELATED CONDITION WITH CC,975,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10489.5,,,,,,,Case Rate,2300,10608.2774,
HIV WITH MAJOR RELATED CONDITION WITH MCC,974,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,23376.6,,,,,,,Case Rate,2300,23641.30392,
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,976,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7245.45,,,,,,,Case Rate,2300,7327.49354,
HIV WITH OR WITHOUT OTHER RELATED CONDITION,977,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10267.56,,,,,,,Case Rate,2300,10383.82427,
HYPERTENSION WITH MCC,304,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9639,,,,,,,Case Rate,2300,9748.1468,
HYPERTENSION WITHOUT MCC,305,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6116.31,,,,,,,Case Rate,2300,6185.567772,
INBORN AND OTHER DISORDERS OF METABOLISM,642,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11519.01,,,,,,,Case Rate,2300,11649.44501,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7929.9,,,,,,,Case Rate,2300,8019.69388,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11598.39,,,,,,,Case Rate,2300,11729.72387,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5375.16,,,,,,,Case Rate,2300,5436.025392,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,854,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16184.61,,,,,,,Case Rate,2300,16367.87573,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,853,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,40002.66,,,,,,,Case Rate,2300,40455.62839,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,855,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12127.32,,,,,,,Case Rate,2300,12264.64318,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,727,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12011.49,,,,,,,Case Rate,2300,12147.50159,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,728,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6570.72,,,,,,,Case Rate,2300,6645.123264,
INFLAMMATORY BOWEL DISEASE WITH CC,386,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7908.03,,,,,,,Case Rate,2300,7997.576236,
INFLAMMATORY BOWEL DISEASE WITH MCC,385,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12816.63,,,,,,,Case Rate,2300,12961.75856,
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,387,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5518.53,,,,,,,Case Rate,2300,5581.018836,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,351,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12348.45,,,,,,,Case Rate,2300,12488.27714,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,350,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,20184.39,,,,,,,Case Rate,2300,20412.94707,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,352,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9459.18,,,,,,,Case Rate,2300,9566.290616,
INTERSTITIAL LUNG DISEASE WITH CC,197,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7687.71,,,,,,,Case Rate,2300,7774.761452,
INTERSTITIAL LUNG DISEASE WITH MCC,196,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15286.32,,,,,,,Case Rate,2300,15459.41398,
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,198,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5801.22,,,,,,,Case Rate,2300,5866.909864,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,65,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8183.43,,,,,,,Case Rate,2300,8276.094716,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,64,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16289.1,,,,,,,Case Rate,2300,16473.54892,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,66,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5543.64,,,,,,,Case Rate,2300,5606.413168,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,21,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,42879.78,,,,,,,Case Rate,2300,43365.32734,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,20,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,63737.28,,,,,,,Case Rate,2300,64459.00634,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,22,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,24908.31,,,,,,,Case Rate,2300,25190.35817,
INTRAOCULAR PROCEDURES WITH CC/MCC,116,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14645.61,,,,,,,Case Rate,2300,14811.44893,
INTRAOCULAR PROCEDURES WITHOUT CC/MCC,117,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8787.69,,,,,,,Case Rate,2300,8887.197028,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",62,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14233.32,,,,,,,Case Rate,2300,14394.49038,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",61,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,22332.51,,,,,,,Case Rate,2300,22585.39121,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",63,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11370.78,,,,,,,Case Rate,2300,11499.53654,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,657,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14823,,,,,,,Case Rate,2300,14990.8476,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,656,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,25788.78,,,,,,,Case Rate,2300,26080.79814,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,658,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12569.58,,,,,,,Case Rate,2300,12711.9111,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,660,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10705.77,,,,,,,Case Rate,2300,10826.99632,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,659,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,20581.29,,,,,,,Case Rate,2300,20814.34135,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,661,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8386.74,,,,,,,Case Rate,2300,8481.706888,
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,689,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9398.43,,,,,,,Case Rate,2300,9504.852716,
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,690,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6556.95,,,,,,,Case Rate,2300,6631.19734,
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,687,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8487.18,,,,,,,Case Rate,2300,8583.284216,
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,686,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14609.97,,,,,,,Case Rate,2300,14775.40536,
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,688,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6401.43,,,,,,,Case Rate,2300,6473.916316,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,695,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9264.78,,,,,,,Case Rate,2300,9369.689336,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,696,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5580.9,,,,,,,Case Rate,2300,5644.09508,
KIDNEY TRANSPLANT,652,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,26158.95,,,,,,,Case Rate,2300,26455.15974,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,650,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,38081.34,,,,,,,Case Rate,2300,38512.55241,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,651,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,30016.98,,,,,,,Case Rate,2300,30356.87598,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,486,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16937.91,,,,,,,Case Rate,2300,17129.70569,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,485,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,26139.51,,,,,,,Case Rate,2300,26435.49961,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,487,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12686.22,,,,,,,Case Rate,2300,12829.87186,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,488,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12341.16,,,,,,,Case Rate,2300,12480.90459,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,489,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9046.08,,,,,,,Case Rate,2300,13879,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,418,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13701.96,,,,,,,Case Rate,2300,13857.11355,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,417,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,19329.84,,,,,,,Case Rate,2300,19548.72061,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,419,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11062.98,,,,,,,Case Rate,2300,11188.25118,
"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,30480.3,,,,,,,Case Rate,2300,30825.44236,
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,5,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,83515.05,,,,,,,Case Rate,2300,84460.72906,
LIVER TRANSPLANT WITHOUT MCC,6,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,37559.7,,,,,,,Case Rate,2300,37985.00564,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,496,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14611.59,,,,,,,Case Rate,2300,14777.04371,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,495,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,29368.17,,,,,,,Case Rate,2300,29700.7192,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,497,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9328.77,,,,,,,Case Rate,2300,9434.403924,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,498,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,24436.08,,,,,,,Case Rate,2300,24712.7809,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,499,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16319.88,,,,,,,Case Rate,2300,16504.67746,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",493,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,20542.41,,,,,,,Case Rate,2300,20775.02109,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",492,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,29739.96,,,,,,,Case Rate,2300,30076.71915,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",494,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16252.65,,,,,,,Case Rate,2300,16436.68618,
LUNG TRANSPLANT,7,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,104896.62,,,,,,,Case Rate,2300,106084.4123,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,821,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,18132.66,,,,,,,Case Rate,2300,18337.98439,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,820,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,47504.88,,,,,,,Case Rate,2300,48042.79946,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,822,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9752.4,,,,,,,Case Rate,2300,9862.83088,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,841,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13214.34,,,,,,,Case Rate,2300,13363.97201,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,840,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,26202.69,,,,,,,Case Rate,2300,26499.39503,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,824,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,18351.36,,,,,,,Case Rate,2300,18559.16083,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,823,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,37136.88,,,,,,,Case Rate,2300,37557.39786,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,825,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10930.14,,,,,,,Case Rate,2300,11053.90697,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,842,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8184.24,,,,,,,Case Rate,2300,8276.913888,
MAJOR BLADDER PROCEDURES WITH CC,654,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,22674.33,,,,,,,Case Rate,2300,22931.0818,
MAJOR BLADDER PROCEDURES WITH MCC,653,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,42090.84,,,,,,,Case Rate,2300,42567.45381,
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,655,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17144.46,,,,,,,Case Rate,2300,17338.59455,
MAJOR CHEST PROCEDURES WITH CC,164,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,20444.4,,,,,,,Case Rate,2300,20675.90128,
MAJOR CHEST PROCEDURES WITH MCC,163,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,36302.58,,,,,,,Case Rate,2300,36713.6507,
MAJOR CHEST PROCEDURES WITHOUT CC/MCC,165,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15505.02,,,,,,,Case Rate,2300,15680.59042,
MAJOR CHEST TRAUMA WITH CC,184,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8619.21,,,,,,,Case Rate,2300,8716.809252,
MAJOR CHEST TRAUMA WITH MCC,183,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12392.19,,,,,,,Case Rate,2300,12532.51243,
MAJOR CHEST TRAUMA WITHOUT CC/MCC,185,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6370.65,,,,,,,Case Rate,2300,6442.78778,
MAJOR ESOPHAGEAL DISORDERS WITH CC,369,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8101.62,,,,,,,Case Rate,2300,8193.358344,
MAJOR ESOPHAGEAL DISORDERS WITH MCC,368,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12894.39,,,,,,,Case Rate,2300,13040.39907,
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,370,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5676.48,,,,,,,Case Rate,2300,5740.757376,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,372,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8270.1,,,,,,,Case Rate,2300,8363.74612,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,371,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14362.11,,,,,,,Case Rate,2300,14524.73873,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,373,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5891.94,,,,,,,Case Rate,2300,5958.657128,
MAJOR HEAD AND NECK PROCEDURES WITH CC,141,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17666.91,,,,,,,Case Rate,2300,17866.96049,
MAJOR HEAD AND NECK PROCEDURES WITH MCC,140,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,34548.93,,,,,,,Case Rate,2300,34940.14332,
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,142,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12930.84,,,,,,,Case Rate,2300,13879,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,809,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10253.79,,,,,,,Case Rate,2300,10369.89835,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,808,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17883.99,,,,,,,Case Rate,2300,18086.49859,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,810,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8477.46,,,,,,,Case Rate,2300,8573.454152,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,469,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,24568.92,,,,,,,Case Rate,2300,24847.1251,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,470,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15624.09,,,,,,,Case Rate,2300,15801.00871,
MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,483,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,22452.39,,,,,,,Case Rate,2300,22706.62867,
MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,707,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16202.43,,,,,,,Case Rate,2300,16385.89752,
MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,708,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12427.02,,,,,,,Case Rate,2300,13879,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,507,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14631.84,,,,,,,Case Rate,2300,14797.52301,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,508,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12266.64,,,,,,,Case Rate,2300,12405.54077,
MAJOR SKIN DISORDERS WITH MCC,595,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17177.67,,,,,,,Case Rate,2300,17372.1806,
MAJOR SKIN DISORDERS WITHOUT MCC,596,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8768.25,,,,,,,Case Rate,2300,8867.5369,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,330,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,19417.32,,,,,,,Case Rate,2300,19637.19118,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,329,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,37231.65,,,,,,,Case Rate,2300,37653.24098,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,331,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13631.49,,,,,,,Case Rate,2300,13785.84559,
MAJOR THUMB OR JOINT PROCEDURES,506,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9716.76,,,,,,,Case Rate,2300,9826.787312,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,436,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9161.91,,,,,,,Case Rate,2300,9265.654492,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,435,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14877.27,,,,,,,Case Rate,2300,15045.73212,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,437,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6911.73,,,,,,,Case Rate,2300,6989.994676,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8811.18,,,,,,,Case Rate,2300,8910.953016,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14917.77,,,,,,,Case Rate,2300,15086.69072,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",756,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7780.05,,,,,,,Case Rate,2300,7868.14706,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9255.87,,,,,,,Case Rate,2300,9360.678444,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14658.57,,,,,,,Case Rate,2300,14824.55568,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",724,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,4954.77,,,,,,,Case Rate,2300,5010.875124,
MALIGNANT BREAST DISORDERS WITH CC,598,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9163.53,,,,,,,Case Rate,2300,9267.292836,
MALIGNANT BREAST DISORDERS WITH MCC,597,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13503.51,,,,,,,Case Rate,2300,13656.41641,
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,599,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5938.92,,,,,,,Case Rate,2300,6006.169104,
MASTECTOMY FOR MALIGNANCY WITH CC/MCC,582,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15605.46,,,,,,,Case Rate,2300,15782.16775,
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,583,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13967.64,,,,,,,Case Rate,2300,14125.80197,
MEDICAL BACK PROBLEMS WITH MCC,551,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13576.41,,,,,,,Case Rate,2300,13730.14189,
MEDICAL BACK PROBLEMS WITHOUT MCC,552,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7786.53,,,,,,,Case Rate,2300,7874.700436,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,760,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8160.75,,,,,,,Case Rate,2300,8253.1579,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,761,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,4613.76,,,,,,,Case Rate,2300,4666.003712,
MINOR BLADDER PROCEDURES WITH CC,663,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12313.62,,,,,,,Case Rate,2300,12453.05274,
MINOR BLADDER PROCEDURES WITH MCC,662,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,24798.15,,,,,,,Case Rate,2300,25078.95078,
MINOR BLADDER PROCEDURES WITHOUT CC/MCC,664,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8479.89,,,,,,,Case Rate,2300,8575.911668,
MINOR SKIN DISORDERS WITH MCC,606,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12256.92,,,,,,,Case Rate,2300,12395.7107,
MINOR SKIN DISORDERS WITHOUT MCC,607,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7341.84,,,,,,,Case Rate,2300,7424.975008,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,345,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12188.07,,,,,,,Case Rate,2300,12326.08108,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,344,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,20920.68,,,,,,,Case Rate,2300,21157.57442,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,346,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9608.22,,,,,,,Case Rate,2300,9717.018264,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10818.36,,,,,,,Case Rate,2300,10940.86123,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6303.42,,,,,,,Case Rate,2300,6374.796504,
MOUTH PROCEDURES WITH CC/MCC,137,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12094.92,,,,,,,Case Rate,2300,12231.8763,
MOUTH PROCEDURES WITHOUT CC/MCC,138,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7178.22,,,,,,,Case Rate,2300,7259.502264,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC,427,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,58470.66,,,,,,,Case Rate,2300,59132.74999,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,426,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,89271.72,,,,,,,Case Rate,2300,90282.58446,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC,428,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,45538.2,,,,,,,Case Rate,2300,46053.84984,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,447,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,54120.96,,,,,,,Case Rate,2300,54733.79635,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,448,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,34350.48,,,,,,,Case Rate,2300,34739.44618,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,59,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10051.29,,,,,,,Case Rate,2300,10165.10535,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,58,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13846.95,,,,,,,Case Rate,2300,14003.74534,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,60,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7450.38,,,,,,,Case Rate,2300,7534.744056,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,827,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,18720.72,,,,,,,Case Rate,2300,18932.70326,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,826,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,37890.18,,,,,,,Case Rate,2300,38319.22782,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,828,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13800.78,,,,,,,Case Rate,2300,13957.05254,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,829,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,25596,,,,,,,Case Rate,2300,25885.8352,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,830,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12190.5,,,,,,,Case Rate,2300,13879,
NEONATE WITH OTHER SIGNIFICANT PROBLEMS,794,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11954.79,,,,,,,Case Rate,1184,12090.15955,
"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14597.82,,,,,,,Case Rate,1184,14763.11778,
NERVOUS SYSTEM NEOPLASMS WITH MCC,54,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12367.89,,,,,,,Case Rate,2300,12507.93727,
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,55,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8258.76,,,,,,,Case Rate,2300,8352.277712,
NEUROLOGICAL EYE DISORDERS,123,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6468.66,,,,,,,Case Rate,2300,6541.907592,
NEUROSES EXCEPT DEPRESSIVE,882,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8697.78,,,,,,,Case Rate,850,8796.268936,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,98,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,18588.69,,,,,,,Case Rate,2300,18799.17823,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,97,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,29255.58,,,,,,,Case Rate,2300,29586.8543,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,99,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11035.44,,,,,,,Case Rate,2300,11160.39933,
NON-EXTENSIVE BURNS,935,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16686,,,,,,,Case Rate,2300,16874.9432,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,988,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13313.16,,,,,,,Case Rate,2300,13463.91099,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,987,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,27770.04,,,,,,,Case Rate,2300,28084.49285,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,989,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9713.52,,,,,,,Case Rate,2300,9823.510624,
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,600,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8436.96,,,,,,,Case Rate,2300,8532.495552,
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,601,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,4900.5,,,,,,,Case Rate,2300,4955.9906,
NONTRAUMATIC STUPOR AND COMA WITH MCC,80,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14661,,,,,,,Case Rate,2300,14827.0132,
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,81,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7254.36,,,,,,,Case Rate,2300,7336.504432,
NORMAL NEWBORN,795,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,1618.38,,,,,,,Case Rate,530,2786,
O.R. PROCEDURES FOR OBESITY WITH CC,620,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12962.43,,,,,,,Case Rate,2300,13879,
O.R. PROCEDURES FOR OBESITY WITH MCC,619,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,23387.94,,,,,,,Case Rate,2300,23652.77233,
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,621,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12218.04,,,,,,,Case Rate,2300,13879,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,940,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,18928.89,,,,,,,Case Rate,2300,19143.23047,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,939,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,29390.85,,,,,,,Case Rate,2300,29723.65602,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,941,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16424.37,,,,,,,Case Rate,2300,16610.35064,
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,876,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,31305.69,,,,,,,Case Rate,850,31660.17863,
ORBITAL PROCEDURES WITH CC/MCC,113,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,19043.91,,,,,,,Case Rate,2300,19259.55289,
ORBITAL PROCEDURES WITHOUT CC/MCC,114,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10959.3,,,,,,,Case Rate,2300,11083.39716,
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,884,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13032.09,,,,,,,Case Rate,850,13179.65831,
OSTEOMYELITIS WITH CC,540,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10500.03,,,,,,,Case Rate,2300,10618.92664,
OSTEOMYELITIS WITH MCC,539,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15954.57,,,,,,,Case Rate,2300,16135.23088,
OSTEOMYELITIS WITHOUT CC/MCC,541,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6249.15,,,,,,,Case Rate,2300,6319.91198,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,818,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8539.02,,,,,,,Case Rate,2300,8635.711224,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,817,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13672.8,,,,,,,Case Rate,2300,13827.62336,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,819,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6965.19,,,,,,,Case Rate,2300,8327,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,832,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5844.96,,,,,,,Case Rate,2300,5911.145152,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,831,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9740.25,,,,,,,Case Rate,2300,9850.5433,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,833,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,4235.49,,,,,,,Case Rate,2300,4283.450388,
OTHER CARDIOTHORACIC PROCEDURES WITH MCC,228,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,40073.94,,,,,,,Case Rate,2300,40527.71553,
OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,229,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,25510.95,,,,,,,Case Rate,2300,25799.82214,
OTHER CEREBROVASCULAR DISORDERS WITH CC,71,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8310.6,,,,,,,Case Rate,2300,8404.70472,
OTHER CEREBROVASCULAR DISORDERS WITH MCC,70,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13484.88,,,,,,,Case Rate,2300,13637.57546,
OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,72,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6125.22,,,,,,,Case Rate,2300,6194.578664,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,315,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7802.73,,,,,,,Case Rate,2300,7891.083876,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,314,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16890.12,,,,,,,Case Rate,2300,17081.37454,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,316,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5525.01,,,,,,,Case Rate,2300,5587.572212,
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,264,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,27058.86,,,,,,,Case Rate,2300,27365.25983,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,394,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7579.17,,,,,,,Case Rate,2300,7664.992404,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,393,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12954.33,,,,,,,Case Rate,2300,13101.0178,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,395,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5256.9,,,,,,,Case Rate,2300,5316.42628,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,357,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,18836.55,,,,,,,Case Rate,2300,19049.84486,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,356,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,35581.68,,,,,,,Case Rate,2300,35984.58762,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,358,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11322.99,,,,,,,Case Rate,2300,11451.20539,
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,92,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8286.3,,,,,,,Case Rate,2300,8380.12956,
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,91,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14225.22,,,,,,,Case Rate,2300,14386.29866,
OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,93,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6450.03,,,,,,,Case Rate,2300,6523.066636,
OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT,124,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10717.11,,,,,,,Case Rate,2300,10838.46473,
OTHER DISORDERS OF THE EYE WITHOUT MCC,125,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6219.18,,,,,,,Case Rate,2300,6289.602616,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7423.65,,,,,,,Case Rate,2300,7507.71138,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12664.35,,,,,,,Case Rate,2300,12807.75422,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5597.91,,,,,,,Case Rate,2300,5661.297692,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14036.49,,,,,,,Case Rate,2300,14195.43159,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,30347.46,,,,,,,Case Rate,2300,30691.09815,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9738.63,,,,,,,Case Rate,2300,9848.904956,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17648.28,,,,,,,Case Rate,2300,17848.11954,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,30187.08,,,,,,,Case Rate,2300,30528.9021,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11821.95,,,,,,,Case Rate,2300,13879,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,319,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,36149.49,,,,,,,Case Rate,2300,36558.82719,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,320,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,19482.93,,,,,,,Case Rate,2300,19703.54412,
OTHER FACTORS INFLUENCING HEALTH STATUS,951,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,4503.6,,,,,,,Case Rate,2300,4972,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,749,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,20797.56,,,,,,,Case Rate,2300,21033.06027,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,750,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11953.98,,,,,,,Case Rate,2300,12089.34038,
OTHER HEART ASSIST SYSTEM IMPLANT,215,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,80651.7,,,,,,,Case Rate,2300,81564.95604,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,424,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17721.99,,,,,,,Case Rate,2300,17922.66419,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,423,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,33639.3,,,,,,,Case Rate,2300,34020.21316,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,425,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12152.43,,,,,,,Case Rate,2300,12290.03752,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,868,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8351.91,,,,,,,Case Rate,2300,8446.482492,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,867,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16954.92,,,,,,,Case Rate,2300,17146.9083,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,869,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5910.57,,,,,,,Case Rate,2300,5977.498084,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14170.14,,,,,,,Case Rate,2300,14330.59497,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8243.37,,,,,,,Case Rate,2300,8336.713444,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,699,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8221.5,,,,,,,Case Rate,2300,8314.5958,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,698,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13400.64,,,,,,,Case Rate,2300,13552.38157,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,700,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5588.19,,,,,,,Case Rate,2300,5651.467628,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,674,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,18942.66,,,,,,,Case Rate,2300,19157.15639,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,673,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,34032.96,,,,,,,Case Rate,2300,34418.33075,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,675,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13295.34,,,,,,,Case Rate,2300,13445.88921,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,271,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,28806.03,,,,,,,Case Rate,2300,29132.21384,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,270,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,42738.03,,,,,,,Case Rate,2300,43221.97224,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,272,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,20679.3,,,,,,,Case Rate,2300,20913.46116,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,729,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8575.47,,,,,,,Case Rate,2300,8672.573964,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,730,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5443.2,,,,,,,Case Rate,2300,5504.83584,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,717,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15313.05,,,,,,,Case Rate,2300,15486.44666,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,718,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10879.11,,,,,,,Case Rate,2300,11002.29913,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,715,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,18122.13,,,,,,,Case Rate,2300,18327.33516,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,716,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11915.1,,,,,,,Case Rate,2300,12050.02012,
OTHER MENTAL DISORDER DIAGNOSES,887,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8674.29,,,,,,,Case Rate,850,8772.512948,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,964,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12414.06,,,,,,,Case Rate,2300,12554.63007,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,963,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,22143.78,,,,,,,Case Rate,2300,22394.52414,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,965,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7618.05,,,,,,,Case Rate,2300,7704.31266,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,565,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7892.64,,,,,,,Case Rate,2300,7982.011968,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,564,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12503.16,,,,,,,Case Rate,2300,12644.73899,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,566,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6069.33,,,,,,,Case Rate,2300,6138.055796,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,516,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16832.61,,,,,,,Case Rate,2300,17023.21333,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,515,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,25813.89,,,,,,,Case Rate,2300,26106.19247,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,517,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12447.27,,,,,,,Case Rate,2300,13879,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,844,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9860.94,,,,,,,Case Rate,2300,9972.599928,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,843,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16157.88,,,,,,,Case Rate,2300,16340.84306,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,845,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6897.96,,,,,,,Case Rate,2300,6976.068752,
OTHER O.R. PROCEDURES FOR INJURIES WITH CC,908,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16161.12,,,,,,,Case Rate,2300,16344.11974,
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,907,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,31098.33,,,,,,,Case Rate,2300,31450.4706,
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,909,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10632.87,,,,,,,Case Rate,2300,10753.27084,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,958,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,34132.59,,,,,,,Case Rate,2300,34519.08891,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,957,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,61721.19,,,,,,,Case Rate,2300,62420.08723,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,959,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,23847.21,,,,,,,Case Rate,2300,24117.24285,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,803,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15057.09,,,,,,,Case Rate,2300,15227.58831,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,802,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,32271.21,,,,,,,Case Rate,2300,32636.63165,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,804,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10983.6,,,,,,,Case Rate,2300,11107.97232,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,205,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14831.1,,,,,,,Case Rate,2300,14999.03932,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,206,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7622.91,,,,,,,Case Rate,2300,7709.227692,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,167,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14607.54,,,,,,,Case Rate,2300,14772.94785,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,166,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,30275.37,,,,,,,Case Rate,2300,30618.19184,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,168,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11067.84,,,,,,,Case Rate,2300,11193.16621,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13996.8,,,,,,,Case Rate,2300,14155.29216,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,26231.85,,,,,,,Case Rate,2300,26528.88522,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11689.11,,,,,,,Case Rate,2300,11821.47113,
OTHER VASCULAR PROCEDURES WITH CC,253,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,21024.36,,,,,,,Case Rate,2300,21262.42843,
OTHER VASCULAR PROCEDURES WITH MCC,252,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,28255.23,,,,,,,Case Rate,2300,28575.17688,
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,254,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14431.77,,,,,,,Case Rate,2300,14595.18752,
OTITIS MEDIA AND URI WITH MCC,152,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9575.82,,,,,,,Case Rate,2300,9684.251384,
OTITIS MEDIA AND URI WITHOUT MCC,153,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5979.42,,,,,,,Case Rate,2300,6047.127704,
PANCREAS TRANSPLANT,10,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,24866.19,,,,,,,Case Rate,2300,25147.76123,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",406,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,23491.62,,,,,,,Case Rate,2300,23757.62634,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",405,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,44311.05,,,,,,,Case Rate,2300,44812.80426,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",407,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17978.76,,,,,,,Case Rate,2300,18182.34171,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,543,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8326.8,,,,,,,Case Rate,2300,8421.08816,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,542,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14308.65,,,,,,,Case Rate,2300,14470.67338,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,544,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6112.26,,,,,,,Case Rate,2300,6181.471912,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17253,,,,,,,Case Rate,2300,17448.3636,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",735,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10898.55,,,,,,,Case Rate,2300,13879,
PENIS PROCEDURES WITH CC/MCC,709,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,18849.51,,,,,,,Case Rate,2300,19062.95161,
PENIS PROCEDURES WITHOUT CC/MCC,710,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11349.72,,,,,,,Case Rate,2300,13879,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,273,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,33416.55,,,,,,,Case Rate,2300,33794.94086,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,274,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,26662.77,,,,,,,Case Rate,2300,26964.68472,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES,321,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,22038.48,,,,,,,Case Rate,2300,22288.03178,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC,322,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14280.3,,,,,,,Case Rate,2300,14442.00236,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC,250,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17678.25,,,,,,,Case Rate,2300,17878.4289,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC,251,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12105.45,,,,,,,Case Rate,2300,13879,
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC,359,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,27852.66,,,,,,,Case Rate,2300,28168.04839,
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC,360,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,19555.83,,,,,,,Case Rate,2300,19777.2696,
PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE,318,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,19619.82,,,,,,,Case Rate,2300,19841.98418,
PERIPHERAL VASCULAR DISORDERS WITH CC,300,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8646.75,,,,,,,Case Rate,2300,8744.6611,
PERIPHERAL VASCULAR DISORDERS WITH MCC,299,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13224.87,,,,,,,Case Rate,2300,13374.62124,
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,301,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5829.57,,,,,,,Case Rate,2300,5895.580884,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",41,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17809.47,,,,,,,Case Rate,2300,18011.13476,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",40,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,31275.72,,,,,,,Case Rate,2300,31629.86926,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",42,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13994.37,,,,,,,Case Rate,2300,14152.83464,
PERITONEAL ADHESIOLYSIS WITH CC,336,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17080.47,,,,,,,Case Rate,2300,17273.87996,
PERITONEAL ADHESIOLYSIS WITH MCC,335,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,28924.29,,,,,,,Case Rate,2300,29251.81295,
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,337,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12433.5,,,,,,,Case Rate,2300,12574.2902,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,243,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17260.29,,,,,,,Case Rate,2300,17455.73615,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,242,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,25861.68,,,,,,,Case Rate,2300,26154.52362,
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,244,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14640.75,,,,,,,Case Rate,2300,14806.5339,
PLEURAL EFFUSION WITH CC,187,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8011.71,,,,,,,Case Rate,2300,8102.430252,
PLEURAL EFFUSION WITH MCC,186,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12623.85,,,,,,,Case Rate,2300,12766.79562,
PLEURAL EFFUSION WITHOUT CC/MCC,188,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5809.32,,,,,,,Case Rate,2300,5875.101584,
PNEUMOTHORAX WITH CC,200,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8904.33,,,,,,,Case Rate,2300,9005.157796,
PNEUMOTHORAX WITH MCC,199,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14289.21,,,,,,,Case Rate,2300,14451.01325,
PNEUMOTHORAX WITHOUT CC/MCC,201,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5792.31,,,,,,,Case Rate,2300,5857.898972,
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,917,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12704.04,,,,,,,Case Rate,2300,12847.89365,
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,918,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6942.51,,,,,,,Case Rate,2300,7021.123212,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,862,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14771.97,,,,,,,Case Rate,2300,14939.23976,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,863,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8082.99,,,,,,,Case Rate,2300,8174.517388,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,857,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17346.15,,,,,,,Case Rate,2300,17542.56838,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,856,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,36844.47,,,,,,,Case Rate,2300,37261.67676,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,858,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11282.49,,,,,,,Case Rate,2300,11410.24679,
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,769,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13687.38,,,,,,,Case Rate,2300,13842.36846,
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,776,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5303.07,,,,,,,Case Rate,2300,5363.119084,
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,67,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11896.47,,,,,,,Case Rate,2300,12031.17916,
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,68,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7001.64,,,,,,,Case Rate,2300,7080.922768,
PREMATURITY WITH MAJOR PROBLEMS,791,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,32877.9,,,,,,,Case Rate,2300,33250.19148,
PREMATURITY WITHOUT MAJOR PROBLEMS,792,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,19838.52,,,,,,,Case Rate,2300,20063.16062,
PROSTATECTOMY WITH CC,666,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14169.33,,,,,,,Case Rate,2300,14329.7758,
PROSTATECTOMY WITH MCC,665,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,25281.72,,,,,,,Case Rate,2300,25567.99646,
PROSTATECTOMY WITHOUT CC/MCC,667,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8960.22,,,,,,,Case Rate,2300,9061.680664,
PSYCHOSES,885,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11314.08,,,,,,,Case Rate,850,11442.1945,
PULMONARY EDEMA AND RESPIRATORY FAILURE,189,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10006.74,,,,,,,Case Rate,2300,10120.05089,
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,175,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11126.16,,,,,,,Case Rate,2300,11252.14659,
PULMONARY EMBOLISM WITHOUT MCC,176,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6520.5,,,,,,,Case Rate,2300,6594.3346,
RADIOTHERAPY,849,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,21946.95,,,,,,,Case Rate,2300,22195.46534,
RECTAL RESECTION WITH CC,333,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,18971.82,,,,,,,Case Rate,2300,19186.64658,
RECTAL RESECTION WITH MCC,332,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,29327.67,,,,,,,Case Rate,2300,29659.7606,
RECTAL RESECTION WITHOUT CC/MCC,334,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13266.99,,,,,,,Case Rate,2300,13417.21819,
RED BLOOD CELL DISORDERS WITH MCC,811,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11374.83,,,,,,,Case Rate,2300,11503.6324,
RED BLOOD CELL DISORDERS WITHOUT MCC,812,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7437.42,,,,,,,Case Rate,2300,7521.637304,
REHABILITATION WITH CC/MCC,945,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12543.66,,,,,,,Case Rate,2300,12685.69759,
REHABILITATION WITHOUT CC/MCC,946,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9289.08,,,,,,,Case Rate,2300,9394.264496,
RENAL FAILURE WITH CC,683,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7093.98,,,,,,,Case Rate,2300,7174.308376,
RENAL FAILURE WITH MCC,682,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11996.1,,,,,,,Case Rate,2300,12131.93732,
RENAL FAILURE WITHOUT CC/MCC,684,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,4862.43,,,,,,,Case Rate,2300,4917.489516,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,178,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7905.6,,,,,,,Case Rate,2300,7995.11872,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,177,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12657.87,,,,,,,Case Rate,2300,12801.20084,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,179,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6115.5,,,,,,,Case Rate,2300,6184.7486,
RESPIRATORY NEOPLASMS WITH CC,181,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8675.1,,,,,,,Case Rate,2300,8773.33212,
RESPIRATORY NEOPLASMS WITH MCC,180,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14304.6,,,,,,,Case Rate,2300,14466.57752,
RESPIRATORY NEOPLASMS WITHOUT CC/MCC,182,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6026.4,,,,,,,Case Rate,2300,6094.63968,
RESPIRATORY SIGNS AND SYMPTOMS,204,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6539.94,,,,,,,Case Rate,2300,6613.994728,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,208,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,22264.47,,,,,,,Case Rate,2300,22516.58076,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,207,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,52121.07,,,,,,,Case Rate,2300,52711.26068,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,815,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8213.4,,,,,,,Case Rate,2300,8306.40408,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,814,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17226.27,,,,,,,Case Rate,2300,17421.33092,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,816,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5119.2,,,,,,,Case Rate,2300,5177.16704,
REVISION OF HIP OR KNEE REPLACEMENT WITH CC,467,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,28565.46,,,,,,,Case Rate,2300,28888.91975,
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,466,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,42163.74,,,,,,,Case Rate,2300,42641.17929,
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,468,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,22258.8,,,,,,,Case Rate,2300,22510.84656,
SALIVARY GLAND PROCEDURES,139,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9789.66,,,,,,,Case Rate,2300,9900.512792,
SEIZURES WITH MCC,100,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15688.08,,,,,,,Case Rate,2300,15865.7233,
SEIZURES WITHOUT MCC,101,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7311.06,,,,,,,Case Rate,2300,7393.846472,
SEPTIC ARTHRITIS WITH CC,549,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9778.32,,,,,,,Case Rate,2300,9889.044384,
SEPTIC ARTHRITIS WITH MCC,548,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15640.29,,,,,,,Case Rate,2300,15817.39215,
SEPTIC ARTHRITIS WITHOUT CC/MCC,550,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7080.21,,,,,,,Case Rate,2300,7160.382452,
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,870,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,55985.58,,,,,,,Case Rate,2300,56619.5303,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,871,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15734.25,,,,,,,Case Rate,2300,15912.4161,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,872,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8288.73,,,,,,,Case Rate,2300,8382.587076,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16843.14,,,,,,,Case Rate,2300,17033.86257,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,24466.05,,,,,,,Case Rate,2300,24743.09026,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13408.74,,,,,,,Case Rate,2300,13879,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,555,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10706.58,,,,,,,Case Rate,2300,10827.8155,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,556,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6727.86,,,,,,,Case Rate,2300,6804.042632,
SIGNS AND SYMPTOMS WITH MCC,947,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10282.14,,,,,,,Case Rate,2300,10398.56937,
SIGNS AND SYMPTOMS WITHOUT MCC,948,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6484.05,,,,,,,Case Rate,2300,6557.47186,
SIMPLE PNEUMONIA AND PLEURISY WITH CC,194,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6527.79,,,,,,,Case Rate,2300,6601.707148,
SIMPLE PNEUMONIA AND PLEURISY WITH MCC,193,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10646.64,,,,,,,Case Rate,2300,10767.19677,
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,195,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5090.85,,,,,,,Case Rate,2300,5148.49602,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,8,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,45397.26,,,,,,,Case Rate,2300,45911.31391,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,19,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,53680.32,,,,,,,Case Rate,2300,54288.16678,
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL,402,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,32566.05,,,,,,,Case Rate,2300,32934.81026,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,450,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,43169.76,,,,,,,Case Rate,2300,43658.59091,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,451,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,26166.24,,,,,,,Case Rate,2300,26462.53229,
SINUS AND MASTOID PROCEDURES WITH CC/MCC,135,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17133.12,,,,,,,Case Rate,2300,17327.12614,
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,136,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8223.93,,,,,,,Case Rate,2300,8327,
SKIN DEBRIDEMENT WITH CC,571,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13684.95,,,,,,,Case Rate,2300,13839.91094,
SKIN DEBRIDEMENT WITH MCC,570,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,23822.91,,,,,,,Case Rate,2300,24092.66769,
SKIN DEBRIDEMENT WITHOUT CC/MCC,572,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9285.03,,,,,,,Case Rate,2300,9390.168636,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,577,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,21470.67,,,,,,,Case Rate,2300,21713.7922,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,576,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,39699.72,,,,,,,Case Rate,2300,40149.25806,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,578,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13011.84,,,,,,,Case Rate,2300,13159.17901,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,574,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,28118.34,,,,,,,Case Rate,2300,28436.73681,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,573,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,53066.34,,,,,,,Case Rate,2300,53667.23441,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,575,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13232.16,,,,,,,Case Rate,2300,13381.99379,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14530.59,,,,,,,Case Rate,2300,14695.12651,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,28829.52,,,,,,,Case Rate,2300,29155.96982,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",624,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10140.39,,,,,,,Case Rate,2300,10255.21427,
SKIN GRAFTS FOR INJURIES WITH CC/MCC,904,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,29752.11,,,,,,,Case Rate,2300,30089.00673,
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,905,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11597.58,,,,,,,Case Rate,2300,11728.9047,
SKIN ULCERS WITH CC,593,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9609.03,,,,,,,Case Rate,2300,9717.837436,
SKIN ULCERS WITH MCC,592,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15675.93,,,,,,,Case Rate,2300,15853.43572,
SKIN ULCERS WITHOUT CC/MCC,594,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7021.08,,,,,,,Case Rate,2300,7100.582896,
SOFT TISSUE PROCEDURES WITH CC,501,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14159.61,,,,,,,Case Rate,2300,14319.94573,
SOFT TISSUE PROCEDURES WITH MCC,500,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,25634.88,,,,,,,Case Rate,2300,25925.15546,
SOFT TISSUE PROCEDURES WITHOUT CC/MCC,502,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10901.79,,,,,,,Case Rate,2300,11025.23595,
SPINAL DISORDERS AND INJURIES WITH CC/MCC,52,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14424.48,,,,,,,Case Rate,2300,14587.81498,
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,53,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7931.52,,,,,,,Case Rate,2300,8021.332224,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",457,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,48301.11,,,,,,,Case Rate,2300,48848.04553,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",456,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,68067.54,,,,,,,Case Rate,2300,68838.29985,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",458,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,33798.06,,,,,,,Case Rate,2300,34180.77087,
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,29,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,27633.96,,,,,,,Case Rate,2300,27946.87195,
SPINAL PROCEDURES WITH MCC,28,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,48667.23,,,,,,,Case Rate,2300,49218.31128,
SPINAL PROCEDURES WITHOUT CC/MCC,30,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17781.12,,,,,,,Case Rate,2300,17982.46374,
SPLENIC PROCEDURES WITH CC,800,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,22756.14,,,,,,,Case Rate,2300,23013.81817,
SPLENIC PROCEDURES WITH MCC,799,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,36684.09,,,,,,,Case Rate,2300,37099.48071,
SPLENIC PROCEDURES WITHOUT CC/MCC,801,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15462.09,,,,,,,Case Rate,2300,15637.17431,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",537,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7729.83,,,,,,,Case Rate,2300,7817.358396,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",538,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5834.43,,,,,,,Case Rate,2300,5900.495916,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,19798.02,,,,,,,Case Rate,2300,20022.20202,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,40397.94,,,,,,,Case Rate,2300,40855.38433,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12978.63,,,,,,,Case Rate,2300,13125.59296,
SYNCOPE AND COLLAPSE,312,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7059.96,,,,,,,Case Rate,2300,7139.903152,
"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12043.89,,,,,,,Case Rate,2300,12180.26847,
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7234.92,,,,,,,Case Rate,2300,7316.844304,
TESTES PROCEDURES WITH CC/MCC,711,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16878.78,,,,,,,Case Rate,2300,17069.90614,
TESTES PROCEDURES WITHOUT CC/MCC,712,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8907.57,,,,,,,Case Rate,2300,9008.434484,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12145.14,,,,,,,Case Rate,2300,13879,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,24462.81,,,,,,,Case Rate,2300,24739.81357,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10759.23,,,,,,,Case Rate,2300,10881.06168,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",12,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,34149.6,,,,,,,Case Rate,2300,34536.29152,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",11,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,44178.21,,,,,,,Case Rate,2300,44678.46005,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",13,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,23342.58,,,,,,,Case Rate,2300,23606.8987,
"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",4,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,112196.34,,,,,,,Case Rate,2300,113466.7904,
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,69,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6470.28,,,,,,,Case Rate,2300,6543.545936,
TRANSURETHRAL PROCEDURES WITH CC,669,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12571.2,,,,,,,Case Rate,2300,12713.54944,
TRANSURETHRAL PROCEDURES WITH MCC,668,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,23652,,,,,,,Case Rate,2300,23919.8224,
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,670,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7916.13,,,,,,,Case Rate,2300,8327,
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,713,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12177.54,,,,,,,Case Rate,2300,12315.43185,
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,714,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8564.94,,,,,,,Case Rate,2300,8661.924728,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11924.01,,,,,,,Case Rate,2300,12059.03101,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7419.6,,,,,,,Case Rate,2300,7503.61552,
TRAUMATIC INJURY WITH MCC,913,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13240.26,,,,,,,Case Rate,2300,13390.18551,
TRAUMATIC INJURY WITHOUT MCC,914,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7172.55,,,,,,,Case Rate,2300,7253.76806,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,86,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10551.87,,,,,,,Case Rate,2300,10671.35364,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,85,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,18402.39,,,,,,,Case Rate,2300,18610.76867,
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,87,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7409.07,,,,,,,Case Rate,2300,7492.966284,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,83,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11305.98,,,,,,,Case Rate,2300,11434.00278,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,82,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,18513.36,,,,,,,Case Rate,2300,18722.99523,
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,84,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7741.98,,,,,,,Case Rate,2300,7829.645976,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC,278,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,45086.22,,,,,,,Case Rate,2300,45596.75186,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC,279,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,29211.84,,,,,,,Case Rate,2300,29542.61901,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM,173,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,24108.84,,,,,,,Case Rate,2300,24381.83541,
UNCOMPLICATED PEPTIC ULCER WITH MCC,383,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11183.67,,,,,,,Case Rate,2300,11310.3078,
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,384,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6923.88,,,,,,,Case Rate,2300,7002.282256,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,256,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13752.99,,,,,,,Case Rate,2300,13908.72139,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,255,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,21848.94,,,,,,,Case Rate,2300,22096.34553,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,257,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8846.82,,,,,,,Case Rate,2300,8946.996584,
URETHRAL PROCEDURES WITH CC/MCC,671,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14539.5,,,,,,,Case Rate,2300,14704.1374,
URETHRAL PROCEDURES WITHOUT CC/MCC,672,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8743.95,,,,,,,Case Rate,2300,8842.96174,
URETHRAL STRICTURE,697,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8730.18,,,,,,,Case Rate,2300,8829.035816,
URINARY STONES WITH MCC,693,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10890.45,,,,,,,Case Rate,2300,11013.76754,
URINARY STONES WITHOUT MCC,694,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6331.77,,,,,,,Case Rate,2300,6403.467524,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,742,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14861.88,,,,,,,Case Rate,2300,15030.16786,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,743,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,10049.67,,,,,,,Case Rate,2300,10163.467,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,740,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14657.76,,,,,,,Case Rate,2300,14823.73651,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,739,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,28563.03,,,,,,,Case Rate,2300,28886.46224,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,741,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11551.41,,,,,,,Case Rate,2300,13879,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,737,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,16690.86,,,,,,,Case Rate,2300,16879.85823,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,736,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,28953.45,,,,,,,Case Rate,2300,29281.30314,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,738,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,11894.85,,,,,,,Case Rate,2300,12029.54082,
"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14070.51,,,,,,,Case Rate,2300,14229.83681,
"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6799.95,,,,,,,Case Rate,2300,8327,
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,768,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8679.96,,,,,,,Case Rate,2300,8778.247152,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,797,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8103.24,,,,,,,Case Rate,2300,8194.996688,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,796,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9452.7,,,,,,,Case Rate,2300,9559.73724,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,798,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7752.51,,,,,,,Case Rate,2300,7840.295212,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,806,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6107.4,,,,,,,Case Rate,2300,6176.55688,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,805,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,8741.52,,,,,,,Case Rate,2300,8840.504224,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,807,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,5461.02,,,,,,,Case Rate,2300,5522.857624,
VEIN LIGATION AND STRIPPING,263,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,24764.94,,,,,,,Case Rate,2300,25045.36473,
VENTRICULAR SHUNT PROCEDURES WITH CC,32,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,17261.1,,,,,,,Case Rate,2300,17456.55532,
VENTRICULAR SHUNT PROCEDURES WITH MCC,31,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,36292.05,,,,,,,Case Rate,2300,36703.00146,
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,33,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,13469.49,,,,,,,Case Rate,2300,13879,
VIRAL ILLNESS WITH MCC,865,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,12136.23,,,,,,,Case Rate,2300,12273.65408,
VIRAL ILLNESS WITHOUT MCC,866,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,7043.76,,,,,,,Case Rate,2300,7123.519712,
VIRAL MENINGITIS WITH CC/MCC,75,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15531.75,,,,,,,Case Rate,2300,15707.6231,
VIRAL MENINGITIS WITHOUT CC/MCC,76,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,6065.28,,,,,,,Case Rate,2300,6133.959936,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,464,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,25229.07,,,,,,,Case Rate,2300,25514.75028,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,463,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,46165.95,,,,,,,Case Rate,2300,46688.70814,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,465,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,14771.97,,,,,,,Case Rate,2300,14939.23976,
WOUND DEBRIDEMENTS FOR INJURIES WITH CC,902,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,15507.45,,,,,,,Case Rate,2300,15683.04794,
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,901,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,33992.46,,,,,,,Case Rate,2300,34377.37215,
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,903,MS-DRG,,,,,,,,inpatient,,,,,Aetna Comm,Aetna Comm,9473.76,,,,,,,Case Rate,2300,9581.035712,
"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8213.837644,
ABORTION WITHOUT D&C,779,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5841.515532,
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,880,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,850,7865.689544,
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,289,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13982.44687,
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,288,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,22168.43266,
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,290,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7615.842084,
ACUTE LEUKEMIA WITH CC,835,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17086.28958,
ACUTE LEUKEMIA WITH MCC,834,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,44971.72363,
ACUTE LEUKEMIA WITH OTHER PROCEDURES,850,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,70936.19934,
ACUTE LEUKEMIA WITHOUT CC/MCC,836,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9989.80254,
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,121,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9529.427876,
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,122,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6437.053576,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",281,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7529.009852,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",280,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13140.33805,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",282,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5923.432732,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",284,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5670.308584,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",283,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,16226.15898,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",285,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,4972,
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,614,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17954.6119,
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,615,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11462.6738,
AFTERCARE WITH CC/MCC,949,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9745.689284,
AFTERCARE WITHOUT CC/MCC,950,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5141.942644,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9224.695892,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15276.73863,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6585.323708,
AICD GENERATOR PROCEDURES,245,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,37373.90333,
AICD LEAD PROCEDURES,265,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,29639.2813,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,850,11596.19883,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,850,14295.37057,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,850,7231.650416,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,850,5053.472068,
ALLERGIC REACTIONS WITH MCC,915,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13775.19635,
ALLERGIC REACTIONS WITHOUT MCC,916,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5458.143036,
ALLOGENEIC BONE MARROW TRANSPLANT,14,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,98447.27179,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,240,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,23350.49786,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,239,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,40317.18832,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,241,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11340.61717,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,475,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,18641.8972,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,474,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,35166.23479,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,476,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9667.867944,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15320.97392,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,28567.80433,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",618,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11618.31648,
ANAL AND STOMAL PROCEDURES WITH CC,348,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10721.32314,
ANAL AND STOMAL PROCEDURES WITH MCC,347,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,18804.91243,
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,349,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7131.711432,
ANGINA PECTORIS,311,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5749.768268,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,268,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,56341.83099,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,269,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,34595.2719,
APPENDIX PROCEDURES WITH CC,398,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12398.98739,
APPENDIX PROCEDURES WITH MCC,397,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,19618.35023,
APPENDIX PROCEDURES WITHOUT CC/MCC,399,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9377.061884,
ATHEROSCLEROSIS WITH MCC,302,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9802.212152,
ATHEROSCLEROSIS WITHOUT MCC,303,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5514.665904,
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,16,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,48574.44208,
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,17,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,39633.99888,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,519,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,16385.07834,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,518,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,30614.91516,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,520,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12237.61051,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,95,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,21128.08422,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,94,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,28829.93937,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,96,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,21128.08422,
BEHAVIORAL AND DEVELOPMENTAL DISORDERS,886,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,850,17000.27652,
BENIGN PROSTATIC HYPERTROPHY WITH MCC,725,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9585.950744,
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,726,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5914.42184,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,461,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,43912.53423,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,462,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,21789.9752,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,409,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17835.83196,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,408,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,29208.39683,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,410,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13005.99384,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,478,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,20145.07782,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,477,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,28299.11591,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,479,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15227.58831,
BONE DISEASES AND ARTHROPATHIES WITH MCC,553,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10618.92664,
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,554,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6799.946772,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17536.015,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15802.64705,
BRONCHITIS AND ASTHMA WITH CC/MCC,202,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7955.798464,
BRONCHITIS AND ASTHMA WITHOUT CC/MCC,203,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5488.4524,
"CARDIAC ARREST, UNEXPLAINED WITH CC",297,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6184,
"CARDIAC ARREST, UNEXPLAINED WITH MCC",296,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12794.64747,
"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",298,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,4972,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,309,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6026.648404,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,308,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9862.83088,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,310,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,4637.332692,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,306,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12908.51238,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,307,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7480.678704,
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC,275,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,58410.24029,
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR,276,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,49204.38535,
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC,277,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,37833.45882,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,258,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,25739.20341,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,259,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,16564.47701,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,261,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15486.44666,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,260,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,26646.02682,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,262,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13351.68443,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,217,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,53863.01652,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,216,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,80137.95842,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,218,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,53863.01652,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,220,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,43684.80442,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,219,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,62898.48368,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,221,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,41287.90714,
CAROTID ARTERY STENT PROCEDURES WITH CC,35,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,19582.30666,
CAROTID ARTERY STENT PROCEDURES WITH MCC,34,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,31707.6906,
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,36,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15914.87362,
CELLULITIS WITH MCC,602,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11642.89164,
CELLULITIS WITHOUT MCC,603,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7134.168948,
CERVICAL SPINAL FUSION WITH CC,472,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,24133.62629,
CERVICAL SPINAL FUSION WITH MCC,471,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,39555.35836,
CERVICAL SPINAL FUSION WITHOUT CC/MCC,473,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,19998.44604,
CESAREAN SECTION WITH STERILIZATION WITH CC,784,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8684.042372,
CESAREAN SECTION WITH STERILIZATION WITH MCC,783,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,20111.49177,
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,785,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7846.029416,
CESAREAN SECTION WITHOUT STERILIZATION WITH CC,787,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9148.512896,
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,786,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13512.24214,
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,788,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7854.221136,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,837,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,39355.4804,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,838,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17099.39633,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,839,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11828.02451,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,847,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10716.4081,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,846,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,21237.0341,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,848,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6958.046968,
CHEST PAIN,313,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5898.0384,
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,18,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,353741.4064,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,415,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,16929.82772,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,414,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,29183.82167,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,416,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11167.77188,
CHOLECYSTECTOMY WITH C.D.E. WITH CC,412,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17223.0913,
CHOLECYSTECTOMY WITH C.D.E. WITH MCC,411,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,27059.70868,
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,413,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13602.35106,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,191,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6905.61996,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,190,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9073.968244,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,192,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5259.08424,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",286,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,18126.63802,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",287,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8765.959572,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,433,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8652.094664,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,432,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,16122.9433,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,434,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5836.6005,
COAGULATION DISORDERS,813,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12494.83052,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC,429,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,73804.12051,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC,430,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,47242.46841,
COMPLEX AORTIC ARCH PROCEDURES,209,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,92720.44034,
COMPLICATED PEPTIC ULCER WITH CC,381,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8875.72862,
COMPLICATED PEPTIC ULCER WITH MCC,380,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,16073.79298,
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,382,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6558.291032,
COMPLICATIONS OF TREATMENT WITH CC,920,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8210.560956,
COMPLICATIONS OF TREATMENT WITH MCC,919,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14997.40098,
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,921,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5639.180048,
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES,212,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,89077.58245,
CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION,317,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,54773.93578,
CONCUSSION WITH CC,89,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8999.423592,
CONCUSSION WITH MCC,88,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11073.5671,
CONCUSSION WITHOUT CC/MCC,90,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6743.423904,
CONNECTIVE TISSUE DISORDERS WITH CC,546,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9448.329848,
CONNECTIVE TISSUE DISORDERS WITH MCC,545,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,20329.39152,
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,547,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6849.916264,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,233,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,62627.33774,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,234,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,44748.90884,
CORONARY BYPASS WITH PTCA WITH MCC,231,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,69055.38043,
CORONARY BYPASS WITH PTCA WITHOUT MCC,232,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,49663.12167,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,235,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,48073.92799,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,236,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,34313.47674,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC,323,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,35448.84913,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC,324,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,25812.10972,
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE,325,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,26298.69789,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,73,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13141.9764,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,74,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8444.024976,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,26,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,25469.69582,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,25,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,37245.29332,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,27,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,20666.89039,
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,955,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,55139.28649,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,23,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,46941.01312,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,24,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,32045.18947,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,16785.65345,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9318.0815,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,56,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,19030.18473,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,57,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10613.19243,
DENTAL AND ORAL DISEASES WITH CC,158,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7452.826856,
DENTAL AND ORAL DISEASES WITH MCC,157,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14063.5449,
DENTAL AND ORAL DISEASES WITHOUT CC/MCC,159,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5803.83362,
DEPRESSIVE NEUROSES,881,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,850,7707.589348,
DIABETES WITH CC,638,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7341.419464,
DIABETES WITH MCC,637,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11769.04412,
DIABETES WITHOUT CC/MCC,639,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5088.696464,
DIGESTIVE MALIGNANCY WITH CC,375,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9908.704512,
DIGESTIVE MALIGNANCY WITH MCC,374,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17519.63156,
DIGESTIVE MALIGNANCY WITHOUT CC/MCC,376,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7571.606796,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7907.467316,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14701.67988,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5731.746484,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,439,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6890.874864,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,438,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13354.14194,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,440,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5090.334808,
DISORDERS OF PERSONALITY AND IMPULSE CONTROL,883,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,850,16107.37904,
DISORDERS OF THE BILIARY TRACT WITH CC,445,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8965.018368,
DISORDERS OF THE BILIARY TRACT WITH MCC,444,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13687.54495,
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,446,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6777.009956,
DYSEQUILIBRIUM,149,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6156.896752,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",147,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10415.77198,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17345.14793,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",148,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6529.620012,
"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",3,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,173870.8953,
ENDOCRINE DISORDERS WITH CC,644,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8396.513,
ENDOCRINE DISORDERS WITH MCC,643,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13484.39029,
ENDOCRINE DISORDERS WITHOUT CC/MCC,645,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6293.698476,
ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES,213,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,46749.32687,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,266,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,50202.13685,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,267,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,38999.14058,
EPISTAXIS WITH MCC,150,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10907.27518,
EPISTAXIS WITHOUT MCC,151,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6012.72248,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10389.55848,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6386.264912,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,927,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,150975.0379,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,933,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,31265.33772,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,982,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,20139.34362,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,981,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,38433.9119,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,983,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14040.60808,
EXTRACRANIAL PROCEDURES WITH CC,38,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13291.88487,
EXTRACRANIAL PROCEDURES WITH MCC,37,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,26967.96141,
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,39,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9629.36686,
EXTRAOCULAR PROCEDURES EXCEPT ORBIT,115,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12573.47103,
"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,48687.48782,
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,748,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13879,
FEVER AND INFLAMMATORY CONDITIONS,864,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7271.789844,
FOOT PROCEDURES WITH CC,504,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15311.96302,
FOOT PROCEDURES WITH MCC,503,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,22863.90969,
FOOT PROCEDURES WITHOUT CC/MCC,505,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14686.11562,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11671.56266,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7335.68526,
FRACTURES OF FEMUR WITH MCC,533,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12842.15944,
FRACTURES OF FEMUR WITHOUT MCC,534,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6603.345492,
FRACTURES OF HIP AND PELVIS WITH MCC,535,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10501.78504,
FRACTURES OF HIP AND PELVIS WITHOUT MCC,536,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6615.633072,
FULL TERM NEONATE WITH MAJOR PROBLEMS,793,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,34156.19571,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,928,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,58756.75004,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,929,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,26383.89178,
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,934,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,18108.61623,
GASTROINTESTINAL HEMORRHAGE WITH CC,378,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8033.619804,
GASTROINTESTINAL HEMORRHAGE WITH MCC,377,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14974.46416,
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,379,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5164.060288,
GASTROINTESTINAL OBSTRUCTION WITH CC,389,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6469.820456,
GASTROINTESTINAL OBSTRUCTION WITH MCC,388,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12097.5321,
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,390,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,4456.29568,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12896.2248,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8374.395356,
HAND PROCEDURES FOR INJURIES,906,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14437.08733,
HEADACHES WITH MCC,102,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9182.098948,
HEADACHES WITHOUT MCC,103,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6850.735436,
HEART FAILURE AND SHOCK WITH CC,292,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6954.77028,
HEART FAILURE AND SHOCK WITH MCC,291,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10516.53014,
HEART FAILURE AND SHOCK WITHOUT CC/MCC,293,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,4636.51352,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,1,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,229563.9421,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,2,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,92826.9327,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,421,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14233.1135,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,420,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,27910.00921,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,422,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11464.31214,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,354,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13781.74973,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,353,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,23772.37144,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,355,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11017.8634,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,481,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17157.55754,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,480,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,23856.74616,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,482,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13360.69532,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,521,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,23511.87474,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,522,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17347.60544,
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,969,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,50143.97564,
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,970,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,21604.84233,
HIV WITH MAJOR RELATED CONDITION WITH CC,975,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10608.2774,
HIV WITH MAJOR RELATED CONDITION WITH MCC,974,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,23641.30392,
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,976,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7327.49354,
HIV WITH OR WITHOUT OTHER RELATED CONDITION,977,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10383.82427,
HYPERTENSION WITH MCC,304,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9748.1468,
HYPERTENSION WITHOUT MCC,305,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6185.567772,
INBORN AND OTHER DISORDERS OF METABOLISM,642,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11649.44501,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8019.69388,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11729.72387,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5436.025392,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,854,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,16367.87573,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,853,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,40455.62839,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,855,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12264.64318,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,727,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12147.50159,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,728,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6645.123264,
INFLAMMATORY BOWEL DISEASE WITH CC,386,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7997.576236,
INFLAMMATORY BOWEL DISEASE WITH MCC,385,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12961.75856,
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,387,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5581.018836,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,351,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12488.27714,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,350,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,20412.94707,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,352,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9566.290616,
INTERSTITIAL LUNG DISEASE WITH CC,197,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7774.761452,
INTERSTITIAL LUNG DISEASE WITH MCC,196,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15459.41398,
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,198,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5866.909864,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,65,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8276.094716,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,64,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,16473.54892,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,66,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5606.413168,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,21,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,43365.32734,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,20,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,64459.00634,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,22,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,25190.35817,
INTRAOCULAR PROCEDURES WITH CC/MCC,116,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14811.44893,
INTRAOCULAR PROCEDURES WITHOUT CC/MCC,117,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8887.197028,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",62,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14394.49038,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",61,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,22585.39121,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",63,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11499.53654,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,657,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14990.8476,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,656,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,26080.79814,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,658,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12711.9111,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,660,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10826.99632,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,659,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,20814.34135,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,661,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8481.706888,
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,689,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9504.852716,
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,690,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6631.19734,
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,687,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8583.284216,
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,686,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14775.40536,
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,688,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6473.916316,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,695,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9369.689336,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,696,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5644.09508,
KIDNEY TRANSPLANT,652,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,26455.15974,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,650,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,38512.55241,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,651,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,30356.87598,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,486,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17129.70569,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,485,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,26435.49961,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,487,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12829.87186,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,488,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12480.90459,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,489,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13879,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,418,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13857.11355,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,417,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,19548.72061,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,419,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11188.25118,
"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,30825.44236,
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,5,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,84460.72906,
LIVER TRANSPLANT WITHOUT MCC,6,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,37985.00564,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,496,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14777.04371,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,495,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,29700.7192,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,497,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9434.403924,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,498,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,24712.7809,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,499,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,16504.67746,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",493,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,20775.02109,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",492,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,30076.71915,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",494,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,16436.68618,
LUNG TRANSPLANT,7,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,106084.4123,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,821,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,18337.98439,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,820,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,48042.79946,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,822,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9862.83088,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,841,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13363.97201,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,840,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,26499.39503,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,824,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,18559.16083,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,823,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,37557.39786,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,825,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11053.90697,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,842,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8276.913888,
MAJOR BLADDER PROCEDURES WITH CC,654,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,22931.0818,
MAJOR BLADDER PROCEDURES WITH MCC,653,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,42567.45381,
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,655,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17338.59455,
MAJOR CHEST PROCEDURES WITH CC,164,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,20675.90128,
MAJOR CHEST PROCEDURES WITH MCC,163,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,36713.6507,
MAJOR CHEST PROCEDURES WITHOUT CC/MCC,165,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15680.59042,
MAJOR CHEST TRAUMA WITH CC,184,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8716.809252,
MAJOR CHEST TRAUMA WITH MCC,183,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12532.51243,
MAJOR CHEST TRAUMA WITHOUT CC/MCC,185,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6442.78778,
MAJOR ESOPHAGEAL DISORDERS WITH CC,369,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8193.358344,
MAJOR ESOPHAGEAL DISORDERS WITH MCC,368,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13040.39907,
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,370,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5740.757376,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,372,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8363.74612,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,371,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14524.73873,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,373,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5958.657128,
MAJOR HEAD AND NECK PROCEDURES WITH CC,141,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17866.96049,
MAJOR HEAD AND NECK PROCEDURES WITH MCC,140,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,34940.14332,
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,142,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13879,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,809,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10369.89835,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,808,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,18086.49859,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,810,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8573.454152,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,469,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,24847.1251,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,470,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15801.00871,
MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,483,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,22706.62867,
MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,707,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,16385.89752,
MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,708,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13879,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,507,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14797.52301,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,508,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12405.54077,
MAJOR SKIN DISORDERS WITH MCC,595,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17372.1806,
MAJOR SKIN DISORDERS WITHOUT MCC,596,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8867.5369,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,330,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,19637.19118,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,329,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,37653.24098,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,331,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13785.84559,
MAJOR THUMB OR JOINT PROCEDURES,506,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9826.787312,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,436,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9265.654492,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,435,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15045.73212,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,437,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6989.994676,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8910.953016,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15086.69072,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",756,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7868.14706,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9360.678444,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14824.55568,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",724,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5010.875124,
MALIGNANT BREAST DISORDERS WITH CC,598,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9267.292836,
MALIGNANT BREAST DISORDERS WITH MCC,597,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13656.41641,
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,599,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6006.169104,
MASTECTOMY FOR MALIGNANCY WITH CC/MCC,582,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15782.16775,
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,583,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14125.80197,
MEDICAL BACK PROBLEMS WITH MCC,551,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13730.14189,
MEDICAL BACK PROBLEMS WITHOUT MCC,552,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7874.700436,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,760,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8253.1579,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,761,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,4666.003712,
MINOR BLADDER PROCEDURES WITH CC,663,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12453.05274,
MINOR BLADDER PROCEDURES WITH MCC,662,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,25078.95078,
MINOR BLADDER PROCEDURES WITHOUT CC/MCC,664,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8575.911668,
MINOR SKIN DISORDERS WITH MCC,606,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12395.7107,
MINOR SKIN DISORDERS WITHOUT MCC,607,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7424.975008,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,345,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12326.08108,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,344,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,21157.57442,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,346,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9717.018264,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10940.86123,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6374.796504,
MOUTH PROCEDURES WITH CC/MCC,137,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12231.8763,
MOUTH PROCEDURES WITHOUT CC/MCC,138,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7259.502264,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC,427,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,59132.74999,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,426,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,90282.58446,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC,428,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,46053.84984,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,447,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,54733.79635,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,448,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,34739.44618,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,59,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10165.10535,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,58,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14003.74534,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,60,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7534.744056,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,827,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,18932.70326,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,826,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,38319.22782,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,828,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13957.05254,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,829,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,25885.8352,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,830,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13879,
NEONATE WITH OTHER SIGNIFICANT PROBLEMS,794,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,1184,12090.15955,
"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,1184,14763.11778,
NERVOUS SYSTEM NEOPLASMS WITH MCC,54,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12507.93727,
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,55,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8352.277712,
NEUROLOGICAL EYE DISORDERS,123,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6541.907592,
NEUROSES EXCEPT DEPRESSIVE,882,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,850,8796.268936,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,98,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,18799.17823,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,97,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,29586.8543,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,99,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11160.39933,
NON-EXTENSIVE BURNS,935,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,16874.9432,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,988,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13463.91099,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,987,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,28084.49285,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,989,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9823.510624,
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,600,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8532.495552,
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,601,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,4955.9906,
NONTRAUMATIC STUPOR AND COMA WITH MCC,80,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14827.0132,
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,81,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7336.504432,
NORMAL NEWBORN,795,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,530,2786,
O.R. PROCEDURES FOR OBESITY WITH CC,620,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13879,
O.R. PROCEDURES FOR OBESITY WITH MCC,619,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,23652.77233,
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,621,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13879,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,940,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,19143.23047,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,939,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,29723.65602,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,941,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,16610.35064,
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,876,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,850,31660.17863,
ORBITAL PROCEDURES WITH CC/MCC,113,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,19259.55289,
ORBITAL PROCEDURES WITHOUT CC/MCC,114,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11083.39716,
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,884,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,850,13179.65831,
OSTEOMYELITIS WITH CC,540,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10618.92664,
OSTEOMYELITIS WITH MCC,539,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,16135.23088,
OSTEOMYELITIS WITHOUT CC/MCC,541,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6319.91198,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,818,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8635.711224,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,817,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13827.62336,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,819,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8327,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,832,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5911.145152,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,831,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9850.5433,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,833,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,4283.450388,
OTHER CARDIOTHORACIC PROCEDURES WITH MCC,228,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,40527.71553,
OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,229,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,25799.82214,
OTHER CEREBROVASCULAR DISORDERS WITH CC,71,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8404.70472,
OTHER CEREBROVASCULAR DISORDERS WITH MCC,70,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13637.57546,
OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,72,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6194.578664,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,315,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7891.083876,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,314,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17081.37454,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,316,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5587.572212,
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,264,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,27365.25983,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,394,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7664.992404,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,393,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13101.0178,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,395,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5316.42628,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,357,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,19049.84486,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,356,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,35984.58762,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,358,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11451.20539,
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,92,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8380.12956,
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,91,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14386.29866,
OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,93,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6523.066636,
OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT,124,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10838.46473,
OTHER DISORDERS OF THE EYE WITHOUT MCC,125,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6289.602616,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7507.71138,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12807.75422,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5661.297692,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14195.43159,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,30691.09815,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9848.904956,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17848.11954,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,30528.9021,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13879,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,319,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,36558.82719,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,320,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,19703.54412,
OTHER FACTORS INFLUENCING HEALTH STATUS,951,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,4972,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,749,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,21033.06027,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,750,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12089.34038,
OTHER HEART ASSIST SYSTEM IMPLANT,215,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,81564.95604,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,424,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17922.66419,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,423,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,34020.21316,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,425,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12290.03752,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,868,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8446.482492,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,867,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17146.9083,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,869,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5977.498084,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14330.59497,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8336.713444,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,699,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8314.5958,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,698,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13552.38157,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,700,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5651.467628,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,674,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,19157.15639,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,673,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,34418.33075,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,675,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13445.88921,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,271,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,29132.21384,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,270,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,43221.97224,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,272,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,20913.46116,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,729,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8672.573964,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,730,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5504.83584,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,717,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15486.44666,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,718,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11002.29913,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,715,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,18327.33516,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,716,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12050.02012,
OTHER MENTAL DISORDER DIAGNOSES,887,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,850,8772.512948,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,964,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12554.63007,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,963,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,22394.52414,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,965,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7704.31266,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,565,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7982.011968,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,564,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12644.73899,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,566,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6138.055796,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,516,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17023.21333,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,515,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,26106.19247,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,517,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13879,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,844,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9972.599928,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,843,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,16340.84306,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,845,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6976.068752,
OTHER O.R. PROCEDURES FOR INJURIES WITH CC,908,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,16344.11974,
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,907,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,31450.4706,
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,909,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10753.27084,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,958,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,34519.08891,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,957,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,62420.08723,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,959,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,24117.24285,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,803,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15227.58831,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,802,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,32636.63165,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,804,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11107.97232,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,205,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14999.03932,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,206,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7709.227692,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,167,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14772.94785,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,166,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,30618.19184,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,168,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11193.16621,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14155.29216,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,26528.88522,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11821.47113,
OTHER VASCULAR PROCEDURES WITH CC,253,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,21262.42843,
OTHER VASCULAR PROCEDURES WITH MCC,252,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,28575.17688,
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,254,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14595.18752,
OTITIS MEDIA AND URI WITH MCC,152,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9684.251384,
OTITIS MEDIA AND URI WITHOUT MCC,153,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6047.127704,
PANCREAS TRANSPLANT,10,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,25147.76123,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",406,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,23757.62634,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",405,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,44812.80426,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",407,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,18182.34171,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,543,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8421.08816,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,542,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14470.67338,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,544,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6181.471912,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17448.3636,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",735,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13879,
PENIS PROCEDURES WITH CC/MCC,709,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,19062.95161,
PENIS PROCEDURES WITHOUT CC/MCC,710,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13879,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,273,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,33794.94086,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,274,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,26964.68472,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES,321,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,22288.03178,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC,322,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14442.00236,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC,250,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17878.4289,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC,251,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13879,
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC,359,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,28168.04839,
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC,360,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,19777.2696,
PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE,318,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,19841.98418,
PERIPHERAL VASCULAR DISORDERS WITH CC,300,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8744.6611,
PERIPHERAL VASCULAR DISORDERS WITH MCC,299,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13374.62124,
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,301,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5895.580884,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",41,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,18011.13476,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",40,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,31629.86926,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",42,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14152.83464,
PERITONEAL ADHESIOLYSIS WITH CC,336,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17273.87996,
PERITONEAL ADHESIOLYSIS WITH MCC,335,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,29251.81295,
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,337,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12574.2902,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,243,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17455.73615,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,242,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,26154.52362,
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,244,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14806.5339,
PLEURAL EFFUSION WITH CC,187,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8102.430252,
PLEURAL EFFUSION WITH MCC,186,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12766.79562,
PLEURAL EFFUSION WITHOUT CC/MCC,188,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5875.101584,
PNEUMOTHORAX WITH CC,200,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9005.157796,
PNEUMOTHORAX WITH MCC,199,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14451.01325,
PNEUMOTHORAX WITHOUT CC/MCC,201,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5857.898972,
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,917,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12847.89365,
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,918,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7021.123212,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,862,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14939.23976,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,863,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8174.517388,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,857,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17542.56838,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,856,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,37261.67676,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,858,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11410.24679,
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,769,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13842.36846,
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,776,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5363.119084,
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,67,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12031.17916,
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,68,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7080.922768,
PREMATURITY WITH MAJOR PROBLEMS,791,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,33250.19148,
PREMATURITY WITHOUT MAJOR PROBLEMS,792,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,20063.16062,
PROSTATECTOMY WITH CC,666,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14329.7758,
PROSTATECTOMY WITH MCC,665,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,25567.99646,
PROSTATECTOMY WITHOUT CC/MCC,667,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9061.680664,
PSYCHOSES,885,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,850,11442.1945,
PULMONARY EDEMA AND RESPIRATORY FAILURE,189,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10120.05089,
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,175,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11252.14659,
PULMONARY EMBOLISM WITHOUT MCC,176,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6594.3346,
RADIOTHERAPY,849,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,22195.46534,
RECTAL RESECTION WITH CC,333,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,19186.64658,
RECTAL RESECTION WITH MCC,332,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,29659.7606,
RECTAL RESECTION WITHOUT CC/MCC,334,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13417.21819,
RED BLOOD CELL DISORDERS WITH MCC,811,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11503.6324,
RED BLOOD CELL DISORDERS WITHOUT MCC,812,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7521.637304,
REHABILITATION WITH CC/MCC,945,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12685.69759,
REHABILITATION WITHOUT CC/MCC,946,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9394.264496,
RENAL FAILURE WITH CC,683,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7174.308376,
RENAL FAILURE WITH MCC,682,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12131.93732,
RENAL FAILURE WITHOUT CC/MCC,684,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,4917.489516,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,178,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7995.11872,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,177,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12801.20084,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,179,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6184.7486,
RESPIRATORY NEOPLASMS WITH CC,181,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8773.33212,
RESPIRATORY NEOPLASMS WITH MCC,180,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14466.57752,
RESPIRATORY NEOPLASMS WITHOUT CC/MCC,182,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6094.63968,
RESPIRATORY SIGNS AND SYMPTOMS,204,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6613.994728,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,208,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,22516.58076,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,207,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,52711.26068,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,815,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8306.40408,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,814,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17421.33092,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,816,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5177.16704,
REVISION OF HIP OR KNEE REPLACEMENT WITH CC,467,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,28888.91975,
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,466,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,42641.17929,
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,468,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,22510.84656,
SALIVARY GLAND PROCEDURES,139,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9900.512792,
SEIZURES WITH MCC,100,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15865.7233,
SEIZURES WITHOUT MCC,101,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7393.846472,
SEPTIC ARTHRITIS WITH CC,549,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9889.044384,
SEPTIC ARTHRITIS WITH MCC,548,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15817.39215,
SEPTIC ARTHRITIS WITHOUT CC/MCC,550,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7160.382452,
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,870,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,56619.5303,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,871,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15912.4161,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,872,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8382.587076,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17033.86257,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,24743.09026,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13879,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,555,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10827.8155,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,556,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6804.042632,
SIGNS AND SYMPTOMS WITH MCC,947,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10398.56937,
SIGNS AND SYMPTOMS WITHOUT MCC,948,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6557.47186,
SIMPLE PNEUMONIA AND PLEURISY WITH CC,194,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6601.707148,
SIMPLE PNEUMONIA AND PLEURISY WITH MCC,193,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10767.19677,
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,195,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5148.49602,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,8,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,45911.31391,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,19,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,54288.16678,
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL,402,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,32934.81026,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,450,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,43658.59091,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,451,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,26462.53229,
SINUS AND MASTOID PROCEDURES WITH CC/MCC,135,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17327.12614,
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,136,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8327,
SKIN DEBRIDEMENT WITH CC,571,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13839.91094,
SKIN DEBRIDEMENT WITH MCC,570,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,24092.66769,
SKIN DEBRIDEMENT WITHOUT CC/MCC,572,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9390.168636,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,577,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,21713.7922,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,576,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,40149.25806,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,578,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13159.17901,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,574,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,28436.73681,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,573,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,53667.23441,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,575,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13381.99379,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14695.12651,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,29155.96982,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",624,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10255.21427,
SKIN GRAFTS FOR INJURIES WITH CC/MCC,904,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,30089.00673,
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,905,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11728.9047,
SKIN ULCERS WITH CC,593,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9717.837436,
SKIN ULCERS WITH MCC,592,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15853.43572,
SKIN ULCERS WITHOUT CC/MCC,594,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7100.582896,
SOFT TISSUE PROCEDURES WITH CC,501,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14319.94573,
SOFT TISSUE PROCEDURES WITH MCC,500,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,25925.15546,
SOFT TISSUE PROCEDURES WITHOUT CC/MCC,502,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11025.23595,
SPINAL DISORDERS AND INJURIES WITH CC/MCC,52,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14587.81498,
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,53,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8021.332224,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",457,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,48848.04553,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",456,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,68838.29985,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",458,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,34180.77087,
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,29,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,27946.87195,
SPINAL PROCEDURES WITH MCC,28,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,49218.31128,
SPINAL PROCEDURES WITHOUT CC/MCC,30,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17982.46374,
SPLENIC PROCEDURES WITH CC,800,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,23013.81817,
SPLENIC PROCEDURES WITH MCC,799,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,37099.48071,
SPLENIC PROCEDURES WITHOUT CC/MCC,801,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15637.17431,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",537,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7817.358396,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",538,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5900.495916,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,20022.20202,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,40855.38433,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13125.59296,
SYNCOPE AND COLLAPSE,312,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7139.903152,
"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12180.26847,
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7316.844304,
TESTES PROCEDURES WITH CC/MCC,711,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17069.90614,
TESTES PROCEDURES WITHOUT CC/MCC,712,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9008.434484,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13879,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,24739.81357,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10881.06168,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",12,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,34536.29152,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",11,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,44678.46005,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",13,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,23606.8987,
"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",4,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,113466.7904,
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,69,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6543.545936,
TRANSURETHRAL PROCEDURES WITH CC,669,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12713.54944,
TRANSURETHRAL PROCEDURES WITH MCC,668,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,23919.8224,
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,670,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8327,
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,713,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12315.43185,
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,714,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8661.924728,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12059.03101,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7503.61552,
TRAUMATIC INJURY WITH MCC,913,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13390.18551,
TRAUMATIC INJURY WITHOUT MCC,914,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7253.76806,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,86,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10671.35364,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,85,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,18610.76867,
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,87,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7492.966284,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,83,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11434.00278,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,82,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,18722.99523,
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,84,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7829.645976,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC,278,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,45596.75186,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC,279,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,29542.61901,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM,173,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,24381.83541,
UNCOMPLICATED PEPTIC ULCER WITH MCC,383,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11310.3078,
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,384,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7002.282256,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,256,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13908.72139,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,255,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,22096.34553,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,257,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8946.996584,
URETHRAL PROCEDURES WITH CC/MCC,671,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14704.1374,
URETHRAL PROCEDURES WITHOUT CC/MCC,672,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8842.96174,
URETHRAL STRICTURE,697,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8829.035816,
URINARY STONES WITH MCC,693,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,11013.76754,
URINARY STONES WITHOUT MCC,694,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6403.467524,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,742,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15030.16786,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,743,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,10163.467,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,740,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14823.73651,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,739,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,28886.46224,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,741,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13879,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,737,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,16879.85823,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,736,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,29281.30314,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,738,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12029.54082,
"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14229.83681,
"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8327,
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,768,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8778.247152,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,797,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8194.996688,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,796,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9559.73724,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,798,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7840.295212,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,806,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6176.55688,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,805,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,8840.504224,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,807,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,5522.857624,
VEIN LIGATION AND STRIPPING,263,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,25045.36473,
VENTRICULAR SHUNT PROCEDURES WITH CC,32,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,17456.55532,
VENTRICULAR SHUNT PROCEDURES WITH MCC,31,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,36703.00146,
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,33,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,13879,
VIRAL ILLNESS WITH MCC,865,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,12273.65408,
VIRAL ILLNESS WITHOUT MCC,866,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,7123.519712,
VIRAL MENINGITIS WITH CC/MCC,75,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15707.6231,
VIRAL MENINGITIS WITHOUT CC/MCC,76,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,6133.959936,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,464,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,25514.75028,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,463,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,46688.70814,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,465,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,14939.23976,
WOUND DEBRIDEMENTS FOR INJURIES WITH CC,902,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,15683.04794,
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,901,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,34377.37215,
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,903,MS-DRG,,,,,,,,inpatient,,,,,Cigna,Commercial,2300,,,,,,,Per Diem,2300,9581.035712,
"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,8213.837644,
ABORTION WITHOUT D&C,779,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,5841.515532,
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,880,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,850,,,,,,,Per Diem,850,7865.689544,
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,289,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,13982.44687,
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,288,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,22168.43266,
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,290,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7615.842084,
ACUTE LEUKEMIA WITH CC,835,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,17086.28958,
ACUTE LEUKEMIA WITH MCC,834,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,44971.72363,
ACUTE LEUKEMIA WITH OTHER PROCEDURES,850,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,70936.19934,
ACUTE LEUKEMIA WITHOUT CC/MCC,836,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,9989.80254,
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,121,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,9529.427876,
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,122,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,6437.053576,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",281,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,7529.009852,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",280,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,13140.33805,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",282,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,5923.432732,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",284,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,5670.308584,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",283,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,16226.15898,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",285,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,4972,
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,614,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,17954.6119,
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,615,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,11462.6738,
AFTERCARE WITH CC/MCC,949,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,9745.689284,
AFTERCARE WITHOUT CC/MCC,950,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5141.942644,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,9224.695892,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,15276.73863,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6585.323708,
AICD GENERATOR PROCEDURES,245,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,37373.90333,
AICD LEAD PROCEDURES,265,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,29639.2813,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,850,,,,,,,Per Diem,850,11596.19883,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,850,,,,,,,Per Diem,850,14295.37057,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,850,,,,,,,Per Diem,850,7231.650416,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,850,,,,,,,Per Diem,850,5053.472068,
ALLERGIC REACTIONS WITH MCC,915,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,13775.19635,
ALLERGIC REACTIONS WITHOUT MCC,916,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,5458.143036,
ALLOGENEIC BONE MARROW TRANSPLANT,14,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,98447.27179,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,240,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,23350.49786,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,239,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,40317.18832,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,241,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,11340.61717,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,475,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,18641.8972,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,474,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,35166.23479,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,476,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,9667.867944,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,15320.97392,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,28567.80433,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",618,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,11618.31648,
ANAL AND STOMAL PROCEDURES WITH CC,348,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,10721.32314,
ANAL AND STOMAL PROCEDURES WITH MCC,347,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,18804.91243,
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,349,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7131.711432,
ANGINA PECTORIS,311,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,5749.768268,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,268,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,56341.83099,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,269,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,34595.2719,
APPENDIX PROCEDURES WITH CC,398,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,12398.98739,
APPENDIX PROCEDURES WITH MCC,397,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,19618.35023,
APPENDIX PROCEDURES WITHOUT CC/MCC,399,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,9377.061884,
ATHEROSCLEROSIS WITH MCC,302,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,9802.212152,
ATHEROSCLEROSIS WITHOUT MCC,303,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5514.665904,
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,16,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,48574.44208,
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,17,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,39633.99888,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,519,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,16385.07834,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,518,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,30614.91516,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,520,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,12237.61051,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,95,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,21128.08422,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,94,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,28829.93937,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,96,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,21128.08422,
BEHAVIORAL AND DEVELOPMENTAL DISORDERS,886,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,850,,,,,,,Per Diem,850,17000.27652,
BENIGN PROSTATIC HYPERTROPHY WITH MCC,725,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,9585.950744,
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,726,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,5914.42184,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,461,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,43912.53423,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,462,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,21789.9752,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,409,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,17835.83196,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,408,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,29208.39683,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,410,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,13005.99384,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,478,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,20145.07782,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,477,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,28299.11591,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,479,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,15227.58831,
BONE DISEASES AND ARTHROPATHIES WITH MCC,553,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,10618.92664,
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,554,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,6799.946772,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,17536.015,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,15802.64705,
BRONCHITIS AND ASTHMA WITH CC/MCC,202,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,7955.798464,
BRONCHITIS AND ASTHMA WITHOUT CC/MCC,203,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,5488.4524,
"CARDIAC ARREST, UNEXPLAINED WITH CC",297,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,6184,
"CARDIAC ARREST, UNEXPLAINED WITH MCC",296,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,12794.64747,
"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",298,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,4972,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,309,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6026.648404,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,308,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,9862.83088,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,310,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,4637.332692,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,306,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,12908.51238,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,307,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,7480.678704,
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC,275,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,58410.24029,
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR,276,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,49204.38535,
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC,277,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,37833.45882,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,258,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,25739.20341,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,259,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,16564.47701,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,261,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,15486.44666,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,260,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,26646.02682,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,262,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,13351.68443,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,217,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,53863.01652,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,216,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,80137.95842,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,218,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,53863.01652,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,220,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,43684.80442,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,219,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,62898.48368,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,221,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,41287.90714,
CAROTID ARTERY STENT PROCEDURES WITH CC,35,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,19582.30666,
CAROTID ARTERY STENT PROCEDURES WITH MCC,34,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,31707.6906,
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,36,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,15914.87362,
CELLULITIS WITH MCC,602,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,11642.89164,
CELLULITIS WITHOUT MCC,603,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7134.168948,
CERVICAL SPINAL FUSION WITH CC,472,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,24133.62629,
CERVICAL SPINAL FUSION WITH MCC,471,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,39555.35836,
CERVICAL SPINAL FUSION WITHOUT CC/MCC,473,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,19998.44604,
CESAREAN SECTION WITH STERILIZATION WITH CC,784,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8684.042372,
CESAREAN SECTION WITH STERILIZATION WITH MCC,783,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,20111.49177,
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,785,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,7846.029416,
CESAREAN SECTION WITHOUT STERILIZATION WITH CC,787,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,9148.512896,
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,786,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,13512.24214,
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,788,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,7854.221136,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,837,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,39355.4804,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,838,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,17099.39633,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,839,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,11828.02451,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,847,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,10716.4081,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,846,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,21237.0341,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,848,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6958.046968,
CHEST PAIN,313,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,5898.0384,
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,18,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,353741.4064,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,415,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,16929.82772,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,414,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,29183.82167,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,416,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,11167.77188,
CHOLECYSTECTOMY WITH C.D.E. WITH CC,412,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,17223.0913,
CHOLECYSTECTOMY WITH C.D.E. WITH MCC,411,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,27059.70868,
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,413,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,13602.35106,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,191,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,6905.61996,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,190,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,9073.968244,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,192,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5259.08424,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",286,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,18126.63802,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",287,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,8765.959572,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,433,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,8652.094664,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,432,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,16122.9433,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,434,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,5836.6005,
COAGULATION DISORDERS,813,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,12494.83052,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC,429,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,73804.12051,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC,430,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,47242.46841,
COMPLEX AORTIC ARCH PROCEDURES,209,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,92720.44034,
COMPLICATED PEPTIC ULCER WITH CC,381,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8875.72862,
COMPLICATED PEPTIC ULCER WITH MCC,380,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,16073.79298,
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,382,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6558.291032,
COMPLICATIONS OF TREATMENT WITH CC,920,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8210.560956,
COMPLICATIONS OF TREATMENT WITH MCC,919,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,14997.40098,
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,921,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,5639.180048,
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES,212,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,89077.58245,
CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION,317,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,54773.93578,
CONCUSSION WITH CC,89,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8999.423592,
CONCUSSION WITH MCC,88,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,11073.5671,
CONCUSSION WITHOUT CC/MCC,90,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,6743.423904,
CONNECTIVE TISSUE DISORDERS WITH CC,546,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,9448.329848,
CONNECTIVE TISSUE DISORDERS WITH MCC,545,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,20329.39152,
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,547,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6849.916264,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,233,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,62627.33774,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,234,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,44748.90884,
CORONARY BYPASS WITH PTCA WITH MCC,231,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,69055.38043,
CORONARY BYPASS WITH PTCA WITHOUT MCC,232,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,49663.12167,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,235,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,48073.92799,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,236,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,34313.47674,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC,323,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,35448.84913,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC,324,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,25812.10972,
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE,325,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,26298.69789,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,73,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,13141.9764,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,74,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8444.024976,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,26,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,25469.69582,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,25,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,37245.29332,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,27,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,20666.89039,
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,955,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,55139.28649,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,23,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,46941.01312,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,24,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,32045.18947,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,16785.65345,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,9318.0815,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,56,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,19030.18473,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,57,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,10613.19243,
DENTAL AND ORAL DISEASES WITH CC,158,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,7452.826856,
DENTAL AND ORAL DISEASES WITH MCC,157,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,14063.5449,
DENTAL AND ORAL DISEASES WITHOUT CC/MCC,159,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,5803.83362,
DEPRESSIVE NEUROSES,881,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,850,,,,,,,Per Diem,850,7707.589348,
DIABETES WITH CC,638,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7341.419464,
DIABETES WITH MCC,637,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,11769.04412,
DIABETES WITHOUT CC/MCC,639,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,5088.696464,
DIGESTIVE MALIGNANCY WITH CC,375,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,9908.704512,
DIGESTIVE MALIGNANCY WITH MCC,374,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,17519.63156,
DIGESTIVE MALIGNANCY WITHOUT CC/MCC,376,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,7571.606796,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,7907.467316,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,14701.67988,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5731.746484,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,439,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,6890.874864,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,438,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,13354.14194,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,440,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5090.334808,
DISORDERS OF PERSONALITY AND IMPULSE CONTROL,883,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,850,,,,,,,Per Diem,850,16107.37904,
DISORDERS OF THE BILIARY TRACT WITH CC,445,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8965.018368,
DISORDERS OF THE BILIARY TRACT WITH MCC,444,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,13687.54495,
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,446,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6777.009956,
DYSEQUILIBRIUM,149,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6156.896752,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",147,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,10415.77198,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,17345.14793,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",148,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,6529.620012,
"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",3,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,173870.8953,
ENDOCRINE DISORDERS WITH CC,644,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,8396.513,
ENDOCRINE DISORDERS WITH MCC,643,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,13484.39029,
ENDOCRINE DISORDERS WITHOUT CC/MCC,645,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6293.698476,
ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES,213,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,46749.32687,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,266,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,50202.13685,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,267,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,38999.14058,
EPISTAXIS WITH MCC,150,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,10907.27518,
EPISTAXIS WITHOUT MCC,151,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6012.72248,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,10389.55848,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6386.264912,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,927,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,150975.0379,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,933,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,31265.33772,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,982,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,20139.34362,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,981,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,38433.9119,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,983,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,14040.60808,
EXTRACRANIAL PROCEDURES WITH CC,38,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,13291.88487,
EXTRACRANIAL PROCEDURES WITH MCC,37,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,26967.96141,
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,39,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,9629.36686,
EXTRAOCULAR PROCEDURES EXCEPT ORBIT,115,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,12573.47103,
"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,48687.48782,
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,748,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,13879,
FEVER AND INFLAMMATORY CONDITIONS,864,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7271.789844,
FOOT PROCEDURES WITH CC,504,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,15311.96302,
FOOT PROCEDURES WITH MCC,503,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,22863.90969,
FOOT PROCEDURES WITHOUT CC/MCC,505,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,14686.11562,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,11671.56266,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,7335.68526,
FRACTURES OF FEMUR WITH MCC,533,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,12842.15944,
FRACTURES OF FEMUR WITHOUT MCC,534,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,6603.345492,
FRACTURES OF HIP AND PELVIS WITH MCC,535,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,10501.78504,
FRACTURES OF HIP AND PELVIS WITHOUT MCC,536,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6615.633072,
FULL TERM NEONATE WITH MAJOR PROBLEMS,793,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,34156.19571,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,928,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,58756.75004,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,929,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,26383.89178,
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,934,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,18108.61623,
GASTROINTESTINAL HEMORRHAGE WITH CC,378,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8033.619804,
GASTROINTESTINAL HEMORRHAGE WITH MCC,377,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,14974.46416,
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,379,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,5164.060288,
GASTROINTESTINAL OBSTRUCTION WITH CC,389,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,6469.820456,
GASTROINTESTINAL OBSTRUCTION WITH MCC,388,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,12097.5321,
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,390,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,4456.29568,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,12896.2248,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,8374.395356,
HAND PROCEDURES FOR INJURIES,906,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,14437.08733,
HEADACHES WITH MCC,102,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,9182.098948,
HEADACHES WITHOUT MCC,103,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6850.735436,
HEART FAILURE AND SHOCK WITH CC,292,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,6954.77028,
HEART FAILURE AND SHOCK WITH MCC,291,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,10516.53014,
HEART FAILURE AND SHOCK WITHOUT CC/MCC,293,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,4636.51352,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,1,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,229563.9421,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,2,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,92826.9327,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,421,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,14233.1135,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,420,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,27910.00921,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,422,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,11464.31214,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,354,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,13781.74973,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,353,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,23772.37144,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,355,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,11017.8634,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,481,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,17157.55754,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,480,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,23856.74616,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,482,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,13360.69532,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,521,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,23511.87474,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,522,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,17347.60544,
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,969,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,50143.97564,
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,970,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,21604.84233,
HIV WITH MAJOR RELATED CONDITION WITH CC,975,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,10608.2774,
HIV WITH MAJOR RELATED CONDITION WITH MCC,974,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,23641.30392,
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,976,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7327.49354,
HIV WITH OR WITHOUT OTHER RELATED CONDITION,977,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,10383.82427,
HYPERTENSION WITH MCC,304,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,9748.1468,
HYPERTENSION WITHOUT MCC,305,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,6185.567772,
INBORN AND OTHER DISORDERS OF METABOLISM,642,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,11649.44501,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,8019.69388,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,11729.72387,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,5436.025392,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,854,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,16367.87573,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,853,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,40455.62839,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,855,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,12264.64318,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,727,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,12147.50159,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,728,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6645.123264,
INFLAMMATORY BOWEL DISEASE WITH CC,386,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,7997.576236,
INFLAMMATORY BOWEL DISEASE WITH MCC,385,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,12961.75856,
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,387,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5581.018836,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,351,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,12488.27714,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,350,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,20412.94707,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,352,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,9566.290616,
INTERSTITIAL LUNG DISEASE WITH CC,197,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,7774.761452,
INTERSTITIAL LUNG DISEASE WITH MCC,196,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,15459.41398,
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,198,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5866.909864,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,65,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8276.094716,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,64,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,16473.54892,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,66,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5606.413168,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,21,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,43365.32734,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,20,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,64459.00634,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,22,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,25190.35817,
INTRAOCULAR PROCEDURES WITH CC/MCC,116,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,14811.44893,
INTRAOCULAR PROCEDURES WITHOUT CC/MCC,117,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,8887.197028,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",62,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,14394.49038,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",61,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,22585.39121,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",63,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,11499.53654,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,657,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,14990.8476,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,656,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,26080.79814,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,658,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,12711.9111,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,660,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,10826.99632,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,659,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,20814.34135,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,661,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,8481.706888,
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,689,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,9504.852716,
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,690,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6631.19734,
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,687,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8583.284216,
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,686,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,14775.40536,
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,688,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6473.916316,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,695,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,9369.689336,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,696,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,5644.09508,
KIDNEY TRANSPLANT,652,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,26455.15974,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,650,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,38512.55241,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,651,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,30356.87598,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,486,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,17129.70569,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,485,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,26435.49961,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,487,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,12829.87186,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,488,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,12480.90459,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,489,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,13879,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,418,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,13857.11355,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,417,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,19548.72061,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,419,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,11188.25118,
"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,30825.44236,
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,5,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,84460.72906,
LIVER TRANSPLANT WITHOUT MCC,6,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,37985.00564,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,496,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,14777.04371,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,495,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,29700.7192,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,497,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,9434.403924,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,498,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,24712.7809,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,499,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,16504.67746,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",493,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,20775.02109,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",492,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,30076.71915,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",494,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,16436.68618,
LUNG TRANSPLANT,7,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,106084.4123,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,821,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,18337.98439,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,820,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,48042.79946,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,822,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,9862.83088,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,841,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,13363.97201,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,840,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,26499.39503,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,824,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,18559.16083,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,823,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,37557.39786,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,825,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,11053.90697,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,842,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8276.913888,
MAJOR BLADDER PROCEDURES WITH CC,654,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,22931.0818,
MAJOR BLADDER PROCEDURES WITH MCC,653,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,42567.45381,
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,655,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,17338.59455,
MAJOR CHEST PROCEDURES WITH CC,164,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,20675.90128,
MAJOR CHEST PROCEDURES WITH MCC,163,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,36713.6507,
MAJOR CHEST PROCEDURES WITHOUT CC/MCC,165,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,15680.59042,
MAJOR CHEST TRAUMA WITH CC,184,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8716.809252,
MAJOR CHEST TRAUMA WITH MCC,183,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,12532.51243,
MAJOR CHEST TRAUMA WITHOUT CC/MCC,185,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6442.78778,
MAJOR ESOPHAGEAL DISORDERS WITH CC,369,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,8193.358344,
MAJOR ESOPHAGEAL DISORDERS WITH MCC,368,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,13040.39907,
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,370,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5740.757376,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,372,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,8363.74612,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,371,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,14524.73873,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,373,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5958.657128,
MAJOR HEAD AND NECK PROCEDURES WITH CC,141,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,17866.96049,
MAJOR HEAD AND NECK PROCEDURES WITH MCC,140,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,34940.14332,
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,142,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,13879,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,809,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,10369.89835,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,808,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,18086.49859,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,810,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8573.454152,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,469,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,24847.1251,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,470,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,15801.00871,
MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,483,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,22706.62867,
MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,707,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,16385.89752,
MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,708,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,13879,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,507,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,14797.52301,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,508,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,12405.54077,
MAJOR SKIN DISORDERS WITH MCC,595,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,17372.1806,
MAJOR SKIN DISORDERS WITHOUT MCC,596,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,8867.5369,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,330,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,19637.19118,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,329,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,37653.24098,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,331,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,13785.84559,
MAJOR THUMB OR JOINT PROCEDURES,506,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,9826.787312,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,436,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,9265.654492,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,435,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,15045.73212,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,437,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6989.994676,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,8910.953016,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,15086.69072,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",756,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7868.14706,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,9360.678444,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,14824.55568,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",724,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,5010.875124,
MALIGNANT BREAST DISORDERS WITH CC,598,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,9267.292836,
MALIGNANT BREAST DISORDERS WITH MCC,597,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,13656.41641,
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,599,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6006.169104,
MASTECTOMY FOR MALIGNANCY WITH CC/MCC,582,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,15782.16775,
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,583,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,14125.80197,
MEDICAL BACK PROBLEMS WITH MCC,551,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,13730.14189,
MEDICAL BACK PROBLEMS WITHOUT MCC,552,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,7874.700436,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,760,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,8253.1579,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,761,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,4666.003712,
MINOR BLADDER PROCEDURES WITH CC,663,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,12453.05274,
MINOR BLADDER PROCEDURES WITH MCC,662,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,25078.95078,
MINOR BLADDER PROCEDURES WITHOUT CC/MCC,664,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,8575.911668,
MINOR SKIN DISORDERS WITH MCC,606,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,12395.7107,
MINOR SKIN DISORDERS WITHOUT MCC,607,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7424.975008,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,345,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,12326.08108,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,344,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,21157.57442,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,346,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,9717.018264,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,10940.86123,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,6374.796504,
MOUTH PROCEDURES WITH CC/MCC,137,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,12231.8763,
MOUTH PROCEDURES WITHOUT CC/MCC,138,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,7259.502264,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC,427,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,59132.74999,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,426,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,90282.58446,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC,428,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,46053.84984,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,447,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,54733.79635,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,448,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,34739.44618,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,59,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,10165.10535,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,58,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,14003.74534,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,60,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,7534.744056,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,827,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,18932.70326,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,826,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,38319.22782,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,828,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,13957.05254,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,829,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,25885.8352,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,830,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,13879,
NEONATE WITH OTHER SIGNIFICANT PROBLEMS,794,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,1184,12090.15955,
"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,1184,14763.11778,
NERVOUS SYSTEM NEOPLASMS WITH MCC,54,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,12507.93727,
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,55,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,8352.277712,
NEUROLOGICAL EYE DISORDERS,123,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,6541.907592,
NEUROSES EXCEPT DEPRESSIVE,882,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,850,,,,,,,Per Diem,850,8796.268936,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,98,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,18799.17823,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,97,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,29586.8543,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,99,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,11160.39933,
NON-EXTENSIVE BURNS,935,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,16874.9432,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,988,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,13463.91099,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,987,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,28084.49285,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,989,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,9823.510624,
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,600,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,8532.495552,
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,601,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,4955.9906,
NONTRAUMATIC STUPOR AND COMA WITH MCC,80,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,14827.0132,
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,81,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7336.504432,
NORMAL NEWBORN,795,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,530,2786,
O.R. PROCEDURES FOR OBESITY WITH CC,620,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,13879,
O.R. PROCEDURES FOR OBESITY WITH MCC,619,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,23652.77233,
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,621,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,13879,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,940,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,19143.23047,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,939,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,29723.65602,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,941,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,16610.35064,
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,876,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,850,,,,,,,Per Diem,850,31660.17863,
ORBITAL PROCEDURES WITH CC/MCC,113,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,19259.55289,
ORBITAL PROCEDURES WITHOUT CC/MCC,114,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,11083.39716,
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,884,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,850,,,,,,,Per Diem,850,13179.65831,
OSTEOMYELITIS WITH CC,540,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,10618.92664,
OSTEOMYELITIS WITH MCC,539,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,16135.23088,
OSTEOMYELITIS WITHOUT CC/MCC,541,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,6319.91198,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,818,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,8635.711224,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,817,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,13827.62336,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,819,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,8327,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,832,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5911.145152,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,831,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,9850.5433,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,833,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,4283.450388,
OTHER CARDIOTHORACIC PROCEDURES WITH MCC,228,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,40527.71553,
OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,229,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,25799.82214,
OTHER CEREBROVASCULAR DISORDERS WITH CC,71,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8404.70472,
OTHER CEREBROVASCULAR DISORDERS WITH MCC,70,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,13637.57546,
OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,72,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6194.578664,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,315,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,7891.083876,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,314,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,17081.37454,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,316,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5587.572212,
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,264,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,27365.25983,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,394,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7664.992404,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,393,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,13101.0178,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,395,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5316.42628,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,357,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,19049.84486,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,356,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,35984.58762,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,358,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,11451.20539,
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,92,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,8380.12956,
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,91,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,14386.29866,
OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,93,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,6523.066636,
OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT,124,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,10838.46473,
OTHER DISORDERS OF THE EYE WITHOUT MCC,125,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6289.602616,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,7507.71138,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,12807.75422,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5661.297692,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,14195.43159,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,30691.09815,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,9848.904956,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,17848.11954,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,30528.9021,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,13879,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,319,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,36558.82719,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,320,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,19703.54412,
OTHER FACTORS INFLUENCING HEALTH STATUS,951,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,4972,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,749,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,21033.06027,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,750,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,12089.34038,
OTHER HEART ASSIST SYSTEM IMPLANT,215,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,81564.95604,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,424,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,17922.66419,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,423,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,34020.21316,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,425,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,12290.03752,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,868,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,8446.482492,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,867,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,17146.9083,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,869,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5977.498084,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,14330.59497,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8336.713444,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,699,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8314.5958,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,698,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,13552.38157,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,700,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5651.467628,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,674,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,19157.15639,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,673,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,34418.33075,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,675,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,13445.88921,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,271,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,29132.21384,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,270,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,43221.97224,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,272,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,20913.46116,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,729,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8672.573964,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,730,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,5504.83584,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,717,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,15486.44666,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,718,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,11002.29913,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,715,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,18327.33516,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,716,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,12050.02012,
OTHER MENTAL DISORDER DIAGNOSES,887,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,850,,,,,,,Per Diem,850,8772.512948,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,964,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,12554.63007,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,963,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,22394.52414,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,965,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,7704.31266,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,565,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7982.011968,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,564,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,12644.73899,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,566,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6138.055796,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,516,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,17023.21333,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,515,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,26106.19247,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,517,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,13879,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,844,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,9972.599928,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,843,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,16340.84306,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,845,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6976.068752,
OTHER O.R. PROCEDURES FOR INJURIES WITH CC,908,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,16344.11974,
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,907,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,31450.4706,
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,909,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,10753.27084,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,958,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,34519.08891,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,957,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,62420.08723,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,959,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,24117.24285,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,803,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,15227.58831,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,802,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,32636.63165,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,804,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,11107.97232,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,205,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,14999.03932,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,206,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7709.227692,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,167,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,14772.94785,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,166,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,30618.19184,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,168,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,11193.16621,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,14155.29216,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,26528.88522,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,11821.47113,
OTHER VASCULAR PROCEDURES WITH CC,253,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,21262.42843,
OTHER VASCULAR PROCEDURES WITH MCC,252,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,28575.17688,
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,254,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,14595.18752,
OTITIS MEDIA AND URI WITH MCC,152,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,9684.251384,
OTITIS MEDIA AND URI WITHOUT MCC,153,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6047.127704,
PANCREAS TRANSPLANT,10,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,25147.76123,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",406,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,23757.62634,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",405,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,44812.80426,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",407,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,18182.34171,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,543,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,8421.08816,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,542,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,14470.67338,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,544,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,6181.471912,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,17448.3636,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",735,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,13879,
PENIS PROCEDURES WITH CC/MCC,709,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,19062.95161,
PENIS PROCEDURES WITHOUT CC/MCC,710,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,13879,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,273,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,33794.94086,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,274,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,26964.68472,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES,321,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,22288.03178,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC,322,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,14442.00236,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC,250,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,17878.4289,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC,251,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,13879,
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC,359,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,28168.04839,
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC,360,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,19777.2696,
PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE,318,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,19841.98418,
PERIPHERAL VASCULAR DISORDERS WITH CC,300,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8744.6611,
PERIPHERAL VASCULAR DISORDERS WITH MCC,299,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,13374.62124,
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,301,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5895.580884,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",41,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,18011.13476,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",40,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,31629.86926,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",42,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,14152.83464,
PERITONEAL ADHESIOLYSIS WITH CC,336,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,17273.87996,
PERITONEAL ADHESIOLYSIS WITH MCC,335,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,29251.81295,
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,337,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,12574.2902,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,243,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,17455.73615,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,242,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,26154.52362,
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,244,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,14806.5339,
PLEURAL EFFUSION WITH CC,187,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8102.430252,
PLEURAL EFFUSION WITH MCC,186,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,12766.79562,
PLEURAL EFFUSION WITHOUT CC/MCC,188,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5875.101584,
PNEUMOTHORAX WITH CC,200,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,9005.157796,
PNEUMOTHORAX WITH MCC,199,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,14451.01325,
PNEUMOTHORAX WITHOUT CC/MCC,201,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5857.898972,
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,917,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,12847.89365,
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,918,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,7021.123212,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,862,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,14939.23976,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,863,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8174.517388,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,857,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,17542.56838,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,856,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,37261.67676,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,858,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,11410.24679,
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,769,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,13842.36846,
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,776,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,5363.119084,
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,67,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,12031.17916,
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,68,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,7080.922768,
PREMATURITY WITH MAJOR PROBLEMS,791,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,33250.19148,
PREMATURITY WITHOUT MAJOR PROBLEMS,792,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,20063.16062,
PROSTATECTOMY WITH CC,666,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,14329.7758,
PROSTATECTOMY WITH MCC,665,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,25567.99646,
PROSTATECTOMY WITHOUT CC/MCC,667,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,9061.680664,
PSYCHOSES,885,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,850,,,,,,,Per Diem,850,11442.1945,
PULMONARY EDEMA AND RESPIRATORY FAILURE,189,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,10120.05089,
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,175,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,11252.14659,
PULMONARY EMBOLISM WITHOUT MCC,176,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6594.3346,
RADIOTHERAPY,849,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,22195.46534,
RECTAL RESECTION WITH CC,333,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,19186.64658,
RECTAL RESECTION WITH MCC,332,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,29659.7606,
RECTAL RESECTION WITHOUT CC/MCC,334,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,13417.21819,
RED BLOOD CELL DISORDERS WITH MCC,811,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,11503.6324,
RED BLOOD CELL DISORDERS WITHOUT MCC,812,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7521.637304,
REHABILITATION WITH CC/MCC,945,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,12685.69759,
REHABILITATION WITHOUT CC/MCC,946,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,9394.264496,
RENAL FAILURE WITH CC,683,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,7174.308376,
RENAL FAILURE WITH MCC,682,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,12131.93732,
RENAL FAILURE WITHOUT CC/MCC,684,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,4917.489516,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,178,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,7995.11872,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,177,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,12801.20084,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,179,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,6184.7486,
RESPIRATORY NEOPLASMS WITH CC,181,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8773.33212,
RESPIRATORY NEOPLASMS WITH MCC,180,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,14466.57752,
RESPIRATORY NEOPLASMS WITHOUT CC/MCC,182,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,6094.63968,
RESPIRATORY SIGNS AND SYMPTOMS,204,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6613.994728,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,208,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,22516.58076,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,207,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,52711.26068,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,815,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,8306.40408,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,814,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,17421.33092,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,816,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5177.16704,
REVISION OF HIP OR KNEE REPLACEMENT WITH CC,467,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,28888.91975,
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,466,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,42641.17929,
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,468,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,22510.84656,
SALIVARY GLAND PROCEDURES,139,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,9900.512792,
SEIZURES WITH MCC,100,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,15865.7233,
SEIZURES WITHOUT MCC,101,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,7393.846472,
SEPTIC ARTHRITIS WITH CC,549,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,9889.044384,
SEPTIC ARTHRITIS WITH MCC,548,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,15817.39215,
SEPTIC ARTHRITIS WITHOUT CC/MCC,550,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7160.382452,
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,870,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,56619.5303,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,871,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,15912.4161,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,872,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,8382.587076,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,17033.86257,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,24743.09026,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,13879,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,555,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,10827.8155,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,556,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6804.042632,
SIGNS AND SYMPTOMS WITH MCC,947,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,10398.56937,
SIGNS AND SYMPTOMS WITHOUT MCC,948,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,6557.47186,
SIMPLE PNEUMONIA AND PLEURISY WITH CC,194,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,6601.707148,
SIMPLE PNEUMONIA AND PLEURISY WITH MCC,193,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,10767.19677,
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,195,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5148.49602,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,8,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,45911.31391,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,19,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,54288.16678,
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL,402,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,32934.81026,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,450,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,43658.59091,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,451,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,26462.53229,
SINUS AND MASTOID PROCEDURES WITH CC/MCC,135,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,17327.12614,
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,136,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,8327,
SKIN DEBRIDEMENT WITH CC,571,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,13839.91094,
SKIN DEBRIDEMENT WITH MCC,570,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,24092.66769,
SKIN DEBRIDEMENT WITHOUT CC/MCC,572,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,9390.168636,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,577,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,21713.7922,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,576,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,40149.25806,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,578,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,13159.17901,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,574,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,28436.73681,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,573,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,53667.23441,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,575,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,13381.99379,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,14695.12651,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,29155.96982,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",624,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,10255.21427,
SKIN GRAFTS FOR INJURIES WITH CC/MCC,904,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,30089.00673,
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,905,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,11728.9047,
SKIN ULCERS WITH CC,593,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,9717.837436,
SKIN ULCERS WITH MCC,592,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,15853.43572,
SKIN ULCERS WITHOUT CC/MCC,594,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,7100.582896,
SOFT TISSUE PROCEDURES WITH CC,501,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,14319.94573,
SOFT TISSUE PROCEDURES WITH MCC,500,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,25925.15546,
SOFT TISSUE PROCEDURES WITHOUT CC/MCC,502,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,11025.23595,
SPINAL DISORDERS AND INJURIES WITH CC/MCC,52,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,14587.81498,
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,53,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8021.332224,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",457,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,48848.04553,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",456,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,68838.29985,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",458,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,34180.77087,
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,29,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,27946.87195,
SPINAL PROCEDURES WITH MCC,28,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,49218.31128,
SPINAL PROCEDURES WITHOUT CC/MCC,30,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,17982.46374,
SPLENIC PROCEDURES WITH CC,800,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,23013.81817,
SPLENIC PROCEDURES WITH MCC,799,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,37099.48071,
SPLENIC PROCEDURES WITHOUT CC/MCC,801,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,15637.17431,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",537,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7817.358396,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",538,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,5900.495916,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,20022.20202,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,40855.38433,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,13125.59296,
SYNCOPE AND COLLAPSE,312,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7139.903152,
"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,12180.26847,
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7316.844304,
TESTES PROCEDURES WITH CC/MCC,711,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,17069.90614,
TESTES PROCEDURES WITHOUT CC/MCC,712,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,9008.434484,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,13879,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,24739.81357,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,10881.06168,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",12,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,34536.29152,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",11,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,44678.46005,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",13,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,23606.8987,
"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",4,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,113466.7904,
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,69,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6543.545936,
TRANSURETHRAL PROCEDURES WITH CC,669,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,12713.54944,
TRANSURETHRAL PROCEDURES WITH MCC,668,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,23919.8224,
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,670,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,8327,
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,713,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,12315.43185,
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,714,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,8661.924728,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,12059.03101,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,7503.61552,
TRAUMATIC INJURY WITH MCC,913,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,13390.18551,
TRAUMATIC INJURY WITHOUT MCC,914,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7253.76806,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,86,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,10671.35364,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,85,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,18610.76867,
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,87,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7492.966284,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,83,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,11434.00278,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,82,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,18722.99523,
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,84,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7829.645976,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC,278,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,45596.75186,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC,279,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,29542.61901,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM,173,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,24381.83541,
UNCOMPLICATED PEPTIC ULCER WITH MCC,383,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,11310.3078,
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,384,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7002.282256,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,256,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,13908.72139,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,255,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,22096.34553,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,257,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8946.996584,
URETHRAL PROCEDURES WITH CC/MCC,671,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,14704.1374,
URETHRAL PROCEDURES WITHOUT CC/MCC,672,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,8842.96174,
URETHRAL STRICTURE,697,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8829.035816,
URINARY STONES WITH MCC,693,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,11013.76754,
URINARY STONES WITHOUT MCC,694,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,6403.467524,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,742,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,15030.16786,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,743,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,10163.467,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,740,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,14823.73651,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,739,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,28886.46224,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,741,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,13879,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,737,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,16879.85823,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,736,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,29281.30314,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,738,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,12029.54082,
"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,14229.83681,
"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,8327,
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,768,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,8778.247152,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,797,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8194.996688,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,796,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,9559.73724,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,798,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7840.295212,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,806,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6176.55688,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,805,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,8840.504224,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,807,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,2786,,,,,,,Per Diem,2300,5522.857624,
VEIN LIGATION AND STRIPPING,263,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,25045.36473,
VENTRICULAR SHUNT PROCEDURES WITH CC,32,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,17456.55532,
VENTRICULAR SHUNT PROCEDURES WITH MCC,31,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,36703.00146,
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,33,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,13879,,,,,,,Per Diem,2300,13879,
VIRAL ILLNESS WITH MCC,865,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,12273.65408,
VIRAL ILLNESS WITHOUT MCC,866,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,7123.519712,
VIRAL MENINGITIS WITH CC/MCC,75,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,15707.6231,
VIRAL MENINGITIS WITHOUT CC/MCC,76,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,6133.959936,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,464,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,25514.75028,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,463,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,6184,,,,,,,Per Diem,2300,46688.70814,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,465,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,8327,,,,,,,Per Diem,2300,14939.23976,
WOUND DEBRIDEMENTS FOR INJURIES WITH CC,902,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,3702,,,,,,,Per Diem,2300,15683.04794,
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,901,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,34377.37215,
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,903,MS-DRG,,,,,,,,inpatient,,,,,BCBS of AL ,BCBS of AL ,4972,,,,,,,Per Diem,2300,9581.035712,
"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7401.93,,,,,,,Fee Schedule,2300,8213.837644,
ABORTION WITHOUT D&C,779,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5264.1,,,,,,,Fee Schedule,2300,5841.515532,
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,880,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7088.2,,,,,,,Fee Schedule,850,7865.689544,
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,289,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12600.34,,,,,,,Fee Schedule,2300,13982.44687,
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,288,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,19977.17,,,,,,,Fee Schedule,2300,22168.43266,
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,290,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6863.05,,,,,,,Fee Schedule,2300,7615.842084,
ACUTE LEUKEMIA WITH CC,835,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15397.38,,,,,,,Fee Schedule,2300,17086.28958,
ACUTE LEUKEMIA WITH MCC,834,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,40526.44,,,,,,,Fee Schedule,2300,44971.72363,
ACUTE LEUKEMIA WITH OTHER PROCEDURES,850,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,63924.43,,,,,,,Fee Schedule,2300,70936.19934,
ACUTE LEUKEMIA WITHOUT CC/MCC,836,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9002.35,,,,,,,Fee Schedule,2300,9989.80254,
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,121,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8587.48,,,,,,,Fee Schedule,2300,9529.427876,
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,122,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5800.78,,,,,,,Fee Schedule,2300,6437.053576,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",281,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6784.8,,,,,,,Fee Schedule,2300,7529.009852,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",280,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11841.47,,,,,,,Fee Schedule,2300,13140.33805,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",282,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5337.92,,,,,,,Fee Schedule,2300,5923.432732,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",284,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5109.82,,,,,,,Fee Schedule,2300,5670.308584,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",283,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14622.27,,,,,,,Fee Schedule,2300,16226.15898,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",285,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4421.08,,,,,,,Fee Schedule,2300,4972,
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,614,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16179.87,,,,,,,Fee Schedule,2300,17954.6119,
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,615,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10329.63,,,,,,,Fee Schedule,2300,11462.6738,
AFTERCARE WITH CC/MCC,949,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8782.37,,,,,,,Fee Schedule,2300,9745.689284,
AFTERCARE WITHOUT CC/MCC,950,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4633.68,,,,,,,Fee Schedule,2300,5141.942644,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8312.87,,,,,,,Fee Schedule,2300,9224.695892,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13766.69,,,,,,,Fee Schedule,2300,15276.73863,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5934.39,,,,,,,Fee Schedule,2300,6585.323708,
AICD GENERATOR PROCEDURES,245,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,33679.64,,,,,,,Fee Schedule,2300,37373.90333,
AICD LEAD PROCEDURES,265,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,26709.55,,,,,,,Fee Schedule,2300,29639.2813,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10449.96,,,,,,,Fee Schedule,850,11596.19883,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12882.33,,,,,,,Fee Schedule,850,14295.37057,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6516.83,,,,,,,Fee Schedule,850,7231.650416,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4553.96,,,,,,,Fee Schedule,850,5053.472068,
ALLERGIC REACTIONS WITH MCC,915,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12413.57,,,,,,,Fee Schedule,2300,13775.19635,
ALLERGIC REACTIONS WITHOUT MCC,916,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4918.63,,,,,,,Fee Schedule,2300,5458.143036,
ALLOGENEIC BONE MARROW TRANSPLANT,14,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,88716.14,,,,,,,Fee Schedule,2300,98447.27179,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,240,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,21042.39,,,,,,,Fee Schedule,2300,23350.49786,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,239,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,36331.99,,,,,,,Fee Schedule,2300,40317.18832,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,241,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10219.64,,,,,,,Fee Schedule,2300,11340.61717,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,475,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16799.22,,,,,,,Fee Schedule,2300,18641.8972,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,474,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,31690.19,,,,,,,Fee Schedule,2300,35166.23479,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,476,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8712.24,,,,,,,Fee Schedule,2300,9667.867944,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13806.55,,,,,,,Fee Schedule,2300,15320.97392,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,25743.99,,,,,,,Fee Schedule,2300,28567.80433,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",618,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10469.89,,,,,,,Fee Schedule,2300,11618.31648,
ANAL AND STOMAL PROCEDURES WITH CC,348,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9661.56,,,,,,,Fee Schedule,2300,10721.32314,
ANAL AND STOMAL PROCEDURES WITH MCC,347,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16946.12,,,,,,,Fee Schedule,2300,18804.91243,
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,349,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6426.77,,,,,,,Fee Schedule,2300,7131.711432,
ANGINA PECTORIS,311,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5181.43,,,,,,,Fee Schedule,2300,5749.768268,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,268,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,50772.66,,,,,,,Fee Schedule,2300,56341.83099,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,269,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,31175.66,,,,,,,Fee Schedule,2300,34595.2719,
APPENDIX PROCEDURES WITH CC,398,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11173.4,,,,,,,Fee Schedule,2300,12398.98739,
APPENDIX PROCEDURES WITH MCC,397,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,17679.15,,,,,,,Fee Schedule,2300,19618.35023,
APPENDIX PROCEDURES WITHOUT CC/MCC,399,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8450.18,,,,,,,Fee Schedule,2300,9377.061884,
ATHEROSCLEROSIS WITH MCC,302,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8833.3,,,,,,,Fee Schedule,2300,9802.212152,
ATHEROSCLEROSIS WITHOUT MCC,303,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4969.56,,,,,,,Fee Schedule,2300,5514.665904,
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,16,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,43773.05,,,,,,,Fee Schedule,2300,48574.44208,
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,17,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,35716.33,,,,,,,Fee Schedule,2300,39633.99888,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,519,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14765.48,,,,,,,Fee Schedule,2300,16385.07834,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,518,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,27588.75,,,,,,,Fee Schedule,2300,30614.91516,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,520,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11027.97,,,,,,,Fee Schedule,2300,12237.61051,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,95,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,19039.65,,,,,,,Fee Schedule,2300,21128.08422,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,94,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,25980.21,,,,,,,Fee Schedule,2300,28829.93937,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,96,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,19039.65,,,,,,,Fee Schedule,2300,21128.08422,
BEHAVIORAL AND DEVELOPMENTAL DISORDERS,886,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15319.86,,,,,,,Fee Schedule,850,17000.27652,
BENIGN PROSTATIC HYPERTROPHY WITH MCC,725,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8638.42,,,,,,,Fee Schedule,2300,9585.950744,
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,726,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5329.8,,,,,,,Fee Schedule,2300,5914.42184,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,461,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,39571.95,,,,,,,Fee Schedule,2300,43912.53423,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,462,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,19636.12,,,,,,,Fee Schedule,2300,21789.9752,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,409,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16072.83,,,,,,,Fee Schedule,2300,17835.83196,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,408,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,26321.26,,,,,,,Fee Schedule,2300,29208.39683,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,410,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11720.4,,,,,,,Fee Schedule,2300,13005.99384,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,478,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,18153.81,,,,,,,Fee Schedule,2300,20145.07782,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,477,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,25501.86,,,,,,,Fee Schedule,2300,28299.11591,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,479,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13722.4,,,,,,,Fee Schedule,2300,15227.58831,
BONE DISEASES AND ARTHROPATHIES WITH MCC,553,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9569.29,,,,,,,Fee Schedule,2300,10618.92664,
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,554,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6127.8,,,,,,,Fee Schedule,2300,6799.946772,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15802.65,,,,,,,Fee Schedule,2300,17536.015,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14240.62,,,,,,,Fee Schedule,2300,15802.64705,
BRONCHITIS AND ASTHMA WITH CC/MCC,202,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7169.4,,,,,,,Fee Schedule,2300,7955.798464,
BRONCHITIS AND ASTHMA WITHOUT CC/MCC,203,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4945.94,,,,,,,Fee Schedule,2300,5488.4524,
"CARDIAC ARREST, UNEXPLAINED WITH CC",297,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4602.68,,,,,,,Fee Schedule,2300,6184,
"CARDIAC ARREST, UNEXPLAINED WITH MCC",296,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11529.95,,,,,,,Fee Schedule,2300,12794.64747,
"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",298,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,3359.55,,,,,,,Fee Schedule,2300,4972,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,309,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5430.94,,,,,,,Fee Schedule,2300,6026.648404,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,308,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8887.93,,,,,,,Fee Schedule,2300,9862.83088,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,310,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4178.95,,,,,,,Fee Schedule,2300,4637.332692,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,306,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11632.56,,,,,,,Fee Schedule,2300,12908.51238,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,307,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6741.24,,,,,,,Fee Schedule,2300,7480.678704,
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC,275,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,52636.61,,,,,,,Fee Schedule,2300,58410.24029,
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR,276,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,44340.72,,,,,,,Fee Schedule,2300,49204.38535,
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC,277,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,34093.77,,,,,,,Fee Schedule,2300,37833.45882,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,258,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,23194.98,,,,,,,Fee Schedule,2300,25739.20341,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,259,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14927.14,,,,,,,Fee Schedule,2300,16564.47701,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,261,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13955.67,,,,,,,Fee Schedule,2300,15486.44666,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,260,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,24012.17,,,,,,,Fee Schedule,2300,26646.02682,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,262,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12031.92,,,,,,,Fee Schedule,2300,13351.68443,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,217,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,48538.86,,,,,,,Fee Schedule,2300,53863.01652,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,216,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,72216.63,,,,,,,Fee Schedule,2300,80137.95842,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,218,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,48538.86,,,,,,,Fee Schedule,2300,53863.01652,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,220,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,39366.73,,,,,,,Fee Schedule,2300,43684.80442,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,219,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,56681.21,,,,,,,Fee Schedule,2300,62898.48368,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,221,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,37206.76,,,,,,,Fee Schedule,2300,41287.90714,
CAROTID ARTERY STENT PROCEDURES WITH CC,35,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,17646.67,,,,,,,Fee Schedule,2300,19582.30666,
CAROTID ARTERY STENT PROCEDURES WITH MCC,34,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,28573.51,,,,,,,Fee Schedule,2300,31707.6906,
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,36,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14341.75,,,,,,,Fee Schedule,2300,15914.87362,
CELLULITIS WITH MCC,602,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10492.04,,,,,,,Fee Schedule,2300,11642.89164,
CELLULITIS WITHOUT MCC,603,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6428.98,,,,,,,Fee Schedule,2300,7134.168948,
CERVICAL SPINAL FUSION WITH CC,472,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,21748.11,,,,,,,Fee Schedule,2300,24133.62629,
CERVICAL SPINAL FUSION WITH MCC,471,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,35645.46,,,,,,,Fee Schedule,2300,39555.35836,
CERVICAL SPINAL FUSION WITHOUT CC/MCC,473,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,18021.68,,,,,,,Fee Schedule,2300,19998.44604,
CESAREAN SECTION WITH STERILIZATION WITH CC,784,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4734,,,,,,,Fee Schedule,2300,8684.042372,
CESAREAN SECTION WITH STERILIZATION WITH MCC,783,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4734,,,,,,,Fee Schedule,2300,20111.49177,
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,785,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4734,,,,,,,Fee Schedule,2300,7846.029416,
CESAREAN SECTION WITHOUT STERILIZATION WITH CC,787,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4734,,,,,,,Fee Schedule,2300,9148.512896,
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,786,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4734,,,,,,,Fee Schedule,2300,13512.24214,
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,788,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4734,,,,,,,Fee Schedule,2300,7854.221136,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,837,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,35465.34,,,,,,,Fee Schedule,2300,39355.4804,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,838,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15409.19,,,,,,,Fee Schedule,2300,17099.39633,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,839,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10658.87,,,,,,,Fee Schedule,2300,11828.02451,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,847,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9657.13,,,,,,,Fee Schedule,2300,10716.4081,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,846,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,19137.84,,,,,,,Fee Schedule,2300,21237.0341,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,848,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6270.27,,,,,,,Fee Schedule,2300,6958.046968,
CHEST PAIN,313,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5315.04,,,,,,,Fee Schedule,2300,5898.0384,
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,18,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,318775.43,,,,,,,Fee Schedule,2300,353741.4064,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,415,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15256.38,,,,,,,Fee Schedule,2300,16929.82772,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,414,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,26299.11,,,,,,,Fee Schedule,2300,29183.82167,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,416,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10063.88,,,,,,,Fee Schedule,2300,11167.77188,
CHOLECYSTECTOMY WITH C.D.E. WITH CC,412,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15520.66,,,,,,,Fee Schedule,2300,17223.0913,
CHOLECYSTECTOMY WITH C.D.E. WITH MCC,411,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,24384.96,,,,,,,Fee Schedule,2300,27059.70868,
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,413,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12257.81,,,,,,,Fee Schedule,2300,13602.35106,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,191,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6223.03,,,,,,,Fee Schedule,2300,6905.61996,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,190,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8177.04,,,,,,,Fee Schedule,2300,9073.968244,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,192,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4739.24,,,,,,,Fee Schedule,2300,5259.08424,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",286,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16334.89,,,,,,,Fee Schedule,2300,18126.63802,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",287,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7899.48,,,,,,,Fee Schedule,2300,8765.959572,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,433,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7796.87,,,,,,,Fee Schedule,2300,8652.094664,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,432,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14529.25,,,,,,,Fee Schedule,2300,16122.9433,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,434,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5259.68,,,,,,,Fee Schedule,2300,5836.6005,
COAGULATION DISORDERS,813,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11259.76,,,,,,,Fee Schedule,2300,12494.83052,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC,429,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,66508.87,,,,,,,Fee Schedule,2300,73804.12051,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC,430,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,42572.73,,,,,,,Fee Schedule,2300,47242.46841,
COMPLEX AORTIC ARCH PROCEDURES,209,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,83555.38,,,,,,,Fee Schedule,2300,92720.44034,
COMPLICATED PEPTIC ULCER WITH CC,381,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7998.4,,,,,,,Fee Schedule,2300,8875.72862,
COMPLICATED PEPTIC ULCER WITH MCC,380,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14484.96,,,,,,,Fee Schedule,2300,16073.79298,
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,382,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5910.03,,,,,,,Fee Schedule,2300,6558.291032,
COMPLICATIONS OF TREATMENT WITH CC,920,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7398.98,,,,,,,Fee Schedule,2300,8210.560956,
COMPLICATIONS OF TREATMENT WITH MCC,919,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13514.97,,,,,,,Fee Schedule,2300,14997.40098,
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,921,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5081.77,,,,,,,Fee Schedule,2300,5639.180048,
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES,212,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,80272.61,,,,,,,Fee Schedule,2300,89077.58245,
CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION,317,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,49359.74,,,,,,,Fee Schedule,2300,54773.93578,
CONCUSSION WITH CC,89,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8109.87,,,,,,,Fee Schedule,2300,8999.423592,
CONCUSSION WITH MCC,88,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9978.99,,,,,,,Fee Schedule,2300,11073.5671,
CONCUSSION WITHOUT CC/MCC,90,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6076.86,,,,,,,Fee Schedule,2300,6743.423904,
CONNECTIVE TISSUE DISORDERS WITH CC,546,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8514.4,,,,,,,Fee Schedule,2300,9448.329848,
CONNECTIVE TISSUE DISORDERS WITH MCC,545,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,18319.91,,,,,,,Fee Schedule,2300,20329.39152,
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,547,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6172.83,,,,,,,Fee Schedule,2300,6849.916264,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,233,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,56436.87,,,,,,,Fee Schedule,2300,62627.33774,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,234,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,40325.65,,,,,,,Fee Schedule,2300,44748.90884,
CORONARY BYPASS WITH PTCA WITH MCC,231,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,62229.52,,,,,,,Fee Schedule,2300,69055.38043,
CORONARY BYPASS WITH PTCA WITHOUT MCC,232,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,44754.11,,,,,,,Fee Schedule,2300,49663.12167,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,235,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,43322.01,,,,,,,Fee Schedule,2300,48073.92799,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,236,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,30921.72,,,,,,,Fee Schedule,2300,34313.47674,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC,323,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,31944.87,,,,,,,Fee Schedule,2300,35448.84913,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC,324,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,23260.68,,,,,,,Fee Schedule,2300,25812.10972,
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE,325,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,23699.17,,,,,,,Fee Schedule,2300,26298.69789,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,73,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11842.94,,,,,,,Fee Schedule,2300,13141.9764,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,74,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7609.37,,,,,,,Fee Schedule,2300,8444.024976,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,26,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,22952.11,,,,,,,Fee Schedule,2300,25469.69582,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,25,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,33563.74,,,,,,,Fee Schedule,2300,37245.29332,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,27,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,18624.05,,,,,,,Fee Schedule,2300,20666.89039,
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,955,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,49688.98,,,,,,,Fee Schedule,2300,55139.28649,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,23,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,42301.07,,,,,,,Fee Schedule,2300,46941.01312,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,24,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,28877.65,,,,,,,Fee Schedule,2300,32045.18947,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15126.46,,,,,,,Fee Schedule,2300,16785.65345,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8397.03,,,,,,,Fee Schedule,2300,9318.0815,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,56,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,17149.12,,,,,,,Fee Schedule,2300,19030.18473,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,57,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9564.12,,,,,,,Fee Schedule,2300,10613.19243,
DENTAL AND ORAL DISEASES WITH CC,158,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6716.14,,,,,,,Fee Schedule,2300,7452.826856,
DENTAL AND ORAL DISEASES WITH MCC,157,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12673.42,,,,,,,Fee Schedule,2300,14063.5449,
DENTAL AND ORAL DISEASES WITHOUT CC/MCC,159,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5230.15,,,,,,,Fee Schedule,2300,5803.83362,
DEPRESSIVE NEUROSES,881,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6945.72,,,,,,,Fee Schedule,850,7707.589348,
DIABETES WITH CC,638,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6615.75,,,,,,,Fee Schedule,2300,7341.419464,
DIABETES WITH MCC,637,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10605.72,,,,,,,Fee Schedule,2300,11769.04412,
DIABETES WITHOUT CC/MCC,639,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4585.7,,,,,,,Fee Schedule,2300,5088.696464,
DIGESTIVE MALIGNANCY WITH CC,375,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8929.27,,,,,,,Fee Schedule,2300,9908.704512,
DIGESTIVE MALIGNANCY WITH MCC,374,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15787.88,,,,,,,Fee Schedule,2300,17519.63156,
DIGESTIVE MALIGNANCY WITHOUT CC/MCC,376,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6823.18,,,,,,,Fee Schedule,2300,7571.606796,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7125.84,,,,,,,Fee Schedule,2300,7907.467316,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13248.48,,,,,,,Fee Schedule,2300,14701.67988,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5165.19,,,,,,,Fee Schedule,2300,5731.746484,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,439,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6209.74,,,,,,,Fee Schedule,2300,6890.874864,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,438,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12034.14,,,,,,,Fee Schedule,2300,13354.14194,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,440,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4587.17,,,,,,,Fee Schedule,2300,5090.334808,
DISORDERS OF PERSONALITY AND IMPULSE CONTROL,883,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14515.23,,,,,,,Fee Schedule,850,16107.37904,
DISORDERS OF THE BILIARY TRACT WITH CC,445,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8078.86,,,,,,,Fee Schedule,2300,8965.018368,
DISORDERS OF THE BILIARY TRACT WITH MCC,444,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12334.58,,,,,,,Fee Schedule,2300,13687.54495,
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,446,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6107.13,,,,,,,Fee Schedule,2300,6777.009956,
DYSEQUILIBRIUM,149,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5548.31,,,,,,,Fee Schedule,2300,6156.896752,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",147,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9386.21,,,,,,,Fee Schedule,2300,10415.77198,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15630.65,,,,,,,Fee Schedule,2300,17345.14793,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",148,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5884.19,,,,,,,Fee Schedule,2300,6529.620012,
"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",3,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,156684.43,,,,,,,Fee Schedule,2300,173870.8953,
ENDOCRINE DISORDERS WITH CC,644,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7566.55,,,,,,,Fee Schedule,2300,8396.513,
ENDOCRINE DISORDERS WITH MCC,643,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12151.51,,,,,,,Fee Schedule,2300,13484.39029,
ENDOCRINE DISORDERS WITHOUT CC/MCC,645,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5671.59,,,,,,,Fee Schedule,2300,6293.698476,
ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES,213,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,42128.34,,,,,,,Fee Schedule,2300,46749.32687,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,266,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,45239.85,,,,,,,Fee Schedule,2300,50202.13685,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,267,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,35144.23,,,,,,,Fee Schedule,2300,38999.14058,
EPISTAXIS WITH MCC,150,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9829.13,,,,,,,Fee Schedule,2300,10907.27518,
EPISTAXIS WITHOUT MCC,151,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5418.39,,,,,,,Fee Schedule,2300,6012.72248,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9362.59,,,,,,,Fee Schedule,2300,10389.55848,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5755.01,,,,,,,Fee Schedule,2300,6386.264912,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,927,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,136051.74,,,,,,,Fee Schedule,2300,150975.0379,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,933,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,28174.88,,,,,,,Fee Schedule,2300,31265.33772,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,982,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,18148.65,,,,,,,Fee Schedule,2300,20139.34362,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,981,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,34634.87,,,,,,,Fee Schedule,2300,38433.9119,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,983,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12652.75,,,,,,,Fee Schedule,2300,14040.60808,
EXTRACRANIAL PROCEDURES WITH CC,38,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11978.03,,,,,,,Fee Schedule,2300,13291.88487,
EXTRACRANIAL PROCEDURES WITH MCC,37,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,24302.28,,,,,,,Fee Schedule,2300,26967.96141,
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,39,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8677.54,,,,,,,Fee Schedule,2300,9629.36686,
EXTRAOCULAR PROCEDURES EXCEPT ORBIT,115,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11330.63,,,,,,,Fee Schedule,2300,12573.47103,
"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,3234,,,,,,,Fee Schedule,2300,48687.48782,
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,748,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10241.05,,,,,,,Fee Schedule,2300,13879,
FEVER AND INFLAMMATORY CONDITIONS,864,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6553,,,,,,,Fee Schedule,2300,7271.789844,
FOOT PROCEDURES WITH CC,504,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13798.43,,,,,,,Fee Schedule,2300,15311.96302,
FOOT PROCEDURES WITH MCC,503,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,20603.9,,,,,,,Fee Schedule,2300,22863.90969,
FOOT PROCEDURES WITHOUT CC/MCC,505,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13234.45,,,,,,,Fee Schedule,2300,14686.11562,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10517.87,,,,,,,Fee Schedule,2300,11671.56266,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6610.58,,,,,,,Fee Schedule,2300,7335.68526,
FRACTURES OF FEMUR WITH MCC,533,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11572.76,,,,,,,Fee Schedule,2300,12842.15944,
FRACTURES OF FEMUR WITHOUT MCC,534,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5950.63,,,,,,,Fee Schedule,2300,6603.345492,
FRACTURES OF HIP AND PELVIS WITH MCC,535,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9463.72,,,,,,,Fee Schedule,2300,10501.78504,
FRACTURES OF HIP AND PELVIS WITHOUT MCC,536,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5961.7,,,,,,,Fee Schedule,2300,6615.633072,
FULL TERM NEONATE WITH MAJOR PROBLEMS,793,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,2367,,,,,,,Fee Schedule,2300,34156.19571,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,928,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,52948.87,,,,,,,Fee Schedule,2300,58756.75004,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,929,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,23775.95,,,,,,,Fee Schedule,2300,26383.89178,
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,934,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16318.65,,,,,,,Fee Schedule,2300,18108.61623,
GASTROINTESTINAL HEMORRHAGE WITH CC,378,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7239.53,,,,,,,Fee Schedule,2300,8033.619804,
GASTROINTESTINAL HEMORRHAGE WITH MCC,377,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13494.3,,,,,,,Fee Schedule,2300,14974.46416,
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,379,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4653.61,,,,,,,Fee Schedule,2300,5164.060288,
GASTROINTESTINAL OBSTRUCTION WITH CC,389,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5830.3,,,,,,,Fee Schedule,2300,6469.820456,
GASTROINTESTINAL OBSTRUCTION WITH MCC,388,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10901.74,,,,,,,Fee Schedule,2300,12097.5321,
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,390,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4015.81,,,,,,,Fee Schedule,2300,4456.29568,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11621.48,,,,,,,Fee Schedule,2300,12896.2248,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7546.62,,,,,,,Fee Schedule,2300,8374.395356,
HAND PROCEDURES FOR INJURIES,906,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13010.04,,,,,,,Fee Schedule,2300,14437.08733,
HEADACHES WITH MCC,102,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8274.48,,,,,,,Fee Schedule,2300,9182.098948,
HEADACHES WITHOUT MCC,103,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6173.57,,,,,,,Fee Schedule,2300,6850.735436,
HEART FAILURE AND SHOCK WITH CC,292,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6267.32,,,,,,,Fee Schedule,2300,6954.77028,
HEART FAILURE AND SHOCK WITH MCC,291,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9477.01,,,,,,,Fee Schedule,2300,10516.53014,
HEART FAILURE AND SHOCK WITHOUT CC/MCC,293,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4178.21,,,,,,,Fee Schedule,2300,4636.51352,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,1,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,206872.43,,,,,,,Fee Schedule,2300,229563.9421,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,2,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,83651.35,,,,,,,Fee Schedule,2300,92826.9327,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,421,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12826.23,,,,,,,Fee Schedule,2300,14233.1135,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,420,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,25151.21,,,,,,,Fee Schedule,2300,27910.00921,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,422,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10331.11,,,,,,,Fee Schedule,2300,11464.31214,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,354,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12419.48,,,,,,,Fee Schedule,2300,13781.74973,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,353,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,21422.56,,,,,,,Fee Schedule,2300,23772.37144,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,355,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9928.79,,,,,,,Fee Schedule,2300,11017.8634,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,481,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15461.6,,,,,,,Fee Schedule,2300,17157.55754,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,480,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,21498.6,,,,,,,Fee Schedule,2300,23856.74616,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,482,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12040.04,,,,,,,Fee Schedule,2300,13360.69532,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,521,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,21187.82,,,,,,,Fee Schedule,2300,23511.87474,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,522,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15632.86,,,,,,,Fee Schedule,2300,17347.60544,
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,969,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,45187.44,,,,,,,Fee Schedule,2300,50143.97564,
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,970,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,19469.29,,,,,,,Fee Schedule,2300,21604.84233,
HIV WITH MAJOR RELATED CONDITION WITH CC,975,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9559.69,,,,,,,Fee Schedule,2300,10608.2774,
HIV WITH MAJOR RELATED CONDITION WITH MCC,974,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,21304.45,,,,,,,Fee Schedule,2300,23641.30392,
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,976,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6603.2,,,,,,,Fee Schedule,2300,7327.49354,
HIV WITH OR WITHOUT OTHER RELATED CONDITION,977,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9357.42,,,,,,,Fee Schedule,2300,10383.82427,
HYPERTENSION WITH MCC,304,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8784.58,,,,,,,Fee Schedule,2300,9748.1468,
HYPERTENSION WITHOUT MCC,305,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5574.15,,,,,,,Fee Schedule,2300,6185.567772,
INBORN AND OTHER DISORDERS OF METABOLISM,642,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10497.94,,,,,,,Fee Schedule,2300,11649.44501,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7226.98,,,,,,,Fee Schedule,2300,8019.69388,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10570.29,,,,,,,Fee Schedule,2300,11729.72387,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4898.7,,,,,,,Fee Schedule,2300,5436.025392,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,854,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14749.97,,,,,,,Fee Schedule,2300,16367.87573,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,853,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,36456.75,,,,,,,Fee Schedule,2300,40455.62839,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,855,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11052.33,,,,,,,Fee Schedule,2300,12264.64318,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,727,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10946.77,,,,,,,Fee Schedule,2300,12147.50159,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,728,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5988.28,,,,,,,Fee Schedule,2300,6645.123264,
INFLAMMATORY BOWEL DISEASE WITH CC,386,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7207.05,,,,,,,Fee Schedule,2300,7997.576236,
INFLAMMATORY BOWEL DISEASE WITH MCC,385,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11680.54,,,,,,,Fee Schedule,2300,12961.75856,
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,387,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5029.36,,,,,,,Fee Schedule,2300,5581.018836,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,351,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11253.86,,,,,,,Fee Schedule,2300,12488.27714,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,350,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,18395.21,,,,,,,Fee Schedule,2300,20412.94707,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,352,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8620.7,,,,,,,Fee Schedule,2300,9566.290616,
INTERSTITIAL LUNG DISEASE WITH CC,197,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7006.26,,,,,,,Fee Schedule,2300,7774.761452,
INTERSTITIAL LUNG DISEASE WITH MCC,196,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13931.31,,,,,,,Fee Schedule,2300,15459.41398,
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,198,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5286.99,,,,,,,Fee Schedule,2300,5866.909864,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,65,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7458.03,,,,,,,Fee Schedule,2300,8276.094716,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,64,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14845.2,,,,,,,Fee Schedule,2300,16473.54892,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,66,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5052.24,,,,,,,Fee Schedule,2300,5606.413168,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,21,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,39078.83,,,,,,,Fee Schedule,2300,43365.32734,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,20,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,58087.48,,,,,,,Fee Schedule,2300,64459.00634,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,22,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,22700.39,,,,,,,Fee Schedule,2300,25190.35817,
INTRAOCULAR PROCEDURES WITH CC/MCC,116,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13347.39,,,,,,,Fee Schedule,2300,14811.44893,
INTRAOCULAR PROCEDURES WITHOUT CC/MCC,117,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8008.73,,,,,,,Fee Schedule,2300,8887.197028,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",62,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12971.65,,,,,,,Fee Schedule,2300,14394.49038,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",61,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,20352.91,,,,,,,Fee Schedule,2300,22585.39121,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",63,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10362.85,,,,,,,Fee Schedule,2300,11499.53654,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,657,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13509.06,,,,,,,Fee Schedule,2300,14990.8476,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,656,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,23502.81,,,,,,,Fee Schedule,2300,26080.79814,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,658,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11455.39,,,,,,,Fee Schedule,2300,12711.9111,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,660,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9756.79,,,,,,,Fee Schedule,2300,10826.99632,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,659,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,18756.92,,,,,,,Fee Schedule,2300,20814.34135,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,661,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7643.32,,,,,,,Fee Schedule,2300,8481.706888,
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,689,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8565.33,,,,,,,Fee Schedule,2300,9504.852716,
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,690,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5975.73,,,,,,,Fee Schedule,2300,6631.19734,
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,687,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7734.86,,,,,,,Fee Schedule,2300,8583.284216,
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,686,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13314.91,,,,,,,Fee Schedule,2300,14775.40536,
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,688,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5833.99,,,,,,,Fee Schedule,2300,6473.916316,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,695,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8443.53,,,,,,,Fee Schedule,2300,9369.689336,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,696,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5086.2,,,,,,,Fee Schedule,2300,5644.09508,
KIDNEY TRANSPLANT,652,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,23840.17,,,,,,,Fee Schedule,2300,26455.15974,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,650,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,34705.73,,,,,,,Fee Schedule,2300,38512.55241,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,651,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,27356.22,,,,,,,Fee Schedule,2300,30356.87598,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,486,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15436.5,,,,,,,Fee Schedule,2300,17129.70569,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,485,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,23822.45,,,,,,,Fee Schedule,2300,26435.49961,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,487,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11561.69,,,,,,,Fee Schedule,2300,12829.87186,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,488,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11247.22,,,,,,,Fee Schedule,2300,12480.90459,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,489,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8244.22,,,,,,,Fee Schedule,2300,13879,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,418,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12487.39,,,,,,,Fee Schedule,2300,13857.11355,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,417,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,17616.4,,,,,,,Fee Schedule,2300,19548.72061,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,419,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10082.34,,,,,,,Fee Schedule,2300,11188.25118,
"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,27778.47,,,,,,,Fee Schedule,2300,30825.44236,
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,5,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,76112.11,,,,,,,Fee Schedule,2300,84460.72906,
LIVER TRANSPLANT WITHOUT MCC,6,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,34230.33,,,,,,,Fee Schedule,2300,37985.00564,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,496,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13316.39,,,,,,,Fee Schedule,2300,14777.04371,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,495,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,26764.92,,,,,,,Fee Schedule,2300,29700.7192,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,497,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8501.85,,,,,,,Fee Schedule,2300,9434.403924,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,498,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,22270.02,,,,,,,Fee Schedule,2300,24712.7809,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,499,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14873.25,,,,,,,Fee Schedule,2300,16504.67746,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",493,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,18721.49,,,,,,,Fee Schedule,2300,20775.02109,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",492,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,27103.75,,,,,,,Fee Schedule,2300,30076.71915,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",494,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14811.98,,,,,,,Fee Schedule,2300,16436.68618,
LUNG TRANSPLANT,7,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,95598.38,,,,,,,Fee Schedule,2300,106084.4123,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,821,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16525.35,,,,,,,Fee Schedule,2300,18337.98439,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,820,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,43293.95,,,,,,,Fee Schedule,2300,48042.79946,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,822,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8887.93,,,,,,,Fee Schedule,2300,9862.83088,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,841,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12042.99,,,,,,,Fee Schedule,2300,13363.97201,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,840,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,23880.03,,,,,,,Fee Schedule,2300,26499.39503,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,824,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16724.66,,,,,,,Fee Schedule,2300,18559.16083,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,823,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,33844.99,,,,,,,Fee Schedule,2300,37557.39786,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,825,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9961.27,,,,,,,Fee Schedule,2300,11053.90697,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,842,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7458.77,,,,,,,Fee Schedule,2300,8276.913888,
MAJOR BLADDER PROCEDURES WITH CC,654,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,20664.43,,,,,,,Fee Schedule,2300,22931.0818,
MAJOR BLADDER PROCEDURES WITH MCC,653,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,38359.82,,,,,,,Fee Schedule,2300,42567.45381,
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,655,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15624.74,,,,,,,Fee Schedule,2300,17338.59455,
MAJOR CHEST PROCEDURES WITH CC,164,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,18632.17,,,,,,,Fee Schedule,2300,20675.90128,
MAJOR CHEST PROCEDURES WITH MCC,163,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,33084.65,,,,,,,Fee Schedule,2300,36713.6507,
MAJOR CHEST PROCEDURES WITHOUT CC/MCC,165,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14130.62,,,,,,,Fee Schedule,2300,15680.59042,
MAJOR CHEST TRAUMA WITH CC,184,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7855.19,,,,,,,Fee Schedule,2300,8716.809252,
MAJOR CHEST TRAUMA WITH MCC,183,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11293.72,,,,,,,Fee Schedule,2300,12532.51243,
MAJOR CHEST TRAUMA WITHOUT CC/MCC,185,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5805.94,,,,,,,Fee Schedule,2300,6442.78778,
MAJOR ESOPHAGEAL DISORDERS WITH CC,369,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7383.48,,,,,,,Fee Schedule,2300,8193.358344,
MAJOR ESOPHAGEAL DISORDERS WITH MCC,368,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11751.41,,,,,,,Fee Schedule,2300,13040.39907,
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,370,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5173.31,,,,,,,Fee Schedule,2300,5740.757376,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,372,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7537.02,,,,,,,Fee Schedule,2300,8363.74612,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,371,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13089.02,,,,,,,Fee Schedule,2300,14524.73873,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,373,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5369.67,,,,,,,Fee Schedule,2300,5958.657128,
MAJOR HEAD AND NECK PROCEDURES WITH CC,141,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16100.88,,,,,,,Fee Schedule,2300,17866.96049,
MAJOR HEAD AND NECK PROCEDURES WITH MCC,140,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,31486.44,,,,,,,Fee Schedule,2300,34940.14332,
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,142,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11784.62,,,,,,,Fee Schedule,2300,13879,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,809,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9344.87,,,,,,,Fee Schedule,2300,10369.89835,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,808,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16298.72,,,,,,,Fee Schedule,2300,18086.49859,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,810,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7726,,,,,,,Fee Schedule,2300,8573.454152,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,469,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,22391.08,,,,,,,Fee Schedule,2300,24847.1251,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,470,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14239.14,,,,,,,Fee Schedule,2300,15801.00871,
MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,483,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,20462.17,,,,,,,Fee Schedule,2300,22706.62867,
MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,707,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14766.21,,,,,,,Fee Schedule,2300,16385.89752,
MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,708,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11325.46,,,,,,,Fee Schedule,2300,13879,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,507,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13334.84,,,,,,,Fee Schedule,2300,14797.52301,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,508,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11179.3,,,,,,,Fee Schedule,2300,12405.54077,
MAJOR SKIN DISORDERS WITH MCC,595,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15655.01,,,,,,,Fee Schedule,2300,17372.1806,
MAJOR SKIN DISORDERS WITHOUT MCC,596,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7991.02,,,,,,,Fee Schedule,2300,8867.5369,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,330,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,17696.13,,,,,,,Fee Schedule,2300,19637.19118,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,329,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,33931.36,,,,,,,Fee Schedule,2300,37653.24098,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,331,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12423.17,,,,,,,Fee Schedule,2300,13785.84559,
MAJOR THUMB OR JOINT PROCEDURES,506,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8855.45,,,,,,,Fee Schedule,2300,9826.787312,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,436,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8349.78,,,,,,,Fee Schedule,2300,9265.654492,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,435,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13558.52,,,,,,,Fee Schedule,2300,15045.73212,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,437,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6299.06,,,,,,,Fee Schedule,2300,6989.994676,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8030.14,,,,,,,Fee Schedule,2300,8910.953016,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13595.43,,,,,,,Fee Schedule,2300,15086.69072,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",756,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7090.41,,,,,,,Fee Schedule,2300,7868.14706,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8435.41,,,,,,,Fee Schedule,2300,9360.678444,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13359.21,,,,,,,Fee Schedule,2300,14824.55568,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",724,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4515.57,,,,,,,Fee Schedule,2300,5010.875124,
MALIGNANT BREAST DISORDERS WITH CC,598,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8351.26,,,,,,,Fee Schedule,2300,9267.292836,
MALIGNANT BREAST DISORDERS WITH MCC,597,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12306.53,,,,,,,Fee Schedule,2300,13656.41641,
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,599,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5412.48,,,,,,,Fee Schedule,2300,6006.169104,
MASTECTOMY FOR MALIGNANCY WITH CC/MCC,582,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14222.16,,,,,,,Fee Schedule,2300,15782.16775,
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,583,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12729.52,,,,,,,Fee Schedule,2300,14125.80197,
MEDICAL BACK PROBLEMS WITH MCC,551,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12372.97,,,,,,,Fee Schedule,2300,13730.14189,
MEDICAL BACK PROBLEMS WITHOUT MCC,552,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7096.32,,,,,,,Fee Schedule,2300,7874.700436,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,760,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7437.37,,,,,,,Fee Schedule,2300,8253.1579,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,761,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4204.79,,,,,,,Fee Schedule,2300,4666.003712,
MINOR BLADDER PROCEDURES WITH CC,663,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11222.12,,,,,,,Fee Schedule,2300,12453.05274,
MINOR BLADDER PROCEDURES WITH MCC,662,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,22599.99,,,,,,,Fee Schedule,2300,25078.95078,
MINOR BLADDER PROCEDURES WITHOUT CC/MCC,664,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7728.22,,,,,,,Fee Schedule,2300,8575.911668,
MINOR SKIN DISORDERS WITH MCC,606,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11170.44,,,,,,,Fee Schedule,2300,12395.7107,
MINOR SKIN DISORDERS WITHOUT MCC,607,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6691.04,,,,,,,Fee Schedule,2300,7424.975008,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,345,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11107.7,,,,,,,Fee Schedule,2300,12326.08108,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,344,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,19066.23,,,,,,,Fee Schedule,2300,21157.57442,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,346,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8756.53,,,,,,,Fee Schedule,2300,9717.018264,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9859.4,,,,,,,Fee Schedule,2300,10940.86123,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5744.67,,,,,,,Fee Schedule,2300,6374.796504,
MOUTH PROCEDURES WITH CC/MCC,137,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11022.8,,,,,,,Fee Schedule,2300,12231.8763,
MOUTH PROCEDURES WITHOUT CC/MCC,138,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6541.93,,,,,,,Fee Schedule,2300,7259.502264,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC,427,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,53287.71,,,,,,,Fee Schedule,2300,59132.74999,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,426,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,81358.5,,,,,,,Fee Schedule,2300,90282.58446,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC,428,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,41501.6,,,,,,,Fee Schedule,2300,46053.84984,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,447,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,49323.57,,,,,,,Fee Schedule,2300,54733.79635,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,448,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,31305.59,,,,,,,Fee Schedule,2300,34739.44618,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,59,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9160.32,,,,,,,Fee Schedule,2300,10165.10535,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,58,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12619.53,,,,,,,Fee Schedule,2300,14003.74534,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,60,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6789.96,,,,,,,Fee Schedule,2300,7534.744056,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,827,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,17061.28,,,,,,,Fee Schedule,2300,18932.70326,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,826,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,34531.52,,,,,,,Fee Schedule,2300,38319.22782,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,828,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12577.45,,,,,,,Fee Schedule,2300,13957.05254,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,829,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,23327.12,,,,,,,Fee Schedule,2300,25885.8352,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,830,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11109.91,,,,,,,Fee Schedule,2300,13879,
NEONATE WITH OTHER SIGNIFICANT PROBLEMS,794,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,1184,,,,,,,Fee Schedule,1184,12090.15955,
"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,1184,,,,,,,Fee Schedule,1184,14763.11778,
NERVOUS SYSTEM NEOPLASMS WITH MCC,54,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11271.58,,,,,,,Fee Schedule,2300,12507.93727,
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,55,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7526.69,,,,,,,Fee Schedule,2300,8352.277712,
NEUROLOGICAL EYE DISORDERS,123,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5895.27,,,,,,,Fee Schedule,2300,6541.907592,
NEUROSES EXCEPT DEPRESSIVE,882,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7926.79,,,,,,,Fee Schedule,850,8796.268936,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,98,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16940.95,,,,,,,Fee Schedule,2300,18799.17823,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,97,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,26662.31,,,,,,,Fee Schedule,2300,29586.8543,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,99,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10057.24,,,,,,,Fee Schedule,2300,11160.39933,
NON-EXTENSIVE BURNS,935,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15206.92,,,,,,,Fee Schedule,2300,16874.9432,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,988,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12133.06,,,,,,,Fee Schedule,2300,13463.91099,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,987,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,25308.45,,,,,,,Fee Schedule,2300,28084.49285,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,989,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8852.49,,,,,,,Fee Schedule,2300,9823.510624,
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,600,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7689.09,,,,,,,Fee Schedule,2300,8532.495552,
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,601,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4466.11,,,,,,,Fee Schedule,2300,4955.9906,
NONTRAUMATIC STUPOR AND COMA WITH MCC,80,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13361.42,,,,,,,Fee Schedule,2300,14827.0132,
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,81,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6611.32,,,,,,,Fee Schedule,2300,7336.504432,
NORMAL NEWBORN,795,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,530,,,,,,,Fee Schedule,530,2786,
O.R. PROCEDURES FOR OBESITY WITH CC,620,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11813.41,,,,,,,Fee Schedule,2300,13879,
O.R. PROCEDURES FOR OBESITY WITH MCC,619,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,21314.79,,,,,,,Fee Schedule,2300,23652.77233,
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,621,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11135.01,,,,,,,Fee Schedule,2300,13879,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,940,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,17251,,,,,,,Fee Schedule,2300,19143.23047,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,939,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,26785.59,,,,,,,Fee Schedule,2300,29723.65602,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,941,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14968.48,,,,,,,Fee Schedule,2300,16610.35064,
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,876,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,28530.69,,,,,,,Fee Schedule,850,31660.17863,
ORBITAL PROCEDURES WITH CC/MCC,113,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,17355.82,,,,,,,Fee Schedule,2300,19259.55289,
ORBITAL PROCEDURES WITHOUT CC/MCC,114,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9987.85,,,,,,,Fee Schedule,2300,11083.39716,
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,884,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11876.9,,,,,,,Fee Schedule,850,13179.65831,
OSTEOMYELITIS WITH CC,540,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9569.29,,,,,,,Fee Schedule,2300,10618.92664,
OSTEOMYELITIS WITH MCC,539,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14540.33,,,,,,,Fee Schedule,2300,16135.23088,
OSTEOMYELITIS WITHOUT CC/MCC,541,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5695.21,,,,,,,Fee Schedule,2300,6319.91198,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,818,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7782.1,,,,,,,Fee Schedule,2300,8635.711224,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,817,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12460.82,,,,,,,Fee Schedule,2300,13827.62336,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,819,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6347.78,,,,,,,Fee Schedule,2300,8327,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,832,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5326.85,,,,,,,Fee Schedule,2300,5911.145152,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,831,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8876.86,,,,,,,Fee Schedule,2300,9850.5433,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,833,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,3860.05,,,,,,,Fee Schedule,2300,4283.450388,
OTHER CARDIOTHORACIC PROCEDURES WITH MCC,228,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,36521.71,,,,,,,Fee Schedule,2300,40527.71553,
OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,229,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,23249.61,,,,,,,Fee Schedule,2300,25799.82214,
OTHER CEREBROVASCULAR DISORDERS WITH CC,71,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7573.93,,,,,,,Fee Schedule,2300,8404.70472,
OTHER CEREBROVASCULAR DISORDERS WITH MCC,70,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12289.55,,,,,,,Fee Schedule,2300,13637.57546,
OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,72,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5582.27,,,,,,,Fee Schedule,2300,6194.578664,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,315,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7111.08,,,,,,,Fee Schedule,2300,7891.083876,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,314,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15392.95,,,,,,,Fee Schedule,2300,17081.37454,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,316,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5035.26,,,,,,,Fee Schedule,2300,5587.572212,
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,264,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,24660.31,,,,,,,Fee Schedule,2300,27365.25983,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,394,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6907.34,,,,,,,Fee Schedule,2300,7664.992404,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,393,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11806.03,,,,,,,Fee Schedule,2300,13101.0178,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,395,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4790.92,,,,,,,Fee Schedule,2300,5316.42628,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,357,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,17166.84,,,,,,,Fee Schedule,2300,19049.84486,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,356,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,32427.65,,,,,,,Fee Schedule,2300,35984.58762,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,358,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10319.3,,,,,,,Fee Schedule,2300,11451.20539,
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,92,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7551.79,,,,,,,Fee Schedule,2300,8380.12956,
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,91,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12964.27,,,,,,,Fee Schedule,2300,14386.29866,
OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,93,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5878.29,,,,,,,Fee Schedule,2300,6523.066636,
OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT,124,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9767.12,,,,,,,Fee Schedule,2300,10838.46473,
OTHER DISORDERS OF THE EYE WITHOUT MCC,125,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5667.9,,,,,,,Fee Schedule,2300,6289.602616,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6765.6,,,,,,,Fee Schedule,2300,7507.71138,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11541.76,,,,,,,Fee Schedule,2300,12807.75422,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5101.7,,,,,,,Fee Schedule,2300,5661.297692,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12792.27,,,,,,,Fee Schedule,2300,14195.43159,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,27657.4,,,,,,,Fee Schedule,2300,30691.09815,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8875.38,,,,,,,Fee Schedule,2300,9848.904956,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16083.9,,,,,,,Fee Schedule,2300,17848.11954,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,27511.24,,,,,,,Fee Schedule,2300,30528.9021,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10774.03,,,,,,,Fee Schedule,2300,13879,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,319,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,32945.13,,,,,,,Fee Schedule,2300,36558.82719,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,320,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,17755.92,,,,,,,Fee Schedule,2300,19703.54412,
OTHER FACTORS INFLUENCING HEALTH STATUS,951,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4104.39,,,,,,,Fee Schedule,2300,4972,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,749,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,18954.02,,,,,,,Fee Schedule,2300,21033.06027,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,750,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10894.36,,,,,,,Fee Schedule,2300,12089.34038,
OTHER HEART ASSIST SYSTEM IMPLANT,215,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,73502.57,,,,,,,Fee Schedule,2300,81564.95604,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,424,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16151.08,,,,,,,Fee Schedule,2300,17922.66419,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,423,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,30657.45,,,,,,,Fee Schedule,2300,34020.21316,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,425,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11075.21,,,,,,,Fee Schedule,2300,12290.03752,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,868,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7611.58,,,,,,,Fee Schedule,2300,8446.482492,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,867,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15452,,,,,,,Fee Schedule,2300,17146.9083,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,869,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5386.65,,,,,,,Fee Schedule,2300,5977.498084,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12914.07,,,,,,,Fee Schedule,2300,14330.59497,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7512.66,,,,,,,Fee Schedule,2300,8336.713444,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,699,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7492.73,,,,,,,Fee Schedule,2300,8314.5958,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,698,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12212.78,,,,,,,Fee Schedule,2300,13552.38157,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,700,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5092.84,,,,,,,Fee Schedule,2300,5651.467628,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,674,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,17263.55,,,,,,,Fee Schedule,2300,19157.15639,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,673,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,31016.21,,,,,,,Fee Schedule,2300,34418.33075,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,675,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12116.81,,,,,,,Fee Schedule,2300,13445.88921,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,271,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,26252.61,,,,,,,Fee Schedule,2300,29132.21384,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,270,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,38949.65,,,,,,,Fee Schedule,2300,43221.97224,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,272,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,18846.25,,,,,,,Fee Schedule,2300,20913.46116,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,729,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7815.32,,,,,,,Fee Schedule,2300,8672.573964,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,730,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4960.7,,,,,,,Fee Schedule,2300,5504.83584,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,717,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13955.67,,,,,,,Fee Schedule,2300,15486.44666,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,718,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9914.76,,,,,,,Fee Schedule,2300,11002.29913,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,715,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16515.75,,,,,,,Fee Schedule,2300,18327.33516,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,716,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10858.92,,,,,,,Fee Schedule,2300,12050.02012,
OTHER MENTAL DISORDER DIAGNOSES,887,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7905.38,,,,,,,Fee Schedule,850,8772.512948,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,964,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11313.65,,,,,,,Fee Schedule,2300,12554.63007,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,963,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,20180.91,,,,,,,Fee Schedule,2300,22394.52414,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,965,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6942.77,,,,,,,Fee Schedule,2300,7704.31266,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,565,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7193.02,,,,,,,Fee Schedule,2300,7982.011968,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,564,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11394.86,,,,,,,Fee Schedule,2300,12644.73899,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,566,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5531.33,,,,,,,Fee Schedule,2300,6138.055796,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,516,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15340.53,,,,,,,Fee Schedule,2300,17023.21333,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,515,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,23525.7,,,,,,,Fee Schedule,2300,26106.19247,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,517,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11343.92,,,,,,,Fee Schedule,2300,13879,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,844,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8986.85,,,,,,,Fee Schedule,2300,9972.599928,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,843,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14725.61,,,,,,,Fee Schedule,2300,16340.84306,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,845,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6286.51,,,,,,,Fee Schedule,2300,6976.068752,
OTHER O.R. PROCEDURES FOR INJURIES WITH CC,908,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14728.57,,,,,,,Fee Schedule,2300,16344.11974,
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,907,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,28341.71,,,,,,,Fee Schedule,2300,31450.4706,
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,909,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9690.35,,,,,,,Fee Schedule,2300,10753.27084,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,958,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,31107.01,,,,,,,Fee Schedule,2300,34519.08891,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,957,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,56250.1,,,,,,,Fee Schedule,2300,62420.08723,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,959,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,21733.35,,,,,,,Fee Schedule,2300,24117.24285,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,803,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13722.4,,,,,,,Fee Schedule,2300,15227.58831,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,802,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,29410.63,,,,,,,Fee Schedule,2300,32636.63165,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,804,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10009.99,,,,,,,Fee Schedule,2300,11107.97232,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,205,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13516.44,,,,,,,Fee Schedule,2300,14999.03932,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,206,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6947.2,,,,,,,Fee Schedule,2300,7709.227692,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,167,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13312.7,,,,,,,Fee Schedule,2300,14772.94785,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,166,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,27591.7,,,,,,,Fee Schedule,2300,30618.19184,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,168,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10086.76,,,,,,,Fee Schedule,2300,11193.16621,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12756.1,,,,,,,Fee Schedule,2300,14155.29216,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,23906.61,,,,,,,Fee Schedule,2300,26528.88522,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10652.96,,,,,,,Fee Schedule,2300,11821.47113,
OTHER VASCULAR PROCEDURES WITH CC,253,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,19160.72,,,,,,,Fee Schedule,2300,21262.42843,
OTHER VASCULAR PROCEDURES WITH MCC,252,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,25750.63,,,,,,,Fee Schedule,2300,28575.17688,
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,254,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13152.51,,,,,,,Fee Schedule,2300,14595.18752,
OTITIS MEDIA AND URI WITH MCC,152,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8727,,,,,,,Fee Schedule,2300,9684.251384,
OTITIS MEDIA AND URI WITHOUT MCC,153,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5449.39,,,,,,,Fee Schedule,2300,6047.127704,
PANCREAS TRANSPLANT,10,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,22662,,,,,,,Fee Schedule,2300,25147.76123,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",406,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,21409.28,,,,,,,Fee Schedule,2300,23757.62634,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",405,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,40383.23,,,,,,,Fee Schedule,2300,44812.80426,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",407,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16385.09,,,,,,,Fee Schedule,2300,18182.34171,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,543,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7588.7,,,,,,,Fee Schedule,2300,8421.08816,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,542,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13040.3,,,,,,,Fee Schedule,2300,14470.67338,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,544,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5570.46,,,,,,,Fee Schedule,2300,6181.471912,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15723.66,,,,,,,Fee Schedule,2300,17448.3636,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",735,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9932.48,,,,,,,Fee Schedule,2300,13879,
PENIS PROCEDURES WITH CC/MCC,709,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,17178.65,,,,,,,Fee Schedule,2300,19062.95161,
PENIS PROCEDURES WITHOUT CC/MCC,710,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10343.66,,,,,,,Fee Schedule,2300,13879,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,273,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,30454.44,,,,,,,Fee Schedule,2300,33794.94086,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,274,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,24299.33,,,,,,,Fee Schedule,2300,26964.68472,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES,321,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,20084.95,,,,,,,Fee Schedule,2300,22288.03178,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC,322,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13014.47,,,,,,,Fee Schedule,2300,14442.00236,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC,250,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16111.22,,,,,,,Fee Schedule,2300,17878.4289,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC,251,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11032.4,,,,,,,Fee Schedule,2300,13879,
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC,359,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,25383.75,,,,,,,Fee Schedule,2300,28168.04839,
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC,360,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,17822.36,,,,,,,Fee Schedule,2300,19777.2696,
PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE,318,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,17880.68,,,,,,,Fee Schedule,2300,19841.98418,
PERIPHERAL VASCULAR DISORDERS WITH CC,300,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7880.29,,,,,,,Fee Schedule,2300,8744.6611,
PERIPHERAL VASCULAR DISORDERS WITH MCC,299,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12052.59,,,,,,,Fee Schedule,2300,13374.62124,
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,301,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5312.83,,,,,,,Fee Schedule,2300,5895.580884,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",41,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16230.8,,,,,,,Fee Schedule,2300,18011.13476,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",40,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,28503.38,,,,,,,Fee Schedule,2300,31629.86926,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",42,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12753.88,,,,,,,Fee Schedule,2300,14152.83464,
PERITONEAL ADHESIOLYSIS WITH CC,336,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15566.42,,,,,,,Fee Schedule,2300,17273.87996,
PERITONEAL ADHESIOLYSIS WITH MCC,335,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,26360.38,,,,,,,Fee Schedule,2300,29251.81295,
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,337,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11331.37,,,,,,,Fee Schedule,2300,12574.2902,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,243,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15730.3,,,,,,,Fee Schedule,2300,17455.73615,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,242,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,23569.25,,,,,,,Fee Schedule,2300,26154.52362,
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,244,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13342.97,,,,,,,Fee Schedule,2300,14806.5339,
PLEURAL EFFUSION WITH CC,187,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7301.54,,,,,,,Fee Schedule,2300,8102.430252,
PLEURAL EFFUSION WITH MCC,186,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11504.85,,,,,,,Fee Schedule,2300,12766.79562,
PLEURAL EFFUSION WITHOUT CC/MCC,188,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5294.37,,,,,,,Fee Schedule,2300,5875.101584,
PNEUMOTHORAX WITH CC,200,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8115.03,,,,,,,Fee Schedule,2300,9005.157796,
PNEUMOTHORAX WITH MCC,199,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13022.59,,,,,,,Fee Schedule,2300,14451.01325,
PNEUMOTHORAX WITHOUT CC/MCC,201,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5278.87,,,,,,,Fee Schedule,2300,5857.898972,
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,917,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11577.93,,,,,,,Fee Schedule,2300,12847.89365,
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,918,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6327.11,,,,,,,Fee Schedule,2300,7021.123212,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,862,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13462.55,,,,,,,Fee Schedule,2300,14939.23976,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,863,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7366.5,,,,,,,Fee Schedule,2300,8174.517388,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,857,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15808.55,,,,,,,Fee Schedule,2300,17542.56838,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,856,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,33578.5,,,,,,,Fee Schedule,2300,37261.67676,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,858,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10282.39,,,,,,,Fee Schedule,2300,11410.24679,
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,769,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12474.1,,,,,,,Fee Schedule,2300,13842.36846,
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,776,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4833,,,,,,,Fee Schedule,2300,5363.119084,
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,67,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10841.94,,,,,,,Fee Schedule,2300,12031.17916,
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,68,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6381,,,,,,,Fee Schedule,2300,7080.922768,
PREMATURITY WITH MAJOR PROBLEMS,791,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,29963.54,,,,,,,Fee Schedule,2300,33250.19148,
PREMATURITY WITHOUT MAJOR PROBLEMS,792,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,18079.99,,,,,,,Fee Schedule,2300,20063.16062,
PROSTATECTOMY WITH CC,666,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12913.33,,,,,,,Fee Schedule,2300,14329.7758,
PROSTATECTOMY WITH MCC,665,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,23040.7,,,,,,,Fee Schedule,2300,25567.99646,
PROSTATECTOMY WITHOUT CC/MCC,667,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8165.97,,,,,,,Fee Schedule,2300,9061.680664,
PSYCHOSES,885,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10311.18,,,,,,,Fee Schedule,850,11442.1945,
PULMONARY EDEMA AND RESPIRATORY FAILURE,189,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9119.72,,,,,,,Fee Schedule,2300,10120.05089,
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,175,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10139.92,,,,,,,Fee Schedule,2300,11252.14659,
PULMONARY EMBOLISM WITHOUT MCC,176,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5942.51,,,,,,,Fee Schedule,2300,6594.3346,
RADIOTHERAPY,849,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,20001.53,,,,,,,Fee Schedule,2300,22195.46534,
RECTAL RESECTION WITH CC,333,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,17290.12,,,,,,,Fee Schedule,2300,19186.64658,
RECTAL RESECTION WITH MCC,332,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,26728.01,,,,,,,Fee Schedule,2300,29659.7606,
RECTAL RESECTION WITHOUT CC/MCC,334,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12090.98,,,,,,,Fee Schedule,2300,13417.21819,
RED BLOOD CELL DISORDERS WITH MCC,811,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10366.54,,,,,,,Fee Schedule,2300,11503.6324,
RED BLOOD CELL DISORDERS WITHOUT MCC,812,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6778.15,,,,,,,Fee Schedule,2300,7521.637304,
REHABILITATION WITH CC/MCC,945,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11431.77,,,,,,,Fee Schedule,2300,12685.69759,
REHABILITATION WITHOUT CC/MCC,946,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8465.68,,,,,,,Fee Schedule,2300,9394.264496,
RENAL FAILURE WITH CC,683,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6465.16,,,,,,,Fee Schedule,2300,7174.308376,
RENAL FAILURE WITH MCC,682,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10932.74,,,,,,,Fee Schedule,2300,12131.93732,
RENAL FAILURE WITHOUT CC/MCC,684,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4431.41,,,,,,,Fee Schedule,2300,4917.489516,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,178,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7204.83,,,,,,,Fee Schedule,2300,7995.11872,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,177,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11535.85,,,,,,,Fee Schedule,2300,12801.20084,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,179,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5573.41,,,,,,,Fee Schedule,2300,6184.7486,
RESPIRATORY NEOPLASMS WITH CC,181,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7906.12,,,,,,,Fee Schedule,2300,8773.33212,
RESPIRATORY NEOPLASMS WITH MCC,180,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13036.61,,,,,,,Fee Schedule,2300,14466.57752,
RESPIRATORY NEOPLASMS WITHOUT CC/MCC,182,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5492.21,,,,,,,Fee Schedule,2300,6094.63968,
RESPIRATORY SIGNS AND SYMPTOMS,204,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5960.23,,,,,,,Fee Schedule,2300,6613.994728,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,208,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,20290.9,,,,,,,Fee Schedule,2300,22516.58076,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,207,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,47500.96,,,,,,,Fee Schedule,2300,52711.26068,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,815,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7485.35,,,,,,,Fee Schedule,2300,8306.40408,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,814,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15699.3,,,,,,,Fee Schedule,2300,17421.33092,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,816,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4665.42,,,,,,,Fee Schedule,2300,5177.16704,
REVISION OF HIP OR KNEE REPLACEMENT WITH CC,467,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,26033.36,,,,,,,Fee Schedule,2300,28888.91975,
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,466,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,38426.26,,,,,,,Fee Schedule,2300,42641.17929,
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,468,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,20285.74,,,,,,,Fee Schedule,2300,22510.84656,
SALIVARY GLAND PROCEDURES,139,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8921.89,,,,,,,Fee Schedule,2300,9900.512792,
SEIZURES WITH MCC,100,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14297.46,,,,,,,Fee Schedule,2300,15865.7233,
SEIZURES WITHOUT MCC,101,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6662.99,,,,,,,Fee Schedule,2300,7393.846472,
SEPTIC ARTHRITIS WITH CC,549,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8911.55,,,,,,,Fee Schedule,2300,9889.044384,
SEPTIC ARTHRITIS WITH MCC,548,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14253.9,,,,,,,Fee Schedule,2300,15817.39215,
SEPTIC ARTHRITIS WITHOUT CC/MCC,550,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6452.61,,,,,,,Fee Schedule,2300,7160.382452,
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,870,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,51022.91,,,,,,,Fee Schedule,2300,56619.5303,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,871,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14339.54,,,,,,,Fee Schedule,2300,15912.4161,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,872,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7554,,,,,,,Fee Schedule,2300,8382.587076,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15350.13,,,,,,,Fee Schedule,2300,17033.86257,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,22297.33,,,,,,,Fee Schedule,2300,24743.09026,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12220.16,,,,,,,Fee Schedule,2300,13879,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,555,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9757.53,,,,,,,Fee Schedule,2300,10827.8155,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,556,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6131.49,,,,,,,Fee Schedule,2300,6804.042632,
SIGNS AND SYMPTOMS WITH MCC,947,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9370.71,,,,,,,Fee Schedule,2300,10398.56937,
SIGNS AND SYMPTOMS WITHOUT MCC,948,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5909.29,,,,,,,Fee Schedule,2300,6557.47186,
SIMPLE PNEUMONIA AND PLEURISY WITH CC,194,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5949.15,,,,,,,Fee Schedule,2300,6601.707148,
SIMPLE PNEUMONIA AND PLEURISY WITH MCC,193,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9702.9,,,,,,,Fee Schedule,2300,10767.19677,
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,195,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,4639.59,,,,,,,Fee Schedule,2300,5148.49602,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,8,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,41373.16,,,,,,,Fee Schedule,2300,45911.31391,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,19,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,48921.99,,,,,,,Fee Schedule,2300,54288.16678,
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL,402,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,29679.33,,,,,,,Fee Schedule,2300,32934.81026,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,450,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,39343.11,,,,,,,Fee Schedule,2300,43658.59091,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,451,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,23846.81,,,,,,,Fee Schedule,2300,26462.53229,
SINUS AND MASTOID PROCEDURES WITH CC/MCC,135,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15614.41,,,,,,,Fee Schedule,2300,17327.12614,
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,136,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7494.94,,,,,,,Fee Schedule,2300,8327,
SKIN DEBRIDEMENT WITH CC,571,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12471.89,,,,,,,Fee Schedule,2300,13839.91094,
SKIN DEBRIDEMENT WITH MCC,570,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,21711.2,,,,,,,Fee Schedule,2300,24092.66769,
SKIN DEBRIDEMENT WITHOUT CC/MCC,572,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8461.99,,,,,,,Fee Schedule,2300,9390.168636,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,577,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,19567.47,,,,,,,Fee Schedule,2300,21713.7922,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,576,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,36180.66,,,,,,,Fee Schedule,2300,40149.25806,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,578,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11858.44,,,,,,,Fee Schedule,2300,13159.17901,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,574,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,25625.87,,,,,,,Fee Schedule,2300,28436.73681,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,573,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,48362.43,,,,,,,Fee Schedule,2300,53667.23441,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,575,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12059.24,,,,,,,Fee Schedule,2300,13381.99379,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13242.57,,,,,,,Fee Schedule,2300,14695.12651,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,26274.01,,,,,,,Fee Schedule,2300,29155.96982,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",624,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9241.53,,,,,,,Fee Schedule,2300,10255.21427,
SKIN GRAFTS FOR INJURIES WITH CC/MCC,904,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,27114.82,,,,,,,Fee Schedule,2300,30089.00673,
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,905,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10569.55,,,,,,,Fee Schedule,2300,11728.9047,
SKIN ULCERS WITH CC,593,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8757.27,,,,,,,Fee Schedule,2300,9717.837436,
SKIN ULCERS WITH MCC,592,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14286.38,,,,,,,Fee Schedule,2300,15853.43572,
SKIN ULCERS WITHOUT CC/MCC,594,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6398.72,,,,,,,Fee Schedule,2300,7100.582896,
SOFT TISSUE PROCEDURES WITH CC,501,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12904.47,,,,,,,Fee Schedule,2300,14319.94573,
SOFT TISSUE PROCEDURES WITH MCC,500,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,23362.55,,,,,,,Fee Schedule,2300,25925.15546,
SOFT TISSUE PROCEDURES WITHOUT CC/MCC,502,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9935.43,,,,,,,Fee Schedule,2300,11025.23595,
SPINAL DISORDERS AND INJURIES WITH CC/MCC,52,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13145.87,,,,,,,Fee Schedule,2300,14587.81498,
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,53,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7228.45,,,,,,,Fee Schedule,2300,8021.332224,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",457,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,44019.6,,,,,,,Fee Schedule,2300,48848.04553,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",456,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,62033.9,,,,,,,Fee Schedule,2300,68838.29985,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",458,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,30802.13,,,,,,,Fee Schedule,2300,34180.77087,
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,29,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,25184.43,,,,,,,Fee Schedule,2300,27946.87195,
SPINAL PROCEDURES WITH MCC,28,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,44353.27,,,,,,,Fee Schedule,2300,49218.31128,
SPINAL PROCEDURES WITHOUT CC/MCC,30,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16204.97,,,,,,,Fee Schedule,2300,17982.46374,
SPLENIC PROCEDURES WITH CC,800,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,20738.99,,,,,,,Fee Schedule,2300,23013.81817,
SPLENIC PROCEDURES WITH MCC,799,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,33432.34,,,,,,,Fee Schedule,2300,37099.48071,
SPLENIC PROCEDURES WITHOUT CC/MCC,801,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14091.5,,,,,,,Fee Schedule,2300,15637.17431,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",537,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7044.64,,,,,,,Fee Schedule,2300,7817.358396,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",538,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5317.25,,,,,,,Fee Schedule,2300,5900.495916,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,18043.08,,,,,,,Fee Schedule,2300,20022.20202,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,36816.99,,,,,,,Fee Schedule,2300,40855.38433,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11828.18,,,,,,,Fee Schedule,2300,13125.59296,
SYNCOPE AND COLLAPSE,312,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6434.15,,,,,,,Fee Schedule,2300,7139.903152,
"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10976.3,,,,,,,Fee Schedule,2300,12180.26847,
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6593.6,,,,,,,Fee Schedule,2300,7316.844304,
TESTES PROCEDURES WITH CC/MCC,711,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15382.61,,,,,,,Fee Schedule,2300,17069.90614,
TESTES PROCEDURES WITHOUT CC/MCC,712,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8117.99,,,,,,,Fee Schedule,2300,9008.434484,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11068.57,,,,,,,Fee Schedule,2300,13879,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,22294.38,,,,,,,Fee Schedule,2300,24739.81357,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9805.51,,,,,,,Fee Schedule,2300,10881.06168,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",12,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,31122.51,,,,,,,Fee Schedule,2300,34536.29152,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",11,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,40262.17,,,,,,,Fee Schedule,2300,44678.46005,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",13,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,21273.45,,,,,,,Fee Schedule,2300,23606.8987,
"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",4,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,102251.03,,,,,,,Fee Schedule,2300,113466.7904,
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,69,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5896.74,,,,,,,Fee Schedule,2300,6543.545936,
TRANSURETHRAL PROCEDURES WITH CC,669,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11456.86,,,,,,,Fee Schedule,2300,12713.54944,
TRANSURETHRAL PROCEDURES WITH MCC,668,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,21555.44,,,,,,,Fee Schedule,2300,23919.8224,
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,670,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7214.43,,,,,,,Fee Schedule,2300,8327,
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,713,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11098.1,,,,,,,Fee Schedule,2300,12315.43185,
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,714,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7805.73,,,,,,,Fee Schedule,2300,8661.924728,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10867.04,,,,,,,Fee Schedule,2300,12059.03101,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6761.91,,,,,,,Fee Schedule,2300,7503.61552,
TRAUMATIC INJURY WITH MCC,913,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12066.62,,,,,,,Fee Schedule,2300,13390.18551,
TRAUMATIC INJURY WITHOUT MCC,914,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6536.76,,,,,,,Fee Schedule,2300,7253.76806,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,86,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9616.53,,,,,,,Fee Schedule,2300,10671.35364,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,85,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16771.17,,,,,,,Fee Schedule,2300,18610.76867,
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,87,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6752.32,,,,,,,Fee Schedule,2300,7492.966284,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,83,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10303.8,,,,,,,Fee Schedule,2300,11434.00278,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,82,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,16872.3,,,,,,,Fee Schedule,2300,18722.99523,
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,84,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7055.72,,,,,,,Fee Schedule,2300,7829.645976,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC,278,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,41089.69,,,,,,,Fee Schedule,2300,45596.75186,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC,279,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,26622.44,,,,,,,Fee Schedule,2300,29542.61901,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM,173,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,21971.78,,,,,,,Fee Schedule,2300,24381.83541,
UNCOMPLICATED PEPTIC ULCER WITH MCC,383,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10192.33,,,,,,,Fee Schedule,2300,11310.3078,
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,384,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6310.13,,,,,,,Fee Schedule,2300,7002.282256,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,256,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12533.9,,,,,,,Fee Schedule,2300,13908.72139,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,255,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,19912.21,,,,,,,Fee Schedule,2300,22096.34553,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,257,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8062.62,,,,,,,Fee Schedule,2300,8946.996584,
URETHRAL PROCEDURES WITH CC/MCC,671,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13250.69,,,,,,,Fee Schedule,2300,14704.1374,
URETHRAL PROCEDURES WITHOUT CC/MCC,672,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7968.87,,,,,,,Fee Schedule,2300,8842.96174,
URETHRAL STRICTURE,697,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,7956.32,,,,,,,Fee Schedule,2300,8829.035816,
URINARY STONES WITH MCC,693,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9925.1,,,,,,,Fee Schedule,2300,11013.76754,
URINARY STONES WITHOUT MCC,694,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5770.51,,,,,,,Fee Schedule,2300,6403.467524,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,742,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13544.49,,,,,,,Fee Schedule,2300,15030.16786,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,743,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,9158.85,,,,,,,Fee Schedule,2300,10163.467,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,740,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13358.47,,,,,,,Fee Schedule,2300,14823.73651,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,739,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,26031.15,,,,,,,Fee Schedule,2300,28886.46224,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,741,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10527.47,,,,,,,Fee Schedule,2300,13879,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,737,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15211.35,,,,,,,Fee Schedule,2300,16879.85823,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,736,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,26386.96,,,,,,,Fee Schedule,2300,29281.30314,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,738,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,10840.47,,,,,,,Fee Schedule,2300,12029.54082,
"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12823.27,,,,,,,Fee Schedule,2300,14229.83681,
"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6197.19,,,,,,,Fee Schedule,2300,8327,
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,768,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,3551,,,,,,,Fee Schedule,2300,8778.247152,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,797,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,3551,,,,,,,Fee Schedule,2300,8194.996688,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,796,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,3551,,,,,,,Fee Schedule,2300,9559.73724,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,798,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,3551,,,,,,,Fee Schedule,2300,7840.295212,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,806,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,3551,,,,,,,Fee Schedule,2300,6176.55688,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,805,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,3551,,,,,,,Fee Schedule,2300,8840.504224,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,807,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,3551,,,,,,,Fee Schedule,2300,5522.857624,
VEIN LIGATION AND STRIPPING,263,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,22569.73,,,,,,,Fee Schedule,2300,25045.36473,
VENTRICULAR SHUNT PROCEDURES WITH CC,32,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,15731.04,,,,,,,Fee Schedule,2300,17456.55532,
VENTRICULAR SHUNT PROCEDURES WITH MCC,31,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,33075.05,,,,,,,Fee Schedule,2300,36703.00146,
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,33,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,12275.53,,,,,,,Fee Schedule,2300,13879,
VIRAL ILLNESS WITH MCC,865,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,11060.45,,,,,,,Fee Schedule,2300,12273.65408,
VIRAL ILLNESS WITHOUT MCC,866,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,6419.39,,,,,,,Fee Schedule,2300,7123.519712,
VIRAL MENINGITIS WITH CC/MCC,75,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14154.99,,,,,,,Fee Schedule,2300,15707.6231,
VIRAL MENINGITIS WITHOUT CC/MCC,76,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,5527.64,,,,,,,Fee Schedule,2300,6133.959936,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,464,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,22992.72,,,,,,,Fee Schedule,2300,25514.75028,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,463,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,42073.71,,,,,,,Fee Schedule,2300,46688.70814,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,465,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,13462.55,,,,,,,Fee Schedule,2300,14939.23976,
WOUND DEBRIDEMENTS FOR INJURIES WITH CC,902,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,14132.84,,,,,,,Fee Schedule,2300,15683.04794,
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,901,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,30979.3,,,,,,,Fee Schedule,2300,34377.37215,
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,903,MS-DRG,,,,,,,,inpatient,,,,,United Health,Commercial,8633.99,,,,,,,Fee Schedule,2300,9581.035712,
"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8213.837644,
ABORTION WITHOUT D&C,779,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5841.515532,
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,880,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,850,7865.689544,
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,289,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13982.44687,
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,288,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,22168.43266,
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,290,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7615.842084,
ACUTE LEUKEMIA WITH CC,835,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17086.28958,
ACUTE LEUKEMIA WITH MCC,834,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,44971.72363,
ACUTE LEUKEMIA WITH OTHER PROCEDURES,850,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,70936.19934,
ACUTE LEUKEMIA WITHOUT CC/MCC,836,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9989.80254,
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,121,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9529.427876,
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,122,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6437.053576,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",281,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7529.009852,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",280,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13140.33805,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",282,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5923.432732,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",284,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5670.308584,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",283,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,16226.15898,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",285,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,4972,
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,614,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17954.6119,
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,615,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11462.6738,
AFTERCARE WITH CC/MCC,949,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9745.689284,
AFTERCARE WITHOUT CC/MCC,950,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5141.942644,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9224.695892,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15276.73863,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6585.323708,
AICD GENERATOR PROCEDURES,245,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,37373.90333,
AICD LEAD PROCEDURES,265,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,29639.2813,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,850,11596.19883,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,850,14295.37057,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,850,7231.650416,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,850,5053.472068,
ALLERGIC REACTIONS WITH MCC,915,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13775.19635,
ALLERGIC REACTIONS WITHOUT MCC,916,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5458.143036,
ALLOGENEIC BONE MARROW TRANSPLANT,14,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,98447.27179,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,240,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,23350.49786,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,239,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,40317.18832,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,241,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11340.61717,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,475,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,18641.8972,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,474,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,35166.23479,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,476,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9667.867944,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15320.97392,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,28567.80433,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",618,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11618.31648,
ANAL AND STOMAL PROCEDURES WITH CC,348,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10721.32314,
ANAL AND STOMAL PROCEDURES WITH MCC,347,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,18804.91243,
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,349,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7131.711432,
ANGINA PECTORIS,311,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5749.768268,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,268,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,56341.83099,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,269,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,34595.2719,
APPENDIX PROCEDURES WITH CC,398,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12398.98739,
APPENDIX PROCEDURES WITH MCC,397,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,19618.35023,
APPENDIX PROCEDURES WITHOUT CC/MCC,399,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9377.061884,
ATHEROSCLEROSIS WITH MCC,302,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9802.212152,
ATHEROSCLEROSIS WITHOUT MCC,303,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5514.665904,
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,16,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,48574.44208,
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,17,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,39633.99888,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,519,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,16385.07834,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,518,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,30614.91516,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,520,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12237.61051,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,95,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,21128.08422,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,94,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,28829.93937,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,96,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,21128.08422,
BEHAVIORAL AND DEVELOPMENTAL DISORDERS,886,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,850,17000.27652,
BENIGN PROSTATIC HYPERTROPHY WITH MCC,725,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9585.950744,
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,726,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5914.42184,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,461,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,43912.53423,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,462,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,21789.9752,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,409,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17835.83196,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,408,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,29208.39683,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,410,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13005.99384,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,478,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,20145.07782,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,477,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,28299.11591,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,479,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15227.58831,
BONE DISEASES AND ARTHROPATHIES WITH MCC,553,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10618.92664,
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,554,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6799.946772,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17536.015,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15802.64705,
BRONCHITIS AND ASTHMA WITH CC/MCC,202,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7955.798464,
BRONCHITIS AND ASTHMA WITHOUT CC/MCC,203,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5488.4524,
"CARDIAC ARREST, UNEXPLAINED WITH CC",297,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6184,
"CARDIAC ARREST, UNEXPLAINED WITH MCC",296,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12794.64747,
"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",298,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,4972,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,309,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6026.648404,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,308,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9862.83088,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,310,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,4637.332692,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,306,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12908.51238,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,307,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7480.678704,
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC,275,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,58410.24029,
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR,276,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,49204.38535,
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC,277,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,37833.45882,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,258,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,25739.20341,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,259,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,16564.47701,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,261,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15486.44666,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,260,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,26646.02682,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,262,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13351.68443,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,217,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,53863.01652,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,216,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,80137.95842,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,218,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,53863.01652,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,220,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,43684.80442,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,219,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,62898.48368,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,221,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,41287.90714,
CAROTID ARTERY STENT PROCEDURES WITH CC,35,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,19582.30666,
CAROTID ARTERY STENT PROCEDURES WITH MCC,34,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,31707.6906,
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,36,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15914.87362,
CELLULITIS WITH MCC,602,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11642.89164,
CELLULITIS WITHOUT MCC,603,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7134.168948,
CERVICAL SPINAL FUSION WITH CC,472,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,24133.62629,
CERVICAL SPINAL FUSION WITH MCC,471,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,39555.35836,
CERVICAL SPINAL FUSION WITHOUT CC/MCC,473,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,19998.44604,
CESAREAN SECTION WITH STERILIZATION WITH CC,784,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,4800,,,,,,,Fee Schedule,2300,8684.042372,
CESAREAN SECTION WITH STERILIZATION WITH MCC,783,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,4800,,,,,,,Fee Schedule,2300,20111.49177,
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,785,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,4800,,,,,,,Fee Schedule,2300,7846.029416,
CESAREAN SECTION WITHOUT STERILIZATION WITH CC,787,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,4800,,,,,,,Fee Schedule,2300,9148.512896,
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,786,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,4800,,,,,,,Fee Schedule,2300,13512.24214,
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,788,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,4800,,,,,,,Fee Schedule,2300,7854.221136,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,837,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,39355.4804,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,838,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17099.39633,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,839,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11828.02451,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,847,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10716.4081,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,846,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,21237.0341,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,848,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6958.046968,
CHEST PAIN,313,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5898.0384,
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,18,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,353741.4064,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,415,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,16929.82772,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,414,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,29183.82167,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,416,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11167.77188,
CHOLECYSTECTOMY WITH C.D.E. WITH CC,412,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17223.0913,
CHOLECYSTECTOMY WITH C.D.E. WITH MCC,411,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,27059.70868,
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,413,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13602.35106,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,191,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6905.61996,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,190,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9073.968244,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,192,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5259.08424,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",286,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,18126.63802,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",287,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8765.959572,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,433,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8652.094664,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,432,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,16122.9433,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,434,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5836.6005,
COAGULATION DISORDERS,813,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12494.83052,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC,429,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,73804.12051,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC,430,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,47242.46841,
COMPLEX AORTIC ARCH PROCEDURES,209,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,92720.44034,
COMPLICATED PEPTIC ULCER WITH CC,381,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8875.72862,
COMPLICATED PEPTIC ULCER WITH MCC,380,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,16073.79298,
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,382,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6558.291032,
COMPLICATIONS OF TREATMENT WITH CC,920,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8210.560956,
COMPLICATIONS OF TREATMENT WITH MCC,919,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14997.40098,
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,921,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5639.180048,
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES,212,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,89077.58245,
CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION,317,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,54773.93578,
CONCUSSION WITH CC,89,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8999.423592,
CONCUSSION WITH MCC,88,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11073.5671,
CONCUSSION WITHOUT CC/MCC,90,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6743.423904,
CONNECTIVE TISSUE DISORDERS WITH CC,546,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9448.329848,
CONNECTIVE TISSUE DISORDERS WITH MCC,545,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,20329.39152,
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,547,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6849.916264,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,233,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,62627.33774,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,234,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,44748.90884,
CORONARY BYPASS WITH PTCA WITH MCC,231,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,69055.38043,
CORONARY BYPASS WITH PTCA WITHOUT MCC,232,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,49663.12167,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,235,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,48073.92799,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,236,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,34313.47674,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC,323,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,35448.84913,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC,324,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,25812.10972,
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE,325,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,26298.69789,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,73,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13141.9764,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,74,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8444.024976,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,26,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,25469.69582,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,25,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,37245.29332,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,27,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,20666.89039,
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,955,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,55139.28649,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,23,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,46941.01312,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,24,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,32045.18947,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,16785.65345,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9318.0815,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,56,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,19030.18473,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,57,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10613.19243,
DENTAL AND ORAL DISEASES WITH CC,158,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7452.826856,
DENTAL AND ORAL DISEASES WITH MCC,157,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14063.5449,
DENTAL AND ORAL DISEASES WITHOUT CC/MCC,159,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5803.83362,
DEPRESSIVE NEUROSES,881,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,850,7707.589348,
DIABETES WITH CC,638,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7341.419464,
DIABETES WITH MCC,637,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11769.04412,
DIABETES WITHOUT CC/MCC,639,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5088.696464,
DIGESTIVE MALIGNANCY WITH CC,375,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9908.704512,
DIGESTIVE MALIGNANCY WITH MCC,374,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17519.63156,
DIGESTIVE MALIGNANCY WITHOUT CC/MCC,376,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7571.606796,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7907.467316,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14701.67988,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5731.746484,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,439,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6890.874864,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,438,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13354.14194,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,440,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5090.334808,
DISORDERS OF PERSONALITY AND IMPULSE CONTROL,883,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,850,16107.37904,
DISORDERS OF THE BILIARY TRACT WITH CC,445,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8965.018368,
DISORDERS OF THE BILIARY TRACT WITH MCC,444,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13687.54495,
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,446,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6777.009956,
DYSEQUILIBRIUM,149,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6156.896752,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",147,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10415.77198,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17345.14793,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",148,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6529.620012,
"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",3,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,173870.8953,
ENDOCRINE DISORDERS WITH CC,644,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8396.513,
ENDOCRINE DISORDERS WITH MCC,643,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13484.39029,
ENDOCRINE DISORDERS WITHOUT CC/MCC,645,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6293.698476,
ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES,213,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,46749.32687,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,266,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,50202.13685,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,267,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,38999.14058,
EPISTAXIS WITH MCC,150,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10907.27518,
EPISTAXIS WITHOUT MCC,151,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6012.72248,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10389.55848,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6386.264912,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,927,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,150975.0379,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,933,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,31265.33772,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,982,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,20139.34362,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,981,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,38433.9119,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,983,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14040.60808,
EXTRACRANIAL PROCEDURES WITH CC,38,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13291.88487,
EXTRACRANIAL PROCEDURES WITH MCC,37,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,26967.96141,
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,39,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9629.36686,
EXTRAOCULAR PROCEDURES EXCEPT ORBIT,115,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12573.47103,
"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2950,,,,,,,Fee Schedule,2300,48687.48782,
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,748,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13879,
FEVER AND INFLAMMATORY CONDITIONS,864,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7271.789844,
FOOT PROCEDURES WITH CC,504,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15311.96302,
FOOT PROCEDURES WITH MCC,503,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,22863.90969,
FOOT PROCEDURES WITHOUT CC/MCC,505,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14686.11562,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11671.56266,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7335.68526,
FRACTURES OF FEMUR WITH MCC,533,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12842.15944,
FRACTURES OF FEMUR WITHOUT MCC,534,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6603.345492,
FRACTURES OF HIP AND PELVIS WITH MCC,535,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10501.78504,
FRACTURES OF HIP AND PELVIS WITHOUT MCC,536,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6615.633072,
FULL TERM NEONATE WITH MAJOR PROBLEMS,793,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2950,,,,,,,Fee Schedule,2300,34156.19571,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,928,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,58756.75004,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,929,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,26383.89178,
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,934,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,18108.61623,
GASTROINTESTINAL HEMORRHAGE WITH CC,378,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8033.619804,
GASTROINTESTINAL HEMORRHAGE WITH MCC,377,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14974.46416,
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,379,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5164.060288,
GASTROINTESTINAL OBSTRUCTION WITH CC,389,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6469.820456,
GASTROINTESTINAL OBSTRUCTION WITH MCC,388,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12097.5321,
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,390,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,4456.29568,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12896.2248,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8374.395356,
HAND PROCEDURES FOR INJURIES,906,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14437.08733,
HEADACHES WITH MCC,102,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9182.098948,
HEADACHES WITHOUT MCC,103,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6850.735436,
HEART FAILURE AND SHOCK WITH CC,292,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6954.77028,
HEART FAILURE AND SHOCK WITH MCC,291,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10516.53014,
HEART FAILURE AND SHOCK WITHOUT CC/MCC,293,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,4636.51352,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,1,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,229563.9421,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,2,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,92826.9327,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,421,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14233.1135,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,420,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,27910.00921,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,422,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11464.31214,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,354,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13781.74973,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,353,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,23772.37144,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,355,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11017.8634,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,481,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17157.55754,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,480,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,23856.74616,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,482,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13360.69532,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,521,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,23511.87474,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,522,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17347.60544,
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,969,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,50143.97564,
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,970,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,21604.84233,
HIV WITH MAJOR RELATED CONDITION WITH CC,975,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10608.2774,
HIV WITH MAJOR RELATED CONDITION WITH MCC,974,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,23641.30392,
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,976,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7327.49354,
HIV WITH OR WITHOUT OTHER RELATED CONDITION,977,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10383.82427,
HYPERTENSION WITH MCC,304,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9748.1468,
HYPERTENSION WITHOUT MCC,305,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6185.567772,
INBORN AND OTHER DISORDERS OF METABOLISM,642,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11649.44501,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8019.69388,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11729.72387,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5436.025392,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,854,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,16367.87573,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,853,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,40455.62839,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,855,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12264.64318,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,727,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12147.50159,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,728,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6645.123264,
INFLAMMATORY BOWEL DISEASE WITH CC,386,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7997.576236,
INFLAMMATORY BOWEL DISEASE WITH MCC,385,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12961.75856,
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,387,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5581.018836,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,351,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12488.27714,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,350,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,20412.94707,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,352,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9566.290616,
INTERSTITIAL LUNG DISEASE WITH CC,197,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7774.761452,
INTERSTITIAL LUNG DISEASE WITH MCC,196,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15459.41398,
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,198,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5866.909864,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,65,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8276.094716,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,64,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,16473.54892,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,66,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5606.413168,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,21,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,43365.32734,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,20,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,64459.00634,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,22,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,25190.35817,
INTRAOCULAR PROCEDURES WITH CC/MCC,116,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14811.44893,
INTRAOCULAR PROCEDURES WITHOUT CC/MCC,117,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8887.197028,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",62,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14394.49038,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",61,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,22585.39121,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",63,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11499.53654,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,657,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14990.8476,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,656,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,26080.79814,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,658,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12711.9111,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,660,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10826.99632,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,659,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,20814.34135,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,661,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8481.706888,
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,689,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9504.852716,
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,690,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6631.19734,
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,687,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8583.284216,
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,686,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14775.40536,
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,688,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6473.916316,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,695,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9369.689336,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,696,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5644.09508,
KIDNEY TRANSPLANT,652,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,26455.15974,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,650,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,38512.55241,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,651,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,30356.87598,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,486,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17129.70569,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,485,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,26435.49961,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,487,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12829.87186,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,488,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12480.90459,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,489,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13879,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,418,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13857.11355,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,417,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,19548.72061,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,419,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11188.25118,
"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,30825.44236,
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,5,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,84460.72906,
LIVER TRANSPLANT WITHOUT MCC,6,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,37985.00564,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,496,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14777.04371,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,495,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,29700.7192,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,497,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9434.403924,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,498,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,24712.7809,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,499,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,16504.67746,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",493,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,20775.02109,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",492,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,30076.71915,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",494,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,16436.68618,
LUNG TRANSPLANT,7,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,106084.4123,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,821,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,18337.98439,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,820,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,48042.79946,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,822,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9862.83088,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,841,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13363.97201,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,840,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,26499.39503,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,824,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,18559.16083,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,823,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,37557.39786,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,825,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11053.90697,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,842,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8276.913888,
MAJOR BLADDER PROCEDURES WITH CC,654,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,22931.0818,
MAJOR BLADDER PROCEDURES WITH MCC,653,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,42567.45381,
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,655,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17338.59455,
MAJOR CHEST PROCEDURES WITH CC,164,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,20675.90128,
MAJOR CHEST PROCEDURES WITH MCC,163,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,36713.6507,
MAJOR CHEST PROCEDURES WITHOUT CC/MCC,165,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15680.59042,
MAJOR CHEST TRAUMA WITH CC,184,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8716.809252,
MAJOR CHEST TRAUMA WITH MCC,183,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12532.51243,
MAJOR CHEST TRAUMA WITHOUT CC/MCC,185,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6442.78778,
MAJOR ESOPHAGEAL DISORDERS WITH CC,369,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8193.358344,
MAJOR ESOPHAGEAL DISORDERS WITH MCC,368,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13040.39907,
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,370,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5740.757376,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,372,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8363.74612,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,371,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14524.73873,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,373,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5958.657128,
MAJOR HEAD AND NECK PROCEDURES WITH CC,141,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17866.96049,
MAJOR HEAD AND NECK PROCEDURES WITH MCC,140,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,34940.14332,
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,142,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13879,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,809,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10369.89835,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,808,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,18086.49859,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,810,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8573.454152,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,469,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,24847.1251,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,470,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15801.00871,
MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,483,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,22706.62867,
MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,707,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,16385.89752,
MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,708,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13879,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,507,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14797.52301,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,508,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12405.54077,
MAJOR SKIN DISORDERS WITH MCC,595,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17372.1806,
MAJOR SKIN DISORDERS WITHOUT MCC,596,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8867.5369,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,330,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,19637.19118,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,329,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,37653.24098,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,331,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13785.84559,
MAJOR THUMB OR JOINT PROCEDURES,506,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9826.787312,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,436,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9265.654492,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,435,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15045.73212,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,437,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6989.994676,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8910.953016,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15086.69072,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",756,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7868.14706,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9360.678444,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14824.55568,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",724,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5010.875124,
MALIGNANT BREAST DISORDERS WITH CC,598,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9267.292836,
MALIGNANT BREAST DISORDERS WITH MCC,597,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13656.41641,
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,599,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6006.169104,
MASTECTOMY FOR MALIGNANCY WITH CC/MCC,582,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15782.16775,
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,583,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14125.80197,
MEDICAL BACK PROBLEMS WITH MCC,551,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13730.14189,
MEDICAL BACK PROBLEMS WITHOUT MCC,552,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7874.700436,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,760,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8253.1579,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,761,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,4666.003712,
MINOR BLADDER PROCEDURES WITH CC,663,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12453.05274,
MINOR BLADDER PROCEDURES WITH MCC,662,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,25078.95078,
MINOR BLADDER PROCEDURES WITHOUT CC/MCC,664,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8575.911668,
MINOR SKIN DISORDERS WITH MCC,606,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12395.7107,
MINOR SKIN DISORDERS WITHOUT MCC,607,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7424.975008,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,345,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12326.08108,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,344,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,21157.57442,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,346,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9717.018264,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10940.86123,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6374.796504,
MOUTH PROCEDURES WITH CC/MCC,137,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12231.8763,
MOUTH PROCEDURES WITHOUT CC/MCC,138,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7259.502264,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC,427,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,59132.74999,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,426,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,90282.58446,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC,428,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,46053.84984,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,447,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,54733.79635,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,448,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,34739.44618,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,59,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10165.10535,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,58,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14003.74534,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,60,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7534.744056,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,827,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,18932.70326,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,826,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,38319.22782,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,828,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13957.05254,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,829,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,25885.8352,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,830,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13879,
NEONATE WITH OTHER SIGNIFICANT PROBLEMS,794,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2950,,,,,,,Fee Schedule,1184,12090.15955,
"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2950,,,,,,,Fee Schedule,1184,14763.11778,
NERVOUS SYSTEM NEOPLASMS WITH MCC,54,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12507.93727,
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,55,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8352.277712,
NEUROLOGICAL EYE DISORDERS,123,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6541.907592,
NEUROSES EXCEPT DEPRESSIVE,882,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,850,8796.268936,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,98,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,18799.17823,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,97,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,29586.8543,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,99,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11160.39933,
NON-EXTENSIVE BURNS,935,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,16874.9432,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,988,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13463.91099,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,987,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,28084.49285,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,989,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9823.510624,
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,600,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8532.495552,
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,601,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,4955.9906,
NONTRAUMATIC STUPOR AND COMA WITH MCC,80,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14827.0132,
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,81,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7336.504432,
NORMAL NEWBORN,795,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,530,2786,
O.R. PROCEDURES FOR OBESITY WITH CC,620,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13879,
O.R. PROCEDURES FOR OBESITY WITH MCC,619,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,23652.77233,
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,621,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13879,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,940,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,19143.23047,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,939,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,29723.65602,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,941,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,16610.35064,
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,876,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,850,31660.17863,
ORBITAL PROCEDURES WITH CC/MCC,113,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,19259.55289,
ORBITAL PROCEDURES WITHOUT CC/MCC,114,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11083.39716,
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,884,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,850,13179.65831,
OSTEOMYELITIS WITH CC,540,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10618.92664,
OSTEOMYELITIS WITH MCC,539,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,16135.23088,
OSTEOMYELITIS WITHOUT CC/MCC,541,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6319.91198,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,818,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8635.711224,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,817,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13827.62336,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,819,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8327,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,832,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5911.145152,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,831,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9850.5433,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,833,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,4283.450388,
OTHER CARDIOTHORACIC PROCEDURES WITH MCC,228,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,40527.71553,
OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,229,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,25799.82214,
OTHER CEREBROVASCULAR DISORDERS WITH CC,71,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8404.70472,
OTHER CEREBROVASCULAR DISORDERS WITH MCC,70,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13637.57546,
OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,72,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6194.578664,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,315,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7891.083876,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,314,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17081.37454,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,316,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5587.572212,
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,264,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,27365.25983,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,394,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7664.992404,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,393,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13101.0178,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,395,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5316.42628,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,357,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,19049.84486,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,356,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,35984.58762,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,358,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11451.20539,
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,92,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8380.12956,
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,91,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14386.29866,
OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,93,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6523.066636,
OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT,124,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10838.46473,
OTHER DISORDERS OF THE EYE WITHOUT MCC,125,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6289.602616,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7507.71138,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12807.75422,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5661.297692,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14195.43159,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,30691.09815,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9848.904956,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17848.11954,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,30528.9021,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13879,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,319,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,36558.82719,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,320,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,19703.54412,
OTHER FACTORS INFLUENCING HEALTH STATUS,951,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,4972,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,749,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,21033.06027,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,750,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12089.34038,
OTHER HEART ASSIST SYSTEM IMPLANT,215,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,81564.95604,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,424,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17922.66419,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,423,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,34020.21316,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,425,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12290.03752,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,868,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8446.482492,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,867,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17146.9083,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,869,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5977.498084,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14330.59497,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8336.713444,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,699,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8314.5958,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,698,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13552.38157,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,700,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5651.467628,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,674,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,19157.15639,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,673,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,34418.33075,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,675,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13445.88921,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,271,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,29132.21384,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,270,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,43221.97224,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,272,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,20913.46116,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,729,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8672.573964,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,730,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5504.83584,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,717,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15486.44666,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,718,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11002.29913,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,715,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,18327.33516,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,716,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12050.02012,
OTHER MENTAL DISORDER DIAGNOSES,887,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,850,8772.512948,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,964,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12554.63007,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,963,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,22394.52414,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,965,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7704.31266,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,565,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7982.011968,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,564,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12644.73899,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,566,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6138.055796,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,516,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17023.21333,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,515,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,26106.19247,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,517,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13879,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,844,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9972.599928,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,843,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,16340.84306,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,845,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6976.068752,
OTHER O.R. PROCEDURES FOR INJURIES WITH CC,908,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,16344.11974,
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,907,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,31450.4706,
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,909,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10753.27084,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,958,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,34519.08891,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,957,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,62420.08723,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,959,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,24117.24285,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,803,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15227.58831,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,802,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,32636.63165,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,804,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11107.97232,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,205,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14999.03932,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,206,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7709.227692,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,167,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14772.94785,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,166,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,30618.19184,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,168,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11193.16621,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14155.29216,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,26528.88522,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11821.47113,
OTHER VASCULAR PROCEDURES WITH CC,253,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,21262.42843,
OTHER VASCULAR PROCEDURES WITH MCC,252,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,28575.17688,
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,254,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14595.18752,
OTITIS MEDIA AND URI WITH MCC,152,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9684.251384,
OTITIS MEDIA AND URI WITHOUT MCC,153,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6047.127704,
PANCREAS TRANSPLANT,10,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,25147.76123,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",406,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,23757.62634,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",405,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,44812.80426,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",407,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,18182.34171,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,543,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8421.08816,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,542,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14470.67338,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,544,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6181.471912,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17448.3636,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",735,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13879,
PENIS PROCEDURES WITH CC/MCC,709,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,19062.95161,
PENIS PROCEDURES WITHOUT CC/MCC,710,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13879,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,273,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,33794.94086,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,274,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,26964.68472,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES,321,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,22288.03178,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC,322,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14442.00236,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC,250,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17878.4289,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC,251,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13879,
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC,359,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,28168.04839,
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC,360,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,19777.2696,
PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE,318,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,19841.98418,
PERIPHERAL VASCULAR DISORDERS WITH CC,300,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8744.6611,
PERIPHERAL VASCULAR DISORDERS WITH MCC,299,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13374.62124,
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,301,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5895.580884,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",41,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,18011.13476,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",40,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,31629.86926,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",42,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14152.83464,
PERITONEAL ADHESIOLYSIS WITH CC,336,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17273.87996,
PERITONEAL ADHESIOLYSIS WITH MCC,335,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,29251.81295,
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,337,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12574.2902,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,243,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17455.73615,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,242,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,26154.52362,
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,244,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14806.5339,
PLEURAL EFFUSION WITH CC,187,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8102.430252,
PLEURAL EFFUSION WITH MCC,186,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12766.79562,
PLEURAL EFFUSION WITHOUT CC/MCC,188,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5875.101584,
PNEUMOTHORAX WITH CC,200,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9005.157796,
PNEUMOTHORAX WITH MCC,199,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14451.01325,
PNEUMOTHORAX WITHOUT CC/MCC,201,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5857.898972,
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,917,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12847.89365,
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,918,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7021.123212,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,862,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14939.23976,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,863,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8174.517388,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,857,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17542.56838,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,856,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,37261.67676,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,858,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11410.24679,
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,769,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13842.36846,
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,776,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5363.119084,
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,67,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12031.17916,
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,68,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7080.922768,
PREMATURITY WITH MAJOR PROBLEMS,791,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2950,,,,,,,Fee Schedule,2300,33250.19148,
PREMATURITY WITHOUT MAJOR PROBLEMS,792,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2950,,,,,,,Fee Schedule,2300,20063.16062,
PROSTATECTOMY WITH CC,666,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14329.7758,
PROSTATECTOMY WITH MCC,665,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,25567.99646,
PROSTATECTOMY WITHOUT CC/MCC,667,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9061.680664,
PSYCHOSES,885,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,850,11442.1945,
PULMONARY EDEMA AND RESPIRATORY FAILURE,189,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10120.05089,
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,175,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11252.14659,
PULMONARY EMBOLISM WITHOUT MCC,176,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6594.3346,
RADIOTHERAPY,849,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,22195.46534,
RECTAL RESECTION WITH CC,333,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,19186.64658,
RECTAL RESECTION WITH MCC,332,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,29659.7606,
RECTAL RESECTION WITHOUT CC/MCC,334,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13417.21819,
RED BLOOD CELL DISORDERS WITH MCC,811,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11503.6324,
RED BLOOD CELL DISORDERS WITHOUT MCC,812,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7521.637304,
REHABILITATION WITH CC/MCC,945,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12685.69759,
REHABILITATION WITHOUT CC/MCC,946,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9394.264496,
RENAL FAILURE WITH CC,683,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7174.308376,
RENAL FAILURE WITH MCC,682,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12131.93732,
RENAL FAILURE WITHOUT CC/MCC,684,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,4917.489516,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,178,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7995.11872,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,177,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12801.20084,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,179,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6184.7486,
RESPIRATORY NEOPLASMS WITH CC,181,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8773.33212,
RESPIRATORY NEOPLASMS WITH MCC,180,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14466.57752,
RESPIRATORY NEOPLASMS WITHOUT CC/MCC,182,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6094.63968,
RESPIRATORY SIGNS AND SYMPTOMS,204,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6613.994728,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,208,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,22516.58076,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,207,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,52711.26068,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,815,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8306.40408,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,814,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17421.33092,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,816,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5177.16704,
REVISION OF HIP OR KNEE REPLACEMENT WITH CC,467,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,28888.91975,
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,466,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,42641.17929,
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,468,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,22510.84656,
SALIVARY GLAND PROCEDURES,139,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9900.512792,
SEIZURES WITH MCC,100,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15865.7233,
SEIZURES WITHOUT MCC,101,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7393.846472,
SEPTIC ARTHRITIS WITH CC,549,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9889.044384,
SEPTIC ARTHRITIS WITH MCC,548,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15817.39215,
SEPTIC ARTHRITIS WITHOUT CC/MCC,550,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7160.382452,
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,870,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,56619.5303,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,871,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15912.4161,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,872,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8382.587076,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17033.86257,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,24743.09026,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13879,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,555,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10827.8155,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,556,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6804.042632,
SIGNS AND SYMPTOMS WITH MCC,947,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10398.56937,
SIGNS AND SYMPTOMS WITHOUT MCC,948,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6557.47186,
SIMPLE PNEUMONIA AND PLEURISY WITH CC,194,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6601.707148,
SIMPLE PNEUMONIA AND PLEURISY WITH MCC,193,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10767.19677,
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,195,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5148.49602,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,8,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,45911.31391,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,19,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,54288.16678,
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL,402,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,32934.81026,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,450,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,43658.59091,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,451,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,26462.53229,
SINUS AND MASTOID PROCEDURES WITH CC/MCC,135,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17327.12614,
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,136,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8327,
SKIN DEBRIDEMENT WITH CC,571,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13839.91094,
SKIN DEBRIDEMENT WITH MCC,570,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,24092.66769,
SKIN DEBRIDEMENT WITHOUT CC/MCC,572,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9390.168636,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,577,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,21713.7922,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,576,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,40149.25806,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,578,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13159.17901,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,574,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,28436.73681,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,573,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,53667.23441,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,575,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13381.99379,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14695.12651,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,29155.96982,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",624,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10255.21427,
SKIN GRAFTS FOR INJURIES WITH CC/MCC,904,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,30089.00673,
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,905,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11728.9047,
SKIN ULCERS WITH CC,593,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9717.837436,
SKIN ULCERS WITH MCC,592,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15853.43572,
SKIN ULCERS WITHOUT CC/MCC,594,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7100.582896,
SOFT TISSUE PROCEDURES WITH CC,501,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14319.94573,
SOFT TISSUE PROCEDURES WITH MCC,500,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,25925.15546,
SOFT TISSUE PROCEDURES WITHOUT CC/MCC,502,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11025.23595,
SPINAL DISORDERS AND INJURIES WITH CC/MCC,52,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14587.81498,
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,53,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8021.332224,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",457,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,48848.04553,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",456,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,68838.29985,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",458,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,34180.77087,
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,29,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,27946.87195,
SPINAL PROCEDURES WITH MCC,28,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,49218.31128,
SPINAL PROCEDURES WITHOUT CC/MCC,30,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17982.46374,
SPLENIC PROCEDURES WITH CC,800,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,23013.81817,
SPLENIC PROCEDURES WITH MCC,799,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,37099.48071,
SPLENIC PROCEDURES WITHOUT CC/MCC,801,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15637.17431,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",537,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7817.358396,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",538,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,5900.495916,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,20022.20202,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,40855.38433,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13125.59296,
SYNCOPE AND COLLAPSE,312,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7139.903152,
"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12180.26847,
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7316.844304,
TESTES PROCEDURES WITH CC/MCC,711,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17069.90614,
TESTES PROCEDURES WITHOUT CC/MCC,712,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9008.434484,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13879,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,24739.81357,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10881.06168,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",12,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,34536.29152,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",11,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,44678.46005,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",13,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,23606.8987,
"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",4,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,113466.7904,
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,69,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6543.545936,
TRANSURETHRAL PROCEDURES WITH CC,669,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12713.54944,
TRANSURETHRAL PROCEDURES WITH MCC,668,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,23919.8224,
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,670,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8327,
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,713,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12315.43185,
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,714,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8661.924728,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12059.03101,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7503.61552,
TRAUMATIC INJURY WITH MCC,913,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13390.18551,
TRAUMATIC INJURY WITHOUT MCC,914,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7253.76806,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,86,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10671.35364,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,85,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,18610.76867,
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,87,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7492.966284,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,83,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11434.00278,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,82,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,18722.99523,
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,84,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7829.645976,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC,278,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,45596.75186,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC,279,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,29542.61901,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM,173,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,24381.83541,
UNCOMPLICATED PEPTIC ULCER WITH MCC,383,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11310.3078,
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,384,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7002.282256,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,256,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13908.72139,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,255,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,22096.34553,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,257,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8946.996584,
URETHRAL PROCEDURES WITH CC/MCC,671,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14704.1374,
URETHRAL PROCEDURES WITHOUT CC/MCC,672,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8842.96174,
URETHRAL STRICTURE,697,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8829.035816,
URINARY STONES WITH MCC,693,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,11013.76754,
URINARY STONES WITHOUT MCC,694,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6403.467524,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,742,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15030.16786,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,743,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,10163.467,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,740,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14823.73651,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,739,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,28886.46224,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,741,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13879,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,737,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,16879.85823,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,736,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,29281.30314,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,738,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12029.54082,
"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14229.83681,
"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,8327,
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,768,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,4000,,,,,,,Fee Schedule,2300,8778.247152,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,797,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,4000,,,,,,,Fee Schedule,2300,8194.996688,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,796,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,4000,,,,,,,Fee Schedule,2300,9559.73724,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,798,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,4000,,,,,,,Fee Schedule,2300,7840.295212,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,806,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,4000,,,,,,,Fee Schedule,2300,6176.55688,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,805,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,4000,,,,,,,Fee Schedule,2300,8840.504224,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,807,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,4000,,,,,,,Fee Schedule,2300,5522.857624,
VEIN LIGATION AND STRIPPING,263,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,25045.36473,
VENTRICULAR SHUNT PROCEDURES WITH CC,32,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,17456.55532,
VENTRICULAR SHUNT PROCEDURES WITH MCC,31,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,36703.00146,
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,33,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,13879,
VIRAL ILLNESS WITH MCC,865,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,12273.65408,
VIRAL ILLNESS WITHOUT MCC,866,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,7123.519712,
VIRAL MENINGITIS WITH CC/MCC,75,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15707.6231,
VIRAL MENINGITIS WITHOUT CC/MCC,76,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,6133.959936,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,464,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,25514.75028,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,463,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,46688.70814,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,465,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,14939.23976,
WOUND DEBRIDEMENTS FOR INJURIES WITH CC,902,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,15683.04794,
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,901,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,34377.37215,
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,903,MS-DRG,,,,,,,,inpatient,,,,,Viva,Commercial,2703,,,,,,,Fee Schedule,2300,9581.035712,
"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8213.84,,,,,,,Fee Schedule,2300,8213.837644,
ABORTION WITHOUT D&C,779,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5841.52,,,,,,,Fee Schedule,2300,5841.515532,
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,880,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7865.69,,,,,,,Fee Schedule,850,7865.689544,
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,289,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13982.45,,,,,,,Fee Schedule,2300,13982.44687,
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,288,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,22168.43,,,,,,,Fee Schedule,2300,22168.43266,
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,290,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7615.84,,,,,,,Fee Schedule,2300,7615.842084,
ACUTE LEUKEMIA WITH CC,835,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17086.29,,,,,,,Fee Schedule,2300,17086.28958,
ACUTE LEUKEMIA WITH MCC,834,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,44971.72,,,,,,,Fee Schedule,2300,44971.72363,
ACUTE LEUKEMIA WITH OTHER PROCEDURES,850,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,70936.2,,,,,,,Fee Schedule,2300,70936.19934,
ACUTE LEUKEMIA WITHOUT CC/MCC,836,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9989.8,,,,,,,Fee Schedule,2300,9989.80254,
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,121,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9529.43,,,,,,,Fee Schedule,2300,9529.427876,
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,122,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6437.05,,,,,,,Fee Schedule,2300,6437.053576,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",281,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7529.01,,,,,,,Fee Schedule,2300,7529.009852,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",280,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13140.34,,,,,,,Fee Schedule,2300,13140.33805,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",282,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5923.43,,,,,,,Fee Schedule,2300,5923.432732,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",284,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5670.31,,,,,,,Fee Schedule,2300,5670.308584,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",283,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,16226.16,,,,,,,Fee Schedule,2300,16226.15898,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",285,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,4906.02,,,,,,,Fee Schedule,2300,4972,
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,614,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17954.61,,,,,,,Fee Schedule,2300,17954.6119,
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,615,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11462.67,,,,,,,Fee Schedule,2300,11462.6738,
AFTERCARE WITH CC/MCC,949,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9745.69,,,,,,,Fee Schedule,2300,9745.689284,
AFTERCARE WITHOUT CC/MCC,950,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5141.94,,,,,,,Fee Schedule,2300,5141.942644,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9224.7,,,,,,,Fee Schedule,2300,9224.695892,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15276.74,,,,,,,Fee Schedule,2300,15276.73863,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6585.32,,,,,,,Fee Schedule,2300,6585.323708,
AICD GENERATOR PROCEDURES,245,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,37373.9,,,,,,,Fee Schedule,2300,37373.90333,
AICD LEAD PROCEDURES,265,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,29639.28,,,,,,,Fee Schedule,2300,29639.2813,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11596.2,,,,,,,Fee Schedule,850,11596.19883,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14295.37,,,,,,,Fee Schedule,850,14295.37057,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7231.65,,,,,,,Fee Schedule,850,7231.650416,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5053.47,,,,,,,Fee Schedule,850,5053.472068,
ALLERGIC REACTIONS WITH MCC,915,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13775.2,,,,,,,Fee Schedule,2300,13775.19635,
ALLERGIC REACTIONS WITHOUT MCC,916,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5458.14,,,,,,,Fee Schedule,2300,5458.143036,
ALLOGENEIC BONE MARROW TRANSPLANT,14,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,98447.27,,,,,,,Fee Schedule,2300,98447.27179,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,240,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,23350.5,,,,,,,Fee Schedule,2300,23350.49786,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,239,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,40317.19,,,,,,,Fee Schedule,2300,40317.18832,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,241,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11340.62,,,,,,,Fee Schedule,2300,11340.61717,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,475,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,18641.9,,,,,,,Fee Schedule,2300,18641.8972,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,474,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,35166.23,,,,,,,Fee Schedule,2300,35166.23479,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,476,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9667.87,,,,,,,Fee Schedule,2300,9667.867944,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15320.97,,,,,,,Fee Schedule,2300,15320.97392,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,28567.8,,,,,,,Fee Schedule,2300,28567.80433,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",618,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11618.32,,,,,,,Fee Schedule,2300,11618.31648,
ANAL AND STOMAL PROCEDURES WITH CC,348,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10721.32,,,,,,,Fee Schedule,2300,10721.32314,
ANAL AND STOMAL PROCEDURES WITH MCC,347,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,18804.91,,,,,,,Fee Schedule,2300,18804.91243,
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,349,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7131.71,,,,,,,Fee Schedule,2300,7131.711432,
ANGINA PECTORIS,311,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5749.77,,,,,,,Fee Schedule,2300,5749.768268,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,268,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,56341.83,,,,,,,Fee Schedule,2300,56341.83099,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,269,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,34595.27,,,,,,,Fee Schedule,2300,34595.2719,
APPENDIX PROCEDURES WITH CC,398,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12398.99,,,,,,,Fee Schedule,2300,12398.98739,
APPENDIX PROCEDURES WITH MCC,397,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,19618.35,,,,,,,Fee Schedule,2300,19618.35023,
APPENDIX PROCEDURES WITHOUT CC/MCC,399,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9377.06,,,,,,,Fee Schedule,2300,9377.061884,
ATHEROSCLEROSIS WITH MCC,302,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9802.21,,,,,,,Fee Schedule,2300,9802.212152,
ATHEROSCLEROSIS WITHOUT MCC,303,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5514.67,,,,,,,Fee Schedule,2300,5514.665904,
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,16,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,48574.44,,,,,,,Fee Schedule,2300,48574.44208,
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,17,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,39634,,,,,,,Fee Schedule,2300,39633.99888,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,519,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,16385.08,,,,,,,Fee Schedule,2300,16385.07834,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,518,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,30614.92,,,,,,,Fee Schedule,2300,30614.91516,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,520,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12237.61,,,,,,,Fee Schedule,2300,12237.61051,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,95,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,21128.08,,,,,,,Fee Schedule,2300,21128.08422,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,94,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,28829.94,,,,,,,Fee Schedule,2300,28829.93937,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,96,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,21128.08,,,,,,,Fee Schedule,2300,21128.08422,
BEHAVIORAL AND DEVELOPMENTAL DISORDERS,886,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17000.28,,,,,,,Fee Schedule,850,17000.27652,
BENIGN PROSTATIC HYPERTROPHY WITH MCC,725,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9585.95,,,,,,,Fee Schedule,2300,9585.950744,
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,726,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5914.42,,,,,,,Fee Schedule,2300,5914.42184,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,461,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,43912.53,,,,,,,Fee Schedule,2300,43912.53423,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,462,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,21789.98,,,,,,,Fee Schedule,2300,21789.9752,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,409,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17835.83,,,,,,,Fee Schedule,2300,17835.83196,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,408,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,29208.4,,,,,,,Fee Schedule,2300,29208.39683,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,410,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13005.99,,,,,,,Fee Schedule,2300,13005.99384,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,478,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,20145.08,,,,,,,Fee Schedule,2300,20145.07782,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,477,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,28299.12,,,,,,,Fee Schedule,2300,28299.11591,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,479,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15227.59,,,,,,,Fee Schedule,2300,15227.58831,
BONE DISEASES AND ARTHROPATHIES WITH MCC,553,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10618.93,,,,,,,Fee Schedule,2300,10618.92664,
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,554,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6799.95,,,,,,,Fee Schedule,2300,6799.946772,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17536.02,,,,,,,Fee Schedule,2300,17536.015,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15802.65,,,,,,,Fee Schedule,2300,15802.64705,
BRONCHITIS AND ASTHMA WITH CC/MCC,202,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7955.8,,,,,,,Fee Schedule,2300,7955.798464,
BRONCHITIS AND ASTHMA WITHOUT CC/MCC,203,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5488.45,,,,,,,Fee Schedule,2300,5488.4524,
"CARDIAC ARREST, UNEXPLAINED WITH CC",297,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5107.54,,,,,,,Fee Schedule,2300,6184,
"CARDIAC ARREST, UNEXPLAINED WITH MCC",296,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12794.65,,,,,,,Fee Schedule,2300,12794.64747,
"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",298,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,3728.05,,,,,,,Fee Schedule,2300,4972,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,309,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6026.65,,,,,,,Fee Schedule,2300,6026.648404,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,308,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9862.83,,,,,,,Fee Schedule,2300,9862.83088,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,310,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,4637.33,,,,,,,Fee Schedule,2300,4637.332692,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,306,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12908.51,,,,,,,Fee Schedule,2300,12908.51238,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,307,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7480.68,,,,,,,Fee Schedule,2300,7480.678704,
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC,275,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,58410.24,,,,,,,Fee Schedule,2300,58410.24029,
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR,276,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,49204.39,,,,,,,Fee Schedule,2300,49204.38535,
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC,277,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,37833.46,,,,,,,Fee Schedule,2300,37833.45882,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,258,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,25739.2,,,,,,,Fee Schedule,2300,25739.20341,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,259,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,16564.48,,,,,,,Fee Schedule,2300,16564.47701,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,261,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15486.45,,,,,,,Fee Schedule,2300,15486.44666,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,260,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,26646.03,,,,,,,Fee Schedule,2300,26646.02682,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,262,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13351.68,,,,,,,Fee Schedule,2300,13351.68443,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,217,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,53863.02,,,,,,,Fee Schedule,2300,53863.01652,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,216,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,80137.96,,,,,,,Fee Schedule,2300,80137.95842,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,218,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,53863.02,,,,,,,Fee Schedule,2300,53863.01652,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,220,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,43684.8,,,,,,,Fee Schedule,2300,43684.80442,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,219,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,62898.48,,,,,,,Fee Schedule,2300,62898.48368,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,221,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,41287.91,,,,,,,Fee Schedule,2300,41287.90714,
CAROTID ARTERY STENT PROCEDURES WITH CC,35,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,19582.31,,,,,,,Fee Schedule,2300,19582.30666,
CAROTID ARTERY STENT PROCEDURES WITH MCC,34,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,31707.69,,,,,,,Fee Schedule,2300,31707.6906,
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,36,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15914.87,,,,,,,Fee Schedule,2300,15914.87362,
CELLULITIS WITH MCC,602,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11642.89,,,,,,,Fee Schedule,2300,11642.89164,
CELLULITIS WITHOUT MCC,603,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7134.17,,,,,,,Fee Schedule,2300,7134.168948,
CERVICAL SPINAL FUSION WITH CC,472,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,24133.63,,,,,,,Fee Schedule,2300,24133.62629,
CERVICAL SPINAL FUSION WITH MCC,471,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,39555.36,,,,,,,Fee Schedule,2300,39555.35836,
CERVICAL SPINAL FUSION WITHOUT CC/MCC,473,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,19998.45,,,,,,,Fee Schedule,2300,19998.44604,
CESAREAN SECTION WITH STERILIZATION WITH CC,784,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8684.04,,,,,,,Fee Schedule,2300,8684.042372,
CESAREAN SECTION WITH STERILIZATION WITH MCC,783,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,20111.49,,,,,,,Fee Schedule,2300,20111.49177,
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,785,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7846.03,,,,,,,Fee Schedule,2300,7846.029416,
CESAREAN SECTION WITHOUT STERILIZATION WITH CC,787,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9148.51,,,,,,,Fee Schedule,2300,9148.512896,
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,786,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13512.24,,,,,,,Fee Schedule,2300,13512.24214,
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,788,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7854.22,,,,,,,Fee Schedule,2300,7854.221136,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,837,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,39355.48,,,,,,,Fee Schedule,2300,39355.4804,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,838,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17099.4,,,,,,,Fee Schedule,2300,17099.39633,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,839,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11828.02,,,,,,,Fee Schedule,2300,11828.02451,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,847,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10716.41,,,,,,,Fee Schedule,2300,10716.4081,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,846,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,21237.03,,,,,,,Fee Schedule,2300,21237.0341,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,848,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6958.05,,,,,,,Fee Schedule,2300,6958.046968,
CHEST PAIN,313,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5898.04,,,,,,,Fee Schedule,2300,5898.0384,
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,18,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,353741.41,,,,,,,Fee Schedule,2300,353741.4064,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,415,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,16929.83,,,,,,,Fee Schedule,2300,16929.82772,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,414,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,29183.82,,,,,,,Fee Schedule,2300,29183.82167,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,416,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11167.77,,,,,,,Fee Schedule,2300,11167.77188,
CHOLECYSTECTOMY WITH C.D.E. WITH CC,412,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17223.09,,,,,,,Fee Schedule,2300,17223.0913,
CHOLECYSTECTOMY WITH C.D.E. WITH MCC,411,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,27059.71,,,,,,,Fee Schedule,2300,27059.70868,
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,413,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13602.35,,,,,,,Fee Schedule,2300,13602.35106,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,191,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6905.62,,,,,,,Fee Schedule,2300,6905.61996,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,190,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9073.97,,,,,,,Fee Schedule,2300,9073.968244,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,192,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5259.08,,,,,,,Fee Schedule,2300,5259.08424,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",286,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,18126.64,,,,,,,Fee Schedule,2300,18126.63802,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",287,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8765.96,,,,,,,Fee Schedule,2300,8765.959572,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,433,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8652.09,,,,,,,Fee Schedule,2300,8652.094664,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,432,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,16122.94,,,,,,,Fee Schedule,2300,16122.9433,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,434,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5836.6,,,,,,,Fee Schedule,2300,5836.6005,
COAGULATION DISORDERS,813,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12494.83,,,,,,,Fee Schedule,2300,12494.83052,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC,429,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,73804.12,,,,,,,Fee Schedule,2300,73804.12051,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC,430,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,47242.47,,,,,,,Fee Schedule,2300,47242.46841,
COMPLEX AORTIC ARCH PROCEDURES,209,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,92720.44,,,,,,,Fee Schedule,2300,92720.44034,
COMPLICATED PEPTIC ULCER WITH CC,381,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8875.73,,,,,,,Fee Schedule,2300,8875.72862,
COMPLICATED PEPTIC ULCER WITH MCC,380,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,16073.79,,,,,,,Fee Schedule,2300,16073.79298,
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,382,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6558.29,,,,,,,Fee Schedule,2300,6558.291032,
COMPLICATIONS OF TREATMENT WITH CC,920,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8210.56,,,,,,,Fee Schedule,2300,8210.560956,
COMPLICATIONS OF TREATMENT WITH MCC,919,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14997.4,,,,,,,Fee Schedule,2300,14997.40098,
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,921,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5639.18,,,,,,,Fee Schedule,2300,5639.180048,
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES,212,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,89077.58,,,,,,,Fee Schedule,2300,89077.58245,
CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION,317,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,54773.94,,,,,,,Fee Schedule,2300,54773.93578,
CONCUSSION WITH CC,89,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8999.42,,,,,,,Fee Schedule,2300,8999.423592,
CONCUSSION WITH MCC,88,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11073.57,,,,,,,Fee Schedule,2300,11073.5671,
CONCUSSION WITHOUT CC/MCC,90,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6743.42,,,,,,,Fee Schedule,2300,6743.423904,
CONNECTIVE TISSUE DISORDERS WITH CC,546,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9448.33,,,,,,,Fee Schedule,2300,9448.329848,
CONNECTIVE TISSUE DISORDERS WITH MCC,545,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,20329.39,,,,,,,Fee Schedule,2300,20329.39152,
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,547,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6849.92,,,,,,,Fee Schedule,2300,6849.916264,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,233,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,62627.34,,,,,,,Fee Schedule,2300,62627.33774,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,234,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,44748.91,,,,,,,Fee Schedule,2300,44748.90884,
CORONARY BYPASS WITH PTCA WITH MCC,231,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,69055.38,,,,,,,Fee Schedule,2300,69055.38043,
CORONARY BYPASS WITH PTCA WITHOUT MCC,232,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,49663.12,,,,,,,Fee Schedule,2300,49663.12167,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,235,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,48073.93,,,,,,,Fee Schedule,2300,48073.92799,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,236,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,34313.48,,,,,,,Fee Schedule,2300,34313.47674,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC,323,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,35448.85,,,,,,,Fee Schedule,2300,35448.84913,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC,324,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,25812.11,,,,,,,Fee Schedule,2300,25812.10972,
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE,325,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,26298.7,,,,,,,Fee Schedule,2300,26298.69789,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,73,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13141.98,,,,,,,Fee Schedule,2300,13141.9764,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,74,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8444.02,,,,,,,Fee Schedule,2300,8444.024976,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,26,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,25469.7,,,,,,,Fee Schedule,2300,25469.69582,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,25,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,37245.29,,,,,,,Fee Schedule,2300,37245.29332,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,27,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,20666.89,,,,,,,Fee Schedule,2300,20666.89039,
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,955,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,55139.29,,,,,,,Fee Schedule,2300,55139.28649,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,23,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,46941.01,,,,,,,Fee Schedule,2300,46941.01312,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,24,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,32045.19,,,,,,,Fee Schedule,2300,32045.18947,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,16785.65,,,,,,,Fee Schedule,2300,16785.65345,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9318.08,,,,,,,Fee Schedule,2300,9318.0815,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,56,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,19030.18,,,,,,,Fee Schedule,2300,19030.18473,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,57,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10613.19,,,,,,,Fee Schedule,2300,10613.19243,
DENTAL AND ORAL DISEASES WITH CC,158,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7452.83,,,,,,,Fee Schedule,2300,7452.826856,
DENTAL AND ORAL DISEASES WITH MCC,157,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14063.54,,,,,,,Fee Schedule,2300,14063.5449,
DENTAL AND ORAL DISEASES WITHOUT CC/MCC,159,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5803.83,,,,,,,Fee Schedule,2300,5803.83362,
DEPRESSIVE NEUROSES,881,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7707.59,,,,,,,Fee Schedule,850,7707.589348,
DIABETES WITH CC,638,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7341.42,,,,,,,Fee Schedule,2300,7341.419464,
DIABETES WITH MCC,637,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11769.04,,,,,,,Fee Schedule,2300,11769.04412,
DIABETES WITHOUT CC/MCC,639,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5088.7,,,,,,,Fee Schedule,2300,5088.696464,
DIGESTIVE MALIGNANCY WITH CC,375,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9908.7,,,,,,,Fee Schedule,2300,9908.704512,
DIGESTIVE MALIGNANCY WITH MCC,374,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17519.63,,,,,,,Fee Schedule,2300,17519.63156,
DIGESTIVE MALIGNANCY WITHOUT CC/MCC,376,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7571.61,,,,,,,Fee Schedule,2300,7571.606796,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7907.47,,,,,,,Fee Schedule,2300,7907.467316,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14701.68,,,,,,,Fee Schedule,2300,14701.67988,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5731.75,,,,,,,Fee Schedule,2300,5731.746484,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,439,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6890.87,,,,,,,Fee Schedule,2300,6890.874864,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,438,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13354.14,,,,,,,Fee Schedule,2300,13354.14194,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,440,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5090.33,,,,,,,Fee Schedule,2300,5090.334808,
DISORDERS OF PERSONALITY AND IMPULSE CONTROL,883,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,16107.38,,,,,,,Fee Schedule,850,16107.37904,
DISORDERS OF THE BILIARY TRACT WITH CC,445,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8965.02,,,,,,,Fee Schedule,2300,8965.018368,
DISORDERS OF THE BILIARY TRACT WITH MCC,444,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13687.54,,,,,,,Fee Schedule,2300,13687.54495,
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,446,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6777.01,,,,,,,Fee Schedule,2300,6777.009956,
DYSEQUILIBRIUM,149,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6156.9,,,,,,,Fee Schedule,2300,6156.896752,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",147,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10415.77,,,,,,,Fee Schedule,2300,10415.77198,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17345.15,,,,,,,Fee Schedule,2300,17345.14793,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",148,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6529.62,,,,,,,Fee Schedule,2300,6529.620012,
"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",3,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,173870.9,,,,,,,Fee Schedule,2300,173870.8953,
ENDOCRINE DISORDERS WITH CC,644,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8396.51,,,,,,,Fee Schedule,2300,8396.513,
ENDOCRINE DISORDERS WITH MCC,643,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13484.39,,,,,,,Fee Schedule,2300,13484.39029,
ENDOCRINE DISORDERS WITHOUT CC/MCC,645,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6293.7,,,,,,,Fee Schedule,2300,6293.698476,
ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES,213,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,46749.33,,,,,,,Fee Schedule,2300,46749.32687,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,266,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,50202.14,,,,,,,Fee Schedule,2300,50202.13685,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,267,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,38999.14,,,,,,,Fee Schedule,2300,38999.14058,
EPISTAXIS WITH MCC,150,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10907.28,,,,,,,Fee Schedule,2300,10907.27518,
EPISTAXIS WITHOUT MCC,151,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6012.72,,,,,,,Fee Schedule,2300,6012.72248,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10389.56,,,,,,,Fee Schedule,2300,10389.55848,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6386.26,,,,,,,Fee Schedule,2300,6386.264912,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,927,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,150975.04,,,,,,,Fee Schedule,2300,150975.0379,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,933,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,31265.34,,,,,,,Fee Schedule,2300,31265.33772,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,982,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,20139.34,,,,,,,Fee Schedule,2300,20139.34362,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,981,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,38433.91,,,,,,,Fee Schedule,2300,38433.9119,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,983,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14040.61,,,,,,,Fee Schedule,2300,14040.60808,
EXTRACRANIAL PROCEDURES WITH CC,38,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13291.88,,,,,,,Fee Schedule,2300,13291.88487,
EXTRACRANIAL PROCEDURES WITH MCC,37,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,26967.96,,,,,,,Fee Schedule,2300,26967.96141,
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,39,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9629.37,,,,,,,Fee Schedule,2300,9629.36686,
EXTRAOCULAR PROCEDURES EXCEPT ORBIT,115,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12573.47,,,,,,,Fee Schedule,2300,12573.47103,
"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,48687.49,,,,,,,Fee Schedule,2300,48687.48782,
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,748,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11364.37,,,,,,,Fee Schedule,2300,13879,
FEVER AND INFLAMMATORY CONDITIONS,864,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7271.79,,,,,,,Fee Schedule,2300,7271.789844,
FOOT PROCEDURES WITH CC,504,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15311.96,,,,,,,Fee Schedule,2300,15311.96302,
FOOT PROCEDURES WITH MCC,503,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,22863.91,,,,,,,Fee Schedule,2300,22863.90969,
FOOT PROCEDURES WITHOUT CC/MCC,505,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14686.12,,,,,,,Fee Schedule,2300,14686.11562,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11671.56,,,,,,,Fee Schedule,2300,11671.56266,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7335.69,,,,,,,Fee Schedule,2300,7335.68526,
FRACTURES OF FEMUR WITH MCC,533,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12842.16,,,,,,,Fee Schedule,2300,12842.15944,
FRACTURES OF FEMUR WITHOUT MCC,534,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6603.35,,,,,,,Fee Schedule,2300,6603.345492,
FRACTURES OF HIP AND PELVIS WITH MCC,535,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10501.79,,,,,,,Fee Schedule,2300,10501.78504,
FRACTURES OF HIP AND PELVIS WITHOUT MCC,536,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6615.63,,,,,,,Fee Schedule,2300,6615.633072,
FULL TERM NEONATE WITH MAJOR PROBLEMS,793,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,34156.2,,,,,,,Fee Schedule,2300,34156.19571,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,928,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,58756.75,,,,,,,Fee Schedule,2300,58756.75004,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,929,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,26383.89,,,,,,,Fee Schedule,2300,26383.89178,
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,934,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,18108.62,,,,,,,Fee Schedule,2300,18108.61623,
GASTROINTESTINAL HEMORRHAGE WITH CC,378,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8033.62,,,,,,,Fee Schedule,2300,8033.619804,
GASTROINTESTINAL HEMORRHAGE WITH MCC,377,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14974.46,,,,,,,Fee Schedule,2300,14974.46416,
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,379,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5164.06,,,,,,,Fee Schedule,2300,5164.060288,
GASTROINTESTINAL OBSTRUCTION WITH CC,389,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6469.82,,,,,,,Fee Schedule,2300,6469.820456,
GASTROINTESTINAL OBSTRUCTION WITH MCC,388,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12097.53,,,,,,,Fee Schedule,2300,12097.5321,
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,390,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,4456.3,,,,,,,Fee Schedule,2300,4456.29568,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12896.22,,,,,,,Fee Schedule,2300,12896.2248,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8374.4,,,,,,,Fee Schedule,2300,8374.395356,
HAND PROCEDURES FOR INJURIES,906,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14437.09,,,,,,,Fee Schedule,2300,14437.08733,
HEADACHES WITH MCC,102,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9182.1,,,,,,,Fee Schedule,2300,9182.098948,
HEADACHES WITHOUT MCC,103,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6850.74,,,,,,,Fee Schedule,2300,6850.735436,
HEART FAILURE AND SHOCK WITH CC,292,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6954.77,,,,,,,Fee Schedule,2300,6954.77028,
HEART FAILURE AND SHOCK WITH MCC,291,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10516.53,,,,,,,Fee Schedule,2300,10516.53014,
HEART FAILURE AND SHOCK WITHOUT CC/MCC,293,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,4636.51,,,,,,,Fee Schedule,2300,4636.51352,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,1,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,229563.94,,,,,,,Fee Schedule,2300,229563.9421,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,2,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,92826.93,,,,,,,Fee Schedule,2300,92826.9327,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,421,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14233.11,,,,,,,Fee Schedule,2300,14233.1135,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,420,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,27910.01,,,,,,,Fee Schedule,2300,27910.00921,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,422,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11464.31,,,,,,,Fee Schedule,2300,11464.31214,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,354,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13781.75,,,,,,,Fee Schedule,2300,13781.74973,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,353,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,23772.37,,,,,,,Fee Schedule,2300,23772.37144,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,355,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11017.86,,,,,,,Fee Schedule,2300,11017.8634,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,481,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17157.56,,,,,,,Fee Schedule,2300,17157.55754,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,480,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,23856.75,,,,,,,Fee Schedule,2300,23856.74616,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,482,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13360.7,,,,,,,Fee Schedule,2300,13360.69532,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,521,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,23511.87,,,,,,,Fee Schedule,2300,23511.87474,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,522,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17347.61,,,,,,,Fee Schedule,2300,17347.60544,
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,969,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,50143.98,,,,,,,Fee Schedule,2300,50143.97564,
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,970,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,21604.84,,,,,,,Fee Schedule,2300,21604.84233,
HIV WITH MAJOR RELATED CONDITION WITH CC,975,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10608.28,,,,,,,Fee Schedule,2300,10608.2774,
HIV WITH MAJOR RELATED CONDITION WITH MCC,974,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,23641.3,,,,,,,Fee Schedule,2300,23641.30392,
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,976,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7327.49,,,,,,,Fee Schedule,2300,7327.49354,
HIV WITH OR WITHOUT OTHER RELATED CONDITION,977,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10383.82,,,,,,,Fee Schedule,2300,10383.82427,
HYPERTENSION WITH MCC,304,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9748.15,,,,,,,Fee Schedule,2300,9748.1468,
HYPERTENSION WITHOUT MCC,305,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6185.57,,,,,,,Fee Schedule,2300,6185.567772,
INBORN AND OTHER DISORDERS OF METABOLISM,642,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11649.45,,,,,,,Fee Schedule,2300,11649.44501,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8019.69,,,,,,,Fee Schedule,2300,8019.69388,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11729.72,,,,,,,Fee Schedule,2300,11729.72387,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5436.03,,,,,,,Fee Schedule,2300,5436.025392,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,854,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,16367.88,,,,,,,Fee Schedule,2300,16367.87573,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,853,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,40455.63,,,,,,,Fee Schedule,2300,40455.62839,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,855,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12264.64,,,,,,,Fee Schedule,2300,12264.64318,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,727,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12147.5,,,,,,,Fee Schedule,2300,12147.50159,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,728,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6645.12,,,,,,,Fee Schedule,2300,6645.123264,
INFLAMMATORY BOWEL DISEASE WITH CC,386,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7997.58,,,,,,,Fee Schedule,2300,7997.576236,
INFLAMMATORY BOWEL DISEASE WITH MCC,385,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12961.76,,,,,,,Fee Schedule,2300,12961.75856,
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,387,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5581.02,,,,,,,Fee Schedule,2300,5581.018836,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,351,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12488.28,,,,,,,Fee Schedule,2300,12488.27714,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,350,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,20412.95,,,,,,,Fee Schedule,2300,20412.94707,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,352,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9566.29,,,,,,,Fee Schedule,2300,9566.290616,
INTERSTITIAL LUNG DISEASE WITH CC,197,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7774.76,,,,,,,Fee Schedule,2300,7774.761452,
INTERSTITIAL LUNG DISEASE WITH MCC,196,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15459.41,,,,,,,Fee Schedule,2300,15459.41398,
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,198,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5866.91,,,,,,,Fee Schedule,2300,5866.909864,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,65,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8276.09,,,,,,,Fee Schedule,2300,8276.094716,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,64,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,16473.55,,,,,,,Fee Schedule,2300,16473.54892,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,66,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5606.41,,,,,,,Fee Schedule,2300,5606.413168,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,21,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,43365.33,,,,,,,Fee Schedule,2300,43365.32734,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,20,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,64459.01,,,,,,,Fee Schedule,2300,64459.00634,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,22,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,25190.36,,,,,,,Fee Schedule,2300,25190.35817,
INTRAOCULAR PROCEDURES WITH CC/MCC,116,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14811.45,,,,,,,Fee Schedule,2300,14811.44893,
INTRAOCULAR PROCEDURES WITHOUT CC/MCC,117,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8887.2,,,,,,,Fee Schedule,2300,8887.197028,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",62,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14394.49,,,,,,,Fee Schedule,2300,14394.49038,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",61,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,22585.39,,,,,,,Fee Schedule,2300,22585.39121,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",63,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11499.54,,,,,,,Fee Schedule,2300,11499.53654,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,657,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14990.85,,,,,,,Fee Schedule,2300,14990.8476,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,656,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,26080.8,,,,,,,Fee Schedule,2300,26080.79814,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,658,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12711.91,,,,,,,Fee Schedule,2300,12711.9111,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,660,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10827,,,,,,,Fee Schedule,2300,10826.99632,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,659,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,20814.34,,,,,,,Fee Schedule,2300,20814.34135,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,661,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8481.71,,,,,,,Fee Schedule,2300,8481.706888,
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,689,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9504.85,,,,,,,Fee Schedule,2300,9504.852716,
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,690,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6631.2,,,,,,,Fee Schedule,2300,6631.19734,
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,687,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8583.28,,,,,,,Fee Schedule,2300,8583.284216,
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,686,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14775.41,,,,,,,Fee Schedule,2300,14775.40536,
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,688,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6473.92,,,,,,,Fee Schedule,2300,6473.916316,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,695,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9369.69,,,,,,,Fee Schedule,2300,9369.689336,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,696,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5644.1,,,,,,,Fee Schedule,2300,5644.09508,
KIDNEY TRANSPLANT,652,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,26455.16,,,,,,,Fee Schedule,2300,26455.15974,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,650,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,38512.55,,,,,,,Fee Schedule,2300,38512.55241,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,651,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,30356.88,,,,,,,Fee Schedule,2300,30356.87598,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,486,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17129.71,,,,,,,Fee Schedule,2300,17129.70569,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,485,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,26435.5,,,,,,,Fee Schedule,2300,26435.49961,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,487,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12829.87,,,,,,,Fee Schedule,2300,12829.87186,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,488,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12480.9,,,,,,,Fee Schedule,2300,12480.90459,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,489,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9148.51,,,,,,,Fee Schedule,2300,13879,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,418,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13857.11,,,,,,,Fee Schedule,2300,13857.11355,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,417,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,19548.72,,,,,,,Fee Schedule,2300,19548.72061,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,419,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11188.25,,,,,,,Fee Schedule,2300,11188.25118,
"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,30825.44,,,,,,,Fee Schedule,2300,30825.44236,
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,5,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,84460.73,,,,,,,Fee Schedule,2300,84460.72906,
LIVER TRANSPLANT WITHOUT MCC,6,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,37985.01,,,,,,,Fee Schedule,2300,37985.00564,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,496,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14777.04,,,,,,,Fee Schedule,2300,14777.04371,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,495,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,29700.72,,,,,,,Fee Schedule,2300,29700.7192,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,497,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9434.4,,,,,,,Fee Schedule,2300,9434.403924,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,498,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,24712.78,,,,,,,Fee Schedule,2300,24712.7809,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,499,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,16504.68,,,,,,,Fee Schedule,2300,16504.67746,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",493,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,20775.02,,,,,,,Fee Schedule,2300,20775.02109,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",492,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,30076.72,,,,,,,Fee Schedule,2300,30076.71915,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",494,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,16436.69,,,,,,,Fee Schedule,2300,16436.68618,
LUNG TRANSPLANT,7,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,106084.41,,,,,,,Fee Schedule,2300,106084.4123,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,821,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,18337.98,,,,,,,Fee Schedule,2300,18337.98439,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,820,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,48042.8,,,,,,,Fee Schedule,2300,48042.79946,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,822,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9862.83,,,,,,,Fee Schedule,2300,9862.83088,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,841,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13363.97,,,,,,,Fee Schedule,2300,13363.97201,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,840,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,26499.4,,,,,,,Fee Schedule,2300,26499.39503,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,824,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,18559.16,,,,,,,Fee Schedule,2300,18559.16083,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,823,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,37557.4,,,,,,,Fee Schedule,2300,37557.39786,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,825,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11053.91,,,,,,,Fee Schedule,2300,11053.90697,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,842,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8276.91,,,,,,,Fee Schedule,2300,8276.913888,
MAJOR BLADDER PROCEDURES WITH CC,654,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,22931.08,,,,,,,Fee Schedule,2300,22931.0818,
MAJOR BLADDER PROCEDURES WITH MCC,653,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,42567.45,,,,,,,Fee Schedule,2300,42567.45381,
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,655,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17338.59,,,,,,,Fee Schedule,2300,17338.59455,
MAJOR CHEST PROCEDURES WITH CC,164,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,20675.9,,,,,,,Fee Schedule,2300,20675.90128,
MAJOR CHEST PROCEDURES WITH MCC,163,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,36713.65,,,,,,,Fee Schedule,2300,36713.6507,
MAJOR CHEST PROCEDURES WITHOUT CC/MCC,165,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15680.59,,,,,,,Fee Schedule,2300,15680.59042,
MAJOR CHEST TRAUMA WITH CC,184,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8716.81,,,,,,,Fee Schedule,2300,8716.809252,
MAJOR CHEST TRAUMA WITH MCC,183,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12532.51,,,,,,,Fee Schedule,2300,12532.51243,
MAJOR CHEST TRAUMA WITHOUT CC/MCC,185,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6442.79,,,,,,,Fee Schedule,2300,6442.78778,
MAJOR ESOPHAGEAL DISORDERS WITH CC,369,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8193.36,,,,,,,Fee Schedule,2300,8193.358344,
MAJOR ESOPHAGEAL DISORDERS WITH MCC,368,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13040.4,,,,,,,Fee Schedule,2300,13040.39907,
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,370,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5740.76,,,,,,,Fee Schedule,2300,5740.757376,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,372,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8363.75,,,,,,,Fee Schedule,2300,8363.74612,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,371,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14524.74,,,,,,,Fee Schedule,2300,14524.73873,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,373,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5958.66,,,,,,,Fee Schedule,2300,5958.657128,
MAJOR HEAD AND NECK PROCEDURES WITH CC,141,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17866.96,,,,,,,Fee Schedule,2300,17866.96049,
MAJOR HEAD AND NECK PROCEDURES WITH MCC,140,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,34940.14,,,,,,,Fee Schedule,2300,34940.14332,
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,142,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13077.26,,,,,,,Fee Schedule,2300,13879,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,809,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10369.9,,,,,,,Fee Schedule,2300,10369.89835,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,808,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,18086.5,,,,,,,Fee Schedule,2300,18086.49859,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,810,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8573.45,,,,,,,Fee Schedule,2300,8573.454152,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,469,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,24847.13,,,,,,,Fee Schedule,2300,24847.1251,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,470,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15801.01,,,,,,,Fee Schedule,2300,15801.00871,
MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,483,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,22706.63,,,,,,,Fee Schedule,2300,22706.62867,
MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,707,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,16385.9,,,,,,,Fee Schedule,2300,16385.89752,
MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,708,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12567.74,,,,,,,Fee Schedule,2300,13879,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,507,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14797.52,,,,,,,Fee Schedule,2300,14797.52301,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,508,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12405.54,,,,,,,Fee Schedule,2300,12405.54077,
MAJOR SKIN DISORDERS WITH MCC,595,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17372.18,,,,,,,Fee Schedule,2300,17372.1806,
MAJOR SKIN DISORDERS WITHOUT MCC,596,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8867.54,,,,,,,Fee Schedule,2300,8867.5369,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,330,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,19637.19,,,,,,,Fee Schedule,2300,19637.19118,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,329,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,37653.24,,,,,,,Fee Schedule,2300,37653.24098,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,331,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13785.85,,,,,,,Fee Schedule,2300,13785.84559,
MAJOR THUMB OR JOINT PROCEDURES,506,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9826.79,,,,,,,Fee Schedule,2300,9826.787312,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,436,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9265.65,,,,,,,Fee Schedule,2300,9265.654492,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,435,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15045.73,,,,,,,Fee Schedule,2300,15045.73212,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,437,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6989.99,,,,,,,Fee Schedule,2300,6989.994676,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8910.95,,,,,,,Fee Schedule,2300,8910.953016,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15086.69,,,,,,,Fee Schedule,2300,15086.69072,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",756,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7868.15,,,,,,,Fee Schedule,2300,7868.14706,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9360.68,,,,,,,Fee Schedule,2300,9360.678444,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14824.56,,,,,,,Fee Schedule,2300,14824.55568,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",724,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5010.88,,,,,,,Fee Schedule,2300,5010.875124,
MALIGNANT BREAST DISORDERS WITH CC,598,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9267.29,,,,,,,Fee Schedule,2300,9267.292836,
MALIGNANT BREAST DISORDERS WITH MCC,597,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13656.42,,,,,,,Fee Schedule,2300,13656.41641,
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,599,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6006.17,,,,,,,Fee Schedule,2300,6006.169104,
MASTECTOMY FOR MALIGNANCY WITH CC/MCC,582,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15782.17,,,,,,,Fee Schedule,2300,15782.16775,
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,583,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14125.8,,,,,,,Fee Schedule,2300,14125.80197,
MEDICAL BACK PROBLEMS WITH MCC,551,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13730.14,,,,,,,Fee Schedule,2300,13730.14189,
MEDICAL BACK PROBLEMS WITHOUT MCC,552,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7874.7,,,,,,,Fee Schedule,2300,7874.700436,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,760,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8253.16,,,,,,,Fee Schedule,2300,8253.1579,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,761,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,4666,,,,,,,Fee Schedule,2300,4666.003712,
MINOR BLADDER PROCEDURES WITH CC,663,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12453.05,,,,,,,Fee Schedule,2300,12453.05274,
MINOR BLADDER PROCEDURES WITH MCC,662,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,25078.95,,,,,,,Fee Schedule,2300,25078.95078,
MINOR BLADDER PROCEDURES WITHOUT CC/MCC,664,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8575.91,,,,,,,Fee Schedule,2300,8575.911668,
MINOR SKIN DISORDERS WITH MCC,606,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12395.71,,,,,,,Fee Schedule,2300,12395.7107,
MINOR SKIN DISORDERS WITHOUT MCC,607,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7424.98,,,,,,,Fee Schedule,2300,7424.975008,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,345,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12326.08,,,,,,,Fee Schedule,2300,12326.08108,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,344,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,21157.57,,,,,,,Fee Schedule,2300,21157.57442,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,346,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9717.02,,,,,,,Fee Schedule,2300,9717.018264,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10940.86,,,,,,,Fee Schedule,2300,10940.86123,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6374.8,,,,,,,Fee Schedule,2300,6374.796504,
MOUTH PROCEDURES WITH CC/MCC,137,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12231.88,,,,,,,Fee Schedule,2300,12231.8763,
MOUTH PROCEDURES WITHOUT CC/MCC,138,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7259.5,,,,,,,Fee Schedule,2300,7259.502264,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC,427,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,59132.75,,,,,,,Fee Schedule,2300,59132.74999,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,426,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,90282.58,,,,,,,Fee Schedule,2300,90282.58446,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC,428,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,46053.85,,,,,,,Fee Schedule,2300,46053.84984,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,447,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,54733.8,,,,,,,Fee Schedule,2300,54733.79635,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,448,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,34739.45,,,,,,,Fee Schedule,2300,34739.44618,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,59,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10165.11,,,,,,,Fee Schedule,2300,10165.10535,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,58,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14003.75,,,,,,,Fee Schedule,2300,14003.74534,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,60,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7534.74,,,,,,,Fee Schedule,2300,7534.744056,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,827,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,18932.7,,,,,,,Fee Schedule,2300,18932.70326,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,826,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,38319.23,,,,,,,Fee Schedule,2300,38319.22782,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,828,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13957.05,,,,,,,Fee Schedule,2300,13957.05254,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,829,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,25885.84,,,,,,,Fee Schedule,2300,25885.8352,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,830,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12328.54,,,,,,,Fee Schedule,2300,13879,
NEONATE WITH OTHER SIGNIFICANT PROBLEMS,794,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12090.16,,,,,,,Fee Schedule,1184,12090.15955,
"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14763.12,,,,,,,Fee Schedule,1184,14763.11778,
NERVOUS SYSTEM NEOPLASMS WITH MCC,54,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12507.94,,,,,,,Fee Schedule,2300,12507.93727,
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,55,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8352.28,,,,,,,Fee Schedule,2300,8352.277712,
NEUROLOGICAL EYE DISORDERS,123,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6541.91,,,,,,,Fee Schedule,2300,6541.907592,
NEUROSES EXCEPT DEPRESSIVE,882,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8796.27,,,,,,,Fee Schedule,850,8796.268936,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,98,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,18799.18,,,,,,,Fee Schedule,2300,18799.17823,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,97,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,29586.85,,,,,,,Fee Schedule,2300,29586.8543,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,99,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11160.4,,,,,,,Fee Schedule,2300,11160.39933,
NON-EXTENSIVE BURNS,935,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,16874.94,,,,,,,Fee Schedule,2300,16874.9432,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,988,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13463.91,,,,,,,Fee Schedule,2300,13463.91099,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,987,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,28084.49,,,,,,,Fee Schedule,2300,28084.49285,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,989,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9823.51,,,,,,,Fee Schedule,2300,9823.510624,
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,600,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8532.5,,,,,,,Fee Schedule,2300,8532.495552,
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,601,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,4955.99,,,,,,,Fee Schedule,2300,4955.9906,
NONTRAUMATIC STUPOR AND COMA WITH MCC,80,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14827.01,,,,,,,Fee Schedule,2300,14827.0132,
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,81,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7336.5,,,,,,,Fee Schedule,2300,7336.504432,
NORMAL NEWBORN,795,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,1636.71,,,,,,,Fee Schedule,530,2786,
O.R. PROCEDURES FOR OBESITY WITH CC,620,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13109.21,,,,,,,Fee Schedule,2300,13879,
O.R. PROCEDURES FOR OBESITY WITH MCC,619,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,23652.77,,,,,,,Fee Schedule,2300,23652.77233,
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,621,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12356.39,,,,,,,Fee Schedule,2300,13879,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,940,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,19143.23,,,,,,,Fee Schedule,2300,19143.23047,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,939,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,29723.66,,,,,,,Fee Schedule,2300,29723.65602,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,941,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,16610.35,,,,,,,Fee Schedule,2300,16610.35064,
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,876,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,31660.18,,,,,,,Fee Schedule,850,31660.17863,
ORBITAL PROCEDURES WITH CC/MCC,113,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,19259.55,,,,,,,Fee Schedule,2300,19259.55289,
ORBITAL PROCEDURES WITHOUT CC/MCC,114,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11083.4,,,,,,,Fee Schedule,2300,11083.39716,
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,884,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13179.66,,,,,,,Fee Schedule,850,13179.65831,
OSTEOMYELITIS WITH CC,540,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10618.93,,,,,,,Fee Schedule,2300,10618.92664,
OSTEOMYELITIS WITH MCC,539,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,16135.23,,,,,,,Fee Schedule,2300,16135.23088,
OSTEOMYELITIS WITHOUT CC/MCC,541,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6319.91,,,,,,,Fee Schedule,2300,6319.91198,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,818,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8635.71,,,,,,,Fee Schedule,2300,8635.711224,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,817,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13827.62,,,,,,,Fee Schedule,2300,13827.62336,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,819,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7044.06,,,,,,,Fee Schedule,2300,8327,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,832,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5911.15,,,,,,,Fee Schedule,2300,5911.145152,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,831,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9850.54,,,,,,,Fee Schedule,2300,9850.5433,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,833,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,4283.45,,,,,,,Fee Schedule,2300,4283.450388,
OTHER CARDIOTHORACIC PROCEDURES WITH MCC,228,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,40527.72,,,,,,,Fee Schedule,2300,40527.71553,
OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,229,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,25799.82,,,,,,,Fee Schedule,2300,25799.82214,
OTHER CEREBROVASCULAR DISORDERS WITH CC,71,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8404.7,,,,,,,Fee Schedule,2300,8404.70472,
OTHER CEREBROVASCULAR DISORDERS WITH MCC,70,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13637.58,,,,,,,Fee Schedule,2300,13637.57546,
OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,72,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6194.58,,,,,,,Fee Schedule,2300,6194.578664,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,315,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7891.08,,,,,,,Fee Schedule,2300,7891.083876,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,314,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17081.37,,,,,,,Fee Schedule,2300,17081.37454,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,316,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5587.57,,,,,,,Fee Schedule,2300,5587.572212,
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,264,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,27365.26,,,,,,,Fee Schedule,2300,27365.25983,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,394,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7664.99,,,,,,,Fee Schedule,2300,7664.992404,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,393,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13101.02,,,,,,,Fee Schedule,2300,13101.0178,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,395,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5316.43,,,,,,,Fee Schedule,2300,5316.42628,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,357,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,19049.84,,,,,,,Fee Schedule,2300,19049.84486,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,356,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,35984.59,,,,,,,Fee Schedule,2300,35984.58762,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,358,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11451.21,,,,,,,Fee Schedule,2300,11451.20539,
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,92,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8380.13,,,,,,,Fee Schedule,2300,8380.12956,
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,91,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14386.3,,,,,,,Fee Schedule,2300,14386.29866,
OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,93,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6523.07,,,,,,,Fee Schedule,2300,6523.066636,
OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT,124,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10838.46,,,,,,,Fee Schedule,2300,10838.46473,
OTHER DISORDERS OF THE EYE WITHOUT MCC,125,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6289.6,,,,,,,Fee Schedule,2300,6289.602616,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7507.71,,,,,,,Fee Schedule,2300,7507.71138,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12807.75,,,,,,,Fee Schedule,2300,12807.75422,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5661.3,,,,,,,Fee Schedule,2300,5661.297692,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14195.43,,,,,,,Fee Schedule,2300,14195.43159,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,30691.1,,,,,,,Fee Schedule,2300,30691.09815,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9848.9,,,,,,,Fee Schedule,2300,9848.904956,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17848.12,,,,,,,Fee Schedule,2300,17848.11954,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,30528.9,,,,,,,Fee Schedule,2300,30528.9021,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11955.82,,,,,,,Fee Schedule,2300,13879,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,319,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,36558.83,,,,,,,Fee Schedule,2300,36558.82719,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,320,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,19703.54,,,,,,,Fee Schedule,2300,19703.54412,
OTHER FACTORS INFLUENCING HEALTH STATUS,951,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,4554.6,,,,,,,Fee Schedule,2300,4972,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,749,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,21033.06,,,,,,,Fee Schedule,2300,21033.06027,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,750,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12089.34,,,,,,,Fee Schedule,2300,12089.34038,
OTHER HEART ASSIST SYSTEM IMPLANT,215,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,81564.96,,,,,,,Fee Schedule,2300,81564.95604,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,424,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17922.66,,,,,,,Fee Schedule,2300,17922.66419,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,423,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,34020.21,,,,,,,Fee Schedule,2300,34020.21316,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,425,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12290.04,,,,,,,Fee Schedule,2300,12290.03752,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,868,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8446.48,,,,,,,Fee Schedule,2300,8446.482492,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,867,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17146.91,,,,,,,Fee Schedule,2300,17146.9083,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,869,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5977.5,,,,,,,Fee Schedule,2300,5977.498084,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14330.59,,,,,,,Fee Schedule,2300,14330.59497,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8336.71,,,,,,,Fee Schedule,2300,8336.713444,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,699,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8314.6,,,,,,,Fee Schedule,2300,8314.5958,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,698,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13552.38,,,,,,,Fee Schedule,2300,13552.38157,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,700,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5651.47,,,,,,,Fee Schedule,2300,5651.467628,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,674,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,19157.16,,,,,,,Fee Schedule,2300,19157.15639,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,673,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,34418.33,,,,,,,Fee Schedule,2300,34418.33075,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,675,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13445.89,,,,,,,Fee Schedule,2300,13445.88921,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,271,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,29132.21,,,,,,,Fee Schedule,2300,29132.21384,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,270,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,43221.97,,,,,,,Fee Schedule,2300,43221.97224,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,272,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,20913.46,,,,,,,Fee Schedule,2300,20913.46116,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,729,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8672.57,,,,,,,Fee Schedule,2300,8672.573964,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,730,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5504.84,,,,,,,Fee Schedule,2300,5504.83584,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,717,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15486.45,,,,,,,Fee Schedule,2300,15486.44666,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,718,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11002.3,,,,,,,Fee Schedule,2300,11002.29913,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,715,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,18327.34,,,,,,,Fee Schedule,2300,18327.33516,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,716,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12050.02,,,,,,,Fee Schedule,2300,12050.02012,
OTHER MENTAL DISORDER DIAGNOSES,887,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8772.51,,,,,,,Fee Schedule,850,8772.512948,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,964,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12554.63,,,,,,,Fee Schedule,2300,12554.63007,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,963,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,22394.52,,,,,,,Fee Schedule,2300,22394.52414,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,965,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7704.31,,,,,,,Fee Schedule,2300,7704.31266,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,565,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7982.01,,,,,,,Fee Schedule,2300,7982.011968,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,564,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12644.74,,,,,,,Fee Schedule,2300,12644.73899,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,566,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6138.06,,,,,,,Fee Schedule,2300,6138.055796,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,516,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17023.21,,,,,,,Fee Schedule,2300,17023.21333,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,515,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,26106.19,,,,,,,Fee Schedule,2300,26106.19247,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,517,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12588.22,,,,,,,Fee Schedule,2300,13879,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,844,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9972.6,,,,,,,Fee Schedule,2300,9972.599928,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,843,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,16340.84,,,,,,,Fee Schedule,2300,16340.84306,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,845,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6976.07,,,,,,,Fee Schedule,2300,6976.068752,
OTHER O.R. PROCEDURES FOR INJURIES WITH CC,908,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,16344.12,,,,,,,Fee Schedule,2300,16344.11974,
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,907,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,31450.47,,,,,,,Fee Schedule,2300,31450.4706,
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,909,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10753.27,,,,,,,Fee Schedule,2300,10753.27084,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,958,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,34519.09,,,,,,,Fee Schedule,2300,34519.08891,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,957,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,62420.09,,,,,,,Fee Schedule,2300,62420.08723,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,959,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,24117.24,,,,,,,Fee Schedule,2300,24117.24285,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,803,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15227.59,,,,,,,Fee Schedule,2300,15227.58831,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,802,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,32636.63,,,,,,,Fee Schedule,2300,32636.63165,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,804,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11107.97,,,,,,,Fee Schedule,2300,11107.97232,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,205,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14999.04,,,,,,,Fee Schedule,2300,14999.03932,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,206,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7709.23,,,,,,,Fee Schedule,2300,7709.227692,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,167,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14772.95,,,,,,,Fee Schedule,2300,14772.94785,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,166,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,30618.19,,,,,,,Fee Schedule,2300,30618.19184,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,168,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11193.17,,,,,,,Fee Schedule,2300,11193.16621,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14155.29,,,,,,,Fee Schedule,2300,14155.29216,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,26528.89,,,,,,,Fee Schedule,2300,26528.88522,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11821.47,,,,,,,Fee Schedule,2300,11821.47113,
OTHER VASCULAR PROCEDURES WITH CC,253,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,21262.43,,,,,,,Fee Schedule,2300,21262.42843,
OTHER VASCULAR PROCEDURES WITH MCC,252,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,28575.18,,,,,,,Fee Schedule,2300,28575.17688,
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,254,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14595.19,,,,,,,Fee Schedule,2300,14595.18752,
OTITIS MEDIA AND URI WITH MCC,152,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9684.25,,,,,,,Fee Schedule,2300,9684.251384,
OTITIS MEDIA AND URI WITHOUT MCC,153,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6047.13,,,,,,,Fee Schedule,2300,6047.127704,
PANCREAS TRANSPLANT,10,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,25147.76,,,,,,,Fee Schedule,2300,25147.76123,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",406,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,23757.63,,,,,,,Fee Schedule,2300,23757.62634,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",405,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,44812.8,,,,,,,Fee Schedule,2300,44812.80426,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",407,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,18182.34,,,,,,,Fee Schedule,2300,18182.34171,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,543,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8421.09,,,,,,,Fee Schedule,2300,8421.08816,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,542,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14470.67,,,,,,,Fee Schedule,2300,14470.67338,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,544,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6181.47,,,,,,,Fee Schedule,2300,6181.471912,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17448.36,,,,,,,Fee Schedule,2300,17448.3636,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",735,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11021.96,,,,,,,Fee Schedule,2300,13879,
PENIS PROCEDURES WITH CC/MCC,709,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,19062.95,,,,,,,Fee Schedule,2300,19062.95161,
PENIS PROCEDURES WITHOUT CC/MCC,710,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11478.24,,,,,,,Fee Schedule,2300,13879,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,273,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,33794.94,,,,,,,Fee Schedule,2300,33794.94086,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,274,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,26964.68,,,,,,,Fee Schedule,2300,26964.68472,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES,321,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,22288.03,,,,,,,Fee Schedule,2300,22288.03178,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC,322,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14442,,,,,,,Fee Schedule,2300,14442.00236,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC,250,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17878.43,,,,,,,Fee Schedule,2300,17878.4289,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC,251,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12242.53,,,,,,,Fee Schedule,2300,13879,
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC,359,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,28168.05,,,,,,,Fee Schedule,2300,28168.04839,
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC,360,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,19777.27,,,,,,,Fee Schedule,2300,19777.2696,
PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE,318,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,19841.98,,,,,,,Fee Schedule,2300,19841.98418,
PERIPHERAL VASCULAR DISORDERS WITH CC,300,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8744.66,,,,,,,Fee Schedule,2300,8744.6611,
PERIPHERAL VASCULAR DISORDERS WITH MCC,299,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13374.62,,,,,,,Fee Schedule,2300,13374.62124,
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,301,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5895.58,,,,,,,Fee Schedule,2300,5895.580884,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",41,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,18011.13,,,,,,,Fee Schedule,2300,18011.13476,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",40,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,31629.87,,,,,,,Fee Schedule,2300,31629.86926,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",42,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14152.83,,,,,,,Fee Schedule,2300,14152.83464,
PERITONEAL ADHESIOLYSIS WITH CC,336,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17273.88,,,,,,,Fee Schedule,2300,17273.87996,
PERITONEAL ADHESIOLYSIS WITH MCC,335,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,29251.81,,,,,,,Fee Schedule,2300,29251.81295,
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,337,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12574.29,,,,,,,Fee Schedule,2300,12574.2902,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,243,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17455.74,,,,,,,Fee Schedule,2300,17455.73615,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,242,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,26154.52,,,,,,,Fee Schedule,2300,26154.52362,
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,244,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14806.53,,,,,,,Fee Schedule,2300,14806.5339,
PLEURAL EFFUSION WITH CC,187,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8102.43,,,,,,,Fee Schedule,2300,8102.430252,
PLEURAL EFFUSION WITH MCC,186,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12766.8,,,,,,,Fee Schedule,2300,12766.79562,
PLEURAL EFFUSION WITHOUT CC/MCC,188,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5875.1,,,,,,,Fee Schedule,2300,5875.101584,
PNEUMOTHORAX WITH CC,200,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9005.16,,,,,,,Fee Schedule,2300,9005.157796,
PNEUMOTHORAX WITH MCC,199,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14451.01,,,,,,,Fee Schedule,2300,14451.01325,
PNEUMOTHORAX WITHOUT CC/MCC,201,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5857.9,,,,,,,Fee Schedule,2300,5857.898972,
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,917,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12847.89,,,,,,,Fee Schedule,2300,12847.89365,
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,918,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7021.12,,,,,,,Fee Schedule,2300,7021.123212,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,862,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14939.24,,,,,,,Fee Schedule,2300,14939.23976,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,863,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8174.52,,,,,,,Fee Schedule,2300,8174.517388,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,857,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17542.57,,,,,,,Fee Schedule,2300,17542.56838,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,856,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,37261.68,,,,,,,Fee Schedule,2300,37261.67676,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,858,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11410.25,,,,,,,Fee Schedule,2300,11410.24679,
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,769,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13842.37,,,,,,,Fee Schedule,2300,13842.36846,
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,776,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5363.12,,,,,,,Fee Schedule,2300,5363.119084,
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,67,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12031.18,,,,,,,Fee Schedule,2300,12031.17916,
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,68,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7080.92,,,,,,,Fee Schedule,2300,7080.922768,
PREMATURITY WITH MAJOR PROBLEMS,791,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,33250.19,,,,,,,Fee Schedule,2300,33250.19148,
PREMATURITY WITHOUT MAJOR PROBLEMS,792,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,20063.16,,,,,,,Fee Schedule,2300,20063.16062,
PROSTATECTOMY WITH CC,666,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14329.78,,,,,,,Fee Schedule,2300,14329.7758,
PROSTATECTOMY WITH MCC,665,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,25568,,,,,,,Fee Schedule,2300,25567.99646,
PROSTATECTOMY WITHOUT CC/MCC,667,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9061.68,,,,,,,Fee Schedule,2300,9061.680664,
PSYCHOSES,885,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11442.19,,,,,,,Fee Schedule,850,11442.1945,
PULMONARY EDEMA AND RESPIRATORY FAILURE,189,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10120.05,,,,,,,Fee Schedule,2300,10120.05089,
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,175,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11252.15,,,,,,,Fee Schedule,2300,11252.14659,
PULMONARY EMBOLISM WITHOUT MCC,176,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6594.33,,,,,,,Fee Schedule,2300,6594.3346,
RADIOTHERAPY,849,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,22195.47,,,,,,,Fee Schedule,2300,22195.46534,
RECTAL RESECTION WITH CC,333,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,19186.65,,,,,,,Fee Schedule,2300,19186.64658,
RECTAL RESECTION WITH MCC,332,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,29659.76,,,,,,,Fee Schedule,2300,29659.7606,
RECTAL RESECTION WITHOUT CC/MCC,334,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13417.22,,,,,,,Fee Schedule,2300,13417.21819,
RED BLOOD CELL DISORDERS WITH MCC,811,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11503.63,,,,,,,Fee Schedule,2300,11503.6324,
RED BLOOD CELL DISORDERS WITHOUT MCC,812,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7521.64,,,,,,,Fee Schedule,2300,7521.637304,
REHABILITATION WITH CC/MCC,945,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12685.7,,,,,,,Fee Schedule,2300,12685.69759,
REHABILITATION WITHOUT CC/MCC,946,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9394.26,,,,,,,Fee Schedule,2300,9394.264496,
RENAL FAILURE WITH CC,683,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7174.31,,,,,,,Fee Schedule,2300,7174.308376,
RENAL FAILURE WITH MCC,682,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12131.94,,,,,,,Fee Schedule,2300,12131.93732,
RENAL FAILURE WITHOUT CC/MCC,684,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,4917.49,,,,,,,Fee Schedule,2300,4917.489516,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,178,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7995.12,,,,,,,Fee Schedule,2300,7995.11872,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,177,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12801.2,,,,,,,Fee Schedule,2300,12801.20084,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,179,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6184.75,,,,,,,Fee Schedule,2300,6184.7486,
RESPIRATORY NEOPLASMS WITH CC,181,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8773.33,,,,,,,Fee Schedule,2300,8773.33212,
RESPIRATORY NEOPLASMS WITH MCC,180,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14466.58,,,,,,,Fee Schedule,2300,14466.57752,
RESPIRATORY NEOPLASMS WITHOUT CC/MCC,182,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6094.64,,,,,,,Fee Schedule,2300,6094.63968,
RESPIRATORY SIGNS AND SYMPTOMS,204,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6613.99,,,,,,,Fee Schedule,2300,6613.994728,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,208,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,22516.58,,,,,,,Fee Schedule,2300,22516.58076,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,207,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,52711.26,,,,,,,Fee Schedule,2300,52711.26068,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,815,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8306.4,,,,,,,Fee Schedule,2300,8306.40408,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,814,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17421.33,,,,,,,Fee Schedule,2300,17421.33092,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,816,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5177.17,,,,,,,Fee Schedule,2300,5177.16704,
REVISION OF HIP OR KNEE REPLACEMENT WITH CC,467,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,28888.92,,,,,,,Fee Schedule,2300,28888.91975,
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,466,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,42641.18,,,,,,,Fee Schedule,2300,42641.17929,
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,468,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,22510.85,,,,,,,Fee Schedule,2300,22510.84656,
SALIVARY GLAND PROCEDURES,139,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9900.51,,,,,,,Fee Schedule,2300,9900.512792,
SEIZURES WITH MCC,100,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15865.72,,,,,,,Fee Schedule,2300,15865.7233,
SEIZURES WITHOUT MCC,101,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7393.85,,,,,,,Fee Schedule,2300,7393.846472,
SEPTIC ARTHRITIS WITH CC,549,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9889.04,,,,,,,Fee Schedule,2300,9889.044384,
SEPTIC ARTHRITIS WITH MCC,548,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15817.39,,,,,,,Fee Schedule,2300,15817.39215,
SEPTIC ARTHRITIS WITHOUT CC/MCC,550,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7160.38,,,,,,,Fee Schedule,2300,7160.382452,
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,870,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,56619.53,,,,,,,Fee Schedule,2300,56619.5303,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,871,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15912.42,,,,,,,Fee Schedule,2300,15912.4161,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,872,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8382.59,,,,,,,Fee Schedule,2300,8382.587076,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17033.86,,,,,,,Fee Schedule,2300,17033.86257,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,24743.09,,,,,,,Fee Schedule,2300,24743.09026,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13560.57,,,,,,,Fee Schedule,2300,13879,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,555,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10827.82,,,,,,,Fee Schedule,2300,10827.8155,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,556,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6804.04,,,,,,,Fee Schedule,2300,6804.042632,
SIGNS AND SYMPTOMS WITH MCC,947,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10398.57,,,,,,,Fee Schedule,2300,10398.56937,
SIGNS AND SYMPTOMS WITHOUT MCC,948,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6557.47,,,,,,,Fee Schedule,2300,6557.47186,
SIMPLE PNEUMONIA AND PLEURISY WITH CC,194,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6601.71,,,,,,,Fee Schedule,2300,6601.707148,
SIMPLE PNEUMONIA AND PLEURISY WITH MCC,193,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10767.2,,,,,,,Fee Schedule,2300,10767.19677,
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,195,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5148.5,,,,,,,Fee Schedule,2300,5148.49602,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,8,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,45911.31,,,,,,,Fee Schedule,2300,45911.31391,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,19,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,54288.17,,,,,,,Fee Schedule,2300,54288.16678,
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL,402,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,32934.81,,,,,,,Fee Schedule,2300,32934.81026,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,450,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,43658.59,,,,,,,Fee Schedule,2300,43658.59091,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,451,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,26462.53,,,,,,,Fee Schedule,2300,26462.53229,
SINUS AND MASTOID PROCEDURES WITH CC/MCC,135,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17327.13,,,,,,,Fee Schedule,2300,17327.12614,
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,136,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8317.05,,,,,,,Fee Schedule,2300,8327,
SKIN DEBRIDEMENT WITH CC,571,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13839.91,,,,,,,Fee Schedule,2300,13839.91094,
SKIN DEBRIDEMENT WITH MCC,570,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,24092.67,,,,,,,Fee Schedule,2300,24092.66769,
SKIN DEBRIDEMENT WITHOUT CC/MCC,572,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9390.17,,,,,,,Fee Schedule,2300,9390.168636,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,577,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,21713.79,,,,,,,Fee Schedule,2300,21713.7922,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,576,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,40149.26,,,,,,,Fee Schedule,2300,40149.25806,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,578,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13159.18,,,,,,,Fee Schedule,2300,13159.17901,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,574,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,28436.74,,,,,,,Fee Schedule,2300,28436.73681,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,573,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,53667.23,,,,,,,Fee Schedule,2300,53667.23441,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,575,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13381.99,,,,,,,Fee Schedule,2300,13381.99379,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14695.13,,,,,,,Fee Schedule,2300,14695.12651,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,29155.97,,,,,,,Fee Schedule,2300,29155.96982,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",624,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10255.21,,,,,,,Fee Schedule,2300,10255.21427,
SKIN GRAFTS FOR INJURIES WITH CC/MCC,904,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,30089.01,,,,,,,Fee Schedule,2300,30089.00673,
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,905,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11728.9,,,,,,,Fee Schedule,2300,11728.9047,
SKIN ULCERS WITH CC,593,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9717.84,,,,,,,Fee Schedule,2300,9717.837436,
SKIN ULCERS WITH MCC,592,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15853.44,,,,,,,Fee Schedule,2300,15853.43572,
SKIN ULCERS WITHOUT CC/MCC,594,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7100.58,,,,,,,Fee Schedule,2300,7100.582896,
SOFT TISSUE PROCEDURES WITH CC,501,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14319.95,,,,,,,Fee Schedule,2300,14319.94573,
SOFT TISSUE PROCEDURES WITH MCC,500,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,25925.16,,,,,,,Fee Schedule,2300,25925.15546,
SOFT TISSUE PROCEDURES WITHOUT CC/MCC,502,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11025.24,,,,,,,Fee Schedule,2300,11025.23595,
SPINAL DISORDERS AND INJURIES WITH CC/MCC,52,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14587.81,,,,,,,Fee Schedule,2300,14587.81498,
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,53,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8021.33,,,,,,,Fee Schedule,2300,8021.332224,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",457,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,48848.05,,,,,,,Fee Schedule,2300,48848.04553,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",456,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,68838.3,,,,,,,Fee Schedule,2300,68838.29985,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",458,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,34180.77,,,,,,,Fee Schedule,2300,34180.77087,
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,29,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,27946.87,,,,,,,Fee Schedule,2300,27946.87195,
SPINAL PROCEDURES WITH MCC,28,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,49218.31,,,,,,,Fee Schedule,2300,49218.31128,
SPINAL PROCEDURES WITHOUT CC/MCC,30,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17982.46,,,,,,,Fee Schedule,2300,17982.46374,
SPLENIC PROCEDURES WITH CC,800,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,23013.82,,,,,,,Fee Schedule,2300,23013.81817,
SPLENIC PROCEDURES WITH MCC,799,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,37099.48,,,,,,,Fee Schedule,2300,37099.48071,
SPLENIC PROCEDURES WITHOUT CC/MCC,801,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15637.17,,,,,,,Fee Schedule,2300,15637.17431,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",537,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7817.36,,,,,,,Fee Schedule,2300,7817.358396,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",538,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5900.5,,,,,,,Fee Schedule,2300,5900.495916,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,20022.2,,,,,,,Fee Schedule,2300,20022.20202,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,40855.38,,,,,,,Fee Schedule,2300,40855.38433,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13125.59,,,,,,,Fee Schedule,2300,13125.59296,
SYNCOPE AND COLLAPSE,312,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7139.9,,,,,,,Fee Schedule,2300,7139.903152,
"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12180.27,,,,,,,Fee Schedule,2300,12180.26847,
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7316.84,,,,,,,Fee Schedule,2300,7316.844304,
TESTES PROCEDURES WITH CC/MCC,711,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17069.91,,,,,,,Fee Schedule,2300,17069.90614,
TESTES PROCEDURES WITHOUT CC/MCC,712,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9008.43,,,,,,,Fee Schedule,2300,9008.434484,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12282.66,,,,,,,Fee Schedule,2300,13879,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,24739.81,,,,,,,Fee Schedule,2300,24739.81357,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10881.06,,,,,,,Fee Schedule,2300,10881.06168,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",12,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,34536.29,,,,,,,Fee Schedule,2300,34536.29152,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",11,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,44678.46,,,,,,,Fee Schedule,2300,44678.46005,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",13,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,23606.9,,,,,,,Fee Schedule,2300,23606.8987,
"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",4,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,113466.79,,,,,,,Fee Schedule,2300,113466.7904,
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,69,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6543.55,,,,,,,Fee Schedule,2300,6543.545936,
TRANSURETHRAL PROCEDURES WITH CC,669,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12713.55,,,,,,,Fee Schedule,2300,12713.54944,
TRANSURETHRAL PROCEDURES WITH MCC,668,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,23919.82,,,,,,,Fee Schedule,2300,23919.8224,
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,670,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8005.77,,,,,,,Fee Schedule,2300,8327,
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,713,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12315.43,,,,,,,Fee Schedule,2300,12315.43185,
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,714,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8661.92,,,,,,,Fee Schedule,2300,8661.924728,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12059.03,,,,,,,Fee Schedule,2300,12059.03101,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7503.62,,,,,,,Fee Schedule,2300,7503.61552,
TRAUMATIC INJURY WITH MCC,913,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13390.19,,,,,,,Fee Schedule,2300,13390.18551,
TRAUMATIC INJURY WITHOUT MCC,914,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7253.77,,,,,,,Fee Schedule,2300,7253.76806,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,86,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10671.35,,,,,,,Fee Schedule,2300,10671.35364,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,85,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,18610.77,,,,,,,Fee Schedule,2300,18610.76867,
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,87,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7492.97,,,,,,,Fee Schedule,2300,7492.966284,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,83,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11434,,,,,,,Fee Schedule,2300,11434.00278,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,82,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,18723,,,,,,,Fee Schedule,2300,18722.99523,
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,84,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7829.65,,,,,,,Fee Schedule,2300,7829.645976,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC,278,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,45596.75,,,,,,,Fee Schedule,2300,45596.75186,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC,279,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,29542.62,,,,,,,Fee Schedule,2300,29542.61901,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM,173,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,24381.84,,,,,,,Fee Schedule,2300,24381.83541,
UNCOMPLICATED PEPTIC ULCER WITH MCC,383,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11310.31,,,,,,,Fee Schedule,2300,11310.3078,
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,384,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7002.28,,,,,,,Fee Schedule,2300,7002.282256,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,256,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13908.72,,,,,,,Fee Schedule,2300,13908.72139,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,255,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,22096.35,,,,,,,Fee Schedule,2300,22096.34553,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,257,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8947,,,,,,,Fee Schedule,2300,8946.996584,
URETHRAL PROCEDURES WITH CC/MCC,671,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14704.14,,,,,,,Fee Schedule,2300,14704.1374,
URETHRAL PROCEDURES WITHOUT CC/MCC,672,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8842.96,,,,,,,Fee Schedule,2300,8842.96174,
URETHRAL STRICTURE,697,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8829.04,,,,,,,Fee Schedule,2300,8829.035816,
URINARY STONES WITH MCC,693,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11013.77,,,,,,,Fee Schedule,2300,11013.76754,
URINARY STONES WITHOUT MCC,694,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6403.47,,,,,,,Fee Schedule,2300,6403.467524,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,742,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15030.17,,,,,,,Fee Schedule,2300,15030.16786,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,743,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,10163.47,,,,,,,Fee Schedule,2300,10163.467,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,740,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14823.74,,,,,,,Fee Schedule,2300,14823.73651,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,739,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,28886.46,,,,,,,Fee Schedule,2300,28886.46224,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,741,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,11682.21,,,,,,,Fee Schedule,2300,13879,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,737,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,16879.86,,,,,,,Fee Schedule,2300,16879.85823,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,736,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,29281.3,,,,,,,Fee Schedule,2300,29281.30314,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,738,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12029.54,,,,,,,Fee Schedule,2300,12029.54082,
"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14229.84,,,,,,,Fee Schedule,2300,14229.83681,
"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6876.95,,,,,,,Fee Schedule,2300,8327,
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,768,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8778.25,,,,,,,Fee Schedule,2300,8778.247152,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,797,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8195,,,,,,,Fee Schedule,2300,8194.996688,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,796,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9559.74,,,,,,,Fee Schedule,2300,9559.73724,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,798,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7840.3,,,,,,,Fee Schedule,2300,7840.295212,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,806,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6176.56,,,,,,,Fee Schedule,2300,6176.55688,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,805,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,8840.5,,,,,,,Fee Schedule,2300,8840.504224,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,807,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,5522.86,,,,,,,Fee Schedule,2300,5522.857624,
VEIN LIGATION AND STRIPPING,263,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,25045.36,,,,,,,Fee Schedule,2300,25045.36473,
VENTRICULAR SHUNT PROCEDURES WITH CC,32,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,17456.56,,,,,,,Fee Schedule,2300,17456.55532,
VENTRICULAR SHUNT PROCEDURES WITH MCC,31,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,36703,,,,,,,Fee Schedule,2300,36703.00146,
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,33,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,13622.01,,,,,,,Fee Schedule,2300,13879,
VIRAL ILLNESS WITH MCC,865,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,12273.65,,,,,,,Fee Schedule,2300,12273.65408,
VIRAL ILLNESS WITHOUT MCC,866,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,7123.52,,,,,,,Fee Schedule,2300,7123.519712,
VIRAL MENINGITIS WITH CC/MCC,75,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15707.62,,,,,,,Fee Schedule,2300,15707.6231,
VIRAL MENINGITIS WITHOUT CC/MCC,76,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,6133.96,,,,,,,Fee Schedule,2300,6133.959936,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,464,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,25514.75,,,,,,,Fee Schedule,2300,25514.75028,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,463,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,46688.71,,,,,,,Fee Schedule,2300,46688.70814,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,465,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,14939.24,,,,,,,Fee Schedule,2300,14939.23976,
WOUND DEBRIDEMENTS FOR INJURIES WITH CC,902,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,15683.05,,,,,,,Fee Schedule,2300,15683.04794,
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,901,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,34377.37,,,,,,,Fee Schedule,2300,34377.37215,
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,903,MS-DRG,,,,,,,,inpatient,,,,,Viva,Medicare Adv,9581.04,,,,,,,Fee Schedule,2300,9581.035712,
IMPLANT MEMORY GEL #350-6004BC,4803876,LOCAL,,,L8600,HCPCS,301,RC,,Outpatient,,,0.01,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
"Protein, Tot & Prot Electrop Interp QSTC",8852423,LOCAL,84165,CPT,,,301,RC,,Outpatient,,,3.92,12.89,Aetna Med ADV,Aetna Med ADV,2.8,,,,,,,Fee Schedule,2.796363636,17.73,
"Protein, Total QSTC",8852413,LOCAL,84165,CPT,,,270,RC,,Outpatient,,,3.92,12.89,Aetna Med ADV,Aetna Med ADV,2.8,,,,,,,Fee Schedule,2.796363636,17.73,
DRESSING TELFA ISLAND 4X10,11074306,LOCAL,,,L3908,HCPCS,302,RC,,Outpatient,,,4.29,86,Aetna Med ADV,Aetna Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
.RPR Titer QSTC,6231113,LOCAL,86593,CPT,,,301,RC,,Outpatient,,,5.9,5.28,Aetna Med ADV,Aetna Med ADV,4.4,,,,,,,Fee Schedule,4.4,15.29,
UA Microscopic,633864,LOCAL,81015,CPT,,,301,RC,,Outpatient,,,6,3.66,Aetna Med ADV,Aetna Med ADV,1.68,,,,,,,Fee Schedule,1.68192607,4.02,
Urinalysis Review Manual,8502419,LOCAL,81015,CPT,,,301,RC,,Outpatient,,,6,3.66,Aetna Med ADV,Aetna Med ADV,1.68,,,,,,,Fee Schedule,1.68192607,4.02,
Hematocrit QSTC,8852782,LOCAL,85014,CPT,,,301,RC,,Outpatient,,,7.21,2.84,Aetna Med ADV,Aetna Med ADV,12.62,,,,,,,Fee Schedule,8.21,12.62068493,
Hemoglobin A2 (Quant) QSTC,8852791,LOCAL,83020,CPT,,,301,RC,,Outpatient,,,7.21,15.44,Aetna Med ADV,Aetna Med ADV,12.87,,,,,,,Fee Schedule,12.87,17.73,
Hemoglobin QSTC,8852780,LOCAL,85018,CPT,,,301,RC,,Outpatient,,,7.21,2.84,Aetna Med ADV,Aetna Med ADV,10.94,,,,,,,Fee Schedule,8.21,10.94316176,
Red Blood Cell Count QSTC,8852779,LOCAL,85041,CPT,,,300,RC,,Outpatient,,,7.21,3.62,Aetna Med ADV,Aetna Med ADV,3.02,,,,,,,Fee Schedule,3.02,8.21,
87107 Fungal Isolate Identification QST,14813753,LOCAL,87107,CPT,,,300,RC,,Outpatient,,,7.5,12.38,Aetna Med ADV,Aetna Med ADV,10.32,,,,,,,Fee Schedule,10.32,20.05,
87143 Fungal Isolate Identification QST,14815667,LOCAL,87143,CPT,,,300,RC,,Outpatient,,,7.5,15.02,Aetna Med ADV,Aetna Med ADV,12.52,,,,,,,Fee Schedule,10.57,12.52,
87149 Fungal Isolate Identification QST,14813753,LOCAL,87149,CPT,,,307,RC,,Outpatient,,,7.5,24.06,Aetna Med ADV,Aetna Med ADV,20.05,,,,,,,Fee Schedule,10.32,20.05,
Glucose Fasting Urine,7974487,LOCAL,81003,CPT,,,301,RC,,Outpatient,,,7.88,2.7,Aetna Med ADV,Aetna Med ADV,3.8,,,,,,,Fee Schedule,3.795286195,4.02,
"Uric Acid, Synovial Fluid QSTC",9607980,LOCAL,84560,CPT,,,301,RC,,Outpatient,,,8.37,6.1,Aetna Med ADV,Aetna Med ADV,19.49,,,,,,,Fee Schedule,7.16,19.49,
Alkaline Phosphatase QSTC,8848272,LOCAL,84075,CPT,,,301,RC,,Outpatient,,,9.11,6.22,Aetna Med ADV,Aetna Med ADV,5.18,,,,,,,Fee Schedule,5.18,7.16,
Bone Isoenzymes QSTC,8848275,LOCAL,84080,CPT,,,270,RC,,Outpatient,,,9.11,17.74,Aetna Med ADV,Aetna Med ADV,14.78,,,,,,,Fee Schedule,14.78,17.73,
SLING ARM MEDIUM,11070727,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,9.3,158,Aetna Med ADV,Aetna Med ADV,77.23,,,,,,,Fee Schedule,77.23,77.23,
acetylcysteine 20% Inhalation Sol [CULL],11208888,LOCAL,J7608,CPT,,,,,,Outpatient,1,ML,10,,Aetna Med ADV,Aetna Med ADV,8.46,,,,,,,Fee Schedule,8.455,8.455,
albuterol 1.25 mg/3 mL (0.042%) Sol [CULL],11203025,LOCAL,J7613,CPT,,,,,,Outpatient,3,ML,10,,Aetna Med ADV,Aetna Med ADV,4.66,,,,,,,Fee Schedule,4.66,4.66,
albuterol 2.5 mg/3 mL (0.083%) inhalation solution 3 mL [CULL],11203024,LOCAL,J7613,CPT,,,,,,Outpatient,3,ML,10,,Aetna Med ADV,Aetna Med ADV,4.66,,,,,,,Fee Schedule,4.66,4.66,
albuterol 5 mg/mL (0.5%) inhalation solution [CULL],11203026,LOCAL,J7611,CPT,,,,,,Outpatient,1,ML,10,,Aetna Med ADV,Aetna Med ADV,0.26,,,,,,,Fee Schedule,0.262,0.262,
amiodarone 50 mg/mL intravenous solution 3 mL [CULL],11200004,LOCAL,J0282,CPT,,,,,,Outpatient,3,ML,10,,Aetna Med ADV,Aetna Med ADV,0.41,,,,,,,Fee Schedule,0.409,0.409,
azaTHIOprine 50 mg oral tablet [CULL],11200492,LOCAL,J7500,CPT,,,,,,Outpatient,1,EA,10,,Aetna Med ADV,Aetna Med ADV,0.06,,,,,,,Fee Schedule,0.057,0.057,
BUPivacaine 0.25% preservative-free Sol [CULL],11282035,LOCAL,J0665,CPT,,,,,,Outpatient,10,ML,10,,Aetna Med ADV,Aetna Med ADV,0.01,,,,,,,Fee Schedule,0.01,0.011,
BUPivacaine 0.75%-D8.25% preservative-free intrathecal solution 2 mL [CULL],11202136,LOCAL,J0665,CPT,,,,,,Outpatient,2,ML,10,,Aetna Med ADV,Aetna Med ADV,0.01,,,,,,,Fee Schedule,0.01,0.011,
cycloSPORINE modified 25 mg oral capsule [CULL],11210499,LOCAL,J7515,CPT,,,,,,Outpatient,1,EA,10,,Aetna Med ADV,Aetna Med ADV,0.53,,,,,,,Fee Schedule,0.526,0.526,
dexAMETHasone 10 mg/mL injectable solution 1 mL [CULL],11202292,LOCAL,J1100,CPT,,,,,,Outpatient,1,ML,10,,Aetna Med ADV,Aetna Med ADV,10.49,,,,,,,Fee Schedule,10.48743758,10.48743758,
ipratropium 500 mcg/2.5 mL inhalation solution 2.5 mL [CULL],11203105,LOCAL,J7644,CPT,,,,,,Outpatient,2.5,ML,10,,Aetna Med ADV,Aetna Med ADV,0.4,,,,,,,Fee Schedule,0.4,0.4,
ketorolac 60 mg/2 mL Sol [CULL],11202716,LOCAL,J1885,CPT,,,,,,Outpatient,2,ML,10,,Aetna Med ADV,Aetna Med ADV,0.27,,,,,,,Fee Schedule,0.27,0.27,
levalbuterol 0.31 mg/3 mL inhalation solution 3 mL [CULL],11203125,LOCAL,J7614,CPT,,,,,,Outpatient,3,ML,10,,Aetna Med ADV,Aetna Med ADV,0.08,,,,,,,Fee Schedule,0.083,0.083,
levalbuterol 0.63 mg/3 mL inhalation solution 3 mL [CULL],11203127,LOCAL,J7614,CPT,,,,,,Outpatient,3,ML,10,,Aetna Med ADV,Aetna Med ADV,0.08,,,,,,,Fee Schedule,0.083,0.083,
levalbuterol 1.25 mg/3 mL inhalation solution 3 mL [CULL],11203128,LOCAL,J7614,CPT,,,,,,Outpatient,3,ML,10,,Aetna Med ADV,Aetna Med ADV,0.08,,,,,,,Fee Schedule,0.083,0.083,
methylPREDNISolone 4 mg oral tablet [CULL],11230944,LOCAL,J7509,CPT,,,,,,Outpatient,1,EA,10,,Aetna Med ADV,Aetna Med ADV,0.14,,,,,,,Fee Schedule,0.139,0.139,
mitoMYcin 20 mg/40 mL Sol [CULL],11205507,LOCAL,J9280,CPT,,,,,,Outpatient,0.5,ML,10,,Aetna Med ADV,Aetna Med ADV,20.35,,,,,,,Fee Schedule,20.35,525.49,
ondansetron 2 mg/mL injectable solution 2 mL [CULL],11211057,LOCAL,J2405,CPT,,,,,,Outpatient,2,ML,10,,Aetna Med ADV,Aetna Med ADV,0.06,,,,,,,Fee Schedule,0.057806268,0.057806268,
phenytoin 50 mg/mL injectable solution 2 mL [CULL],11282560,LOCAL,J1165,CPT,,,,,,Outpatient,2,ML,10,,Aetna Med ADV,Aetna Med ADV,0.6,,,,,,,Fee Schedule,0.595,0.595,
phenytoin 50 mg/mL injectable solution 5 mL [CULL],11212135,LOCAL,J1165,CPT,,,,,,Outpatient,5,ML,10,,Aetna Med ADV,Aetna Med ADV,0.6,,,,,,,Fee Schedule,0.595,0.595,
prednisoLONE sodium phosphate 15 mg/5 mL Liq [CULL],11250339,LOCAL,J7510,CPT,,,,,,Outpatient,5,ML,10,,Aetna Med ADV,Aetna Med ADV,0.92,,,,,,,Fee Schedule,0.919,0.919,
"rabies immune globulin, human 150 intl units/mL intramuscular solution 2 mL [CULL]",11212251,LOCAL,90376,CPT,,,,,,Outpatient,0.007,ML,10,347,Aetna Med ADV,Aetna Med ADV,347.32,,,,,,,Fee Schedule,347.32,2110.36,
tacrolimus 0.5 mg oral capsule [CULL],11205999,LOCAL,J7507,CPT,,,,,,Outpatient,1,EA,10,,Aetna Med ADV,Aetna Med ADV,0.2,,,,,,,Fee Schedule,0.197,0.197,
tobramycin 40 mg/mL injectable solution 2 mL [CULL],11212375,LOCAL,J3260,CPT,,,,,,Outpatient,2,ML,10,,Aetna Med ADV,Aetna Med ADV,2.07,,,,,,,Fee Schedule,2.071,2.071,
BUPivacaine 0.25% preservative-free injectable solution 30 mL [CULL],11202111,LOCAL,J0665,CPT,,,301,RC,,Outpatient,30,ML,10.24,,Aetna Med ADV,Aetna Med ADV,0.01,,,,,,,Fee Schedule,0.01,0.011,
"Protein, Total, Peritoneal Fluid QSTC",9039313,LOCAL,84157,CPT,,,301,RC,,Outpatient,,,10.44,4.8,Aetna Med ADV,Aetna Med ADV,4,,,,,,,Fee Schedule,4,7.16,
Rheumatoid Factor QSTC,9039252,LOCAL,86431,CPT,,,,,,Outpatient,,,10.8,6.8,Aetna Med ADV,Aetna Med ADV,6.3,,,,,,,Fee Schedule,6.29875,15.29,
ketorolac 30 mg/mL injectable solution 1 mL [CULL],11202715,LOCAL,J1885,CPT,,,301,RC,,Outpatient,1,ML,10.944,,Aetna Med ADV,Aetna Med ADV,0.27,,,,,,,Fee Schedule,0.27,0.27,
RPR (Dx) w/Refl Titer/Confrm Testing QST,8972905,LOCAL,86592,CPT,,,301,RC,,Outpatient,,,11.16,5.12,Aetna Med ADV,Aetna Med ADV,19.99,,,,,,,Fee Schedule,15.29,19.99375,
RPR (Monitor) w/Refl Titer QSTC,8972905,LOCAL,86592,CPT,,,,,,Outpatient,,,11.16,5.12,Aetna Med ADV,Aetna Med ADV,19.99,,,,,,,Fee Schedule,15.29,19.99375,
cefuroxime 750 mg injection [CULL],11201445,LOCAL,J0697,CPT,,,301,RC,,Outpatient,1,EA,11.22304,,Aetna Med ADV,Aetna Med ADV,2.05,,,,,,,Fee Schedule,2.054,2.054,
"Creatinine, Random Ur QSTC",9320766,LOCAL,82570,CPT,,,,,,Outpatient,,,11.25,6.22,Aetna Med ADV,Aetna Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
BUPivacaine 0.5% preservative-free injectable solution 10 mL [CULL],11282050,LOCAL,J0665,CPT,,,,,,Outpatient,10,ML,11.52,,Aetna Med ADV,Aetna Med ADV,0.01,,,,,,,Fee Schedule,0.01,0.011,
ciprofloxacin 200 mg/100 mL-D5% intravenous solution 100 mL [CULL],11201485,LOCAL,J0744,CPT,,,,,,Outpatient,100,ML,11.52,,Aetna Med ADV,Aetna Med ADV,2,,,,,,,Fee Schedule,1.997,1.997,
diphenhydrAMINE 50 mg/mL injectable solution 1 mL [CULL],11202342,LOCAL,J1200,CPT,,,,,,Outpatient,1,ML,11.5584,,Aetna Med ADV,Aetna Med ADV,0.14,,,,,,,Fee Schedule,0.143,0.143,
HYDROmorphone 2 mg/mL Sol [CULL],11202621,LOCAL,J1171,CPT,,,306,RC,,Outpatient,1,ML,11.7504,,Aetna Med ADV,Aetna Med ADV,1.84,,,,,,,Fee Schedule,1.836603774,1.836603774,
Source QSTC,8983584,LOCAL,87209,CPT,,,,,,Outpatient,,,13.19,21.58,Aetna Med ADV,Aetna Med ADV,17.98,,,,,,,Fee Schedule,10.57,17.98,
ampicillin 500 mg injection [CULL],11201162,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,13.28,,Aetna Med ADV,Aetna Med ADV,0.59,,,,,,,Fee Schedule,0.591,0.591,
ampicillin 250 mg injection [CULL],11201150,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,13.3952,,Aetna Med ADV,Aetna Med ADV,0.59,,,,,,,Fee Schedule,0.591,0.591,
clindamycin 150 mg/mL injectable solution 4 mL [CULL],11202228,LOCAL,J0736,CPT,,,301,RC,,Outpatient,4,ML,13.4784,,Aetna Med ADV,Aetna Med ADV,0.82,,,,,,,Fee Schedule,0.819,0.819,
"ANA IFA Scrn w/Rfx Titr & Patt, IFA QSTC",8764654,LOCAL,86038,CPT,,,300,RC,,Outpatient,,,13.5,14.51,Aetna Med ADV,Aetna Med ADV,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
"ANA Scr,IFA w/R Tit/Ptn/MPX Ab Casc QSTC",8764642,LOCAL,86038,CPT,,,301,RC,,Outpatient,,,13.5,14.51,Aetna Med ADV,Aetna Med ADV,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
"Bacterial Identification, Aerobic QST",13344175,LOCAL,87077,CPT,,,301,RC,,Outpatient,,,13.5,9.7,Aetna Med ADV,Aetna Med ADV,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
T3 Uptake QSTC,9039244,LOCAL,84479,CPT,,,274,RC,,Outpatient,,,13.5,7.76,Aetna Med ADV,Aetna Med ADV,6.47,,,,,,,Fee Schedule,6.47,18.43,
COLLAR CERVICAL SOFT MEDIUM,11071045,LOCAL,,,L0120,HCPCS,,,,Outpatient,,,13.75,44,Aetna Med ADV,Aetna Med ADV,34.57,,,,,,,Fee Schedule,34.57,34.57,
HYDROmorphone 1 mg/mL Sol,11202620,LOCAL,J1171,CPT,,,,,,Outpatient,1,ML,13.824,,Aetna Med ADV,Aetna Med ADV,1.84,,,,,,,Fee Schedule,1.836603774,1.836603774,
tacrolimus 1 mg oral capsule [CULL],11205998,LOCAL,J7507,CPT,,,301,RC,,Outpatient,1,EA,14.2704,,Aetna Med ADV,Aetna Med ADV,0.2,,,,,,,Fee Schedule,0.197,0.197,
Measles Antibody (IgG) QSTC,8764682,LOCAL,86765,CPT,,,,,,Outpatient,,,14.63,15.46,Aetna Med ADV,Aetna Med ADV,12.88,,,,,,,Fee Schedule,12.88,15.29,
gentamicin 60 mg/50 mL-NaCl 0.9% intravenous solution 50 mL [CULL],11201825,LOCAL,J1580,CPT,,,270,RC,,Outpatient,50,ML,14.69466667,,Aetna Med ADV,Aetna Med ADV,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
SLING ARM LARGE,11071011,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,14.8,158,Aetna Med ADV,Aetna Med ADV,77.23,,,,,,,Fee Schedule,77.23,77.23,
HYDROmorphone 10 mg/mL Sol [CULL],11202625,LOCAL,J1171,CPT,,,301,RC,,Outpatient,1,ML,14.96064,,Aetna Med ADV,Aetna Med ADV,1.84,,,,,,,Fee Schedule,1.836603774,1.836603774,
"hCG, Total, QN Male Only QSTC",8853229,LOCAL,84702,CPT,,,301,RC,,Outpatient,,,15,18.06,Aetna Med ADV,Aetna Med ADV,15.05,,,,,,,Fee Schedule,15.05,18.43,
"Herpes Simplex Virus 2 (IgG), with Reflex to HSV-2 Inhibition QST",14811888,LOCAL,86696,CPT,,,,,,Outpatient,,,15,23.22,Aetna Med ADV,Aetna Med ADV,19.35,,,,,,,Fee Schedule,15.29,19.35,
gentamicin 80 mg/50 mL-NaCl 0.9% intravenous solution 50 mL [CULL],11201824,LOCAL,J1580,CPT,,,,,,Outpatient,50,ML,15.62533333,,Aetna Med ADV,Aetna Med ADV,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
gentamicin 40 mg/mL injectable solution 2 mL [CULL],11282205,LOCAL,J1580,CPT,,,,,,Outpatient,2,ML,15.6288,,Aetna Med ADV,Aetna Med ADV,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
HYDROmorphone 0.5 mg/0.5 mL Sol [CULL],11202622,LOCAL,J1171,CPT,,,,,,Outpatient,0.5,ML,15.936,,Aetna Med ADV,Aetna Med ADV,1.84,,,,,,,Fee Schedule,1.836603774,1.836603774,
gentamicin 120 mg/100 mL-NaCl 0.9% intravenous solution 100 mL [CULL],11209100,LOCAL,J1580,CPT,,,,,,Outpatient,100,ML,15.98666667,,Aetna Med ADV,Aetna Med ADV,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
alpha 1-proteinase inhibitor human Sol 10 mg [CULL],11211124,LOCAL,J0256,CPT,,,301,RC,,Outpatient,1,EA,16,,Aetna Med ADV,Aetna Med ADV,5.46,,,,,,,Fee Schedule,5.46,2110.36,
"Chloride, Random Urine without Creatinine QSTC",10011691,LOCAL,82436,CPT,,,301,RC,,Outpatient,,,16.25,6.9,Aetna Med ADV,Aetna Med ADV,5.75,,,,,,,Fee Schedule,5.75,7.16,
"Potassium, U24 w/o Creatinine QSTC",13864422,LOCAL,84133,CPT,,,301,RC,,Outpatient,,,16.25,5.68,Aetna Med ADV,Aetna Med ADV,19.32,,,,,,,Fee Schedule,7.16,19.32,
Sickle Cell Screen QSTC,10073685,LOCAL,85660,CPT,,,,,,Outpatient,,,16.25,6.61,Aetna Med ADV,Aetna Med ADV,5.51,,,,,,,Fee Schedule,5.51,8.21,
gentamicin 100 mg/100 mL-NaCl 0.9% intravenous solution 100 mL [CULL],11201827,LOCAL,J1580,CPT,,,301,RC,,Outpatient,100,ML,16.41066667,,Aetna Med ADV,Aetna Med ADV,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
"Creatinine, Random Ur, Microalbumin QSTC",9041589,LOCAL,82570,CPT,,,301,RC,,Outpatient,,,16.88,6.22,Aetna Med ADV,Aetna Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Ratio, Microalbumin Random Ur QSTC",9041592,LOCAL,82043,CPT,,,301,RC,,Outpatient,,,16.88,6.94,Aetna Med ADV,Aetna Med ADV,20.16,,,,,,,Fee Schedule,4.02,20.15557971,
Protein Level 24 Hour Urine,633811,LOCAL,84156,CPT,,,301,RC,,Outpatient,,,17,4.4,Aetna Med ADV,Aetna Med ADV,11.68,,,,,,,Fee Schedule,7.16,11.68,
Thrombin Clotting Time QSTC,8764547,LOCAL,85670,CPT,,,301,RC,,Outpatient,,,17.1,6.92,Aetna Med ADV,Aetna Med ADV,5.77,,,,,,,Fee Schedule,5.42,5.77,
"Urea Nitrogen Ur, Rand QSTC",13864416,LOCAL,84540,CPT,,,,,,Outpatient,,,17.1,6.67,Aetna Med ADV,Aetna Med ADV,5.56,,,,,,,Fee Schedule,5.56,7.16,
nalbuphine 10 mg/mL Sol,J2300,CPT,,,,,,,,Outpatient,10,ML,17.12,,Aetna Med ADV,Aetna Med ADV,3.45,,,,,,,Fee Schedule,3.45,3.45,
cycloSPORINE modified 100 mg oral capsule [CULL],11210500,LOCAL,J7502,CPT,,,274,RC,,Outpatient,1,EA,17.58826667,,Aetna Med ADV,Aetna Med ADV,1.81,,,,,,,Fee Schedule,1.81,1.81,
SPLINT WRIST FOREARM LEFT LG,11071054,LOCAL,,,L3908,HCPCS,274,RC,,Outpatient,,,17.66,86,Aetna Med ADV,Aetna Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM LT MED,11071053,LOCAL,,,L3908,HCPCS,274,RC,,Outpatient,,,17.66,86,Aetna Med ADV,Aetna Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM LT SM,11071052,LOCAL,,,L3908,HCPCS,274,RC,,Outpatient,,,17.66,86,Aetna Med ADV,Aetna Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM RT LG,11071050,LOCAL,,,L3908,HCPCS,274,RC,,Outpatient,,,17.66,86,Aetna Med ADV,Aetna Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM RT MED,11071049,LOCAL,,,L3908,HCPCS,274,RC,,Outpatient,,,17.66,86,Aetna Med ADV,Aetna Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM RT PED,11071047,LOCAL,,,L3908,HCPCS,274,RC,,Outpatient,,,17.66,86,Aetna Med ADV,Aetna Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM RT SM,11071048,LOCAL,,,L3908,HCPCS,420,RC,,Outpatient,,,17.66,86,Aetna Med ADV,Aetna Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
95852 RANGE OF MOTION-HAND 15 MIN CHARGE,9410221,LOCAL,95852,CPT,,,274,RC,GP,Outpatient,,,17.86,12,Aetna Med ADV,Aetna Med ADV,4.74,,,,,,,Fee Schedule,4.74,4.74,
SPLINT WRIST FOREARM LEFT X L,11074363,LOCAL,,,L3908,HCPCS,274,RC,,Outpatient,,,17.88,86,Aetna Med ADV,Aetna Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT XLG WRIST FOREARM RIGHT,11074362,LOCAL,,,L3908,HCPCS,301,RC,,Outpatient,,,17.88,86,Aetna Med ADV,Aetna Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
Creatine Kinase Isoenzyme Interp. QSTC,8852390,LOCAL,82550,CPT,,,301,RC,,Outpatient,,,18,7.81,Aetna Med ADV,Aetna Med ADV,23.74,,,,,,,Fee Schedule,7.16,23.7373913,
Creatine Kinase Isoenzyme w/ Tot CK QSTC,8764767,LOCAL,82552,CPT,,,301,RC,,Outpatient,,,18,16.07,Aetna Med ADV,Aetna Med ADV,13.39,,,,,,,Fee Schedule,13.39,17.73,
Creatine Kinase Isoenzymes w/o Ttl QSTC,13864524,LOCAL,82552,CPT,,,301,RC,,Outpatient,,,18,16.07,Aetna Med ADV,Aetna Med ADV,13.39,,,,,,,Fee Schedule,13.39,17.73,
"Creatine Kinase, Total QSTC",8852386,LOCAL,82552,CPT,,,301,RC,,Outpatient,,,18,16.07,Aetna Med ADV,Aetna Med ADV,13.39,,,,,,,Fee Schedule,13.39,17.73,
Rubella Antibody (IgG) QSTC,8853250,LOCAL,86762,CPT,,,301,RC,,Outpatient,,,18,17.27,Aetna Med ADV,Aetna Med ADV,14.39,,,,,,,Fee Schedule,14.39,15.29,
Urine Creatinine,7050475,LOCAL,82570,CPT,,,301,RC,,Outpatient,,,18,6.22,Aetna Med ADV,Aetna Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
Urine Protein Level,7412757,LOCAL,84156,CPT,,,,,,Outpatient,,,18,4.4,Aetna Med ADV,Aetna Med ADV,11.68,,,,,,,Fee Schedule,7.16,11.68,
phytonadione 1 mg/0.5 mL injectable solution 0.5 mL [CULL],11212147,LOCAL,J3430,CPT,,,274,RC,,Outpatient,0.5,ML,18.223104,,Aetna Med ADV,Aetna Med ADV,2.81,,,,,,,Fee Schedule,2.808,2.808,
SPLINT WRIST FOREARM LT PED,11070883,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,18.43,86,Aetna Med ADV,Aetna Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
fosphenytoin 100 mgPE/2 mL Sol [CULL],11205072,LOCAL,Q2009,CPT,,,,,,Outpatient,2,ML,18.432,,Aetna Med ADV,Aetna Med ADV,1.47,,,,,,,Fee Schedule,1.47,1.47,
methylPREDNISolone 40 mg Pow [CULL],11204478,LOCAL,J2919,CPT,,,301,RC,,Outpatient,1,UN,18.432,,Aetna Med ADV,Aetna Med ADV,0.21,,,,,,,Fee Schedule,0.21,0.21,
Almond (F20) IgE QST,14586519,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Alternaria Alternata (M6) IgE QST,14586545,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Brazil Nut (F18) IgE QST,14586553,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cashew Nut (F202) IgE QST,14586555,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cat Dander (E1) IgE QST,14586539,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cladosporium Herbarum (M2) IgE QST,14586543,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cockroach (I6) IgE QST,14586549,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Codfish (F3) IgE QST,14586521,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cow's Milk (F2) IgE QST,14586529,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dermatophagoides Farinae (D2) IgE QST,14586537,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dermatophagoides Pteronyssinu D1 IgE QST,14586535,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dog Dander (E5) IgE QST,14586541,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Egg White (F1) IgE QST,14586527,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Hazelnut (F17) IgE QST,14586551,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Immunoglobulin E QST,14586516,LOCAL,82785,CPT,,,301,RC,,Outpatient,,,18.5,19.75,Aetna Med ADV,Aetna Med ADV,203.96,,,,,,,Fee Schedule,17.73,203.9616667,
Macadamia Nut (RF345) IgE QST,14586525,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Mouse Urine Proteins (E72) IgE QST,14586547,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Peanut (F13) IgE QST,14586517,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Shrimp (F24) IgE QST,14586523,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Soybean (F14) IgE QST,14586533,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Walnut (F256) IgE QST,14586557,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Wheat (F4) IgE QST,14586531,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
droNABinol 2.5 mg Cap [CULL],11220183,LOCAL,Q0167,CPT,,,311,RC,,Outpatient,1,EA,18.853344,,Aetna Med ADV,Aetna Med ADV,1.35,,,,,,,Fee Schedule,1.352,1.352,
"HPV mRNA E6/E7, POST-$HYST, VAGINAL W/REFL QST",14782711,LOCAL,87624,CPT,,,301,RC,,Outpatient,,,18.9,42.11,Aetna Med ADV,Aetna Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
Lead Capillary QSTC,14116315,LOCAL,83655,CPT,,,301,RC,,Outpatient,,,19.12,14.53,Aetna Med ADV,Aetna Med ADV,13.99,,,,,,,Fee Schedule,13.99076923,16.07,
"Lead, Blood QSTC",8764839,LOCAL,83655,CPT,,,301,RC,,Outpatient,,,19.13,14.53,Aetna Med ADV,Aetna Med ADV,13.99,,,,,,,Fee Schedule,13.99076923,16.07,
"Lead, Blood QSTC",13864923,LOCAL,83655,CPT,,,,,,Outpatient,,,19.13,14.53,Aetna Med ADV,Aetna Med ADV,13.99,,,,,,,Fee Schedule,13.99076923,16.07,
fluconazole 100 mg/50 mL-NaCl 0.9% intravenous solution 50 mL [CULL],11291246,LOCAL,J1450,CPT,,,301,RC,,Outpatient,50,ML,19.2,,Aetna Med ADV,Aetna Med ADV,4.48,,,,,,,Fee Schedule,4.48,4.48,
"Albumin, Peritoneal Fluid QSTC",8972935,LOCAL,82042,CPT,,,301,RC,,Outpatient,,,19.4,9.34,Aetna Med ADV,Aetna Med ADV,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Albumin, Pleural Fluid QST",12130816,LOCAL,82042,CPT,,,301,RC,,Outpatient,,,19.4,9.34,Aetna Med ADV,Aetna Med ADV,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Albumin, Pleural Fluid QSTC",12130706,LOCAL,82042,CPT,,,301,RC,,Outpatient,,,19.4,9.34,Aetna Med ADV,Aetna Med ADV,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Glucose, Peritoneal Fluid QSTC",9039310,LOCAL,82945,CPT,,,301,RC,,Outpatient,,,19.4,4.72,Aetna Med ADV,Aetna Med ADV,3.93,,,,,,,Fee Schedule,3.93,7.16,
Cardiolipin Ab (IgA)QSTC,9215429,LOCAL,86147,CPT,,,301,RC,,Outpatient,,,19.58,30.54,Aetna Med ADV,Aetna Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Antibody IgG QSTC,10100354,LOCAL,86147,CPT,,,301,RC,,Outpatient,,,19.58,30.54,Aetna Med ADV,Aetna Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Antibody IgM QSTC,10100355,LOCAL,86147,CPT,,,301,RC,,Outpatient,,,19.58,30.54,Aetna Med ADV,Aetna Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
24hr Urine Creatinine QSTC,10005155,LOCAL,82570,CPT,,,301,RC,,Outpatient,,,19.76,6.22,Aetna Med ADV,Aetna Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Creatinine, Random U QSTC",12290061,LOCAL,82570,CPT,,,301,RC,,Outpatient,,,19.76,6.22,Aetna Med ADV,Aetna Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
Interp: QSTC,8851928,LOCAL,84166,CPT,,,301,RC,,Outpatient,,,19.76,21.4,Aetna Med ADV,Aetna Med ADV,18.62,,,,,,,Fee Schedule,17.73,18.62,
Interp: QSTC,8851952,LOCAL,84166,CPT,,,301,RC,,Outpatient,,,19.76,21.4,Aetna Med ADV,Aetna Med ADV,18.62,,,,,,,Fee Schedule,17.73,18.62,
"Protein, Total, Random Urine QSTC",8851945,LOCAL,84156,CPT,,,270,RC,,Outpatient,,,19.76,4.4,Aetna Med ADV,Aetna Med ADV,11.68,,,,,,,Fee Schedule,7.16,11.68,
SHOE POST OP MALE LARGE,11070723,LOCAL,,,L0172,HCPCS,270,RC,,Outpatient,,,19.86,223,Aetna Med ADV,Aetna Med ADV,175.72,,,,,,,Fee Schedule,175.72,175.72,
SHOE POST OP MALE MD,11071019,LOCAL,,,L3650,HCPCS,270,RC,,Outpatient,,,19.86,12,Aetna Med ADV,Aetna Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
SHOE POST OP MALE SMALL,11070721,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,19.86,223,Aetna Med ADV,Aetna Med ADV,175.72,,,,,,,Fee Schedule,175.72,175.72,
methotrexate 2.5 mg oral tablet [CULL],11240138,LOCAL,J8610,CPT,,,,,,Outpatient,1,EA,19.9584,,Aetna Med ADV,Aetna Med ADV,0.15,,,,,,,Fee Schedule,0.151,0.151,
cefTAZidime 1 g injection [CULL],11201385,LOCAL,J0713,CPT,,,305,RC,,Outpatient,1,EA,19.968,,Aetna Med ADV,Aetna Med ADV,1.47,,,,,,,Fee Schedule,1.468,1.468,
Carbon Dioxide Level,7903173,LOCAL,82374,CPT,,,305,RC,,Outpatient,,,20,5.86,Aetna Med ADV,Aetna Med ADV,4.88,,,,,,,Fee Schedule,4.88,7.16,
Creatinine,3454470,LOCAL,82565,CPT,,,274,RC,,Outpatient,,,20,6.14,Aetna Med ADV,Aetna Med ADV,10.06,,,,,,,Fee Schedule,7.16,10.061625,
COLLAR CERVICAL SOFT SMALL,11071044,LOCAL,,,L0120,HCPCS,301,RC,,Outpatient,,,20.13,44,Aetna Med ADV,Aetna Med ADV,34.57,,,,,,,Fee Schedule,34.57,34.57,
Gastric Occult Blood,7974128,LOCAL,82271,CPT,,,301,RC,,Outpatient,,,20.16,6.38,Aetna Med ADV,Aetna Med ADV,5.32,,,,,,,Fee Schedule,5.32,7.16,
Immunoglobulin A QSTC,8764567,LOCAL,82784,CPT,,,301,RC,,Outpatient,,,20.25,11.16,Aetna Med ADV,Aetna Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
Immunoglobulin M QSTC,8853219,LOCAL,82784,CPT,,,301,RC,,Outpatient,,,20.25,11.16,Aetna Med ADV,Aetna Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
"PSA, Free QSTC",8852652,LOCAL,84154,CPT,,,274,RC,,Outpatient,,,20.25,22.07,Aetna Med ADV,Aetna Med ADV,19.14,,,,,,,Fee Schedule,17.73,19.14,
COLLAR CERVICAL SOFT LARGE,11071046,LOCAL,,,L0120,HCPCS,,,,Outpatient,,,20.63,44,Aetna Med ADV,Aetna Med ADV,34.57,,,,,,,Fee Schedule,34.57,34.57,
gentamicin 10 mg/mL injectable solution 2 mL [CULL],11201813,LOCAL,J1580,CPT,,,305,RC,,Outpatient,2,ML,20.7744,,Aetna Med ADV,Aetna Med ADV,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
.Manual Differential (CULL),13467987,LOCAL,85007,CPT,,,305,RC,,Outpatient,,,20.81,4.56,Aetna Med ADV,Aetna Med ADV,3.34,,,,,,,Fee Schedule,3.338698061,8.21,
.Manual Differential (CULL_AL),6237143,LOCAL,85007,CPT,,,,,,Outpatient,,,20.81,4.56,Aetna Med ADV,Aetna Med ADV,3.34,,,,,,,Fee Schedule,3.338698061,8.21,
cefuroxime 1.5 g injection [CULL],11201459,LOCAL,J0697,CPT,,,301,RC,,Outpatient,1,EA,20.83712,,Aetna Med ADV,Aetna Med ADV,2.05,,,,,,,Fee Schedule,2.054,2.054,
"Albumin, CSF QSTC",13873322,LOCAL,82042,CPT,,,301,RC,,Outpatient,,,20.95,9.34,Aetna Med ADV,Aetna Med ADV,7.78,,,,,,,Fee Schedule,7.16,7.78,
"IgG, CSF QSTC",13873321,LOCAL,82784,CPT,,,301,RC,,Outpatient,,,20.95,11.16,Aetna Med ADV,Aetna Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
"Amylase, Pleural Fluid QSTC",9039309,LOCAL,82150,CPT,,,301,RC,,Outpatient,,,20.97,7.78,Aetna Med ADV,Aetna Med ADV,1.24,,,,,,,Fee Schedule,1.237209302,7.16,
"Calcium, Random Ur QSTC",13864744,LOCAL,82310,CPT,,,301,RC,,Outpatient,,,20.99,6.19,Aetna Med ADV,Aetna Med ADV,5.16,,,,,,,Fee Schedule,5.16,7.16,
"Creatinine, Random U QSTC",13864745,LOCAL,82570,CPT,,,301,RC,,Outpatient,,,20.99,6.22,Aetna Med ADV,Aetna Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
Fructosamine QSTC,8853273,LOCAL,82985,CPT,,,,,,Outpatient,,,21.02,20.11,Aetna Med ADV,Aetna Med ADV,16.76,,,,,,,Fee Schedule,16.76,17.73,
butorphanol 1 mg/mL Sol [CULL],11202144,LOCAL,J0595,CPT,,,301,RC,,Outpatient,1,ML,21.40416,,Aetna Med ADV,Aetna Med ADV,5.54,,,,,,,Fee Schedule,5.544,5.544,
Direct LDL QSTC,9039357,LOCAL,83721,CPT,,,301,RC,,Outpatient,,,21.6,12.6,Aetna Med ADV,Aetna Med ADV,10.5,,,,,,,Fee Schedule,10.5,17.73,
Hemoglobin A1c QSTC,6213055,LOCAL,83036,CPT,,,301,RC,,Outpatient,,,21.6,11.65,Aetna Med ADV,Aetna Med ADV,28.6,,,,,,,Fee Schedule,7.16,28.59604426,
Varicella-Zoster Virus Ab (IgG) QSTC,8853252,LOCAL,86787,CPT,,,301,RC,,Outpatient,,,21.6,15.46,Aetna Med ADV,Aetna Med ADV,12.88,,,,,,,Fee Schedule,12.88,15.29,
Serum Osmolality QSTC,8972765,LOCAL,83930,CPT,,,350,RC,,Outpatient,,,21.65,7.93,Aetna Med ADV,Aetna Med ADV,6.61,,,,,,,Fee Schedule,6.61,7.16,
76376 3D RENDER W/O POSTPR CHARGE,9284912,LOCAL,76376,CPT,,,510,RC,,Outpatient,,,22,391.88,Aetna Med ADV,Aetna Med ADV,13.93,,,,,,,Fee Schedule,13.93,13.93,
POC Hgb,7160347,LOCAL,83036,CPT,,,301,RC,,Outpatient,,,22,11.65,Aetna Med ADV,Aetna Med ADV,28.6,,,,,,,Fee Schedule,7.16,28.59604426,
Creatinine Level 24 Hour Urine,1634894,LOCAL,82570,CPT,,,301,RC,,Outpatient,,,22.03,6.22,Aetna Med ADV,Aetna Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Albumin, 24 Hour Urine w/o Creat QSTC",13864523,LOCAL,82043,CPT,,,301,RC,,Outpatient,,,22.5,6.94,Aetna Med ADV,Aetna Med ADV,20.16,,,,,,,Fee Schedule,4.02,20.15557971,
"Folate, RBC QSTS",13899938,LOCAL,82747,CPT,,,301,RC,,Outpatient,,,22.5,21.18,Aetna Med ADV,Aetna Med ADV,17.65,,,,,,,Fee Schedule,17.65,46.74,
Hepatitis C Ab rfx HCV RNA Qnt PCR QSTC,8764583,LOCAL,86803,CPT,,,274,RC,,Outpatient,,,22.5,17.12,Aetna Med ADV,Aetna Med ADV,32.1,,,,,,,Fee Schedule,15.29,32.10014925,
IMMOBILIZER  SHOULDER MEDIUM,11070739,LOCAL,,,L3650,HCPCS,274,RC,,Outpatient,,,22.5,12,Aetna Med ADV,Aetna Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
IMMOBILIZER SHOULDER XL,11070165,LOCAL,,,L3650,HCPCS,301,RC,,Outpatient,,,22.5,12,Aetna Med ADV,Aetna Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
"PSA, Total QSTC",8852651,LOCAL,84153,CPT,,,301,RC,,Outpatient,,,22.5,22.07,Aetna Med ADV,Aetna Med ADV,104.84,,,,,,,Fee Schedule,17.73,104.8447059,
"T4, Free QSTC",9291013,LOCAL,84439,CPT,,,270,RC,,Outpatient,,,22.5,10.82,Aetna Med ADV,Aetna Med ADV,28.58,,,,,,,Fee Schedule,18.43,28.58065455,
DRAIN ROUND JP 10FR----OR,11071535,LOCAL,,,L3650,HCPCS,301,RC,,Outpatient,,,22.55,12,Aetna Med ADV,Aetna Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
"Heterophile, Mono Screen QSTC",13864506,LOCAL,86308,CPT,,,301,RC,,Outpatient,,,22.68,6.22,Aetna Med ADV,Aetna Med ADV,5.18,,,,,,,Fee Schedule,5.18,15.29,
"T3, Free QSTC",8972902,LOCAL,84481,CPT,,,274,RC,,Outpatient,,,22.68,20.33,Aetna Med ADV,Aetna Med ADV,34.46,,,,,,,Fee Schedule,18.43,34.46424242,
IMMOBILIZER SHOULDER SMALL,11071014,LOCAL,,,L3650,HCPCS,300,RC,,Outpatient,,,22.72,12,Aetna Med ADV,Aetna Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
COLLECTION: Venous Draw,1779389,LOCAL,36415,CPT,,,274,RC,,Outpatient,,,22.73,10.91,Aetna Med ADV,Aetna Med ADV,6.74,,,,,,,Fee Schedule,3.41,6.740753664,
IMMOBILIZER SHOULDER LARGE,11071760,LOCAL,,,L3650,HCPCS,305,RC,,Outpatient,,,22.77,12,Aetna Med ADV,Aetna Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
Urine Eosinophil Smear,8690390,LOCAL,85008,CPT,,,305,RC,,Outpatient,,,22.85,4.12,Aetna Med ADV,Aetna Med ADV,3.43,,,,,,,Fee Schedule,3.43,8.21,
Urine Eosinophils,7974116,LOCAL,89051,CPT,,,301,RC,,Outpatient,,,22.85,6.72,Aetna Med ADV,Aetna Med ADV,35.8,,,,,,,Fee Schedule,14.07,35.795,
Sodium Level Urine,4185817,LOCAL,84300,CPT,,,302,RC,,Outpatient,,,23,6.07,Aetna Med ADV,Aetna Med ADV,9.74,,,,,,,Fee Schedule,7.16,9.74,
Almond (F20) IgE QST,13344505,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Almond (f20) IgE QSTC,8764712,LOCAL,86003,CPT,,,300,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Beef (f27) IgE QSTC,8764717,LOCAL,86003,CPT,86003,HCPCS,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Brazil Nut (F18) IgE QST,13344495,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Brazil Nut (f18) IgE QSTC,8764711,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cashew Nut (F202) IgE QST,13344499,LOCAL,86003,CPT,,,300,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cashew Nut (f202) IgE QSTC,8764689,LOCAL,86003,CPT,,,300,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cat Dander (e1) IgE QSTC,6241002,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Catfish (f369) IgE QSTC,8764761,LOCAL,86003,CPT,,,300,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Chicken Meat (f83) IgE QSTC,8761426,LOCAL,86003,CPT,,,300,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Clam (f207) IgE QSTC,8764592,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cocoa (f93) IgE QSTC,8764728,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Coconut (f36) IgE QSTC,8764719,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cow'S Milk (F2) IgE w/Rflx to Panel QST,12886535,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cow'S Milk(F2) IgE W/Rfx Panel QSTC,14129187,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Crab (f23) IgE QSTC,6210507,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Crayfish (Rf320) IgE** QSTC,9039458,LOCAL,86003,CPT,,,300,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
D. Pteronyssinus (d1) IgE QST,6241001,LOCAL,86003,CPT,,,300,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dermatophagoides Farinae (d2) IgE QST,10217085,LOCAL,86003,CPT,,,300,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dog Dander (e5) IgE QSTC,6241003,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Egg White (f1) IgE QSTC,8764699,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Egg White (F2) IgE w/Rflx to Panel QST,12886536,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Egg Yolk (f75) IgE QSTC,8764725,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Fire Ant (i70) IgE QSTC,8764698,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Gluten (f79) IgE QSTC,9039341,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Hazelnut (F17) IgE QST,13344503,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Hazelnut (f17) IgE QSTC,8764710,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Lobster (f80) IgE QSTC,6210505,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Macadamia Nut (RF345) IgE QST,13344491,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Milk Component Panel QST,10217179,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Oyster (f290) IgE QSTC,6210503,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Peanut (F13) IgE QST,13344507,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Peanut (f13) IgE QSTC,8764708,LOCAL,86003,CPT,86003,HCPCS,301,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
"Peanut,Tot w/rfx to Peanut Comp Pnl QSTC",8764811,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pecan Nut (F201) IgE QST,13344493,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pecan Nut (f201) IgE QSTC,8764727,LOCAL,86003,CPT,86003,HCPCS,301,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Perch Ocean IgE QSTC,8764760,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pistachio (F203) IgE QST,13344501,LOCAL,86003,CPT,,,300,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pork (f26) IgE QSTC,8764716,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Scallop (f338) IgE QSTC,6210506,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Shrimp (f24) IgE QSTC,6241010,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Soybean (f14) IgE QSTC,8764709,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Strawberry (f44) IgE QSTC,8764722,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Tilapia IgE* QSTC,8972793,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Tomato (f25) IgE QSTC,8764715,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Walnut (F256) IgE QST,13344497,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Walnut (f256) IgE QSTC,8764747,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Wheat (f4) IgE QSTC,6241013,LOCAL,86003,CPT,,,420,RC,,Outpatient,,,23.13,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
95851 ROM MEASUREMENT(EXCLUDE HANDS) CHARGE,9410226,LOCAL,95851,CPT,,,,,GP,Outpatient,,,23.49,15,Aetna Med ADV,Aetna Med ADV,6.41,,,,,,,Fee Schedule,6.41,6.41,
digoxin 250 mcg/mL (0.25 mg/mL) injectable solution 2 mL [CULL],11282125,LOCAL,J1160,CPT,,,,,,Outpatient,2,ML,23.92,,Aetna Med ADV,Aetna Med ADV,9.57,,,,,,,Fee Schedule,9.574,9.574,
sulfamethoxazole-trimethoprim 80 mg-16 mg/mL Sol [CULL],11211277,LOCAL,J2865,CPT,,,301,RC,,Outpatient,5,ML,24.3328,,Aetna Med ADV,Aetna Med ADV,0.04,,,,,,,Fee Schedule,0.01,0.038,
Immunoglobulin G QSTC,8764569,LOCAL,82784,CPT,,,302,RC,,Outpatient,,,24.75,11.16,Aetna Med ADV,Aetna Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
Sjogren's Antibody (SS-A) QSTC,8860711,LOCAL,86235,CPT,,,301,RC,,Outpatient,,,24.75,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-A) QSTC,9039451,LOCAL,86235,CPT,,,302,RC,,Outpatient,,,24.75,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-B) QSTC,8860712,LOCAL,86235,CPT,,,301,RC,,Outpatient,,,24.75,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-B) QSTC,9039452,LOCAL,86235,CPT,,,,,,Outpatient,,,24.75,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
methylPREDNISolone 125 mg Pow [CULL],11247586,LOCAL,J2919,CPT,,,274,RC,,Outpatient,1,EA,24.8064,,Aetna Med ADV,Aetna Med ADV,0.21,,,,,,,Fee Schedule,0.21,0.21,
STRAP CLAVACLE LARGE,11070713,LOCAL,,,L3650,HCPCS,274,RC,,Outpatient,,,24.97,12,Aetna Med ADV,Aetna Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
STRAP CLAVICLE MED 3IN,11098246,LOCAL,,,L3650,HCPCS,300,RC,,Outpatient,,,24.97,12,Aetna Med ADV,Aetna Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
Aerobic Bacterium ID/ Susceptibility QST,13344167,LOCAL,87077,CPT,,,300,RC,,Outpatient,,,25,9.7,Aetna Med ADV,Aetna Med ADV,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
"Catecholamines, Fractionated, Plasma QSTC",11335672,LOCAL,82384,CPT,,,311,RC,,Outpatient,,,25,30.3,Aetna Med ADV,Aetna Med ADV,25.25,,,,,,,Fee Schedule,18.43,25.25,
Tissue A Clinical Impression QST,10148697,LOCAL,88300,CPT,,,311,RC,,Outpatient,,,25,,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,22.39,32.32,
Tissue A Comment QST,10148702,LOCAL,88302,CPT,,,311,RC,,Outpatient,,,25,,Aetna Med ADV,Aetna Med ADV,35.88,,,,,,,Fee Schedule,32.32,35.88,
Tissue A Diagnosis QST,10148701,LOCAL,88304,CPT,,,311,RC,,Outpatient,,,25,,Aetna Med ADV,Aetna Med ADV,48.85,,,,,,,Fee Schedule,32.32,48.85,
Tissue A Gross Description QST,10148699,LOCAL,88305,CPT,,,311,RC,,Outpatient,,,25,,Aetna Med ADV,Aetna Med ADV,48.85,,,,,,,Fee Schedule,48.85,59.06,
Tissue A Micro Description QST,10148700,LOCAL,88307,CPT,,,311,RC,,Outpatient,,,25,,Aetna Med ADV,Aetna Med ADV,328.88,,,,,,,Fee Schedule,59.06,328.88,
Tissue A Procedure QST,10148698,LOCAL,88309,CPT,,,301,RC,,Outpatient,,,25,,Aetna Med ADV,Aetna Med ADV,746.86,,,,,,,Fee Schedule,59.06,746.86,
Childhood Allergy Profile QSTC,8972792,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,25.16,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Expanded Childhood Allergy Profile ADD ON,14019143,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,25.16,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
"Albumin, CSF QSTC",8861454,LOCAL,82042,CPT,,,301,RC,,Outpatient,,,25.28,9.34,Aetna Med ADV,Aetna Med ADV,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Albumin, Serum QSTC",8861457,LOCAL,82040,CPT,,,301,RC,,Outpatient,,,25.28,5.94,Aetna Med ADV,Aetna Med ADV,127.89,,,,,,,Fee Schedule,7.16,127.89,
Immunoglobulin G QSTC,8861456,LOCAL,82784,CPT,,,301,RC,,Outpatient,,,25.28,11.16,Aetna Med ADV,Aetna Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
Maternal Serum AFP QST,8972825,LOCAL,82105,CPT,,,301,RC,,Outpatient,,,25.88,20.12,Aetna Med ADV,Aetna Med ADV,26.22,,,,,,,Fee Schedule,17.73,26.22,
Maternal Serum AFP QSTC,8972825,LOCAL,82105,CPT,,,301,RC,,Outpatient,,,25.88,20.12,Aetna Med ADV,Aetna Med ADV,26.22,,,,,,,Fee Schedule,17.73,26.22,
"G-6-PD, RBC QSTC",8764537,LOCAL,82955,CPT,,,,,,Outpatient,,,26.15,11.64,Aetna Med ADV,Aetna Med ADV,9.7,,,,,,,Fee Schedule,7.16,9.7,
ampicillin 1 g injection [CULL],11201129,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,26.256,,Aetna Med ADV,Aetna Med ADV,0.59,,,,,,,Fee Schedule,0.591,0.591,
DOBUTamine 12.5 mg/mL intravenous solution 20 mL [CULL],11201690,LOCAL,J1250,CPT,,,302,RC,,Outpatient,20,ML,26.6144,,Aetna Med ADV,Aetna Med ADV,8.02,,,,,,,Fee Schedule,8.024,8.024,
Serotype 1 (1) QST,10243602,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 12 (12F) QST,10243608,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 14 (14) QST,10243609,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 17 (17F) QST,10242538,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 19 (19F) QST,10243610,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 2 (2) QST,10242514,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 20 (20) QST,10242544,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 22 (22F) QST,10242547,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 23 (23F) QST,10243611,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 26 (6B) QST,10243612,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 3 (3) QST,10243603,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 34 (10A) QST,10242556,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 4 (4) QST,10243604,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 43 (11A) QST,10242559,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 5 (5) QST,10243605,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 51 (7F) QST,10243613,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 54 (15B) QST,10242565,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 56 (18C) QST,10243614,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 57 (19A) QST,10242571,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 68 (9V) QST,10243615,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 70 (33F) QST,10242577,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 8 (8) QST,10243606,LOCAL,86317,CPT,,,302,RC,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 9 (9N) QST,10243607,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Aetna Med ADV,Aetna Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
ciprofloxacin 400 mg/200 mL-5% Sol,11201486,LOCAL,J0744,CPT,,,301,RC,,Outpatient,200,ML,26.8416,,Aetna Med ADV,Aetna Med ADV,2,,,,,,,Fee Schedule,1.997,1.997,
Aldolase QSTC,8764531,LOCAL,82085,CPT,,,301,RC,,Outpatient,,,26.87,11.65,Aetna Med ADV,Aetna Med ADV,18.2,,,,,,,Fee Schedule,7.16,18.195,
Glucose Fingerstick Clinic POC (RE),4192199,LOCAL,82962,CPT,,,302,RC,,Outpatient,,,26.93,3.94,Aetna Med ADV,Aetna Med ADV,9.08,,,,,,,Fee Schedule,7.16,9.084767596,
".Smooth Muscle Ab, Titer QSTC",13864540,LOCAL,86256,CPT,,,301,RC,,Outpatient,,,27,14.46,Aetna Med ADV,Aetna Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
DNA (ds) Antibody QSTC,8764566,LOCAL,86225,CPT,,,301,RC,,Outpatient,,,27,16.49,Aetna Med ADV,Aetna Med ADV,14.72,,,,,,,Fee Schedule,14.71636364,15.29,
Hepatitis B Core Ab (IgM) QSTC,8764681,LOCAL,86705,CPT,,,301,RC,,Outpatient,,,27,14.12,Aetna Med ADV,Aetna Med ADV,32.8,,,,,,,Fee Schedule,15.29,32.80285714,
Mumps Virus Antibody (IgG) QSTC,8764679,LOCAL,86735,CPT,,,301,RC,,Outpatient,,,27,15.66,Aetna Med ADV,Aetna Med ADV,13.05,,,,,,,Fee Schedule,13.05,15.29,
Prolactin QSTC,8972761,LOCAL,84146,CPT,,,301,RC,,Outpatient,,,27,23.26,Aetna Med ADV,Aetna Med ADV,19.38,,,,,,,Fee Schedule,18.43,19.38,
Smooth Muscle Ab w/refl Titer QSTC,13864539,LOCAL,83497,CPT,,,301,RC,,Outpatient,,,27,15.48,Aetna Med ADV,Aetna Med ADV,12.9,,,,,,,Fee Schedule,12.9,19.405,
Smooth Muscle Ab w/rfx Titer QSTC,13864539,LOCAL,86015,CPT,,,301,RC,,Outpatient,,,27,14.46,Aetna Med ADV,Aetna Med ADV,19.41,,,,,,,Fee Schedule,12.9,19.405,
"Treponema pall Ab, Particle Agg QSTC",8972906,LOCAL,86780,CPT,,,301,RC,,Outpatient,,,27,15.89,Aetna Med ADV,Aetna Med ADV,13.24,,,,,,,Fee Schedule,13.24,15.29,
Protein Level Urine,4186691,LOCAL,84156,CPT,,,301,RC,,Outpatient,,,27.74,4.4,Aetna Med ADV,Aetna Med ADV,11.68,,,,,,,Fee Schedule,7.16,11.68,
Lipid Panel w/ Rfx to Direct LDL QSTC,13864433,LOCAL,80061,CPT,,,,,,Outpatient,,,27.9,16.07,Aetna Med ADV,Aetna Med ADV,16.6,,,,,,,Fee Schedule,12.14,16.59934459,
cyanocobalamin 1000 mcg/mL injectable solution 1 mL [CULL],11202258,LOCAL,J3420,CPT,,,942,RC,,Outpatient,1,ML,27.968,,Aetna Med ADV,Aetna Med ADV,3.17,,,,,,,Fee Schedule,3.167142857,3.167142857,
G0109 DM OP SMT GRP PER 30 MIN CHARGE,8709096,LOCAL,,,G0109,HCPCS,300,RC,,Outpatient,,,27.99,18,Aetna Med ADV,Aetna Med ADV,15.04,,,,,,,Fee Schedule,15.04,67.18,
ID,8131550,LOCAL,87077,CPT,,,300,RC,,Outpatient,,,28.15,9.7,Aetna Med ADV,Aetna Med ADV,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
ID Add On,13661571,LOCAL,87077,CPT,,,301,RC,,Outpatient,,,28.15,9.7,Aetna Med ADV,Aetna Med ADV,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
Mitochondria M2 Ab (IgG) QSTC,8764575,LOCAL,86381,CPT,,,972,RC,,Outpatient,,,28.26,30.54,Aetna Med ADV,Aetna Med ADV,26.61,,,,,,,Fee Schedule,15.29,26.605,
PC DOPP LOWER EXT ART/ABI,8200227,LOCAL,93922,CPT,,,,,,Outpatient,,,28.29,265,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,117.85,161.71,
clindamycin 300 mg/50 mL-NaCl 0.9% Sol [CULL],11290065,LOCAL,J0737,CPT,,,,,,Outpatient,50,ML,28.32,,Aetna Med ADV,Aetna Med ADV,2.35,,,,,,,Fee Schedule,0.819,2.346,
butorphanol 2 mg/mL Sol [CULL],11202147,LOCAL,J0595,CPT,,,301,RC,,Outpatient,1,ML,28.7968,,Aetna Med ADV,Aetna Med ADV,5.54,,,,,,,Fee Schedule,5.544,5.544,
"Gastrin, Serum QSTC",8764526,LOCAL,82941,CPT,,,301,RC,,Outpatient,,,28.8,21.16,Aetna Med ADV,Aetna Med ADV,17.63,,,,,,,Fee Schedule,17.63,18.43,
Hep B Core Ab (Total)w/Rfx to IgM QSTC,9039408,LOCAL,86704,CPT,,,301,RC,,Outpatient,,,28.8,14.46,Aetna Med ADV,Aetna Med ADV,17.4,,,,,,,Fee Schedule,15.29,17.40428571,
Hepatitis A IgM QSTC,8764600,LOCAL,86709,CPT,,,301,RC,,Outpatient,,,28.8,13.51,Aetna Med ADV,Aetna Med ADV,11.26,,,,,,,Fee Schedule,11.26,15.29,
"Hepatitis B Core Ab, Total QSTC",8764579,LOCAL,86704,CPT,,,301,RC,,Outpatient,,,28.8,14.46,Aetna Med ADV,Aetna Med ADV,17.4,,,,,,,Fee Schedule,15.29,17.40428571,
Complement Component C3c QSTC,8972768,LOCAL,86160,CPT,,,301,RC,,Outpatient,,,29.25,14.4,Aetna Med ADV,Aetna Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
Complement Component C4c QSTC,8972769,LOCAL,86160,CPT,,,301,RC,,Outpatient,,,29.25,14.4,Aetna Med ADV,Aetna Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
Insulin QSTC,9039285,LOCAL,83525,CPT,,,301,RC,,Outpatient,,,29.25,13.72,Aetna Med ADV,Aetna Med ADV,11.43,,,,,,,Fee Schedule,11.43,18.43,
Clozapine QSTC,8764629,LOCAL,80159,CPT,,,300,RC,,Outpatient,,,29.7,24.18,Aetna Med ADV,Aetna Med ADV,20.15,,,,,,,Fee Schedule,15.38,20.15,
HSV 1 and 2 IgG Antibodies QSTC,8853241,LOCAL,86695,CPT,,,300,RC,,Outpatient,,,29.97,15.83,Aetna Med ADV,Aetna Med ADV,13.19,,,,,,,Fee Schedule,13.19,15.29,
"HSV 1/2 IgG,Type Specific Ab QST",8389465,LOCAL,86695,CPT,,,942,RC,,Outpatient,,,29.97,15.83,Aetna Med ADV,Aetna Med ADV,13.19,,,,,,,Fee Schedule,13.19,15.29,
97804 Medical Nutrit Group 30Min CHARGE,9323172,LOCAL,97804,CPT,,,301,RC,,Outpatient,,,30,20,Aetna Med ADV,Aetna Med ADV,11.75,,,,,,,Fee Schedule,11.75,287.34,
Insulin Level Total,3454335,LOCAL,83525,CPT,,,,,,Outpatient,,,30,13.72,Aetna Med ADV,Aetna Med ADV,11.43,,,,,,,Fee Schedule,11.43,18.43,
budesonide 0.25 mg/2 mL inhalation suspension 2 mL [CULL],11205254,LOCAL,J7626,CPT,,,,,,Outpatient,2,ML,30.1056,,Aetna Med ADV,Aetna Med ADV,1.05,,,,,,,Fee Schedule,1.049,1.049,
cefTRIAXone 2 g injection ADDV [CULL],11282070,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,30.61632,,Aetna Med ADV,Aetna Med ADV,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
labetalol 5 mg/mL intravenous solution 20 mL [CULL],11201873,LOCAL,J1920,CPT,,,,,,Outpatient,20,ML,30.72,,Aetna Med ADV,Aetna Med ADV,5.46,,,,,,,Fee Schedule,5.464225352,5.464225352,
triamcinolone acetonide 40 mg/mL injectable suspension 1 mL [CULL],11212390,LOCAL,J3301,CPT,,,,,,Outpatient,1,ML,31.072,,Aetna Med ADV,Aetna Med ADV,3.03,,,,,,,Fee Schedule,3.025614035,3.025614035,
clindamycin 300 mg/50 mL-D5% intravenous solution 50 mL [CULL],11290065,LOCAL,J0736,CPT,,,301,RC,,Outpatient,50,ML,31.48133333,,Aetna Med ADV,Aetna Med ADV,0.82,,,,,,,Fee Schedule,0.819,2.346,
".ANA, Titer and Pattern QSTC",8764643,LOCAL,86039,CPT,,,301,RC,,Outpatient,,,31.5,13.39,Aetna Med ADV,Aetna Med ADV,21.22,,,,,,,Fee Schedule,15.29,21.22,
Cytomegalovirus Antibody (IgG) QSTC,13972135,LOCAL,86644,CPT,,,301,RC,,Outpatient,,,31.5,17.27,Aetna Med ADV,Aetna Med ADV,14.39,,,,,,,Fee Schedule,14.39,15.29,
Cytomegalovirus Antibody (IgG) QSTC,8853227,LOCAL,86644,CPT,,,302,RC,,Outpatient,,,31.5,17.27,Aetna Med ADV,Aetna Med ADV,14.39,,,,,,,Fee Schedule,14.39,15.29,
C-Reactive Protein,1628890,LOCAL,86140,CPT,,,306,RC,,Outpatient,,,32,6.22,Aetna Med ADV,Aetna Med ADV,13.3,,,,,,,Fee Schedule,13.29690962,15.29,
Fecal WBC,4123047,LOCAL,87205,CPT,,,306,RC,,Outpatient,,,32,5.12,Aetna Med ADV,Aetna Med ADV,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
Stool WBC,10294481,LOCAL,87205,CPT,,,301,RC,,Outpatient,,,32,5.12,Aetna Med ADV,Aetna Med ADV,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
"Complement, Total (CH50) QSTC",8764582,LOCAL,86162,CPT,,,301,RC,,Outpatient,,,32.4,24.38,Aetna Med ADV,Aetna Med ADV,20.32,,,,,,,Fee Schedule,15.29,20.32,
DHEA Sulfate QSTC,9696140,LOCAL,82627,CPT,,,301,RC,,Outpatient,,,32.4,26.68,Aetna Med ADV,Aetna Med ADV,27.1,,,,,,,Fee Schedule,18.43,27.095,
Haptoglobin QSTC,8764542,LOCAL,83010,CPT,,,301,RC,,Outpatient,,,32.4,15.1,Aetna Med ADV,Aetna Med ADV,12.58,,,,,,,Fee Schedule,12.58,17.73,
"Hepatitis A Ab, Total QSTC",8764599,LOCAL,86708,CPT,,,301,RC,,Outpatient,,,32.4,14.87,Aetna Med ADV,Aetna Med ADV,12.39,,,,,,,Fee Schedule,12.39,15.29,
Jo-1 Antibody QSTC,8764688,LOCAL,86235,CPT,,,301,RC,,Outpatient,,,32.4,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
"RNP Antibody, QSTC",10100359,LOCAL,86235,CPT,,,301,RC,,Outpatient,,,32.4,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
"Sm Antibody, QSTC",10100362,LOCAL,86235,CPT,,,274,RC,,Outpatient,,,32.4,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
"STRAP, CLAVICLE SMALL-3004-06",6010605,LOCAL,,,L3650,HCPCS,301,RC,,Outpatient,,,32.4,12,Aetna Med ADV,Aetna Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
"Albumin, CSF QSTC",13873031,LOCAL,82042,CPT,,,301,RC,,Outpatient,,,32.46,9.34,Aetna Med ADV,Aetna Med ADV,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Albumin, Serum QSTC",13873034,LOCAL,82040,CPT,,,301,RC,,Outpatient,,,32.46,5.94,Aetna Med ADV,Aetna Med ADV,127.89,,,,,,,Fee Schedule,7.16,127.89,
Immunoglobulin G QSTC,13873033,LOCAL,82784,CPT,,,301,RC,,Outpatient,,,32.46,11.16,Aetna Med ADV,Aetna Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
"Oligoclonal Bands (IgG),CSF QSTC",13873028,LOCAL,83916,CPT,,,301,RC,,Outpatient,,,32.46,32.87,Aetna Med ADV,Aetna Med ADV,27.39,,,,,,,Fee Schedule,17.73,27.39,
Immunoglobulin A QSTC,13904383,LOCAL,82784,CPT,,,301,RC,,Outpatient,,,32.62,11.16,Aetna Med ADV,Aetna Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
tTG IgA Ab QSTC,13904382,LOCAL,86364,CPT,,,301,RC,,Outpatient,,,32.63,13.84,Aetna Med ADV,Aetna Med ADV,61.9,,,,,,,Fee Schedule,15.29,61.9,
"Delta-Aminolevulinic Acid, Random Urine QSTC",12329984,LOCAL,82135,CPT,,,301,RC,,Outpatient,,,32.81,19.74,Aetna Med ADV,Aetna Med ADV,16.45,,,,,,,Fee Schedule,16.45,17.73,
Bilirubin Cord Blood,10237211,LOCAL,82247,CPT,,,301,RC,,Outpatient,,,33.46,6.02,Aetna Med ADV,Aetna Med ADV,5.02,,,,,,,Fee Schedule,5.02,7.16,
Bilirubin Neonatal (Bu/Bc),14541767,LOCAL,82248,CPT,,,301,RC,,Outpatient,,,33.46,6.02,Aetna Med ADV,Aetna Med ADV,26.63,,,,,,,Fee Schedule,7.16,26.6275,
Bilirubin Neonatal 2,8883195,LOCAL,82247,CPT,,,301,RC,,Outpatient,,,33.46,6.02,Aetna Med ADV,Aetna Med ADV,5.02,,,,,,,Fee Schedule,5.02,7.16,
Bilirubin Total,633672,LOCAL,82247,CPT,,,301,RC,,Outpatient,,,33.46,6.02,Aetna Med ADV,Aetna Med ADV,5.02,,,,,,,Fee Schedule,5.02,7.16,
Bilirubin Total,7939102,LOCAL,82247,CPT,,,301,RC,,Outpatient,,,33.46,6.02,Aetna Med ADV,Aetna Med ADV,5.02,,,,,,,Fee Schedule,5.02,7.16,
Bilirubin Total,8443661,LOCAL,82247,CPT,,,301,RC,,Outpatient,,,33.46,6.02,Aetna Med ADV,Aetna Med ADV,5.02,,,,,,,Fee Schedule,5.02,7.16,
Cyclic Citrull Peptide (CCP) Ab IgG QSTC,8764613,LOCAL,86200,CPT,,,301,RC,,Outpatient,,,33.75,15.54,Aetna Med ADV,Aetna Med ADV,7.49,,,,,,,Fee Schedule,7.491935484,15.29,
"Cholinesterase, Plasma QSTC",13873320,LOCAL,82482,CPT,,,301,RC,,Outpatient,,,33.8,11.77,Aetna Med ADV,Aetna Med ADV,9.81,,,,,,,Fee Schedule,7.16,9.81,
"Cholinesterase, RBC QSTC",13873317,LOCAL,82480,CPT,,,274,RC,,Outpatient,,,33.8,9.44,Aetna Med ADV,Aetna Med ADV,7.87,,,,,,,Fee Schedule,7.16,7.87,
STRAP CLAVICLE PED.,11071010,LOCAL,,,L3650,HCPCS,302,RC,,Outpatient,,,33.94,12,Aetna Med ADV,Aetna Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
"Calcium, 24 hour Urine QSTC",13864700,LOCAL,82340,CPT,,,302,RC,,Outpatient,,,33.95,7.24,Aetna Med ADV,Aetna Med ADV,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
"Citric Acid, 24 Hour Urine QSTC",13864703,LOCAL,82507,CPT,,,302,RC,,Outpatient,,,33.95,33.36,Aetna Med ADV,Aetna Med ADV,30.63,,,,,,,Fee Schedule,17.73,30.625,
"Creatinine, 24 Hour Urine QSTC",13864712,LOCAL,82570,CPT,,,302,RC,,Outpatient,,,33.95,6.22,Aetna Med ADV,Aetna Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Magnesium, 24 Hour Urine QSTC",13864709,LOCAL,83735,CPT,,,302,RC,,Outpatient,,,33.95,8.04,Aetna Med ADV,Aetna Med ADV,3.66,,,,,,,Fee Schedule,3.657824427,7.16,
"Oxalate, 24 Hour Urine QSTC",13864701,LOCAL,83945,CPT,,,302,RC,,Outpatient,,,33.95,17.34,Aetna Med ADV,Aetna Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.085,
pH Urine QSTC,13864699,LOCAL,83986,CPT,,,302,RC,,Outpatient,,,33.95,4.3,Aetna Med ADV,Aetna Med ADV,18.76,,,,,,,Fee Schedule,7.16,18.755,
"Phosphorus, 24 Hour Urine QSTC",13864707,LOCAL,84105,CPT,,,302,RC,,Outpatient,,,33.95,6.94,Aetna Med ADV,Aetna Med ADV,19.84,,,,,,,Fee Schedule,7.16,19.835,
"Potassium, 24 Hour Urine QSTC",13864711,LOCAL,84133,CPT,,,302,RC,,Outpatient,,,33.95,5.68,Aetna Med ADV,Aetna Med ADV,19.32,,,,,,,Fee Schedule,7.16,19.32,
"Sodium, 24 Hour Urine QSTC",13864704,LOCAL,84300,CPT,,,302,RC,,Outpatient,,,33.95,6.07,Aetna Med ADV,Aetna Med ADV,9.74,,,,,,,Fee Schedule,7.16,9.74,
"Sulfate, 24 Hour Urine QSTC",13864705,LOCAL,84392,CPT,,,302,RC,,Outpatient,,,33.95,6.59,Aetna Med ADV,Aetna Med ADV,19.7,,,,,,,Fee Schedule,4.02,19.695,
Uric Acid QSTC,13864716,LOCAL,84560,CPT,,,311,RC,,Outpatient,,,33.95,6.1,Aetna Med ADV,Aetna Med ADV,19.49,,,,,,,Fee Schedule,7.16,19.49,
Ammonium Urine QSTC,8997190,LOCAL,82140,CPT,,,311,RC,,Outpatient,,,34,17.48,Aetna Med ADV,Aetna Med ADV,22.63,,,,,,,Fee Schedule,17.73,22.62909091,
"Calcium, 24 hour Urine QSTC",8997182,LOCAL,82340,CPT,,,311,RC,,Outpatient,,,34,7.24,Aetna Med ADV,Aetna Med ADV,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
"Citric Acid, 24 Hour Urine QSTC",8997185,LOCAL,82507,CPT,,,311,RC,,Outpatient,,,34,33.36,Aetna Med ADV,Aetna Med ADV,30.63,,,,,,,Fee Schedule,17.73,30.625,
"Creatinine, 24 Hour Urine QSTC",8997192,LOCAL,82570,CPT,,,311,RC,,Outpatient,,,34,6.22,Aetna Med ADV,Aetna Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Magnesium, 24 Hour Urine QSTC",8997189,LOCAL,83735,CPT,,,311,RC,,Outpatient,,,34,8.04,Aetna Med ADV,Aetna Med ADV,3.66,,,,,,,Fee Schedule,3.657824427,7.16,
"Oxalate, 24 Hour Urine QSTC",8997183,LOCAL,83945,CPT,,,311,RC,,Outpatient,,,34,17.34,Aetna Med ADV,Aetna Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.085,
pH Urine QSTC,8997180,LOCAL,83986,CPT,,,311,RC,,Outpatient,,,34,4.3,Aetna Med ADV,Aetna Med ADV,18.76,,,,,,,Fee Schedule,7.16,18.755,
"Phosphorus, 24 Hour Urine QSTC",8997188,LOCAL,84105,CPT,,,311,RC,,Outpatient,,,34,6.94,Aetna Med ADV,Aetna Med ADV,19.84,,,,,,,Fee Schedule,7.16,19.835,
"Potassium, 24 Hour Urine QSTC",8997191,LOCAL,84133,CPT,,,311,RC,,Outpatient,,,34,5.68,Aetna Med ADV,Aetna Med ADV,19.32,,,,,,,Fee Schedule,7.16,19.32,
"Sodium, 24 Hour Urine QSTC",8997186,LOCAL,84300,CPT,,,311,RC,,Outpatient,,,34,6.07,Aetna Med ADV,Aetna Med ADV,9.74,,,,,,,Fee Schedule,7.16,9.74,
"Sulfate, 24 Hour Urine QSTC",8997187,LOCAL,84392,CPT,,,311,RC,,Outpatient,,,34,6.59,Aetna Med ADV,Aetna Med ADV,19.7,,,,,,,Fee Schedule,4.02,19.695,
"Uric Acid, 24 Hour Urine QSTC",8997184,LOCAL,84560,CPT,,,274,RC,,Outpatient,,,34,6.1,Aetna Med ADV,Aetna Med ADV,19.49,,,,,,,Fee Schedule,7.16,19.49,
BINDER ABDOMINAL MALE,11070715,LOCAL,,,L0625,HCPCS,301,RC,,Outpatient,,,34.21,86,Aetna Med ADV,Aetna Med ADV,42.8,,,,,,,Fee Schedule,42.8,42.8,
Lipase Level,633776,LOCAL,83690,CPT,,,,,,Outpatient,,,34.27,8.27,Aetna Med ADV,Aetna Med ADV,1.3,,,,,,,Fee Schedule,1.304132029,7.16,
fluconazole 200 mg/100 mL-NaCl 0.9% intravenous solution 100 mL [CULL],11220720,LOCAL,J1450,CPT,,,,,,Outpatient,100,ML,34.56,,Aetna Med ADV,Aetna Med ADV,4.48,,,,,,,Fee Schedule,4.48,4.48,
vancomycin 500 mg/100 mL intravenous solution 100 mL [CULL],11290008,LOCAL,J3375,CPT,,,301,RC,,Outpatient,100,ML,34.56,,Aetna Med ADV,Aetna Med ADV,0.13,,,,,,,Fee Schedule,0.134,0.134,
Ceruloplasmin QSTC,8764535,LOCAL,82390,CPT,,,,,,Outpatient,,,34.88,12.89,Aetna Med ADV,Aetna Med ADV,10.74,,,,,,,Fee Schedule,10.74,17.73,
labetalol 5 mg/mL intravenous solution 4 mL [CULL],11201874,LOCAL,J1920,CPT,,,301,RC,,Outpatient,4,ML,34.88,,Aetna Med ADV,Aetna Med ADV,5.46,,,,,,,Fee Schedule,5.464225352,5.464225352,
Amikacin Level,9034955,LOCAL,80150,CPT,,,301,RC,,Outpatient,,,35,18.1,Aetna Med ADV,Aetna Med ADV,15.08,,,,,,,Fee Schedule,15.08,15.38,
"ANA Screen, IFA QSTC",14116751,LOCAL,86038,CPT,,,301,RC,,Outpatient,,,35,14.51,Aetna Med ADV,Aetna Med ADV,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
Breath Alcohol,9687753,LOCAL,82075,CPT,,,301,RC,,Outpatient,,,35,36,Aetna Med ADV,Aetna Med ADV,30,,,,,,,Fee Schedule,17.73,30,
"CCP, Antibody (IgG) QSTC",14116753,LOCAL,86200,CPT,,,301,RC,,Outpatient,,,35,15.54,Aetna Med ADV,Aetna Med ADV,7.49,,,,,,,Fee Schedule,7.491935484,15.29,
"MCV, Antibody QSTC",14116754,LOCAL,83520,CPT,,,301,RC,,Outpatient,,,35,20.72,Aetna Med ADV,Aetna Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rheumatoid Factor QSTC,14116752,LOCAL,86431,CPT,,,301,RC,,Outpatient,,,35,6.8,Aetna Med ADV,Aetna Med ADV,6.3,,,,,,,Fee Schedule,6.29875,15.29,
T4 Total,633845,LOCAL,84436,CPT,,,302,RC,,Outpatient,,,35.09,8.24,Aetna Med ADV,Aetna Med ADV,17.54,,,,,,,Fee Schedule,17.54230769,18.43,
Rheumatoid Factor Qualitative,7906954,LOCAL,86430,CPT,,,301,RC,,Outpatient,,,35.1,7.37,Aetna Med ADV,Aetna Med ADV,20.56,,,,,,,Fee Schedule,15.29,20.56,
Protein Tot & Protein Electrophore QSTC,8764768,LOCAL,84155,CPT,,,300,RC,,Outpatient,,,35.23,4.4,Aetna Med ADV,Aetna Med ADV,3.67,,,,,,,Fee Schedule,3.67,7.16,
Glucose 2 Hour Post Prandial,7973897,LOCAL,82947,CPT,,,301,RC,,Outpatient,,,35.5,4.72,Aetna Med ADV,Aetna Med ADV,10.3,,,,,,,Fee Schedule,7.16,10.29541667,
Lithium Level,2046348,LOCAL,80178,CPT,,,301,RC,,Outpatient,,,35.5,7.93,Aetna Med ADV,Aetna Med ADV,20.99,,,,,,,Fee Schedule,15.38,20.99,
Magnesium Level,633781,LOCAL,83735,CPT,,,274,RC,,Outpatient,,,35.5,8.04,Aetna Med ADV,Aetna Med ADV,3.66,,,,,,,Fee Schedule,3.657824427,7.16,
BINDER ABDOMINAL FEMALE,11070714,LOCAL,,,L0625,HCPCS,301,RC,,Outpatient,,,35.59,86,Aetna Med ADV,Aetna Med ADV,42.8,,,,,,,Fee Schedule,42.8,42.8,
Crystal Analysis QSTC,9658951,LOCAL,89060,CPT,,,300,RC,,Outpatient,,,35.87,8.8,Aetna Med ADV,Aetna Med ADV,21.53,,,,,,,Fee Schedule,14.07,21.53,
Glucose 1 Hour,7973889,LOCAL,82951,CPT,,,300,RC,,Outpatient,,,35.9,15.44,Aetna Med ADV,Aetna Med ADV,12.87,,,,,,,Fee Schedule,12.87,17.73,
Glucose 2 Hour,7973890,LOCAL,82952,CPT,,,300,RC,,Outpatient,,,35.9,4.7,Aetna Med ADV,Aetna Med ADV,3.92,,,,,,,Fee Schedule,3.92,7.16,
Glucose Level,633594,LOCAL,82947,CPT,,,302,RC,,Outpatient,,,35.9,4.72,Aetna Med ADV,Aetna Med ADV,10.3,,,,,,,Fee Schedule,7.16,10.29541667,
Thyroid Peroxidase Abs QSTC,8861417,LOCAL,86376,CPT,,,301,RC,,Outpatient,,,35.91,17.46,Aetna Med ADV,Aetna Med ADV,25.09,,,,,,,Fee Schedule,15.29,25.085,
Thyroid Peroxidase Antibodies QSTC,8764563,LOCAL,86376,CPT,,,301,RC,,Outpatient,,,35.91,17.46,Aetna Med ADV,Aetna Med ADV,25.09,,,,,,,Fee Schedule,15.29,25.085,
"Alpha-1-Antitrypsin, Qn QSTC",9039253,LOCAL,82103,CPT,,,301,RC,,Outpatient,,,36,16.13,Aetna Med ADV,Aetna Med ADV,60.59,,,,,,,Fee Schedule,17.73,60.59,
"Alpha-Fetoprotein, Tumor Marker QSTC",8764596,LOCAL,82105,CPT,,,301,RC,,Outpatient,,,36,20.12,Aetna Med ADV,Aetna Med ADV,26.22,,,,,,,Fee Schedule,17.73,26.22,
"B2 Microglobulin, Serum QSTC",8764794,LOCAL,82232,CPT,,,,,,Outpatient,,,36,19.42,Aetna Med ADV,Aetna Med ADV,16.18,,,,,,,Fee Schedule,16.18,18.43,
Bill Decalcification Procedure,8489589,LOCAL,88311,CPT,,,301,RC,,Outpatient,,,36,,Aetna Med ADV,Aetna Med ADV,7.2,,,,,,,Fee Schedule,7.2,59.06,
CA 125 QSTC,8764680,LOCAL,86304,CPT,,,301,RC,,Outpatient,,,36,24.97,Aetna Med ADV,Aetna Med ADV,20.81,,,,,,,Fee Schedule,15.29,20.81,
CA 19-9 QSTC,8764669,LOCAL,86301,CPT,,,301,RC,,Outpatient,,,36,24.97,Aetna Med ADV,Aetna Med ADV,20.81,,,,,,,Fee Schedule,15.29,20.81,
CA 27.29 QSTC,8764762,LOCAL,86300,CPT,,,301,RC,,Outpatient,,,36,24.97,Aetna Med ADV,Aetna Med ADV,43.34,,,,,,,Fee Schedule,15.29,43.34448276,
Copper QSTC,8764536,LOCAL,82525,CPT,,,301,RC,,Outpatient,,,36,14.89,Aetna Med ADV,Aetna Med ADV,24.09,,,,,,,Fee Schedule,16.07,24.085,
"Fungal Identification, Molds QSTC",8873558,LOCAL,87107,CPT,,,301,RC,,Outpatient,,,36,12.38,Aetna Med ADV,Aetna Med ADV,10.32,,,,,,,Fee Schedule,10.32,10.57,
"Gliadin(Deamidated) Ab,IgA QSTC",9039363,LOCAL,86258,CPT,,,301,RC,,Outpatient,,,36,14.46,Aetna Med ADV,Aetna Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
"Gliadin(Deamidated) Ab,IgG QSTC",9039362,LOCAL,86258,CPT,,,301,RC,,Outpatient,,,36,14.46,Aetna Med ADV,Aetna Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
Lamotrigine QSTC,8853218,LOCAL,80175,CPT,,,301,RC,,Outpatient,,,36,15.9,Aetna Med ADV,Aetna Med ADV,13.25,,,,,,,Fee Schedule,13.25,15.38,
"Protein, Total, w/Creat, Random Ur QSTC",9291011,LOCAL,84156,CPT,,,301,RC,,Outpatient,,,36,4.4,Aetna Med ADV,Aetna Med ADV,11.68,,,,,,,Fee Schedule,7.16,11.68,
"Testosterone, Total, MS QSTC",8848606,LOCAL,84402,CPT,,,270,RC,,Outpatient,,,36,30.56,Aetna Med ADV,Aetna Med ADV,30.49,,,,,,,Fee Schedule,18.43,30.485,
SLING PED/INFANT 5'X9,6000156,LOCAL,,,A4565,HCPCS,301,RC,,Outpatient,,,36.19,19,Aetna Med ADV,Aetna Med ADV,10.98,,,,,,,Fee Schedule,10.98,10.98,
"Copper, 24-Hour Urine QSTC",9390117,LOCAL,82525,CPT,,,306,RC,,Outpatient,,,36.27,14.89,Aetna Med ADV,Aetna Med ADV,24.09,,,,,,,Fee Schedule,16.07,24.085,
MALDI ID,X87077,LOCAL,87077,CPT,,,,,,Outpatient,,,36.36,9.7,Aetna Med ADV,Aetna Med ADV,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
cefTAZidime 2 g injection [CULL],11201395,LOCAL,J0713,CPT,,,311,RC,,Outpatient,1,EA,36.67968,,Aetna Med ADV,Aetna Med ADV,1.47,,,,,,,Fee Schedule,1.468,1.468,
"ANA Screen, IFA QST",9110748,LOCAL,86038,CPT,,,311,RC,,Outpatient,,,37,14.51,Aetna Med ADV,Aetna Med ADV,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
Complement Component C3C QST,12876950,LOCAL,86160,CPT,,,311,RC,,Outpatient,,,37,14.4,Aetna Med ADV,Aetna Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
Complement Component C4C QST,12876951,LOCAL,86160,CPT,,,311,RC,,Outpatient,,,37,14.4,Aetna Med ADV,Aetna Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
DNA (DS) Antibody QST,9110747,LOCAL,86225,CPT,,,301,RC,,Outpatient,,,37,16.49,Aetna Med ADV,Aetna Med ADV,14.72,,,,,,,Fee Schedule,14.71636364,15.29,
Microalbumin Level Urine,7974117,LOCAL,82043,CPT,,,311,RC,,Outpatient,,,37,6.94,Aetna Med ADV,Aetna Med ADV,20.16,,,,,,,Fee Schedule,4.02,20.15557971,
Rheumatoid Factor QST,9110751,LOCAL,86431,CPT,,,311,RC,,Outpatient,,,37,6.8,Aetna Med ADV,Aetna Med ADV,6.3,,,,,,,Fee Schedule,6.29875,15.29,
Ribosomal P Antibody QST,9110754,LOCAL,83516,CPT,,,311,RC,,Outpatient,,,37,13.84,Aetna Med ADV,Aetna Med ADV,11.53,,,,,,,Fee Schedule,11.53,17.73,
SCL-70 Antibody QST,9110757,LOCAL,86235,CPT,,,311,RC,,Outpatient,,,37,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-A) QST,9110760,LOCAL,86235,CPT,,,311,RC,,Outpatient,,,37,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-B) QST,9110763,LOCAL,86235,CPT,,,311,RC,,Outpatient,,,37,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sm Antibody QST,9110766,LOCAL,86235,CPT,,,311,RC,,Outpatient,,,37,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
SM/RNP Antibody QST,9110769,LOCAL,86235,CPT,,,311,RC,,Outpatient,,,37,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Thyroid Peroxidase Antibodies QST,9110772,LOCAL,86376,CPT,,,302,RC,,Outpatient,,,37,17.46,Aetna Med ADV,Aetna Med ADV,25.09,,,,,,,Fee Schedule,15.29,25.085,
EBV EBNA Ab (IgG) Interp QSTC,8849012,LOCAL,86664,CPT,,,302,RC,,Outpatient,,,37.13,18.35,Aetna Med ADV,Aetna Med ADV,15.29,,,,,,,Fee Schedule,15.29,15.29,
EBV VCA Ab (IgM) QSTC,8849009,LOCAL,86665,CPT,,,300,RC,,Outpatient,,,37.13,21.77,Aetna Med ADV,Aetna Med ADV,18.14,,,,,,,Fee Schedule,15.29,18.14,
".B. henselae Ab(IgG),Titer QSTC",8764830,LOCAL,86611,CPT,,,300,RC,,Outpatient,,,37.35,12.22,Aetna Med ADV,Aetna Med ADV,10.18,,,,,,,Fee Schedule,10.18,15.29,
".B. henselae Ab(IgM),Titer QSTC",8764831,LOCAL,86611,CPT,,,301,RC,,Outpatient,,,37.35,12.22,Aetna Med ADV,Aetna Med ADV,10.18,,,,,,,Fee Schedule,10.18,15.29,
".B. quintana Ab(IgG),Titer QSTC",10128892,LOCAL,86611,CPT,,,274,RC,,Outpatient,,,37.35,12.22,Aetna Med ADV,Aetna Med ADV,10.18,,,,,,,Fee Schedule,10.18,15.29,
IMMOBLIZER KNEE XX-LARGE,11070340,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,37.9,158,Aetna Med ADV,Aetna Med ADV,77.23,,,,,,,Fee Schedule,77.23,77.23,
methocarbamol 100 mg/mL injectable solution 10 mL [CULL],11201939,LOCAL,J2800,CPT,,,,,,Outpatient,10,ML,38.4,,Aetna Med ADV,Aetna Med ADV,4.54,,,,,,,Fee Schedule,4.535,4.535,
calcium gluconate 100 mg/mL injectable solution 10 mL [CULL],11201252,LOCAL,J0612,CPT,,,274,RC,,Outpatient,10,ML,38.4768,,Aetna Med ADV,Aetna Med ADV,0.03,,,,,,,Fee Schedule,0.01,0.03,
SLING & SWATHE W/SLEEVE,11071056,LOCAL,,,L3650,HCPCS,301,RC,,Outpatient,,,38.89,12,Aetna Med ADV,Aetna Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
TBG QSTC,8853216,LOCAL,84442,CPT,,,301,RC,,Outpatient,,,39.06,17.74,Aetna Med ADV,Aetna Med ADV,14.78,,,,,,,Fee Schedule,14.78,18.43,
"Culture, Fungus, Skin, Hair, Nails QSTC",8972785,LOCAL,87101,CPT,,,300,RC,,Outpatient,,,39.11,9.25,Aetna Med ADV,Aetna Med ADV,7.71,,,,,,,Fee Schedule,7.71,10.57,
Prostate Specific Antigen Total,7939094,LOCAL,84153,CPT,,,301,RC,,Outpatient,,,39.17,22.07,Aetna Med ADV,Aetna Med ADV,104.84,,,,,,,Fee Schedule,17.73,104.8447059,
Prealbumin,3454341,LOCAL,84134,CPT,,,420,RC,,Outpatient,,,39.98,17.51,Aetna Med ADV,Aetna Med ADV,4.93,,,,,,,Fee Schedule,4.934545455,17.73,
20560 DRY NEEDLING 1 OR 2 MUSCLES WO INJECTION,9650048,LOCAL,20560,CPT,,,311,RC,,Outpatient,,,40,26,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,22.39,863,
Beef (F27) IgE Class QSTC,14129407,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,40,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Glucose Body Fluid,1628896,LOCAL,82945,CPT,,,311,RC,,Outpatient,,,40,4.72,Aetna Med ADV,Aetna Med ADV,3.93,,,,,,,Fee Schedule,3.93,7.16,
Lamb (F88) IgE Class QSTC,14129413,LOCAL,86003,CPT,,,311,RC,,Outpatient,,,40,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pork (F26) IgE Class QSTC,14129419,LOCAL,86003,CPT,,,311,RC,,Outpatient,,,40,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
RESULTS_QSTC,14755730,LOCAL,86008,CPT,,,301,RC,,Outpatient,,,40,21.52,Aetna Med ADV,Aetna Med ADV,17.93,,,,,,,Fee Schedule,15.29,17.93,
"Pyruvic Acid (Pyruvate),B QSTC",13864526,LOCAL,84210,CPT,,,301,RC,,Outpatient,,,40.1,17.38,Aetna Med ADV,Aetna Med ADV,14.48,,,,,,,Fee Schedule,14.48,17.73,
"VDRL, CSF QSTC",8764738,LOCAL,86592,CPT,,,301,RC,,Outpatient,,,40.41,5.12,Aetna Med ADV,Aetna Med ADV,19.99,,,,,,,Fee Schedule,15.29,19.99375,
Angiotensin Converting Enzyme QSTC,8764564,LOCAL,82164,CPT,,,301,RC,,Outpatient,,,40.5,17.52,Aetna Med ADV,Aetna Med ADV,27.41,,,,,,,Fee Schedule,17.73,27.405,
Intrinsic Factor Blocking Antibody QSTC,8764611,LOCAL,86340,CPT,,,301,RC,,Outpatient,,,40.5,18.1,Aetna Med ADV,Aetna Med ADV,15.08,,,,,,,Fee Schedule,15.08,15.29,
Osmolality Serum,9414322,LOCAL,83930,CPT,,,430,RC,,Outpatient,,,40.5,7.93,Aetna Med ADV,Aetna Med ADV,6.61,,,,,,,Fee Schedule,6.61,7.16,
97018 OT PARAFFIN BATH 1+ AREAS APPLIC CHARGE,9850020,LOCAL,97018,CPT,,,430,RC,GO,Outpatient,,,40.9,27,Aetna Med ADV,Aetna Med ADV,5.41,,,,,,,Fee Schedule,5.41,47.26,
97018 OT PARAFFIN BATH CHARGE,9860020,LOCAL,97018,CPT,,,430,RC,GO|CO,Outpatient,,,40.9,27,Aetna Med ADV,Aetna Med ADV,5.41,,,,,,,Fee Schedule,5.41,47.26,
OT Paraffin Bath Assistant Units,7895270,LOCAL,97018,CPT,,,430,RC,CQ,Outpatient,,,40.9,27,Aetna Med ADV,Aetna Med ADV,5.41,,,,,,,Fee Schedule,5.41,47.26,
OT Paraffin Bath Units,1373447,LOCAL,97018,CPT,,,430,RC,GO,Outpatient,,,40.9,27,Aetna Med ADV,Aetna Med ADV,5.41,,,,,,,Fee Schedule,5.41,47.26,
Paraffin Bath Charge,7895270,LOCAL,97018,CPT,,,301,RC,GO,Outpatient,,,40.9,27,Aetna Med ADV,Aetna Med ADV,5.41,,,,,,,Fee Schedule,5.41,47.26,
Centromere B Antibody QSTC,8764633,LOCAL,86235,CPT,,,274,RC,,Outpatient,,,40.91,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
COLLAR LG HARD C,11070731,LOCAL,,,L0172,HCPCS,274,RC,,Outpatient,,,41.14,223,Aetna Med ADV,Aetna Med ADV,175.72,,,,,,,Fee Schedule,175.72,175.72,
COLLAR MED.HARD,11071039,LOCAL,,,L0172,HCPCS,274,RC,,Outpatient,,,41.14,223,Aetna Med ADV,Aetna Med ADV,175.72,,,,,,,Fee Schedule,175.72,175.72,
COLLAR SM HARD C,11070729,LOCAL,,,L0172,HCPCS,301,RC,,Outpatient,,,41.14,223,Aetna Med ADV,Aetna Med ADV,175.72,,,,,,,Fee Schedule,175.72,175.72,
M. pneumoniae Ab (IgM) QSTC,8764773,LOCAL,86738,CPT,,,610,RC,,Outpatient,,,41.49,15.89,Aetna Med ADV,Aetna Med ADV,13.24,,,,,,,Fee Schedule,13.24,15.29,
CULL Pre-MRI Device Screening,14536295,LOCAL,76014,CPT,,,610,RC,,Outpatient,,,41.5,19.8,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,22.39,22.39,
MRI Safety Screening,14536295,LOCAL,76014,CPT,,,301,RC,,Outpatient,,,41.5,19.8,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,22.39,22.39,
Zinc QSTC,8764557,LOCAL,84630,CPT,,,306,RC,,Outpatient,,,41.58,13.67,Aetna Med ADV,Aetna Med ADV,26.38,,,,,,,Fee Schedule,16.07,26.375,
Gram Stain (General Lab),8726050,LOCAL,87205,CPT,,,306,RC,,Outpatient,,,41.62,5.12,Aetna Med ADV,Aetna Med ADV,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
Gram Stain Intraoperative,13436049,LOCAL,87205,CPT,,,306,RC,,Outpatient,,,41.62,5.12,Aetna Med ADV,Aetna Med ADV,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
Gram Stain Report,634217,LOCAL,87205,CPT,,,301,RC,,Outpatient,,,41.62,5.12,Aetna Med ADV,Aetna Med ADV,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
"Bile Acids, Fractionated and Total QSTC",13864500,LOCAL,82542,CPT,,,301,RC,,Outpatient,,,41.85,28.91,Aetna Med ADV,Aetna Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.09,
"Calcium, 24 hr Ur (w/o Creatinine) QSTC",9039238,LOCAL,82340,CPT,,,301,RC,,Outpatient,,,41.99,7.24,Aetna Med ADV,Aetna Med ADV,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
Drug Panel (10),13954356,LOCAL,80306,CPT,,,,,,Outpatient,,,42.45,20.57,Aetna Med ADV,Aetna Med ADV,0.24,,,,,,,Fee Schedule,0.2416,17.73,
Bill Intraoperative Additonal,14048005,LOCAL,88332,CPT,,,302,RC,,Outpatient,,,42.46,,Aetna Med ADV,Aetna Med ADV,21.23,,,,,,,Fee Schedule,21.23,53.82,
Toxoplasma Antibody (IgG) QSTC,8861628,LOCAL,86777,CPT,,,302,RC,,Outpatient,,,42.48,17.27,Aetna Med ADV,Aetna Med ADV,14.39,,,,,,,Fee Schedule,14.39,15.29,
Toxoplasma Antibody (IgM) QSTC,8861629,LOCAL,86778,CPT,,,,,,Outpatient,,,42.48,17.29,Aetna Med ADV,Aetna Med ADV,14.41,,,,,,,Fee Schedule,14.41,15.29,
clindamycin 600 mg/50 mL-NaCl 0.9% Sol [CULL],11290024,LOCAL,J0737,CPT,,,301,RC,,Outpatient,50,ML,42.72,,Aetna Med ADV,Aetna Med ADV,2.35,,,,,,,Fee Schedule,0.819,2.346,
"Cadmium, Blood, QSTC",13864925,LOCAL,82300,CPT,,,301,RC,,Outpatient,,,42.75,28.37,Aetna Med ADV,Aetna Med ADV,29.91,,,,,,,Fee Schedule,16.07,29.91,
"Vitamin B1 (Thiamine), B QSTC",8972833,LOCAL,84425,CPT,,,301,RC,,Outpatient,,,42.75,25.48,Aetna Med ADV,Aetna Med ADV,30.05,,,,,,,Fee Schedule,17.73,30.04654545,
"Calcium, Ionized QSTC",9039239,LOCAL,82330,CPT,,,301,RC,,Outpatient,,,43.2,16.42,Aetna Med ADV,Aetna Med ADV,28.31,,,,,,,Fee Schedule,17.73,28.305,
"Cortisol, Free, U24 QSTC",8764823,LOCAL,82530,CPT,,,301,RC,,Outpatient,,,43.2,20.05,Aetna Med ADV,Aetna Med ADV,29.79,,,,,,,Fee Schedule,17.73,29.79,
"Vanillylmandelic Acid, U24 QSTC",8764683,LOCAL,84585,CPT,,,301,RC,,Outpatient,,,43.2,18.6,Aetna Med ADV,Aetna Med ADV,15.5,,,,,,,Fee Schedule,15.5,18.43,
"Aspergillus fumigatus, IgG Ab QSTC",13864492,LOCAL,86606,CPT,,,300,RC,,Outpatient,,,43.25,18.06,Aetna Med ADV,Aetna Med ADV,15.05,,,,,,,Fee Schedule,15.05,15.29,
"Blastomyces Ab,Immunodiff QSTC",10100364,LOCAL,86612,CPT,,,301,RC,,Outpatient,,,43.25,15.48,Aetna Med ADV,Aetna Med ADV,12.9,,,,,,,Fee Schedule,12.9,15.29,
Cryptococcal Antigen Latex QSTC,8972754,LOCAL,86403,CPT,,,301,RC,,Outpatient,,,43.25,13.85,Aetna Med ADV,Aetna Med ADV,11.54,,,,,,,Fee Schedule,11.54,15.29,
"5HIAA, 24-Hour Urine QSTC",8764545,LOCAL,83497,CPT,,,,,,Outpatient,,,43.34,15.48,Aetna Med ADV,Aetna Med ADV,12.9,,,,,,,Fee Schedule,12.9,18.43,
betamethasone 12 mg/mL injectable suspension 2mL [CULL],11205515,LOCAL,J0702,CPT,,,301,RC,,Outpatient,1,ML,43.4048,,Aetna Med ADV,Aetna Med ADV,22.48,,,,,,,Fee Schedule,22.47566502,22.47566502,
O2 Saturation Arterial,12487723,LOCAL,82810,CPT,,,301,RC,,Outpatient,,,43.6,11.72,Aetna Med ADV,Aetna Med ADV,9.77,,,,,,,Fee Schedule,9.77,17.73,
O2 Saturation Venous,12487723,LOCAL,82810,CPT,,,301,RC,,Outpatient,,,43.6,11.72,Aetna Med ADV,Aetna Med ADV,9.77,,,,,,,Fee Schedule,9.77,17.73,
"Creatinine Random Ur, QSTC",10127838,LOCAL,82570,CPT,,,301,RC,,Outpatient,,,43.61,6.22,Aetna Med ADV,Aetna Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Metanephrine Ur, Total QSTC",10127837,LOCAL,83835,CPT,,,301,RC,,Outpatient,,,43.61,20.33,Aetna Med ADV,Aetna Med ADV,98.31,,,,,,,Fee Schedule,18.43,98.305,
CA 15-3 QSTC,8764684,LOCAL,86300,CPT,,,301,RC,,Outpatient,,,44.55,24.97,Aetna Med ADV,Aetna Med ADV,43.34,,,,,,,Fee Schedule,15.29,43.34448276,
"Electrolytes, Urine",12312936,LOCAL,84166,CPT,,,301,RC,,Outpatient,,,44.88,21.4,Aetna Med ADV,Aetna Med ADV,18.62,,,,,,,Fee Schedule,17.73,18.62,
Occult Blood Stool Screen,7909957,LOCAL,82272,CPT,,,301,RC,,Outpatient,,,44.88,5.08,Aetna Med ADV,Aetna Med ADV,4.46,,,,,,,Fee Schedule,4.457272727,7.16,
"Carbamazepine, Total QSTC",9039320,LOCAL,80156,CPT,,,301,RC,,Outpatient,,,44.95,17.48,Aetna Med ADV,Aetna Med ADV,16.45,,,,,,,Fee Schedule,15.38,16.45277778,
Gastric Parietal Cell AB QSTC,8764524,LOCAL,83516,CPT,,,301,RC,,Outpatient,,,44.96,13.84,Aetna Med ADV,Aetna Med ADV,11.53,,,,,,,Fee Schedule,11.53,17.73,
"ACTH, Plasma QSTC",8764544,LOCAL,82024,CPT,,,301,RC,,Outpatient,,,45,46.34,Aetna Med ADV,Aetna Med ADV,38.62,,,,,,,Fee Schedule,18.43,38.62,
Beta2-Glycoprotein IgA QSTC,10100357,LOCAL,86146,CPT,,,301,RC,,Outpatient,,,45,30.54,Aetna Med ADV,Aetna Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
Immunoglobulin G Subclass 4 QSTC,10100372,LOCAL,82787,CPT,,,301,RC,,Outpatient,,,45,9.62,Aetna Med ADV,Aetna Med ADV,8.02,,,,,,,Fee Schedule,7.16,8.02,
Testosterone Free & Total MS QSTC,8764632,LOCAL,84403,CPT,,,301,RC,,Outpatient,,,45,30.97,Aetna Med ADV,Aetna Med ADV,52.38,,,,,,,Fee Schedule,18.43,52.3775,
Tissue Transglutaminase IgA Ab QSTC,8764753,LOCAL,86364,CPT,,,,,,Outpatient,,,45,13.84,Aetna Med ADV,Aetna Med ADV,61.9,,,,,,,Fee Schedule,15.29,61.9,
acetaminophen 10 mg/mL intravenous solution 100 mL [CULL],11200037,LOCAL,J0134,CPT,,,301,RC,,Outpatient,100,ML,46.08,,Aetna Med ADV,Aetna Med ADV,3.16,,,,,,,Fee Schedule,3.159596774,3.159596774,
Scl-70 Antibody QSTC,8853206,LOCAL,86235,CPT,,,301,RC,,Outpatient,,,46.17,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Egg Component Panel QSTC,9039428,LOCAL,86008,CPT,,,301,RC,,Outpatient,,,46.26,21.52,Aetna Med ADV,Aetna Med ADV,17.93,,,,,,,Fee Schedule,15.29,17.93,
Total Iron Binding Capacity,7909796,LOCAL,83550,CPT,,,,,,Outpatient,,,47,10.49,Aetna Med ADV,Aetna Med ADV,8.74,,,,,,,Fee Schedule,8.74,17.73,
amikacin 250 mg/mL injectable solution 2 mL [CULL],11201051,LOCAL,J0278,CPT,,,,,,Outpatient,2,ML,47.0592,,Aetna Med ADV,Aetna Med ADV,0.62,,,,,,,Fee Schedule,0.621,0.621,
cefTRIAXone 250 mg injection [CULL],11202192,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,47.4112,,Aetna Med ADV,Aetna Med ADV,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
clindamycin 600 mg/50 mL-D5% intravenous solution 50 mL [CULL],11290024,LOCAL,J0736,CPT,,,306,RC,,Outpatient,50,ML,47.484,,Aetna Med ADV,Aetna Med ADV,0.82,,,,,,,Fee Schedule,0.819,2.346,
Yeast Culture,7909554,LOCAL,87101,CPT,,,301,RC,,Outpatient,,,47.7,9.25,Aetna Med ADV,Aetna Med ADV,7.71,,,,,,,Fee Schedule,7.71,10.57,
T3 Total,633833,LOCAL,84480,CPT,,,430,RC,,Outpatient,,,48,17.02,Aetna Med ADV,Aetna Med ADV,33.01,,,,,,,Fee Schedule,18.43,33.01411765,
97035 OT ULTRASOUND,9850026,LOCAL,97035,CPT,,,430,RC,GO,Outpatient,,,48.35,31,Aetna Med ADV,Aetna Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
97035 OT Ultrasound Assistant Units,9860026,LOCAL,97035,CPT,,,420,RC,GO|CO,Outpatient,,,48.35,31,Aetna Med ADV,Aetna Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
97035 PT ULTRASOUND,9640026,LOCAL,97035,CPT,,,420,RC,GP,Outpatient,,,48.35,31,Aetna Med ADV,Aetna Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
97035 PT Ultrasound Assistant Units,9650026,LOCAL,97035,CPT,,,420,RC,GP|CQ,Outpatient,,,48.35,31,Aetna Med ADV,Aetna Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
97035 ULTRASOUND EA 15 MIN CHARGE,9410126,LOCAL,97035,CPT,,,430,RC,GP,Outpatient,,,48.35,31,Aetna Med ADV,Aetna Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
OT Ultrasound Assistant Units,1366376,LOCAL,97035,CPT,,,430,RC,CQ,Outpatient,,,48.35,31,Aetna Med ADV,Aetna Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
OT Ultrasound Charges,1366376,LOCAL,97035,CPT,,,430,RC,GO,Outpatient,,,48.35,31,Aetna Med ADV,Aetna Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
OT Ultrasound Units,1373448,LOCAL,97035,CPT,,,420,RC,GO,Outpatient,,,48.35,31,Aetna Med ADV,Aetna Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
PT Ultrasound Assistant Units,9390428,LOCAL,97035,CPT,,,430,RC,CQ,Outpatient,,,48.35,31,Aetna Med ADV,Aetna Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
Ultrasound Charges,1366376,LOCAL,97035,CPT,,,420,RC,GO,Outpatient,,,48.35,31,Aetna Med ADV,Aetna Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
Ultrasound Charges,7895933,LOCAL,97035,CPT,,,301,RC,GP,Outpatient,,,48.35,31,Aetna Med ADV,Aetna Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
Phenobarbital QSTC,8972760,LOCAL,80184,CPT,,,,,,Outpatient,,,48.65,18.36,Aetna Med ADV,Aetna Med ADV,15.3,,,,,,,Fee Schedule,15.3,15.38,
"penicillin G potassium 5,000,000 units injection [CULL]",11211091,LOCAL,J2540,CPT,,,309,RC,,Outpatient,1,EA,48.84864,,Aetna Med ADV,Aetna Med ADV,0.78,,,,,,,Fee Schedule,0.78,0.78,
Semen Analysis Post Vasectomy,3454457,LOCAL,89320,CPT,,,301,RC,,Outpatient,,,48.96,14.77,Aetna Med ADV,Aetna Med ADV,12.31,,,,,,,Fee Schedule,12.31,14.07,
"HIV Ag/Ab, 4th Gen w reflexes QSTC",8764806,LOCAL,87389,CPT,,,301,RC,,Outpatient,,,49.5,28.9,Aetna Med ADV,Aetna Med ADV,36.55,,,,,,,Fee Schedule,10.57,36.55,
"Phenytoin, Free QSTC",8764686,LOCAL,80186,CPT,,,301,RC,,Outpatient,,,49.5,16.51,Aetna Med ADV,Aetna Med ADV,31.5,,,,,,,Fee Schedule,15.38,31.495,
"T3, Reverse, LCMSMS QSTC",8764804,LOCAL,84482,CPT,,,301,RC,,Outpatient,,,49.5,18.91,Aetna Med ADV,Aetna Med ADV,32.48,,,,,,,Fee Schedule,18.43,32.475,
"82140 Ammonium, 24 HR, U",14789403,LOCAL,82140,CPT,,,301,RC,,Outpatient,,,49.65,17.48,Aetna Med ADV,Aetna Med ADV,22.63,,,,,,,Fee Schedule,17.73,22.62909091,
"82340 Calcium, 24 HR, U",14797185,LOCAL,82340,CPT,,,301,RC,,Outpatient,,,49.65,7.24,Aetna Med ADV,Aetna Med ADV,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
"82436 Chloride, 24 HR, U",14797182,LOCAL,82436,CPT,,,301,RC,,Outpatient,,,49.65,6.9,Aetna Med ADV,Aetna Med ADV,5.75,,,,,,,Fee Schedule,5.75,7.16,
"82507 Citrate Excretion, 24 HR, U",14787436,LOCAL,82507,CPT,,,301,RC,,Outpatient,,,49.65,33.36,Aetna Med ADV,Aetna Med ADV,30.63,,,,,,,Fee Schedule,17.73,30.625,
"82570 Creatinine, 24 HR, U",14798767,LOCAL,82570,CPT,,,301,RC,,Outpatient,,,49.65,6.22,Aetna Med ADV,Aetna Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"83735 Magnesium, 24 HR, U",14789401,LOCAL,83735,CPT,,,301,RC,,Outpatient,,,49.65,8.04,Aetna Med ADV,Aetna Med ADV,3.66,,,,,,,Fee Schedule,3.657824427,7.16,
"83945 Oxalate, 24 HR, U",14797186,LOCAL,83945,CPT,,,301,RC,,Outpatient,,,49.65,17.34,Aetna Med ADV,Aetna Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.085,
"84105 Phosphorus, 24 HR, U",14787442,LOCAL,84105,CPT,,,301,RC,,Outpatient,,,49.65,6.94,Aetna Med ADV,Aetna Med ADV,19.84,,,,,,,Fee Schedule,7.16,19.835,
"84133 Potassium, 24 HR, U",14797183,LOCAL,84133,CPT,,,301,RC,,Outpatient,,,49.65,5.68,Aetna Med ADV,Aetna Med ADV,19.32,,,,,,,Fee Schedule,7.16,19.32,
"84300 Sodium, 24 HR, U",14797184,LOCAL,84300,CPT,,,301,RC,,Outpatient,,,49.65,6.07,Aetna Med ADV,Aetna Med ADV,9.74,,,,,,,Fee Schedule,7.16,9.74,
"84540 Urea Nitrogen, 24 HR, U",14789404,LOCAL,84540,CPT,,,301,RC,,Outpatient,,,49.65,6.67,Aetna Med ADV,Aetna Med ADV,5.56,,,,,,,Fee Schedule,5.56,7.16,
"84560 Uric Acid, 24 HR, U",14787441,LOCAL,84560,CPT,,,,,,Outpatient,,,49.65,6.1,Aetna Med ADV,Aetna Med ADV,19.49,,,,,,,Fee Schedule,7.16,19.49,
BUPivacaine 0.5% preservative-free injectable solution 30 mL [CULL],11282051,LOCAL,J0665,CPT,,,,,,Outpatient,30,ML,49.68576,,Aetna Med ADV,Aetna Med ADV,0.01,,,,,,,Fee Schedule,0.01,0.011,
deferoxamine 500 mg injection [CULL],11214520,LOCAL,J0895,CPT,,,301,RC,,Outpatient,1,EA,49.728,,Aetna Med ADV,Aetna Med ADV,8.47,,,,,,,Fee Schedule,8.468,8.468,
C-Peptide,12252873,LOCAL,84681,CPT,,,305,RC,,Outpatient,,,50,24.97,Aetna Med ADV,Aetna Med ADV,33.24,,,,,,,Fee Schedule,17.73,33.24444444,
D-Dimer,3454398,LOCAL,85380,CPT,,,942,RC,,Outpatient,,,50,12.22,Aetna Med ADV,Aetna Med ADV,5.76,,,,,,,Fee Schedule,5.76079096,8.21,
G0447 BEHAVIORAL COUNSIL OBESITY 15 MIN CHARGE,8635988,LOCAL,,,G0447,HCPCS,302,RC,,Outpatient,,,50,33,Aetna Med ADV,Aetna Med ADV,84.57,,,,,,,Fee Schedule,84.57,177.17,
Hepatitis B S Ab,1628908,LOCAL,86706,CPT,,,302,RC,,Outpatient,,,50,12.89,Aetna Med ADV,Aetna Med ADV,17.79,,,,,,,Fee Schedule,15.29,17.794,
Hepatitis B Surface Antibody w/ Interp,9299896,LOCAL,86706,CPT,,,301,RC,,Outpatient,,,50,12.89,Aetna Med ADV,Aetna Med ADV,17.79,,,,,,,Fee Schedule,15.29,17.794,
Lactate Dehydrogenase Body Fluid,3454444,LOCAL,83615,CPT,,,301,RC,,Outpatient,,,50,7.25,Aetna Med ADV,Aetna Med ADV,21.68,,,,,,,Fee Schedule,7.16,21.675,
"Cytomegalovirus Antibodies (IgG,IgM) QSTC",8972893,LOCAL,86645,CPT,,,301,RC,,Outpatient,,,50.4,20.22,Aetna Med ADV,Aetna Med ADV,16.85,,,,,,,Fee Schedule,15.29,16.85,
Cytomegalovirus Antibody (IgM) QSTC,8764581,LOCAL,86645,CPT,,,301,RC,,Outpatient,,,50.4,20.22,Aetna Med ADV,Aetna Med ADV,16.85,,,,,,,Fee Schedule,15.29,16.85,
Micronutrient Vitamin E QSTC,14116320,LOCAL,84446,CPT,,,301,RC,,Outpatient,,,50.4,17.02,Aetna Med ADV,Aetna Med ADV,14.18,,,,,,,Fee Schedule,14.18,17.73,
Vitamin A (Retinol) QSTC,8764529,LOCAL,84590,CPT,,,300,RC,,Outpatient,,,50.4,13.93,Aetna Med ADV,Aetna Med ADV,30.89,,,,,,,Fee Schedule,17.73,30.89,
Ethosuximide QSTC,8764552,LOCAL,80168,CPT,,,,,,Outpatient,,,50.54,19.61,Aetna Med ADV,Aetna Med ADV,16.34,,,,,,,Fee Schedule,15.38,16.34,
77061 MG Diagnostic Tomo Charge: AddOn Left,13960722,LOCAL,G0279,CPT,,,,,LT,Outpatient,,,50.92,,Aetna Med ADV,Aetna Med ADV,11.11,,,,,,,Fee Schedule,11.11,74,
77061 MG Diagnostic Tomo Charge: AddOn Right,13960723,LOCAL,G0279,CPT,,,,,RT,Outpatient,,,50.92,,Aetna Med ADV,Aetna Med ADV,11.11,,,,,,,Fee Schedule,11.11,74,
77061 MG Diagnostic Tomo Charge: AddOn Right,13969683,LOCAL,G0279,CPT,,,403,RC,RT,Outpatient,,,50.92,,Aetna Med ADV,Aetna Med ADV,11.11,,,,,,,Fee Schedule,11.11,74,
77063 MG Tomo Charge: AddOn Left,13621442,LOCAL,77063,CPT,,,403,RC,LT,Outpatient,,,50.92,54.45,Aetna Med ADV,Aetna Med ADV,20.75,,,,,,,Fee Schedule,20.75,74,
77063 MG Tomo Charge: AddOn Right,13621441,LOCAL,77063,CPT,,,972,RC,RT,Outpatient,,,50.92,54.45,Aetna Med ADV,Aetna Med ADV,20.75,,,,,,,Fee Schedule,20.75,74,
PC DOPP ART BIL REST,8200579,LOCAL,93923,CPT,,,,,,Outpatient,,,51.06,401,Aetna Med ADV,Aetna Med ADV,143.05,,,,,,,Fee Schedule,143.05,244.97,
acyclovir 50 mg/mL intravenous solution 10 mL [CULL],11201009,LOCAL,J0133,CPT,,,301,RC,,Outpatient,10,ML,51.2,,Aetna Med ADV,Aetna Med ADV,0.12,,,,,,,Fee Schedule,0.119,0.119,
Chloride Level,633621,LOCAL,82435,CPT,,,301,RC,,Outpatient,,,51.41,5.52,Aetna Med ADV,Aetna Med ADV,4.6,,,,,,,Fee Schedule,4.6,7.16,
KOH POCT,10913182,LOCAL,87220,CPT,,,420,RC,,Outpatient,,,51.41,5.12,Aetna Med ADV,Aetna Med ADV,4.27,,,,,,,Fee Schedule,4.27,10.57,
E-Stim for Wound Other Charge,7895924,LOCAL,G0283,CPT,G0283,HCPCS,420,RC,GP,Outpatient,,,51.51,33,Aetna Med ADV,Aetna Med ADV,11.75,,,,,,,Fee Schedule,11.75,47.26,
G0283 INTERFERENCE CHARGES,9640019,LOCAL,,,G0283,HCPCS,420,RC,GP,Outpatient,,,51.51,33,Aetna Med ADV,Aetna Med ADV,11.81,,,,,,,Fee Schedule,11.81,47.26,
G0283 PT Elect Stim Unattended Assistant Units Charge,9650019,LOCAL,,,G0283,HCPCS,430,RC,GP,Outpatient,,,51.51,33,Aetna Med ADV,Aetna Med ADV,11.81,,,,,,,Fee Schedule,11.81,47.26,
G0283 OT ELEC STIM MEDICARE CHARGE,9860018,LOCAL,,,G0283,HCPCS,430,RC,GO|CO,Outpatient,,,51.52,33,Aetna Med ADV,Aetna Med ADV,11.81,,,,,,,Fee Schedule,11.81,47.26,
G0283 OT ESTIM UNATTENDED CHARGE,9850018,LOCAL,,,G0283,HCPCS,430,RC,GO,Outpatient,,,51.52,33,Aetna Med ADV,Aetna Med ADV,11.81,,,,,,,Fee Schedule,11.81,47.26,
OT Unattended E-Stim Assistant Units,7895266,LOCAL,,,G0283,HCPCS,430,RC,CQ,Outpatient,,,51.52,33,Aetna Med ADV,Aetna Med ADV,11.81,,,,,,,Fee Schedule,11.81,47.26,
OTElectrical Stim (Unattended) - Non-Wound,1373552,LOCAL,,,G0283,HCPCS,307,RC,GO,Outpatient,,,51.52,33,Aetna Med ADV,Aetna Med ADV,11.81,,,,,,,Fee Schedule,11.81,47.26,
UA w Micro if Ind,1148022,LOCAL,81003,CPT,,,307,RC,,Outpatient,,,51.6,2.7,Aetna Med ADV,Aetna Med ADV,3.8,,,,,,,Fee Schedule,3.795286195,4.02,
UA w Micro if Ind & Cult if Ind,8088555,LOCAL,81003,CPT,,,307,RC,,Outpatient,,,51.6,2.7,Aetna Med ADV,Aetna Med ADV,3.8,,,,,,,Fee Schedule,3.795286195,4.02,
Urinalysis Macroscopic,633863,LOCAL,81003,CPT,,,301,RC,,Outpatient,,,51.6,2.7,Aetna Med ADV,Aetna Med ADV,3.8,,,,,,,Fee Schedule,3.795286195,4.02,
"T4, Free, Direct Dialysis QSTC",13864535,LOCAL,84439,CPT,,,301,RC,,Outpatient,,,51.98,10.82,Aetna Med ADV,Aetna Med ADV,28.58,,,,,,,Fee Schedule,18.43,28.58065455,
"Immunofixation, Serum QSTC",8764779,LOCAL,86334,CPT,,,,,,Outpatient,,,52.7,26.81,Aetna Med ADV,Aetna Med ADV,37.3,,,,,,,Fee Schedule,15.29,37.3,
77061 MG Diagnostic Tomo Charge: AddOn Left,13960724,LOCAL,G0279,CPT,,,306,RC,LT,Outpatient,,,52.92,,Aetna Med ADV,Aetna Med ADV,11.11,,,,,,,Fee Schedule,11.11,74,
"CtrachomatisRNA, TMA, Urog QSTC",8996973,LOCAL,87491,CPT,,,306,RC,QW,Outpatient,,,53.48,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"NgonorrhoeaeRNA, TMA, Urog QSTC",8996974,LOCAL,87591,CPT,,,311,RC,QW,Outpatient,,,53.48,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Chlamydia Trachomatis RNA, TMA QST",8395007,LOCAL,87491,CPT,,,311,RC,,Outpatient,,,53.5,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",8395010,LOCAL,87591,CPT,,,301,RC,,Outpatient,,,53.5,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"N. Gonorrhoeae RNA, TMA, Urogenital QSTC",13864518,LOCAL,87591,CPT,,,301,RC,QW,Outpatient,,,53.51,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Homocysteine QSTC,8764574,LOCAL,83090,CPT,,,301,RC,,Outpatient,,,53.55,21.5,Aetna Med ADV,Aetna Med ADV,17.92,,,,,,,Fee Schedule,17.92,18.43,
"Mycobact Culture, w Fluorochrome Sm QSTC",9039257,LOCAL,87116,CPT,,,301,RC,,Outpatient,,,53.55,12.96,Aetna Med ADV,Aetna Med ADV,25.66,,,,,,,Fee Schedule,10.57,25.656,
"Mycobacteria, Cult, w Fluoro Smear QST",9039257,LOCAL,87116,CPT,,,,,,Outpatient,,,53.55,12.96,Aetna Med ADV,Aetna Med ADV,25.66,,,,,,,Fee Schedule,10.57,25.656,
ampicillin 2 g injection [CULL],11201144,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,53.6096,,Aetna Med ADV,Aetna Med ADV,0.59,,,,,,,Fee Schedule,0.591,0.591,
DOBUTamine 2 mg/mL-D5% intravenous solution 250 mL [CULL],11201692,LOCAL,J1250,CPT,,,,,,Outpatient,250,ML,53.68,,Aetna Med ADV,Aetna Med ADV,8.02,,,,,,,Fee Schedule,8.024,8.024,
acetylcysteine 20% inhalation solution 4 mL [CULL],11205094,LOCAL,J7608,CPT,,,301,RC,,Outpatient,4,ML,53.7984,,Aetna Med ADV,Aetna Med ADV,8.46,,,,,,,Fee Schedule,8.455,8.455,
"Angiotensin Converting Enzyme (ACE), CSF QSTC",10170069,LOCAL,82164,CPT,,,301,RC,,Outpatient,,,54,17.52,Aetna Med ADV,Aetna Med ADV,27.41,,,,,,,Fee Schedule,17.73,27.405,
"Endomysial Ab Screen IgA, Rfx Titer QSTC",8764677,LOCAL,86231,CPT,,,301,RC,,Outpatient,,,54,14.51,Aetna Med ADV,Aetna Med ADV,106.94,,,,,,,Fee Schedule,15.29,106.935,
Hexagonal Phase Confirm. QSTC,9039456,LOCAL,85598,CPT,,,301,RC,,Outpatient,,,54,21.58,Aetna Med ADV,Aetna Med ADV,17.98,,,,,,,Fee Schedule,5.42,17.98,
hs-CRP QSTC,8853237,LOCAL,86141,CPT,,,301,RC,,Outpatient,,,54,15.54,Aetna Med ADV,Aetna Med ADV,12.95,,,,,,,Fee Schedule,12.95,15.29,
Lipoprotein (a) QSTC,8853258,LOCAL,83695,CPT,,,301,RC,,Outpatient,,,54,17.18,Aetna Med ADV,Aetna Med ADV,14.32,,,,,,,Fee Schedule,14.32,17.73,
"Oligoclonal Bands (IgG), CSF QSTC",8764540,LOCAL,83916,CPT,,,301,RC,,Outpatient,,,54,32.87,Aetna Med ADV,Aetna Med ADV,27.39,,,,,,,Fee Schedule,17.73,27.39,
"Plasma Renin Activity, LC/MS/MS QSTC",8764647,LOCAL,84244,CPT,,,301,RC,,Outpatient,,,54,26.39,Aetna Med ADV,Aetna Med ADV,37.78,,,,,,,Fee Schedule,18.43,37.78,
"Vitamin D, 1,25-Dihydroxy QSTC",8764639,LOCAL,82652,CPT,,,301,RC,,Outpatient,,,54,46.2,Aetna Med ADV,Aetna Med ADV,38.5,,,,,,,Fee Schedule,38.5,46.74,
Apolipoprotein Evaluation QSTC,13864521,LOCAL,82172,CPT,,,,,,Outpatient,,,54.36,25.31,Aetna Med ADV,Aetna Med ADV,37.52,,,,,,,Fee Schedule,17.73,37.515,
nitroglycerin 5 mg/mL intravenous solution 10 mL [CULL],11211028,LOCAL,J2305,CPT,,,301,RC,,Outpatient,10,ML,54.7968,,Aetna Med ADV,Aetna Med ADV,1.52,,,,,,,Fee Schedule,1.523,1.523,
"C1 Esterase Inhibitor, Protein QSTC",8764554,LOCAL,86160,CPT,,,,,,Outpatient,,,54.9,14.4,Aetna Med ADV,Aetna Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
droNABinol 5 mg Cap [CULL],11200011,LOCAL,Q0167,CPT,,,306,RC,,Outpatient,1,EA,54.9824,,Aetna Med ADV,Aetna Med ADV,1.35,,,,,,,Fee Schedule,1.352,1.352,
Hepatitis B Surface Antigen,633752,LOCAL,87340,CPT,,,306,RC,,Outpatient,,,55,12.4,Aetna Med ADV,Aetna Med ADV,22.2,,,,,,,Fee Schedule,10.57,22.20058824,
Hepatitis B Surface Antigen w/ Interp,9517997,LOCAL,87340,CPT,,,302,RC,,Outpatient,,,55,12.4,Aetna Med ADV,Aetna Med ADV,22.2,,,,,,,Fee Schedule,10.57,22.20058824,
HIV 1/2 Antibody Screen (exposure only),9609059,LOCAL,86701,CPT,,,274,RC,,Outpatient,,,55,10.67,Aetna Med ADV,Aetna Med ADV,8.89,,,,,,,Fee Schedule,8.89,15.29,
IMMOBILIZER KNEE LARGE,11071020,LOCAL,,,L1830,HCPCS,274,RC,,Outpatient,,,55,158,Aetna Med ADV,Aetna Med ADV,77.23,,,,,,,Fee Schedule,77.23,77.23,
IMMOBILIZER KNEE XL 79-80028,11070735,LOCAL,,,L1830,HCPCS,301,RC,,Outpatient,,,55,158,Aetna Med ADV,Aetna Med ADV,77.23,,,,,,,Fee Schedule,77.23,77.23,
Potassium POCT,9616981,LOCAL,84132,CPT,,,274,RC,,Outpatient,,,55,5.71,Aetna Med ADV,Aetna Med ADV,8.7,,,,,,,Fee Schedule,7.16,8.697880184,
IMMOBILIZER KNEE MEDIUM,11071084,LOCAL,,,L1830,HCPCS,274,RC,,Outpatient,,,55.06,158,Aetna Med ADV,Aetna Med ADV,77.23,,,,,,,Fee Schedule,77.23,77.23,
IMMOBILIZER KNEE SMALL,11071082,LOCAL,,,L1830,HCPCS,305,RC,,Outpatient,,,55.06,158,Aetna Med ADV,Aetna Med ADV,77.23,,,,,,,Fee Schedule,77.23,77.23,
Additional Testing PTT-LA QSTC,9004754,LOCAL,85730,CPT,,,305,RC,,Outpatient,,,55.1,7.21,Aetna Med ADV,Aetna Med ADV,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
dRVVT Mix Interpretation: QSTC,9004757,LOCAL,85613,CPT,,,301,RC,,Outpatient,,,55.1,11.5,Aetna Med ADV,Aetna Med ADV,9.58,,,,,,,Fee Schedule,5.42,9.58,
Valproic Acid Level,3170351,LOCAL,80164,CPT,,,301,RC,,Outpatient,,,55.49,16.25,Aetna Med ADV,Aetna Med ADV,34.38,,,,,,,Fee Schedule,15.38,34.38,
.RMSF IgG Titer QSTC,8764766,LOCAL,86757,CPT,,,301,RC,,Outpatient,,,56.25,23.22,Aetna Med ADV,Aetna Med ADV,19.35,,,,,,,Fee Schedule,15.29,19.35,
.RMSF IgM Titer QSTC,8764765,LOCAL,86757,CPT,,,302,RC,,Outpatient,,,56.25,23.22,Aetna Med ADV,Aetna Med ADV,19.35,,,,,,,Fee Schedule,15.29,19.35,
HIV 1 Antibody QSTC,8852095,LOCAL,86701,CPT,,,302,RC,,Outpatient,,,56.25,10.67,Aetna Med ADV,Aetna Med ADV,8.89,,,,,,,Fee Schedule,8.89,15.29,
HIV 2 Antibody QSTC,8852096,LOCAL,86702,CPT,,,301,RC,,Outpatient,,,56.25,16.22,Aetna Med ADV,Aetna Med ADV,13.52,,,,,,,Fee Schedule,13.52,15.29,
"Aldosterone, LC/MS QSTC",8853271,LOCAL,82088,CPT,,,300,RC,,Outpatient,,,56.93,48.9,Aetna Med ADV,Aetna Med ADV,48.44,,,,,,,Fee Schedule,18.43,48.435,
Calcium Level Total,1628887,LOCAL,82310,CPT,,,,,,Outpatient,,,57.12,6.19,Aetna Med ADV,Aetna Med ADV,5.16,,,,,,,Fee Schedule,5.16,7.16,
EPINEPHrine 1 mg/mL injectable solution 1 mL [CULL],11202413,LOCAL,J0169,CPT,,,307,RC,,Outpatient,1,ML,57.4464,,Aetna Med ADV,Aetna Med ADV,1.38,,,,,,,Fee Schedule,1.383,1.383,
Bill UA With Microscopic,14634624,LOCAL,81001,CPT,,,972,RC,,Outpatient,,,57.6,3.8,Aetna Med ADV,Aetna Med ADV,6.91,,,,,,,Fee Schedule,4.02,6.910081301,
PC DOPP ART BIL EXERCISE,8200578,LOCAL,93924,CPT,,,305,RC,,Outpatient,,,57.94,302,Aetna Med ADV,Aetna Med ADV,143.05,,,,,,,Fee Schedule,143.05,161.71,
Reticulocyte Count,7909814,LOCAL,85044,CPT,,,305,RC,,Outpatient,,,57.94,5.17,Aetna Med ADV,Aetna Med ADV,16.96,,,,,,,Fee Schedule,8.21,16.95545455,
Reticulocyte Count with Immature Reticulocyte Fraction,3454466,LOCAL,85044,CPT,,,,,,Outpatient,,,57.94,5.17,Aetna Med ADV,Aetna Med ADV,16.96,,,,,,,Fee Schedule,8.21,16.95545455,
clindamycin 900 mg/50 mL-D5% intravenous solution 50 mL [CULL],11212348,LOCAL,J0736,CPT,,,,,,Outpatient,50,ML,57.99733333,,Aetna Med ADV,Aetna Med ADV,0.82,,,,,,,Fee Schedule,0.819,0.819,
milrinone 200 mcg/mL-D5% intravenous solution 100 mL [CULL],11290134,LOCAL,J2260,CPT,,,301,RC,,Outpatient,100,ML,58.368,,Aetna Med ADV,Aetna Med ADV,1.35,,,,,,,Fee Schedule,1.351,1.351,
"Vitamin B6, Plasma QSTC",8853234,LOCAL,84207,CPT,,,301,RC,,Outpatient,,,58.5,33.72,Aetna Med ADV,Aetna Med ADV,40.33,,,,,,,Fee Schedule,17.73,40.33125,
Total Iron Binding Capacity,7050172,LOCAL,84466,CPT,,,301,RC,,Outpatient,,,58.75,15.31,Aetna Med ADV,Aetna Med ADV,29.64,,,,,,,Fee Schedule,17.73,29.64248366,
Total Iron Binding Capacity,10543521,LOCAL,84466,CPT,,,301,RC,,Outpatient,,,58.75,15.31,Aetna Med ADV,Aetna Med ADV,29.64,,,,,,,Fee Schedule,17.73,29.64248366,
"Varicella-Zoster Virus Abs(IgG,IgM) QSTC",8853253,LOCAL,86787,CPT,,,,,,Outpatient,,,59.4,15.46,Aetna Med ADV,Aetna Med ADV,12.88,,,,,,,Fee Schedule,12.88,15.29,
protamine 10 mg/mL injectable solution 5 mL [CULL],11211135,LOCAL,J2720,CPT,,,301,RC,,Outpatient,5,ML,59.4432,,Aetna Med ADV,Aetna Med ADV,1.57,,,,,,,Fee Schedule,1.571,1.571,
Immunoglobulin E QSTC,8764571,LOCAL,82785,CPT,,,274,RC,,Outpatient,,,59.49,19.75,Aetna Med ADV,Aetna Med ADV,203.96,,,,,,,Fee Schedule,17.73,203.9616667,
IMMOBILIZER SHOULDER XXXLARGE,4803390,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,59.62,12,Aetna Med ADV,Aetna Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
orphenadrine 30 mg/mL injectable solution 2 mL [CULL],11212051,LOCAL,J2360,CPT,,,300,RC,,Outpatient,2,ML,59.904,,Aetna Med ADV,Aetna Med ADV,1.76,,,,,,,Fee Schedule,1.756666667,1.756666667,
Cortisol,3352314,LOCAL,82533,CPT,,,300,RC,,Outpatient,,,60,19.56,Aetna Med ADV,Aetna Med ADV,15.2,,,,,,,Fee Schedule,15.196,18.43,
Cortisol 60 Min,8373789,LOCAL,82533,CPT,,,301,RC,,Outpatient,,,60,19.56,Aetna Med ADV,Aetna Med ADV,15.2,,,,,,,Fee Schedule,15.196,18.43,
Free T4 Level,3170324,LOCAL,84439,CPT,,,302,RC,,Outpatient,,,60,10.82,Aetna Med ADV,Aetna Med ADV,28.58,,,,,,,Fee Schedule,18.43,28.58065455,
Hepatitis A Antibody IgM,1628904,LOCAL,86709,CPT,,,301,RC,,Outpatient,,,60,13.51,Aetna Med ADV,Aetna Med ADV,11.26,,,,,,,Fee Schedule,11.26,15.29,
HIV 1/2 Antibody and P24 Screen,633757,LOCAL,87389,CPT,,,,,,Outpatient,,,60,28.9,Aetna Med ADV,Aetna Med ADV,36.55,,,,,,,Fee Schedule,10.57,36.55,
HIV 1/2 Antibody and P24 Screen,633757,LOCAL,G0475,CPT,,,301,RC,,Outpatient,,,60,28.9,Aetna Med ADV,Aetna Med ADV,20.9,,,,,,,Fee Schedule,10.57,36.55,
Protein Body Fluid,1634879,LOCAL,84157,CPT,,,274,RC,,Outpatient,,,60.38,4.8,Aetna Med ADV,Aetna Med ADV,4,,,,,,,Fee Schedule,4,7.16,
IMMOBILIZER SHOULDER XXLARGE 9008-05,4803139,LOCAL,,,L3650,HCPCS,302,RC,,Outpatient,,,60.39,12,Aetna Med ADV,Aetna Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
Aspergillus fumigatus QSTC,9966204,LOCAL,86331,CPT,,,302,RC,,Outpatient,,,60.8,14.38,Aetna Med ADV,Aetna Med ADV,11.98,,,,,,,Fee Schedule,11.98,15.29,
S. viridis QSTC,9966214,LOCAL,86609,CPT,,,302,RC,,Outpatient,,,60.8,15.46,Aetna Med ADV,Aetna Med ADV,12.88,,,,,,,Fee Schedule,12.88,15.29,
T. candidus QSTC,9966205,LOCAL,86606,CPT,,,,,,Outpatient,,,60.8,18.06,Aetna Med ADV,Aetna Med ADV,15.05,,,,,,,Fee Schedule,15.05,15.29,
adenosine 3 mg/mL intravenous solution 2 mL [CULL],11201015,LOCAL,J0153,CPT,,,301,RC,,Outpatient,2,ML,61.056,,Aetna Med ADV,Aetna Med ADV,0.53,,,,,,,Fee Schedule,0.529,0.529,
"Mercury, Blood QSTC",13864924,LOCAL,83825,CPT,,,301,RC,,Outpatient,,,61.2,19.51,Aetna Med ADV,Aetna Med ADV,35.86,,,,,,,Fee Schedule,16.07,35.86038462,
Sex Hormone Binding Glob QSTC,8764670,LOCAL,84270,CPT,,,301,RC,,Outpatient,,,61.2,26.08,Aetna Med ADV,Aetna Med ADV,21.73,,,,,,,Fee Schedule,17.73,21.73,
Stone Analysis w/ Image QSTC,9777240,LOCAL,82365,CPT,,,430,RC,,Outpatient,,,61.2,15.48,Aetna Med ADV,Aetna Med ADV,24.62,,,,,,,Fee Schedule,17.73,24.61666667,
97012 APPLICATION OF TRACTION/MECH CHARGE,8133034,LOCAL,97012,CPT,,,430,RC,GP,Outpatient,,,61.28,40,Aetna Med ADV,Aetna Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
97012 MECH TRACTION THERAPY Assistant Charge,9860050,LOCAL,97012,CPT,,,430,RC,GO|CO,Outpatient,,,61.28,40,Aetna Med ADV,Aetna Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
97012 Mechanical Traction PT,9850050,LOCAL,97012,CPT,,,420,RC,GO,Outpatient,,,61.28,40,Aetna Med ADV,Aetna Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
97012 TRACTION - MECHANICAL,9640018,LOCAL,97012,CPT,,,420,RC,GP,Outpatient,,,61.28,40,Aetna Med ADV,Aetna Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
Mechanical Traction Charge -> Yes,13786833,LOCAL,97012,CPT,,,420,RC,GP,Outpatient,,,61.28,40,Aetna Med ADV,Aetna Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
Mechanical Traction Provided,8510678,LOCAL,97012,CPT,,,430,RC,GP,Outpatient,,,61.28,40,Aetna Med ADV,Aetna Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
OT Mechanical Trac Therapy Asist Units,7897758,LOCAL,97012,CPT,,,430,RC,CQ,Outpatient,,,61.28,40,Aetna Med ADV,Aetna Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
OT Mechanical Traction Therapy Units,7897758,LOCAL,97012,CPT,,,420,RC,GO,Outpatient,,,61.28,40,Aetna Med ADV,Aetna Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
PT Mechanical Traction Assistant Units,9390392,LOCAL,97012,CPT,,,420,RC,CQ,Outpatient,,,61.28,40,Aetna Med ADV,Aetna Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
PT TRACTION MECHANICAL,9650018,LOCAL,97012,CPT,,,301,RC,GP|CQ,Outpatient,,,61.28,40,Aetna Med ADV,Aetna Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
"Ethylene Glycol, Blood QSTC",8764539,LOCAL,82693,CPT,,,,,,Outpatient,,,61.34,17.88,Aetna Med ADV,Aetna Med ADV,14.9,,,,,,,Fee Schedule,14.9,16.07,
vancomycin 1 g/200 mL intravenous solution 200 mL [CULL],11291267,LOCAL,J3372,CPT,,,301,RC,,Outpatient,200,ML,61.44,,Aetna Med ADV,Aetna Med ADV,5.49,,,,,,,Fee Schedule,5.487407407,5.487407407,
HIV 1/2 Antibody Screen,7939338,LOCAL,86703,CPT,,,301,RC,,Outpatient,,,61.7,16.45,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.57,
"Alprazolam (Xanax), Serum QSTC",8972830,LOCAL,80299,CPT,,,300,RC,,Outpatient,,,62.06,22.37,Aetna Med ADV,Aetna Med ADV,18.64,,,,,,,Fee Schedule,15.38,18.64,
Glucose 3 Hour,7973891,LOCAL,82952,CPT,,,300,RC,,Outpatient,,,62.17,4.7,Aetna Med ADV,Aetna Med ADV,3.92,,,,,,,Fee Schedule,3.92,7.16,
Glucose 4 Hour,7973892,LOCAL,82952,CPT,,,300,RC,,Outpatient,,,62.17,4.7,Aetna Med ADV,Aetna Med ADV,3.92,,,,,,,Fee Schedule,3.92,7.16,
Glucose 5 Hour,7973894,LOCAL,82952,CPT,,,301,RC,,Outpatient,,,62.17,4.7,Aetna Med ADV,Aetna Med ADV,3.92,,,,,,,Fee Schedule,3.92,7.16,
"Cyclosporine Trough,LCMSMS QSTC",8764656,LOCAL,80158,CPT,,,306,RC,,Outpatient,,,62.37,21.66,Aetna Med ADV,Aetna Med ADV,18.05,,,,,,,Fee Schedule,15.38,18.05,
"Ova&Parasite,Conc&Perm Smear Result QSTC",8873966,LOCAL,87177,CPT,,,420,RC,,Outpatient,,,62.37,10.68,Aetna Med ADV,Aetna Med ADV,8.9,,,,,,,Fee Schedule,8.9,10.57,
97150  Group Therapeutic Procedure,9640074,LOCAL,97150,CPT,,,430,RC,GP,Outpatient,,,62.69,41,Aetna Med ADV,Aetna Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
97150 OT Group Therapy Charge,9850058,LOCAL,97150,CPT,,,430,RC,GO,Outpatient,,,62.69,41,Aetna Med ADV,Aetna Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
97150 OT Group Therapy Modifier Charge,9860058,LOCAL,97150,CPT,,,420,RC,GO|CO,Outpatient,,,62.69,41,Aetna Med ADV,Aetna Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
97150 PT Group Therapy Assistant Units,9650074,LOCAL,97150,CPT,,,420,RC,GP|CQ,Outpatient,,,62.69,41,Aetna Med ADV,Aetna Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
Group Therapy Charge,7895938,LOCAL,97150,CPT,,,430,RC,GP,Outpatient,,,62.69,41,Aetna Med ADV,Aetna Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
Group Therapy Provided,7895280,LOCAL,97150,CPT,,,430,RC,GO,Outpatient,,,62.69,41,Aetna Med ADV,Aetna Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
OT Group Therapy Assistant Units,7895280,LOCAL,97150,CPT,,,430,RC,CQ,Outpatient,,,62.69,41,Aetna Med ADV,Aetna Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
OT Group Therapy Assistant Units,7897695,LOCAL,97150,CPT,,,430,RC,CQ,Outpatient,,,62.69,41,Aetna Med ADV,Aetna Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
OT Group Therapy Rehab Units,7897695,LOCAL,97150,CPT,,,420,RC,GO,Outpatient,,,62.69,41,Aetna Med ADV,Aetna Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
PT Group Therapy Assistant Units,9390418,LOCAL,97150,CPT,,,306,RC,CQ,Outpatient,,,62.69,41,Aetna Med ADV,Aetna Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
"Giardia Antigen, EIA, Stool QSTC",8972764,LOCAL,87329,CPT,,,301,RC,,Outpatient,,,63,14.38,Aetna Med ADV,Aetna Med ADV,11.98,,,,,,,Fee Schedule,10.57,11.98,
Methylmalonic Acid QSTC,8853212,LOCAL,83921,CPT,,,301,RC,,Outpatient,,,63,25.45,Aetna Med ADV,Aetna Med ADV,21.21,,,,,,,Fee Schedule,17.73,21.21,
Nortriptyline QSTC,8853203,LOCAL,80299,CPT,,,430,RC,,Outpatient,,,63.45,22.37,Aetna Med ADV,Aetna Med ADV,18.64,,,,,,,Fee Schedule,15.38,18.64,
97034 CONTRAST BATH THERAPY,9860025,LOCAL,97034,CPT,,,420,RC,GO|CO,Outpatient,,,63.72,41,Aetna Med ADV,Aetna Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
97034 CONTRAST BATHS EACH 15 MIN CHARGE,9640025,LOCAL,97034,CPT,,,430,RC,GP,Outpatient,,,63.72,41,Aetna Med ADV,Aetna Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
97034 OT CONTRAST BATH 15 MIN APPL CHARGE,9850025,LOCAL,97034,CPT,,,420,RC,GO,Outpatient,,,63.72,41,Aetna Med ADV,Aetna Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
97034 PT CONTRAST BATH 15 MIN ASST,9650025,LOCAL,97034,CPT,,,430,RC,GP|CQ,Outpatient,,,63.72,41,Aetna Med ADV,Aetna Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
OT Contrast Bath Assistant Units,7895283,LOCAL,97034,CPT,,,430,RC,CQ,Outpatient,,,63.72,41,Aetna Med ADV,Aetna Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
OT Contrast Bath Assistant Units,1373567,LOCAL,97034,CPT,,,430,RC,CQ,Outpatient,,,63.72,41,Aetna Med ADV,Aetna Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
OT Contrast Bath Charges,7895283,LOCAL,97034,CPT,,,430,RC,GO,Outpatient,,,63.72,41,Aetna Med ADV,Aetna Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
OT Contrast Bath Units,1373567,LOCAL,97034,CPT,,,420,RC,GO,Outpatient,,,63.72,41,Aetna Med ADV,Aetna Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
PT Attended E-Stim Assistant Units,9390422,LOCAL,97034,CPT,,,420,RC,CQ,Outpatient,,,63.72,41,Aetna Med ADV,Aetna Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
PT Contrast Bath Charges,7895979,LOCAL,97034,CPT,,,274,RC,GP,Outpatient,,,63.72,41,Aetna Med ADV,Aetna Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
BRACE ANKLE LG,9400076,LOCAL,,,L1902,HCPCS,274,RC,,Outpatient,,,64.13,,Aetna Med ADV,Aetna Med ADV,94.39,,,,,,,Fee Schedule,94.39,94.39,
Medium Ankle Brace,9400086,LOCAL,,,L1902,HCPCS,311,RC,,Outpatient,,,64.13,,Aetna Med ADV,Aetna Med ADV,94.39,,,,,,,Fee Schedule,94.39,94.39,
"ANA Screen, IFA QSTC",14127792,LOCAL,86038,CPT,,,311,RC,,Outpatient,,,64.31,14.51,Aetna Med ADV,Aetna Med ADV,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
Beta2-Glycoprotein I (IgA) QSTC,14127808,LOCAL,86146,CPT,,,311,RC,,Outpatient,,,64.31,30.54,Aetna Med ADV,Aetna Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
Beta2-Glycoprotein I (IgG) QSTC,14127809,LOCAL,86146,CPT,,,311,RC,,Outpatient,,,64.31,30.54,Aetna Med ADV,Aetna Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
Beta2-Glycoprotein I (IgM) QSTC,14127810,LOCAL,86146,CPT,,,311,RC,,Outpatient,,,64.31,30.54,Aetna Med ADV,Aetna Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Ab (IgA) QSTC,14127805,LOCAL,86147,CPT,,,311,RC,,Outpatient,,,64.31,30.54,Aetna Med ADV,Aetna Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Ab (IgG) QSTC,14127806,LOCAL,86147,CPT,,,311,RC,,Outpatient,,,64.31,30.54,Aetna Med ADV,Aetna Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Ab (IgM) QSTC,14127807,LOCAL,86147,CPT,,,311,RC,,Outpatient,,,64.31,30.54,Aetna Med ADV,Aetna Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
"CCP, Antibody (IgG) QSTC",14127817,LOCAL,86200,CPT,,,311,RC,,Outpatient,,,64.31,15.54,Aetna Med ADV,Aetna Med ADV,7.49,,,,,,,Fee Schedule,7.491935484,15.29,
Centromere B Antibody QSTC,14127802,LOCAL,86235,CPT,,,311,RC,,Outpatient,,,64.31,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Chromatin (Nucleosomal) Ab QSTC,14127794,LOCAL,86235,CPT,,,311,RC,,Outpatient,,,64.31,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Complement Component C3c QSTC,14127803,LOCAL,86160,CPT,,,311,RC,,Outpatient,,,64.31,14.4,Aetna Med ADV,Aetna Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
Complement Component C4c QSTC,14127804,LOCAL,86160,CPT,,,311,RC,,Outpatient,,,64.31,14.4,Aetna Med ADV,Aetna Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
"DNA Ab (DS) Crithidia, IFA QSTC",14127793,LOCAL,86255,CPT,,,311,RC,,Outpatient,,,64.31,14.46,Aetna Med ADV,Aetna Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
Jo-1 Antibody QSTC,14127801,LOCAL,86235,CPT,,,311,RC,,Outpatient,,,64.31,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
"MCV, Antibody QSTC",14127818,LOCAL,83520,CPT,,,311,RC,,Outpatient,,,64.31,20.72,Aetna Med ADV,Aetna Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rheumatoid Factor (IgA) QSTC,14127812,LOCAL,83520,CPT,,,311,RC,,Outpatient,,,64.31,20.72,Aetna Med ADV,Aetna Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rheumatoid Factor (IgG) QSTC,14127814,LOCAL,83520,CPT,,,311,RC,,Outpatient,,,64.31,20.72,Aetna Med ADV,Aetna Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rheumatoid Factor (IgM) QSTC,14127816,LOCAL,83520,CPT,,,311,RC,,Outpatient,,,64.31,20.72,Aetna Med ADV,Aetna Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
RNP Antibody QSTC,14127797,LOCAL,86235,CPT,,,311,RC,,Outpatient,,,64.31,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Scl-70 Antibody QSTC,14127800,LOCAL,86235,CPT,,,311,RC,,Outpatient,,,64.31,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-A) QSTC,14127798,LOCAL,86235,CPT,,,311,RC,,Outpatient,,,64.31,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-B) QSTC,14127799,LOCAL,86235,CPT,,,311,RC,,Outpatient,,,64.31,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sm Antibody QSTC,14127795,LOCAL,86235,CPT,,,311,RC,,Outpatient,,,64.31,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sm/RNP Antibody QSTC,14127796,LOCAL,86235,CPT,,,311,RC,,Outpatient,,,64.31,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Thyroid Peroxidase Abs QSTC,14127819,LOCAL,86376,CPT,,,301,RC,,Outpatient,,,64.31,17.46,Aetna Med ADV,Aetna Med ADV,25.09,,,,,,,Fee Schedule,15.29,25.085,
Calcitonin QSTC,8764739,LOCAL,82308,CPT,,,301,RC,,Outpatient,,,64.8,32.15,Aetna Med ADV,Aetna Med ADV,26.79,,,,,,,Fee Schedule,18.43,26.79,
"DHEA, Unconjugated QSTC",8853248,LOCAL,82626,CPT,,,302,RC,,Outpatient,,,64.8,30.32,Aetna Med ADV,Aetna Med ADV,25.27,,,,,,,Fee Schedule,17.73,25.27,
"Sjogren's Antibodies (SS-A, SS-B) QSTC",8853207,LOCAL,86235,CPT,,,,,,Outpatient,,,64.85,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Bill Special Stains Group II,8489591,LOCAL,88313,CPT,,,301,RC,,Outpatient,,,64.93,,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,32.32,117.85,
17-Hydroxyprogesterone QSTC,8853287,LOCAL,83498,CPT,,,301,RC,,Outpatient,,,64.94,32.6,Aetna Med ADV,Aetna Med ADV,27.17,,,,,,,Fee Schedule,18.43,27.17,
Carcinoembryonic Antigen,633697,LOCAL,82378,CPT,,,302,RC,,Outpatient,,,65,22.75,Aetna Med ADV,Aetna Med ADV,36.03,,,,,,,Fee Schedule,17.73,36.03017241,
Hepatitis B Core Antibody IgM,1628907,LOCAL,86705,CPT,,,300,RC,,Outpatient,,,65,14.12,Aetna Med ADV,Aetna Med ADV,32.8,,,,,,,Fee Schedule,15.29,32.80285714,
Celiac Disease Comp w/Gliadin Ab IgG QSTC,13864455,LOCAL,82784,CPT,,,301,RC,,Outpatient,,,65.25,11.16,Aetna Med ADV,Aetna Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
Hep B Surface Ag w/Rflx to Confirm. QSTC,9039254,LOCAL,87340,CPT,,,301,RC,,Outpatient,,,65.25,12.4,Aetna Med ADV,Aetna Med ADV,22.2,,,,,,,Fee Schedule,10.57,22.20058824,
Immunoglobulin Panel QSTC,8764543,LOCAL,82784,CPT,,,305,RC,,Outpatient,,,65.25,11.16,Aetna Med ADV,Aetna Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
Body Fluid Cell Count w/ Diff,6213822,LOCAL,89051,CPT,,,309,RC,,Outpatient,,,66.1,6.72,Aetna Med ADV,Aetna Med ADV,35.8,,,,,,,Fee Schedule,14.07,35.795,
Body Fluid Cell Count with Differential If Indicated,8127214,LOCAL,89051,CPT,,,309,RC,,Outpatient,,,66.1,6.72,Aetna Med ADV,Aetna Med ADV,35.8,,,,,,,Fee Schedule,14.07,35.795,
Body Fluid Differential,4240538,LOCAL,89051,CPT,,,309,RC,,Outpatient,,,66.1,6.72,Aetna Med ADV,Aetna Med ADV,35.8,,,,,,,Fee Schedule,14.07,35.795,
CSF Cell Count with Differential If Indicated,3454318,LOCAL,89051,CPT,,,309,RC,,Outpatient,,,66.1,6.72,Aetna Med ADV,Aetna Med ADV,35.8,,,,,,,Fee Schedule,14.07,35.795,
CSF Differential,3454393,LOCAL,89051,CPT,,,301,RC,,Outpatient,,,66.1,6.72,Aetna Med ADV,Aetna Med ADV,35.8,,,,,,,Fee Schedule,14.07,35.795,
Digoxin Level,1628891,LOCAL,80162,CPT,,,301,RC,,Outpatient,,,66.1,15.94,Aetna Med ADV,Aetna Med ADV,26.44,,,,,,,Fee Schedule,15.38,26.44,
Potassium Level,633616,LOCAL,84132,CPT,,,301,RC,,Outpatient,,,66.1,5.71,Aetna Med ADV,Aetna Med ADV,8.7,,,,,,,Fee Schedule,7.16,8.697880184,
24hr Urine Creatinine QSTC,10600648,LOCAL,82570,CPT,,,301,RC,,Outpatient,,,66.76,6.22,Aetna Med ADV,Aetna Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Aldosterone, 24-Hour Urine QSTC",8995528,LOCAL,82088,CPT,,,301,RC,,Outpatient,,,66.76,48.9,Aetna Med ADV,Aetna Med ADV,48.44,,,,,,,Fee Schedule,18.43,48.435,
"Aspergillus Ab, Immunodiffusion QSTC",13864516,LOCAL,86606,CPT,,,301,RC,,Outpatient,,,66.87,18.06,Aetna Med ADV,Aetna Med ADV,15.05,,,,,,,Fee Schedule,15.05,15.29,
T3 Free,3170323,LOCAL,84481,CPT,,,301,RC,,Outpatient,,,67,20.33,Aetna Med ADV,Aetna Med ADV,34.46,,,,,,,Fee Schedule,18.43,34.46424242,
ANCA Screen w Reflex to ANCA Titer QSTC,8764789,LOCAL,86036,CPT,,,301,RC,,Outpatient,,,67.5,14.46,Aetna Med ADV,Aetna Med ADV,39.66,,,,,,,Fee Schedule,15.29,39.655,
Androstenedione QSTC,8764648,LOCAL,82157,CPT,,,301,RC,,Outpatient,,,67.5,35.14,Aetna Med ADV,Aetna Med ADV,29.28,,,,,,,Fee Schedule,18.43,29.28,
Antithrombin III Activity QSTC,8764597,LOCAL,85300,CPT,,,300,RC,,Outpatient,,,67.5,14.22,Aetna Med ADV,Aetna Med ADV,11.85,,,,,,,Fee Schedule,5.42,11.85,
Influenza A,7909953,LOCAL,87804,CPT,,,300,RC,,Outpatient,,,67.5,19.86,Aetna Med ADV,Aetna Med ADV,6.42,,,,,,,Fee Schedule,6.419753086,10.57,
Influenza B,7909954,LOCAL,87804,CPT,,,301,RC,,Outpatient,,,67.5,19.86,Aetna Med ADV,Aetna Med ADV,6.42,,,,,,,Fee Schedule,6.419753086,10.57,
"Protein C, Activity QSTC",8764685,LOCAL,85303,CPT,,,301,RC,,Outpatient,,,67.5,16.61,Aetna Med ADV,Aetna Med ADV,13.84,,,,,,,Fee Schedule,5.42,13.84,
"Protein S Antigen, Free QSTC",9777259,LOCAL,85306,CPT,,,301,RC,,Outpatient,,,67.5,18.38,Aetna Med ADV,Aetna Med ADV,15.32,,,,,,,Fee Schedule,5.42,15.32,
"Protein S, Activity QSTC",8764774,LOCAL,85306,CPT,,,306,RC,,Outpatient,,,67.5,18.38,Aetna Med ADV,Aetna Med ADV,15.32,,,,,,,Fee Schedule,5.42,15.32,
Shiga Toxin 1 and 2,7939191,LOCAL,87427,CPT,,,306,RC,,Outpatient,,,67.5,14.38,Aetna Med ADV,Aetna Med ADV,29.72,,,,,,,Fee Schedule,10.57,29.71875,
Shiga Toxin 1 and 2,8875416,LOCAL,87427,CPT,,,301,RC,,Outpatient,,,67.5,14.38,Aetna Med ADV,Aetna Med ADV,29.72,,,,,,,Fee Schedule,10.57,29.71875,
Tissue Transglutaminase IgG Ab QSTC,8764825,LOCAL,86364,CPT,,,301,RC,,Outpatient,,,67.5,13.84,Aetna Med ADV,Aetna Med ADV,61.9,,,,,,,Fee Schedule,15.29,61.9,
Vitamin B12 QSTC,9291002,LOCAL,82607,CPT,,,301,RC,,Outpatient,,,67.5,18.1,Aetna Med ADV,Aetna Med ADV,82.43,,,,,,,Fee Schedule,18.43,82.43266533,
Glucose CSF,1628897,LOCAL,82945,CPT,,,301,RC,,Outpatient,,,67.73,4.72,Aetna Med ADV,Aetna Med ADV,3.93,,,,,,,Fee Schedule,3.93,7.16,
Protein CSF,1634881,LOCAL,84157,CPT,,,301,RC,,Outpatient,,,67.73,4.8,Aetna Med ADV,Aetna Med ADV,4,,,,,,,Fee Schedule,4,7.16,
Erythropoietin (EPO) QSTC,8764551,LOCAL,82668,CPT,,,410,RC,,Outpatient,,,68.4,22.55,Aetna Med ADV,Aetna Med ADV,43.41,,,,,,,Fee Schedule,17.73,43.41,
RT Vapotherm Subsequent CHARGE,8143879,LOCAL,94003,CPT,,,305,RC,,Outpatient,,,68.49,613,Aetna Med ADV,Aetna Med ADV,604.42,,,,,,,Fee Schedule,604.42,941,
Hematocrit,633742,LOCAL,85014,CPT,,,300,RC,,Outpatient,,,68.54,2.84,Aetna Med ADV,Aetna Med ADV,12.62,,,,,,,Fee Schedule,8.21,12.62068493,
Hematocrit,1635636,LOCAL,85014,CPT,,,305,RC,,Outpatient,,,68.54,2.84,Aetna Med ADV,Aetna Med ADV,12.62,,,,,,,Fee Schedule,8.21,12.62068493,
Hemoglobin,633741,LOCAL,85018,CPT,,,300,RC,,Outpatient,,,68.54,2.84,Aetna Med ADV,Aetna Med ADV,10.94,,,,,,,Fee Schedule,8.21,10.94316176,
Hemoglobin,1635635,LOCAL,85018,CPT,,,302,RC,,Outpatient,,,68.54,2.84,Aetna Med ADV,Aetna Med ADV,10.94,,,,,,,Fee Schedule,8.21,10.94316176,
C1 Esterase Inhibitor QST,13870084,LOCAL,86160,CPT,,,301,RC,,Outpatient,,,68.85,14.4,Aetna Med ADV,Aetna Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
"C1 Esterase Inhibitor, Functional QSTC",8853251,LOCAL,86161,CPT,,,302,RC,,Outpatient,,,68.85,14.4,Aetna Med ADV,Aetna Med ADV,12,,,,,,,Fee Schedule,12,15.29,
Antibody Screen Gel 2,8196056,LOCAL,86850,CPT,,,302,RC,,Outpatient,,,68.88,11.72,Aetna Med ADV,Aetna Med ADV,48.85,,,,,,,Fee Schedule,6.29,48.85,
Antibody Screen Tube.,8417431,LOCAL,86850,CPT,,,302,RC,,Outpatient,,,68.88,11.72,Aetna Med ADV,Aetna Med ADV,48.85,,,,,,,Fee Schedule,6.29,48.85,
BB RH (D) TYPE XX,6432042,LOCAL,86901,CPT,,,306,RC,,Outpatient,,,68.88,3.59,Aetna Med ADV,Aetna Med ADV,35.88,,,,,,,Fee Schedule,6.29,35.88,
Acid Fast Stain Report,634214,LOCAL,87206,CPT,,,301,RC,,Outpatient,,,69.36,6.47,Aetna Med ADV,Aetna Med ADV,34.45,,,,,,,Fee Schedule,10.57,34.45384615,
Milk Component Panel QSTC,8912186,LOCAL,86008,CPT,,,300,RC,,Outpatient,,,69.39,21.52,Aetna Med ADV,Aetna Med ADV,17.93,,,,,,,Fee Schedule,15.29,17.93,
REF TRXN Pathologist Interp,13479165,LOCAL,86078,CPT,,,302,RC,,Outpatient,,,69.8,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.88,156.67,
BB REF RH(D) TYPING TRANSFUSION RXN,6433001,LOCAL,86901,CPT,,,300,RC,,Outpatient,,,69.86,3.59,Aetna Med ADV,Aetna Med ADV,35.88,,,,,,,Fee Schedule,6.29,35.88,
BB REF XMATCH (IAT) TRANSFUSION RXN,6433004,LOCAL,86922,CPT,,,302,RC,,Outpatient,,,69.86,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
REF ABO/Rh (TRXN),13479164,LOCAL,86900,CPT,,,302,RC,,Outpatient,,,69.86,3.59,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,6.29,117.85,
REF Antibody Screen (TRXN),13479162,LOCAL,86850,CPT,,,302,RC,,Outpatient,,,69.86,11.72,Aetna Med ADV,Aetna Med ADV,48.85,,,,,,,Fee Schedule,6.29,48.85,
REF Crossmatch (TRXN),13481255,LOCAL,86920,CPT,,,302,RC,,Outpatient,,,69.86,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
REF DAT (TRXN),13479163,LOCAL,86880,CPT,,,306,RC,,Outpatient,,,69.86,6.47,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,6.29,54.31,
Clostridium difficile Quik Chek Complete,10574492,LOCAL,87324,CPT,,,510,RC,,Outpatient,,,70,14.38,Aetna Med ADV,Aetna Med ADV,20.44,,,,,,,Fee Schedule,10.57,20.4375,
Hemoglobin (POCT),4192190,LOCAL,85018,CPT,,,302,RC,,Outpatient,,,70,2.84,Aetna Med ADV,Aetna Med ADV,10.94,,,,,,,Fee Schedule,8.21,10.94316176,
Hepatitis C Ab,1628911,LOCAL,86803,CPT,,,410,RC,,Outpatient,,,70,17.12,Aetna Med ADV,Aetna Med ADV,32.1,,,,,,,Fee Schedule,15.29,32.10014925,
RT Education/Instruction CHARGE,90840011,LOCAL,94664,CPT,,,410,RC,,Outpatient,,,70.15,46,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
"RT Evaluation, Respiratory CHARGE",90840013,LOCAL,94664,CPT,,,,,,Outpatient,,,70.15,46,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
tacrolimus 5 mg oral capsule [CULL],11205997,LOCAL,J7507,CPT,,,301,RC,,Outpatient,1,EA,71.352,,Aetna Med ADV,Aetna Med ADV,0.2,,,,,,,Fee Schedule,0.197,0.197,
"Gliadin (Deamidated) Ab (IgG, IgA) QSTC",8764748,LOCAL,86258,CPT,,,274,RC,,Outpatient,,,72,14.46,Aetna Med ADV,Aetna Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
HFO (L3929),10393294,LOCAL,,,L3929,HCPCS,301,RC,,Outpatient,,,72,,Aetna Med ADV,Aetna Med ADV,94.67,,,,,,,Fee Schedule,94.67,94.67,
Hemoglobin A1c,1383763,LOCAL,83036,CPT,,,301,RC,,Outpatient,,,72.22,11.65,Aetna Med ADV,Aetna Med ADV,28.6,,,,,,,Fee Schedule,7.16,28.59604426,
"Arsenic, Blood QSTC",13864922,LOCAL,82175,CPT,,,440,RC,,Outpatient,,,72.27,22.76,Aetna Med ADV,Aetna Med ADV,42.26,,,,,,,Fee Schedule,16.07,42.25673077,
97032 ELECTRIC STIM,8478060,LOCAL,97032,CPT,,,440,RC,GN,Outpatient,,,72.32,47,Aetna Med ADV,Aetna Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 ELECTRIC STIM OT,9630084,LOCAL,97032,CPT,,,430,RC,GN,Outpatient,,,72.32,47,Aetna Med ADV,Aetna Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 OT E STIM CON - EA 15MIN CHARGE,9856105,LOCAL,97032,CPT,,,430,RC,GO,Outpatient,,,72.32,47,Aetna Med ADV,Aetna Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 OT Elec Stim Attended Assistant Units,9866105,LOCAL,97032,CPT,,,420,RC,GO|CO,Outpatient,,,72.32,47,Aetna Med ADV,Aetna Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 PT E STIM CON - EA 15MIN CHARGE,9640023,LOCAL,97032,CPT,,,420,RC,GP,Outpatient,,,72.32,47,Aetna Med ADV,Aetna Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 PT Elect Stim Attended Assistant Units,9650023,LOCAL,97032,CPT,,,430,RC,GP|CQ,Outpatient,,,72.32,47,Aetna Med ADV,Aetna Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
Attended E-Stim Charges,1366373,LOCAL,97032,CPT,,,420,RC,GO,Outpatient,,,72.32,47,Aetna Med ADV,Aetna Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
Attended E-Stim Charges,7895926,LOCAL,97032,CPT,,,430,RC,GP,Outpatient,,,72.32,47,Aetna Med ADV,Aetna Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
OT Attended E-Stim Assistant Units,1366373,LOCAL,97032,CPT,,,430,RC,CQ,Outpatient,,,72.32,47,Aetna Med ADV,Aetna Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
OT Attended E-Stim Assistant Units,1373442,LOCAL,97032,CPT,,,430,RC,CQ,Outpatient,,,72.32,47,Aetna Med ADV,Aetna Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
OT Attended E-Stim Charges,1366373,LOCAL,97032,CPT,,,430,RC,GO,Outpatient,,,72.32,47,Aetna Med ADV,Aetna Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
OT Attended E-Stim Units,1373442,LOCAL,97032,CPT,,,420,RC,GO,Outpatient,,,72.32,47,Aetna Med ADV,Aetna Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
PT Attended E-Stim Assistant Units,9396343,LOCAL,97032,CPT,,,470,RC,CQ,Outpatient,,,72.32,47,Aetna Med ADV,Aetna Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
Newborn Hearing Test Type -> Auditory brainstem response,8982858,LOCAL,92700,CPT,,,301,RC,,Outpatient,,,72.72,47,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,22.39,162.41,
"IGF-1, LC/MS QSTC",8764636,LOCAL,84305,CPT,,,311,RC,,Outpatient,,,72.9,25.51,Aetna Med ADV,Aetna Med ADV,46.87,,,,,,,Fee Schedule,18.43,46.87,
"Chlamydia Trachomatis RNA, TMA QST",10578255,LOCAL,87491,CPT,,,311,RC,,Outpatient,,,73.16,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",10578245,LOCAL,87591,CPT,,,311,RC,,Outpatient,,,73.16,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Thinprep Review Cytotechnologist: QST,10590230,LOCAL,88175,CPT,,,,,,Outpatient,,,73.16,31.93,Aetna Med ADV,Aetna Med ADV,26.61,,,,,,,Fee Schedule,25.25,26.61,
pyridoxine 100 mg/mL injectable solution 1 mL [CULL],11212249,LOCAL,J3415,CPT,,,942,RC,,Outpatient,1,ML,73.1904,,Aetna Med ADV,Aetna Med ADV,15.56,,,,,,,Fee Schedule,15.555,15.555,
97803 RE-ASSESSMENT & INTERVENTION CHARGE,8821410,LOCAL,97803,CPT,,,301,RC,,Outpatient,,,73.41,48,Aetna Med ADV,Aetna Med ADV,21.06,,,,,,,Fee Schedule,21.06,287.34,
Amylase Level,631567,LOCAL,82150,CPT,,,305,RC,,Outpatient,,,73.44,7.78,Aetna Med ADV,Aetna Med ADV,1.24,,,,,,,Fee Schedule,1.237209302,7.16,
Prothrombin Time,7904947,LOCAL,85610,CPT,,,305,RC,,Outpatient,,,73.44,5.15,Aetna Med ADV,Aetna Med ADV,2.36,,,,,,,Fee Schedule,2.355196507,5.42,
Prothrombin Time and INR,633793,LOCAL,85610,CPT,,,301,RC,,Outpatient,,,73.44,5.15,Aetna Med ADV,Aetna Med ADV,2.36,,,,,,,Fee Schedule,2.355196507,5.42,
Vancomycin Level,1634895,LOCAL,80202,CPT,,,301,RC,,Outpatient,,,73.44,16.25,Aetna Med ADV,Aetna Med ADV,29.02,,,,,,,Fee Schedule,15.38,29.0215,
Vancomycin Level Peak,1634896,LOCAL,80202,CPT,,,301,RC,,Outpatient,,,73.44,16.25,Aetna Med ADV,Aetna Med ADV,29.02,,,,,,,Fee Schedule,15.38,29.0215,
Vancomycin Level Trough,1634897,LOCAL,80202,CPT,,,430,RC,,Outpatient,,,73.44,16.25,Aetna Med ADV,Aetna Med ADV,29.02,,,,,,,Fee Schedule,15.38,29.0215,
97016 OT VASOPNEUMATIC DEVICE CHARGE,9850019,LOCAL,97016,CPT,,,420,RC,GO,Outpatient,,,73.6,48,Aetna Med ADV,Aetna Med ADV,11.17,,,,,,,Fee Schedule,11.17,47.26,
97016 PT JOBST COMPRESSION CHARGE,9640020,LOCAL,97016,CPT,,,420,RC,GP,Outpatient,,,73.6,48,Aetna Med ADV,Aetna Med ADV,11.17,,,,,,,Fee Schedule,11.17,47.26,
97016 PT VASOPNEUMATIC DEVICE CHARGE,9650020,LOCAL,97016,CPT,,,430,RC,GP|CQ,Outpatient,,,73.6,48,Aetna Med ADV,Aetna Med ADV,11.17,,,,,,,Fee Schedule,11.17,47.26,
OT Vasopneumatic Device Charge,7895255,LOCAL,97016,CPT,,,430,RC,GO,Outpatient,,,73.6,48,Aetna Med ADV,Aetna Med ADV,11.17,,,,,,,Fee Schedule,11.17,47.26,
OT Vasopneumatic Devices Assistant Units,7895255,LOCAL,97016,CPT,,,430,RC,CQ,Outpatient,,,73.6,48,Aetna Med ADV,Aetna Med ADV,11.17,,,,,,,Fee Schedule,11.17,47.26,
OT Vasopneumatic Devices Units,1373553,LOCAL,97016,CPT,,,420,RC,GO,Outpatient,,,73.6,48,Aetna Med ADV,Aetna Med ADV,11.17,,,,,,,Fee Schedule,11.17,47.26,
PT Vasopneumatic Devices Assistant Units,9390396,LOCAL,97016,CPT,,,420,RC,CQ,Outpatient,,,73.6,48,Aetna Med ADV,Aetna Med ADV,11.17,,,,,,,Fee Schedule,11.17,47.26,
Vasopneumatic Device Charge,7895963,LOCAL,97016,CPT,,,301,RC,GP,Outpatient,,,73.6,48,Aetna Med ADV,Aetna Med ADV,11.17,,,,,,,Fee Schedule,11.17,47.26,
Beta hCG Quantitative,633665,LOCAL,84702,CPT,,,300,RC,,Outpatient,,,75,18.06,Aetna Med ADV,Aetna Med ADV,15.05,,,,,,,Fee Schedule,15.05,18.43,
Flu A -Sofia,8267167,LOCAL,87804,CPT,,,300,RC,,Outpatient,,,75,19.86,Aetna Med ADV,Aetna Med ADV,6.42,,,,,,,Fee Schedule,6.419753086,10.57,
Flu B -Sofia,8267168,LOCAL,87804,CPT,,,301,RC,,Outpatient,,,75,19.86,Aetna Med ADV,Aetna Med ADV,6.42,,,,,,,Fee Schedule,6.419753086,10.57,
pH Venous,3454453,LOCAL,82800,CPT,,,301,RC,,Outpatient,,,75,13.2,Aetna Med ADV,Aetna Med ADV,11,,,,,,,Fee Schedule,11,17.73,
"Protein, Total, 24 Hr Ur QSTC",8851917,LOCAL,84156,CPT,,,301,RC,,Outpatient,,,75,4.4,Aetna Med ADV,Aetna Med ADV,11.68,,,,,,,Fee Schedule,7.16,11.68,
SARS-CoV-2 (COVID-19) IgG Ab,9706404,LOCAL,86769,CPT,,,301,RC,,Outpatient,,,75,50.56,Aetna Med ADV,Aetna Med ADV,42.13,,,,,,,Fee Schedule,15.29,42.13,
Total hCG Quantitative,9299894,LOCAL,84702,CPT,,,301,RC,,Outpatient,,,75,18.06,Aetna Med ADV,Aetna Med ADV,15.05,,,,,,,Fee Schedule,15.05,18.43,
pH Pleural Fluid,9631697,LOCAL,83986,CPT,,,,,,Outpatient,,,75.14,4.3,Aetna Med ADV,Aetna Med ADV,18.76,,,,,,,Fee Schedule,7.16,18.755,
terbutaline 1 mg/mL injectable solution 1 mL [CULL],11212324,LOCAL,J3105,CPT,,,301,RC,,Outpatient,1,ML,75.648,,Aetna Med ADV,Aetna Med ADV,2.47,,,,,,,Fee Schedule,2.473,2.473,
Estradiol Lvl,3170319,LOCAL,82670,CPT,,,301,RC,,Outpatient,,,75.89,33.53,Aetna Med ADV,Aetna Med ADV,51.64,,,,,,,Fee Schedule,18.43,51.64,
"Metanephrines, Fraction, LCMSMS,U24 QSTC",8764626,LOCAL,83835,CPT,,,301,RC,,Outpatient,,,75.96,20.33,Aetna Med ADV,Aetna Med ADV,98.31,,,,,,,Fee Schedule,18.43,98.305,
"Mycobacteria Stain, Acid Fast, Fluorochrome QST",12126168,LOCAL,87206,CPT,,,302,RC,,Outpatient,,,76,6.47,Aetna Med ADV,Aetna Med ADV,34.45,,,,,,,Fee Schedule,10.57,34.45384615,
C1 Esterase Inhibitor Protein QST,13870086,LOCAL,86160,CPT,,,302,RC,,Outpatient,,,76.5,14.4,Aetna Med ADV,Aetna Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
Complement Component C4C QST,13870085,LOCAL,86161,CPT,,,301,RC,,Outpatient,,,76.5,14.4,Aetna Med ADV,Aetna Med ADV,12,,,,,,,Fee Schedule,12,15.29,
"Serotonin, Serum QSTC",8853235,LOCAL,84260,CPT,,,301,RC,,Outpatient,,,76.5,37.18,Aetna Med ADV,Aetna Med ADV,30.98,,,,,,,Fee Schedule,18.43,30.98,
.Thyroglobulin QSTC,13864485,LOCAL,84432,CPT,,,,,,Outpatient,,,76.73,19.27,Aetna Med ADV,Aetna Med ADV,46.24,,,,,,,Fee Schedule,18.43,46.235,
dexAMETHasone 4 mg/mL Sol [CULL],11202297,LOCAL,J1100,CPT,,,301,RC,,Outpatient,1,ML,76.9408,,Aetna Med ADV,Aetna Med ADV,10.49,,,,,,,Fee Schedule,10.48743758,10.48743758,
CT PCR,12526323,LOCAL,87491,CPT,,,301,RC,,Outpatient,,,76.95,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
NG PCR,12526324,LOCAL,87591,CPT,,,300,RC,,Outpatient,,,76.95,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Alkaline Phosphatase,1620878,LOCAL,84075,CPT,,,771,RC,,Outpatient,,,77.11,6.22,Aetna Med ADV,Aetna Med ADV,5.18,,,,,,,Fee Schedule,5.18,7.16,
G0008 MC ADMIN INFLUENZA VIRUS VACCINE CHARGE,7923017,LOCAL,,,G0008,HCPCS,771,RC,,Outpatient,,,77.13,50,Aetna Med ADV,Aetna Med ADV,42.18,,,,,,,Fee Schedule,42.18,56.18,
G0009 VACCINE ADMINISTRATION PNEUMONIA,12214659,LOCAL,,,G0009,HCPCS,361,RC,,Outpatient,,,77.13,50,Aetna Med ADV,Aetna Med ADV,42.18,,,,,,,Fee Schedule,42.18,56.18,
64461 THORACIC PARAVERTEBRAL BLOCK,5661020,LOCAL,64461,CPT,,,301,RC,,Outpatient,,,77.31,50,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
"Cryoglobulin (% Cryocrit), Serum QSTC",8764756,LOCAL,82595,CPT,,,306,RC,,Outpatient,,,78.75,7.76,Aetna Med ADV,Aetna Med ADV,6.47,,,,,,,Fee Schedule,6.47,7.16,
Group B Strep Culture,7842541,LOCAL,87070,CPT,,,305,RC,,Outpatient,,,79.56,10.34,Aetna Med ADV,Aetna Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Partial Thromboplastin Time,633794,LOCAL,85730,CPT,,,305,RC,,Outpatient,,,79.56,7.21,Aetna Med ADV,Aetna Med ADV,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
Partial Thromboplastin Time,7904949,LOCAL,85730,CPT,,,306,RC,,Outpatient,,,79.56,7.21,Aetna Med ADV,Aetna Med ADV,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
Strep Confirmation,8019111,LOCAL,87081,CPT,,,370,RC,,Outpatient,,,79.56,7.96,Aetna Med ADV,Aetna Med ADV,37.18,,,,,,,Fee Schedule,10.57,37.17627685,
99152 MOD SED SAME PHYS/QHP 5/>YRS,8653149,LOCAL,99152,CPT,,,,,,Outpatient,,,79.64,52,Aetna Med ADV,Aetna Med ADV,10.38,,,,,,,Fee Schedule,10.38,34.95,
fluconazole 400 mg/200 mL-NaCl 0.9% intravenous solution 200 mL [CULL],11220722,LOCAL,J1450,CPT,,,420,RC,,Outpatient,200,ML,79.9168,,Aetna Med ADV,Aetna Med ADV,4.48,,,,,,,Fee Schedule,4.48,4.48,
20561 DRY NEEDLING 3+ MUSCLES WO INJECTION,9650049,LOCAL,20561,CPT,,,306,RC,,Outpatient,,,80,52,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,22.39,863,
GC Culture,633895,LOCAL,87081,CPT,,,301,RC,,Outpatient,,,80.78,7.96,Aetna Med ADV,Aetna Med ADV,37.18,,,,,,,Fee Schedule,10.57,37.17627685,
Lactate Dehydrogenase,633770,LOCAL,83615,CPT,,,306,RC,,Outpatient,,,80.78,7.25,Aetna Med ADV,Aetna Med ADV,21.68,,,,,,,Fee Schedule,7.16,21.675,
MRSA Screen Culture,8244872,LOCAL,87081,CPT,,,301,RC,,Outpatient,,,80.78,7.96,Aetna Med ADV,Aetna Med ADV,37.18,,,,,,,Fee Schedule,10.57,37.17627685,
Protein Total,633818,LOCAL,84155,CPT,,,302,RC,,Outpatient,,,80.78,4.4,Aetna Med ADV,Aetna Med ADV,3.67,,,,,,,Fee Schedule,3.67,7.16,
"Bill Only ABID Panel, Selected Cell",8629507,LOCAL,86885,CPT,,,301,RC,,Outpatient,,,81,6.86,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,6.29,156.67,
"Chromium, Serum QSTC",9701437,LOCAL,82495,CPT,,,301,RC,,Outpatient,,,81,24.34,Aetna Med ADV,Aetna Med ADV,20.28,,,,,,,Fee Schedule,16.07,20.28,
Levetiracetam QSTC,8764628,LOCAL,80177,CPT,,,311,RC,,Outpatient,,,81,15.9,Aetna Med ADV,Aetna Med ADV,9.4,,,,,,,Fee Schedule,9.399,15.38,
"Chlamydia Trachomatis RNA, TMA QST",10585658,LOCAL,87491,CPT,,,311,RC,,Outpatient,,,82,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
HPV mRNA E6/E7 QST,10585657,LOCAL,87624,CPT,,,311,RC,,Outpatient,,,82,42.11,Aetna Med ADV,Aetna Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
"Neisseria Gonorrhoeae RNA, TMA QST",10585659,LOCAL,87591,CPT,,,311,RC,,Outpatient,,,82,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Thinprep Review Cytotechnologist: QST,10585654,LOCAL,88175,CPT,,,301,RC,,Outpatient,,,82,31.93,Aetna Med ADV,Aetna Med ADV,26.61,,,,,,,Fee Schedule,25.25,26.61,
Testosterone Level Total,3170320,LOCAL,84403,CPT,,,,,,Outpatient,,,82.01,30.97,Aetna Med ADV,Aetna Med ADV,52.38,,,,,,,Fee Schedule,18.43,52.3775,
methadone 10 mg/mL Injectable Sol 20 mL UD [CULL],11240064,LOCAL,J1230,CPT,,,301,RC,,Outpatient,1,ML,82.07808,,Aetna Med ADV,Aetna Med ADV,17.7,,,,,,,Fee Schedule,17.7,17.7,
Malaria/Babesia/Other Blood Parasites QSTC,10707969,LOCAL,87207,CPT,,,302,RC,,Outpatient,,,82.35,7.19,Aetna Med ADV,Aetna Med ADV,5.99,,,,,,,Fee Schedule,5.99,10.57,
H. Pylori CLO,9517164,LOCAL,86677,CPT,,,301,RC,,Outpatient,,,83.23,20.22,Aetna Med ADV,Aetna Med ADV,16.85,,,,,,,Fee Schedule,15.29,16.85,
Phosphorus Level,633803,LOCAL,84100,CPT,,,301,RC,,Outpatient,,,83.23,5.69,Aetna Med ADV,Aetna Med ADV,26.45,,,,,,,Fee Schedule,7.16,26.45123596,
"Estrogen, Total, Serum QSTC",8764701,LOCAL,82672,CPT,,,,,,Outpatient,,,83.25,26.04,Aetna Med ADV,Aetna Med ADV,21.7,,,,,,,Fee Schedule,18.43,21.7,
PHENobarbital 65 mg/mL Sol [CULL],11211087,LOCAL,J2560,CPT,,,440,RC,,Outpatient,1,ML,83.7888,,Aetna Med ADV,Aetna Med ADV,29.08,,,,,,,Fee Schedule,29.077,29.077,
97129 ST COG/ATTEN/MEM/PROD CHARGE,9600117,LOCAL,97129,CPT,,,440,RC,GN,Outpatient,,,84.77,114,Aetna Med ADV,Aetna Med ADV,18.94,,,,,,,Fee Schedule,18.94,56.44,
97130 ST Cognitive skills development each additional 15 minutes,9600118,LOCAL,97130,CPT,,,440,RC,GN,Outpatient,,,84.77,114,Aetna Med ADV,Aetna Med ADV,18.08,,,,,,,Fee Schedule,18.08,56.44,
"SLP Cog Ther Intervent, Addl 15Min Units",9399379,LOCAL,97130,CPT,,,440,RC,GN,Outpatient,,,84.77,114,Aetna Med ADV,Aetna Med ADV,18.08,,,,,,,Fee Schedule,18.08,56.44,
"SLP Cog Ther Intervent,First 15Min Units",9399375,LOCAL,97129,CPT,,,942,RC,GN,Outpatient,,,84.77,114,Aetna Med ADV,Aetna Med ADV,18.94,,,,,,,Fee Schedule,18.94,56.44,
97802 MEDICAL NUTRITIONAL THERAPY CHARGE,13475610,LOCAL,97802,CPT,,,306,RC,,Outpatient,,,84.82,55,Aetna Med ADV,Aetna Med ADV,25.2,,,,,,,Fee Schedule,25.2,287.34,
Minimum Inhibitory Concentration,294946,LOCAL,87186,CPT,,,311,RC,,Outpatient,,,85,10.38,Aetna Med ADV,Aetna Med ADV,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
"HPV mRNA E6/E7, POST-$HYSTERECTOMY, VAGINAL QST",14782713,LOCAL,87624,CPT,,,302,RC,,Outpatient,,,85.05,42.11,Aetna Med ADV,Aetna Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
BB REF LAB RH (D) TYPING,6413256,LOCAL,86901,CPT,,,300,RC,,Outpatient,,,85.5,3.59,Aetna Med ADV,Aetna Med ADV,35.88,,,,,,,Fee Schedule,6.29,35.88,
"Ehrlichia chaffeensis Ab (IgG,IgM) QSTC",8853255,LOCAL,86666,CPT,,,302,RC,,Outpatient,,,85.5,12.22,Aetna Med ADV,Aetna Med ADV,10.18,,,,,,,Fee Schedule,10.18,15.29,
REF ABO/Rh,7939266,LOCAL,86900,CPT,,,301,RC,,Outpatient,,,85.5,3.59,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,6.29,117.85,
Uric Acid,633858,LOCAL,84550,CPT,,,,,,Outpatient,,,85.68,5.42,Aetna Med ADV,Aetna Med ADV,35.18,,,,,,,Fee Schedule,7.16,35.17852564,
cefTRIAXone 500 mg injection [CULL],11202193,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,85.9328,,Aetna Med ADV,Aetna Med ADV,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
chloroprocaine 3% preservative-free Sol [CULL],11202203,LOCAL,J2401,CPT,,,311,RC,,Outpatient,20,ML,85.9392,,Aetna Med ADV,Aetna Med ADV,0.04,,,,,,,Fee Schedule,0.01,0.038,
Chol/HDL C QSTC,14129541,LOCAL,80061,CPT,,,311,RC,,Outpatient,,,86,16.07,Aetna Med ADV,Aetna Med ADV,16.6,,,,,,,Fee Schedule,12.14,16.59934459,
HDL P QSTC,14129559,LOCAL,83704,CPT,,,311,RC,,Outpatient,,,86,41.03,Aetna Med ADV,Aetna Med ADV,34.19,,,,,,,Fee Schedule,34.19,46.74,
HPV mRNA E6/E7 QST,9773934,LOCAL,87624,CPT,,,311,RC,,Outpatient,,,86,42.11,Aetna Med ADV,Aetna Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
HPV mRNA E6/E7 QST,9773934,LOCAL,87624,CPT,,,311,RC,,Outpatient,,,86,42.11,Aetna Med ADV,Aetna Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
HPV mRNA E6/E7 QSTC,9773934,LOCAL,87624,CPT,,,,,,Outpatient,,,86,42.11,Aetna Med ADV,Aetna Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
DOBUTamine 1 mg/mL-D5% Sol [CULL],11201073,LOCAL,J1250,CPT,,,301,RC,,Outpatient,250,ML,86.208,,Aetna Med ADV,Aetna Med ADV,8.02,,,,,,,Fee Schedule,8.024,8.024,
Estrone QSTC,8853208,LOCAL,82679,CPT,,,,,,Outpatient,,,86.4,29.94,Aetna Med ADV,Aetna Med ADV,24.95,,,,,,,Fee Schedule,18.43,24.95,
fosphenytoin 500 mgPE/10 mL injectable solution 10 mL [CULL],11205071,LOCAL,Q2009,CPT,,,,,,Outpatient,10,ML,86.4,,Aetna Med ADV,Aetna Med ADV,1.47,,,,,,,Fee Schedule,1.47,1.47,
methacholine varying strength inhalation solution [CULL],11290186,LOCAL,J7674,CPT,,,301,RC,,Outpatient,3,ML,86.4,,Aetna Med ADV,Aetna Med ADV,1.9,,,,,,,Fee Schedule,1.898,1.898,
Cyanide QSTC,13864508,LOCAL,82600,CPT,,,,,,Outpatient,,,86.45,23.28,Aetna Med ADV,Aetna Med ADV,19.4,,,,,,,Fee Schedule,16.07,19.4,
nitroglycerin 200 mcg/mL-D5% intravenous solution 250 mL [CULL],11211024,LOCAL,J2305,CPT,,,301,RC,,Outpatient,250,ML,86.54666667,,Aetna Med ADV,Aetna Med ADV,1.52,,,,,,,Fee Schedule,1.523,1.523,
Electrolyte Panel,633610,LOCAL,80051,CPT,,,301,RC,,Outpatient,,,86.9,8.41,Aetna Med ADV,Aetna Med ADV,7.01,,,,,,,Fee Schedule,7.01,12.14,
Sodium Level,633611,LOCAL,84295,CPT,,,350,RC,,Outpatient,,,86.9,5.77,Aetna Med ADV,Aetna Med ADV,18.32,,,,,,,Fee Schedule,7.16,18.324,
76377 Requiring image post processing on an independent workstation,10740136,LOCAL,76377,CPT,,,,,,Outpatient,,,87,,Aetna Med ADV,Aetna Med ADV,36.62,,,,,,,Fee Schedule,36.62,36.62,
acetylcysteine 20% inhalation solution 30 mL [CULL],11203022,LOCAL,J7608,CPT,,,301,RC,,Outpatient,30,ML,87.62688,,Aetna Med ADV,Aetna Med ADV,8.46,,,,,,,Fee Schedule,8.455,8.455,
Measles Antibody (IgM) QSTC,8853259,LOCAL,86765,CPT,,,301,RC,,Outpatient,,,87.8,15.46,Aetna Med ADV,Aetna Med ADV,12.88,,,,,,,Fee Schedule,12.88,15.29,
Maize/Corn (F8) IgE QSTC,14116318,LOCAL,86001,CPT,,,420,RC,,Outpatient,,,87.93,9.38,Aetna Med ADV,Aetna Med ADV,7.82,,,,,,,Fee Schedule,7.82,15.29,
97022 FLUIDOTHERAPY CHARGES,9646093,LOCAL,97022,CPT,,,430,RC,GP,Outpatient,,,88.1,57,Aetna Med ADV,Aetna Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
97022 OT WHIRLPOOL - ASEPTIC,9856111,LOCAL,97022,CPT,,,430,RC,GO,Outpatient,,,88.1,57,Aetna Med ADV,Aetna Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
97022 OT WHIRLPOOL 1+ AREAS APPL CHARGE,9866111,LOCAL,97022,CPT,,,420,RC,GO|CO,Outpatient,,,88.1,57,Aetna Med ADV,Aetna Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
97022 PT SMALL WHIRLPOOL CHARGE,9656093,LOCAL,97022,CPT,,,420,RC,GP|CQ,Outpatient,,,88.1,57,Aetna Med ADV,Aetna Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
97022 WHIRLPOOL CHARGE,9410091,LOCAL,97022,CPT,,,430,RC,GP,Outpatient,,,88.1,57,Aetna Med ADV,Aetna Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
OT Whirlpool Therapy Assitant Units,9401114,LOCAL,97022,CPT,,,430,RC,CQ,Outpatient,,,88.1,57,Aetna Med ADV,Aetna Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
OT Whirlpool Units,9401114,LOCAL,97022,CPT,,,430,RC,GO,Outpatient,,,88.1,57,Aetna Med ADV,Aetna Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
"OT Whirlpool, Fluidotherapy Assistant Units",1373554,LOCAL,97022,CPT,,,430,RC,CQ,Outpatient,,,88.1,57,Aetna Med ADV,Aetna Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
"OT Whirlpool, Fluidotherapy Units",1373554,LOCAL,97022,CPT,,,420,RC,GO,Outpatient,,,88.1,57,Aetna Med ADV,Aetna Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
Whirlpool Full Body Charge,7895951,LOCAL,97022,CPT,,,420,RC,GP,Outpatient,,,88.1,57,Aetna Med ADV,Aetna Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
"Whirlpool, 1+ Areas 97022",9640021,LOCAL,97022,CPT,,,301,RC,,Outpatient,,,88.1,57,Aetna Med ADV,Aetna Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
"Factor XI Activity, Clotting QSTC",10358416,LOCAL,85270,CPT,,,370,RC,,Outpatient,,,88.2,21.48,Aetna Med ADV,Aetna Med ADV,17.9,,,,,,,Fee Schedule,5.42,17.9,
99151 MOD SED SAME PHYS/QHP <5 YRS,8653147,LOCAL,99151,CPT,,,301,RC,,Outpatient,,,88.82,58,Aetna Med ADV,Aetna Med ADV,20.19,,,,,,,Fee Schedule,20.19,34.95,
Selenium QSTC,8972757,LOCAL,84255,CPT,,,301,RC,,Outpatient,,,89.6,30.64,Aetna Med ADV,Aetna Med ADV,57.31,,,,,,,Fee Schedule,17.73,57.31,
Theophylline Level,1634886,LOCAL,80198,CPT,,,420,RC,,Outpatient,,,89.76,16.97,Aetna Med ADV,Aetna Med ADV,14.14,,,,,,,Fee Schedule,14.14,15.38,
97552 OT Caregiver Training Group,13649812,LOCAL,97552,CPT,,,420,RC,,Outpatient,,,90,,Aetna Med ADV,Aetna Med ADV,9.04,,,,,,,Fee Schedule,9.04,67.18,
97552 Speech Caregiver Training Group,13767339,LOCAL,97552,CPT,,,301,RC,,Outpatient,,,90,,Aetna Med ADV,Aetna Med ADV,9.04,,,,,,,Fee Schedule,9.04,67.18,
"Beta-2-Glycoprotein I Antibodies (IgG, IgM) QSTC",10094523,LOCAL,86146,CPT,,,302,RC,,Outpatient,,,90,30.54,Aetna Med ADV,Aetna Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
Bill Only ABO,7936964,LOCAL,86900,CPT,,,302,RC,,Outpatient,,,90,3.59,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,6.29,117.85,
Bill Only Rh,7936965,LOCAL,86901,CPT,,,301,RC,,Outpatient,,,90,3.59,Aetna Med ADV,Aetna Med ADV,35.88,,,,,,,Fee Schedule,6.29,35.88,
B-Type Natriuretic Peptide,1383771,LOCAL,83880,CPT,,,420,RC,,Outpatient,,,90,47.11,Aetna Med ADV,Aetna Med ADV,13.36,,,,,,,Fee Schedule,13.36379562,46.74,
"GROUP CAREGIVER TRAINING IN STRATEGIES & TECHNIQUES, FACE TO FACE, INITIAL 30 MIN 97552",13788179,LOCAL,97552,CPT,,,301,RC,,Outpatient,,,90,,Aetna Med ADV,Aetna Med ADV,9.04,,,,,,,Fee Schedule,9.04,67.18,
"Helicobacter pylori Ag, EIA, Stool QSTC",8873559,LOCAL,87338,CPT,,,301,RC,,Outpatient,,,90,17.26,Aetna Med ADV,Aetna Med ADV,14.38,,,,,,,Fee Schedule,10.57,14.38,
Heparin Induced Plt Ab QSTC,8995550,LOCAL,86022,CPT,,,311,RC,,Outpatient,,,90,22.04,Aetna Med ADV,Aetna Med ADV,18.37,,,,,,,Fee Schedule,15.29,18.37,
"HPV Genotypes 16,18/45 QST",9773953,LOCAL,87625,CPT,,,311,RC,,Outpatient,,,90,48.66,Aetna Med ADV,Aetna Med ADV,64.87,,,,,,,Fee Schedule,40.19,64.87,
"HPV GENOTYPES 16,18/45,$POST-HYST, VAGINAL QST",14782712,LOCAL,87625,CPT,,,301,RC,,Outpatient,,,90,48.66,Aetna Med ADV,Aetna Med ADV,64.87,,,,,,,Fee Schedule,40.19,64.87,
N-Terminal Pro B-Type Natriuretic Peptide,1503769,LOCAL,83880,CPT,,,420,RC,,Outpatient,,,90,47.11,Aetna Med ADV,Aetna Med ADV,13.36,,,,,,,Fee Schedule,13.36379562,46.74,
OT Group Caregiver Training Units,13624357,LOCAL,,,G0543,HCPCS,420,RC,,Outpatient,,,90,,Aetna Med ADV,Aetna Med ADV,20.25,,,,,,,Fee Schedule,20.25,67.18,
SLP Group Caregiver Training Time,14466882,LOCAL,,,G0543,HCPCS,301,RC,,Outpatient,,,90,,Aetna Med ADV,Aetna Med ADV,20.25,,,,,,,Fee Schedule,20.25,67.18,
"Tacrolimus, Highly Sens, LC/MS/MS QSTC",8764783,LOCAL,80197,CPT,,,301,RC,,Outpatient,,,90,16.48,Aetna Med ADV,Aetna Med ADV,51.73,,,,,,,Fee Schedule,15.38,51.73,
Topiramate QSTC,8764585,LOCAL,80201,CPT,,,301,RC,,Outpatient,,,90,14.3,Aetna Med ADV,Aetna Med ADV,11.92,,,,,,,Fee Schedule,11.92,15.38,
Vitamin D 25 Hydroxy Level,4240407,LOCAL,82306,CPT,,,918,RC,,Outpatient,,,90,35.52,Aetna Med ADV,Aetna Med ADV,45.2,,,,,,,Fee Schedule,17.73,45.19775253,
NEUROPSYCHOLOGICAL TEST ADMINISTRATION,13472049,LOCAL,96146,CPT,,,301,RC,,Outpatient,,,91.31,59,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,22.39,846.56,
Creatinine Urine,1930782,LOCAL,82570,CPT,,,305,RC,,Outpatient,,,91.8,6.22,Aetna Med ADV,Aetna Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
Fibrinogen Level,633728,LOCAL,85384,CPT,,,302,RC,,Outpatient,,,92.21,11.66,Aetna Med ADV,Aetna Med ADV,9.72,,,,,,,Fee Schedule,5.42,9.72,
Rapid Plasma Reagin,633820,LOCAL,86592,CPT,,,302,RC,,Outpatient,,,92.21,5.12,Aetna Med ADV,Aetna Med ADV,19.99,,,,,,,Fee Schedule,15.29,19.99375,
Rapid Plasma Reagin Qualitative,7948395,LOCAL,86592,CPT,,,302,RC,,Outpatient,,,92.21,5.12,Aetna Med ADV,Aetna Med ADV,19.99,,,,,,,Fee Schedule,15.29,19.99375,
Rapid Plasma Reagin Qualitative w/ Reflex,8166073,LOCAL,86592,CPT,,,302,RC,,Outpatient,,,92.21,5.12,Aetna Med ADV,Aetna Med ADV,19.99,,,,,,,Fee Schedule,15.29,19.99375,
Blood Type ABO/Rh Typing,634326,LOCAL,86900,CPT,,,302,RC,,Outpatient,,,92.71,3.59,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,6.29,117.85,
Cord ABORh,8019069,LOCAL,86900,CPT,,,302,RC,,Outpatient,,,92.71,3.59,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,6.29,117.85,
Neonatal ABORh,8070665,LOCAL,86900,CPT,,,305,RC,,Outpatient,,,92.71,3.59,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,6.29,117.85,
Fetal Screen,634335,LOCAL,85461,CPT,,,,,,Outpatient,,,93.02,11.23,Aetna Med ADV,Aetna Med ADV,9.36,,,,,,,Fee Schedule,8.21,9.36,
methylPREDNISolone sodium succinate 500 mg injection [CULL],11201954,LOCAL,J2919,CPT,,,450,RC,,Outpatient,1,EA,93.2352,,Aetna Med ADV,Aetna Med ADV,0.21,,,,,,,Fee Schedule,0.21,0.21,
99175 IPECAC EMESIS W/OBSERVATION TechFee,8057714,LOCAL,99175,CPT,,,410,RC,,Outpatient,,,93.74,61,Aetna Med ADV,Aetna Med ADV,39.94,,,,,,,Fee Schedule,39.94,983.02,
RT Vapotherm Initial CHARGE,8144190,LOCAL,94002,CPT,,,301,RC,,Outpatient,,,94.68,663,Aetna Med ADV,Aetna Med ADV,604.42,,,,,,,Fee Schedule,604.42,941,
"Coccidioides Antibody, CF & ID, S QSTC",8764815,LOCAL,86635,CPT,,,311,RC,,Outpatient,,,95.18,13.76,Aetna Med ADV,Aetna Med ADV,11.47,,,,,,,Fee Schedule,11.47,15.29,
"Chlamydia Trachomatis RNA, TMA QST",9774353,LOCAL,87491,CPT,,,,,,Outpatient,,,96,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
DAPTOmycin 350 mg intravenous injection [CULL],11210540,LOCAL,J0878,CPT,,,311,RC,,Outpatient,1,EA,96,480,Aetna Med ADV,Aetna Med ADV,0.03,,,,,,,Fee Schedule,0.01,122.4,
"Neisseria Gonorrhoeae RNA, TMA QST",9774354,LOCAL,87591,CPT,,,311,RC,,Outpatient,,,96,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Trichomonas Vaginalis RNA, Ql, TMA QST",9774358,LOCAL,87661,CPT,,,301,RC,,Outpatient,,,96,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Creat Clear,633609,LOCAL,82575,CPT,,,301,RC,,Outpatient,,,96.29,11.35,Aetna Med ADV,Aetna Med ADV,52.79,,,,,,,Fee Schedule,7.16,52.785,
Creat Clear (No U24),8477916,LOCAL,82575,CPT,,,,,,Outpatient,,,96.29,11.35,Aetna Med ADV,Aetna Med ADV,52.79,,,,,,,Fee Schedule,7.16,52.785,
doxycycline 100 mg injection [CULL],11201705,LOCAL,J1271,CPT,,,301,RC,,Outpatient,1,EA,96.64,,Aetna Med ADV,Aetna Med ADV,0.1,,,,,,,Fee Schedule,0.102,0.102,
Aspartate aminotransferase,633633,LOCAL,84450,CPT,,,300,RC,,Outpatient,,,96.7,6.22,Aetna Med ADV,Aetna Med ADV,50.89,,,,,,,Fee Schedule,7.16,50.89,
Blood Urea Nitrogen,633605,LOCAL,84520,CPT,,,302,RC,,Outpatient,,,96.7,4.74,Aetna Med ADV,Aetna Med ADV,26.82,,,,,,,Fee Schedule,7.16,26.82133333,
Mononucleosis Screen,633785,LOCAL,86308,CPT,,,301,RC,,Outpatient,,,96.7,6.22,Aetna Med ADV,Aetna Med ADV,5.18,,,,,,,Fee Schedule,5.18,15.29,
Monospot POCT,9038464,LOCAL,86308,CPT,,,301,RC,,Outpatient,,,96.7,6.22,Aetna Med ADV,Aetna Med ADV,5.18,,,,,,,Fee Schedule,5.18,15.29,
Gentamicin Level,3454415,LOCAL,80170,CPT,,,301,RC,,Outpatient,,,97.1,19.66,Aetna Med ADV,Aetna Med ADV,16.38,,,,,,,Fee Schedule,15.38,16.38,
Gentamicin Level Peak,633736,LOCAL,80170,CPT,,,301,RC,,Outpatient,,,97.1,19.66,Aetna Med ADV,Aetna Med ADV,16.38,,,,,,,Fee Schedule,15.38,16.38,
Gentamicin Level Trough,633737,LOCAL,80170,CPT,,,301,RC,,Outpatient,,,97.1,19.66,Aetna Med ADV,Aetna Med ADV,16.38,,,,,,,Fee Schedule,15.38,16.38,
Gamma Glutamyl Transferase,1628895,LOCAL,82977,CPT,,,301,RC,,Outpatient,,,97.92,8.64,Aetna Med ADV,Aetna Med ADV,52.49,,,,,,,Fee Schedule,7.16,52.49,
Renal Function Panel,1634883,LOCAL,80069,CPT,,,343,RC,,Outpatient,,,97.92,10.42,Aetna Med ADV,Aetna Med ADV,37.66,,,,,,,Fee Schedule,12.14,37.65984615,
CULL NM Therapy I131 Cap Per MCI,13644969,LOCAL,,,A9517,HCPCS,335,RC,,Outpatient,,,98.48,64,Aetna Med ADV,Aetna Med ADV,23.13,,,,,,,Fee Schedule,23.13,662.39,
96423 CHEMO ARTRL INF EA ADDL HR CHARGE,9404493,LOCAL,96423,CPT,,,420,RC,,Outpatient,,,98.94,64,Aetna Med ADV,Aetna Med ADV,42.18,,,,,,,Fee Schedule,42.18,749.76,
90913 - Bfb training ea addl 15 min.,9442436,LOCAL,90913,CPT,,,420,RC,,Outpatient,,,99,64,Aetna Med ADV,Aetna Med ADV,20.19,,,,,,,Fee Schedule,20.19,233.61,
Caregiver Agreement on Discipline,7355021,LOCAL,,,G0543,HCPCS,420,RC,,Outpatient,,,99,,Aetna Med ADV,Aetna Med ADV,20.25,,,,,,,Fee Schedule,20.25,67.18,
Caregiver Agreement on Discipline,7355021,LOCAL,,,G0543,HCPCS,301,RC,,Outpatient,,,99,,Aetna Med ADV,Aetna Med ADV,20.25,,,,,,,Fee Schedule,20.25,67.18,
Cholesterol Total,633705,LOCAL,82465,CPT,,,301,RC,,Outpatient,,,99.14,5.22,Aetna Med ADV,Aetna Med ADV,4.35,,,,,,,Fee Schedule,4.35,7.16,
Progesterone Level,3454459,LOCAL,84144,CPT,,,301,RC,,Outpatient,,,99.14,25.03,Aetna Med ADV,Aetna Med ADV,59.8,,,,,,,Fee Schedule,18.43,59.795,
Triglyceride,633852,LOCAL,84478,CPT,,,301,RC,,Outpatient,,,99.14,6.89,Aetna Med ADV,Aetna Med ADV,52.39,,,,,,,Fee Schedule,7.16,52.385,
"Histoplasma Antibody Panel, CF and ID, Serum QSTC",10185600,LOCAL,86698,CPT,,,,,,Outpatient,,,99.5,16.55,Aetna Med ADV,Aetna Med ADV,13.79,,,,,,,Fee Schedule,13.79,15.29,
"64420 INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVE, SINGLE ProFee",13959631,LOCAL,64420,CPT,,,390,RC,,Outpatient,,,100,693,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
E3581 Thawed Cryo AHF,7267123,LOCAL,,,P9012,HCPCS,311,RC,,Outpatient,,,100,65,Aetna Med ADV,Aetna Med ADV,63.57,,,,,,,Fee Schedule,63.57,217.45,
HPV mRNA E6/E7 QST,9775619,LOCAL,87624,CPT,,,311,RC,,Outpatient,,,100,42.11,Aetna Med ADV,Aetna Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
HPV mRNA E6/E7 QST,10585636,LOCAL,87624,CPT,,,300,RC,,Outpatient,,,100,42.11,Aetna Med ADV,Aetna Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
POC Chem8+ Panel,8920330,LOCAL,80048,CPT,,,311,RC,,Outpatient,,,100,10.15,Aetna Med ADV,Aetna Med ADV,37.17,,,,,,,Fee Schedule,12.14,37.17170492,
Thinprep Review Cytotechnologist: QST,9775616,LOCAL,88175,CPT,,,311,RC,,Outpatient,,,100,31.93,Aetna Med ADV,Aetna Med ADV,26.61,,,,,,,Fee Schedule,25.25,26.61,
Thinprep Review Cytotechnologist: QST,10585633,LOCAL,88175,CPT,,,420,RC,,Outpatient,,,100,31.93,Aetna Med ADV,Aetna Med ADV,26.61,,,,,,,Fee Schedule,25.25,26.61,
97116  SB Pt Gait Train 15 mn,9640030,LOCAL,97116,CPT,,,420,RC,GP,Outpatient,,,100.04,65,Aetna Med ADV,Aetna Med ADV,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
97116 GAIT TRAINING CHARGE,9410151,LOCAL,97116,CPT,,,420,RC,GP,Outpatient,,,100.04,65,Aetna Med ADV,Aetna Med ADV,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
97116 PT Gait Training Assistant Units,9650030,LOCAL,97116,CPT,,,420,RC,GP|CQ,Outpatient,,,100.04,65,Aetna Med ADV,Aetna Med ADV,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
Gait Training Charges,7895941,LOCAL,97116,CPT,,,420,RC,GP,Outpatient,,,100.04,65,Aetna Med ADV,Aetna Med ADV,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
PT Gait Training Assistant Units,9390436,LOCAL,97116,CPT,,,305,RC,CQ,Outpatient,,,100.04,65,Aetna Med ADV,Aetna Med ADV,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
Activated PTT,7938959,LOCAL,85730,CPT,,,301,RC,,Outpatient,,,101.52,7.21,Aetna Med ADV,Aetna Med ADV,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
Bilirubin Direct,4240528,LOCAL,82248,CPT,,,301,RC,,Outpatient,,,101.59,6.02,Aetna Med ADV,Aetna Med ADV,26.63,,,,,,,Fee Schedule,7.16,26.6275,
Bilirubin Direct,7939101,LOCAL,82248,CPT,,,301,RC,,Outpatient,,,101.59,6.02,Aetna Med ADV,Aetna Med ADV,26.63,,,,,,,Fee Schedule,7.16,26.6275,
Bilirubin Direct,8443662,LOCAL,82248,CPT,,,301,RC,,Outpatient,,,101.59,6.02,Aetna Med ADV,Aetna Med ADV,26.63,,,,,,,Fee Schedule,7.16,26.6275,
iSTAT Creatinine POCT,11673045,LOCAL,82565,CPT,,,301,RC,,Outpatient,,,101.59,6.14,Aetna Med ADV,Aetna Med ADV,10.06,,,,,,,Fee Schedule,7.16,10.061625,
Lipid Pnl,633777,LOCAL,80061,CPT,,,,,,Outpatient,,,101.59,16.07,Aetna Med ADV,Aetna Med ADV,16.6,,,,,,,Fee Schedule,12.14,16.59934459,
77062 MG Diagnostic Tomo Charge: AddOn Bilateral,13969682,LOCAL,G0279,CPT,,,403,RC,,Outpatient,,,101.84,,Aetna Med ADV,Aetna Med ADV,11.11,,,,,,,Fee Schedule,11.11,74,
77063 MG Tomo Charge: AddOn Bilateral,13621440,LOCAL,77063,CPT,,,403,RC,,Outpatient,,,101.84,54.45,Aetna Med ADV,Aetna Med ADV,20.75,,,,,,,Fee Schedule,20.75,74,
CULL Mammo Tomo Add On,7867705,LOCAL,77063,CPT,,,,,,Outpatient,,,101.84,54.45,Aetna Med ADV,Aetna Med ADV,20.75,,,,,,,Fee Schedule,20.75,74,
hepatitis B pediatric vaccine 10 mcg/0.5 mL intramuscular suspension 0.5 mL [CULL],11202559,LOCAL,90744,CPT,,,301,RC,,Outpatient,0.5,ML,102.17472,,Aetna Med ADV,Aetna Med ADV,33.2,,,,,,,Fee Schedule,33.204,39.58,
Immunoglobulin G Subclass 1 QSTC,8851875,LOCAL,82787,CPT,,,301,RC,,Outpatient,,,102.38,9.62,Aetna Med ADV,Aetna Med ADV,8.02,,,,,,,Fee Schedule,7.16,8.02,
"Immunoglobulin G, Serum QSTC",8851879,LOCAL,82784,CPT,,,301,RC,,Outpatient,,,102.38,11.16,Aetna Med ADV,Aetna Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
"HVA, 24h Urine w/o Creat QSTC",13864511,LOCAL,83150,CPT,,,360,RC,,Outpatient,,,102.56,26.89,Aetna Med ADV,Aetna Med ADV,22.41,,,,,,,Fee Schedule,18.43,22.41,
CYSTOGRAM INJ,8210035,LOCAL,51600,CPT,,,301,RC,,Outpatient,,,103,246,Aetna Med ADV,Aetna Med ADV,35.39,,,,,,,Fee Schedule,35.39,863,
Therapeutic Phlebotomy,8118276,LOCAL,99195,CPT,,,301,RC,,Outpatient,,,103.04,67,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,85.79,117.85,
Strep A Xpress (GeneXpert),8642789,LOCAL,87651,CPT,,,306,RC,,Outpatient,,,103.5,42.11,Aetna Med ADV,Aetna Med ADV,3.7,,,,,,,Fee Schedule,3.7,40.19,
Cerebrospinal Fluid Culture,4122737,LOCAL,87070,CPT,,,,,,Outpatient,,,103.63,10.34,Aetna Med ADV,Aetna Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
pamidronate 3 mg/mL intravenous solution 10 mL [CULL],11211072,LOCAL,J2430,CPT,,,301,RC,,Outpatient,10,ML,103.68,,Aetna Med ADV,Aetna Med ADV,11.29,,,,,,,Fee Schedule,11.29,11.29,
Coronavirus SARS Ag (Sofia),9803641,LOCAL,87426,CPT,,,301,RC,,Outpatient,,,104,42.4,Aetna Med ADV,Aetna Med ADV,56.41,,,,,,,Fee Schedule,10.57,56.40806897,
COVID-19 Ag,11561110,LOCAL,87426,CPT,,,301,RC,,Outpatient,,,104,42.4,Aetna Med ADV,Aetna Med ADV,56.41,,,,,,,Fee Schedule,10.57,56.40806897,
Urine Drug Screen,3454403,LOCAL,80306,CPT,,,430,RC,,Outpatient,,,104,20.57,Aetna Med ADV,Aetna Med ADV,0.24,,,,,,,Fee Schedule,0.2416,17.73,
97533 PT SENSORY INTEGRATIVE TECH 15MIN,9866109,LOCAL,97533,CPT,,,430,RC,GO|CO,Outpatient,,,104.14,68,Aetna Med ADV,Aetna Med ADV,55.09,,,,,,,Fee Schedule,55.09,56.44,
97533 SENSORY INTEGATIVE TECHNIQUES EACH 15 MINS,9856109,LOCAL,97533,CPT,,,430,RC,GO,Outpatient,,,104.14,68,Aetna Med ADV,Aetna Med ADV,55.09,,,,,,,Fee Schedule,55.09,56.44,
OT Sensory Integrative Tech Assistant Units,7895276,LOCAL,97533,CPT,,,430,RC,CQ,Outpatient,,,104.14,68,Aetna Med ADV,Aetna Med ADV,55.09,,,,,,,Fee Schedule,55.09,56.44,
OT Sensory Integrative Techniques Units,1373568,LOCAL,97533,CPT,,,430,RC,GO,Outpatient,,,104.14,68,Aetna Med ADV,Aetna Med ADV,55.09,,,,,,,Fee Schedule,55.09,56.44,
Sensory Stimulation Charge,7895276,LOCAL,97533,CPT,,,274,RC,GO,Outpatient,,,104.14,68,Aetna Med ADV,Aetna Med ADV,55.09,,,,,,,Fee Schedule,55.09,56.44,
L3908 Clavicle Brace,9800048,LOCAL,,,L3908,HCPCS,274,RC,,Outpatient,,,104.31,86,Aetna Med ADV,Aetna Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
L3908 Wrist/forearm Brace,9800047,LOCAL,,,L3908,HCPCS,311,RC,,Outpatient,,,104.31,86,Aetna Med ADV,Aetna Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
"Chlamydia Trachomatis RNA, TMA QST",14435138,LOCAL,87491,CPT,,,311,RC,,Outpatient,,,105,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
HPV mRNA E6/E7 QST,14435137,LOCAL,87624,CPT,,,311,RC,,Outpatient,,,105,42.11,Aetna Med ADV,Aetna Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
"Neisseria Gonorrhoeae RNA, TMA QST",14435139,LOCAL,87591,CPT,,,311,RC,,Outpatient,,,105,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Thinprep Review Cytotechnologist: QST,14435134,LOCAL,88175,CPT,,,301,RC,,Outpatient,,,105,31.93,Aetna Med ADV,Aetna Med ADV,26.61,,,,,,,Fee Schedule,25.25,26.61,
Iron Level,633765,LOCAL,83540,CPT,,,301,RC,,Outpatient,,,105.26,7.76,Aetna Med ADV,Aetna Med ADV,48.88,,,,,,,Fee Schedule,7.16,48.87820628,
Iron Level,7050169,LOCAL,83540,CPT,,,301,RC,,Outpatient,,,105.26,7.76,Aetna Med ADV,Aetna Med ADV,48.88,,,,,,,Fee Schedule,7.16,48.87820628,
Iron Level,10543519,LOCAL,83540,CPT,,,310,RC,,Outpatient,,,105.26,7.76,Aetna Med ADV,Aetna Med ADV,48.88,,,,,,,Fee Schedule,7.16,48.87820628,
"Vitamin B2 (Riboflavin), P QSTC",8972877,LOCAL,84252,CPT,,,274,RC,,Outpatient,,,106.2,24.29,Aetna Med ADV,Aetna Med ADV,20.24,,,,,,,Fee Schedule,17.73,20.24,
L3908 Daytimer Wrist Support,9800046,LOCAL,,,L3908,HCPCS,420,RC,,Outpatient,,,106.38,86,Aetna Med ADV,Aetna Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
97537 COMMUNITY/WORK REINTEGRATION,9650036,LOCAL,97537,CPT,,,430,RC,GP|CQ,Outpatient,,,107.75,70,Aetna Med ADV,Aetna Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
97537 Community/work reintegration training; each 15 minutes,9860034,LOCAL,97537,CPT,,,430,RC,GO|CO,Outpatient,,,107.75,70,Aetna Med ADV,Aetna Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
97537 OT COMM WORK INTEGRATION CHARGE,9850034,LOCAL,97537,CPT,,,420,RC,GO,Outpatient,,,107.75,70,Aetna Med ADV,Aetna Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
97537 PT ERGONOMIC TRAINING,9640036,LOCAL,97537,CPT,,,430,RC,GP,Outpatient,,,107.75,70,Aetna Med ADV,Aetna Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
Community/Work Reintegration Charges,1366455,LOCAL,97537,CPT,,,430,RC,GO,Outpatient,,,107.75,70,Aetna Med ADV,Aetna Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
"OT Community, Work Reintegration Assistant Units",1366455,LOCAL,97537,CPT,,,430,RC,CQ,Outpatient,,,107.75,70,Aetna Med ADV,Aetna Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
"OT Community, Work Reintegration Assistant Units",1373453,LOCAL,97537,CPT,,,430,RC,CQ,Outpatient,,,107.75,70,Aetna Med ADV,Aetna Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
"OT Community, Work Reintegration Units",1373453,LOCAL,97537,CPT,,,430,RC,GO,Outpatient,,,107.75,70,Aetna Med ADV,Aetna Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
OT Community/Work Reintegration Charges,1366455,LOCAL,97537,CPT,,,420,RC,GO,Outpatient,,,107.75,70,Aetna Med ADV,Aetna Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
"PT Community,Work Reintegration Assistant Units",9390450,LOCAL,97537,CPT,,,420,RC,CQ,Outpatient,,,107.75,70,Aetna Med ADV,Aetna Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
PT Community/Work Reintegration Charge,7895991,LOCAL,97537,CPT,,,301,RC,GP,Outpatient,,,107.75,70,Aetna Med ADV,Aetna Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
AChR Bind Ab w/rfx MuSK Ab QSTC,13864498,LOCAL,86041,CPT,,,301,RC,,Outpatient,,,108,22.08,Aetna Med ADV,Aetna Med ADV,18.4,,,,,,,Fee Schedule,15.29,18.4,
Alpha-1-Antitrypsin QN QSTC,13873077,LOCAL,82103,CPT,,,301,RC,,Outpatient,,,108,16.13,Aetna Med ADV,Aetna Med ADV,60.59,,,,,,,Fee Schedule,17.73,60.59,
Carnitine QSTC,8764784,LOCAL,82379,CPT,,,730,RC,,Outpatient,,,108,20.24,Aetna Med ADV,Aetna Med ADV,16.87,,,,,,,Fee Schedule,16.87,17.73,
EKG Charges - RT -> Routine ECG 12 lead/15 lead tracing only,5367589,LOCAL,93041,CPT,,,420,RC,,Outpatient,,,108.53,71,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,38.53,54.31,
97542  SB PT Wheelchair Mgt,9640037,LOCAL,97542,CPT,,,430,RC,GP,Outpatient,,,108.91,71,Aetna Med ADV,Aetna Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
97542 OT WHEELCHAIR MANAGE/TRAIN 15MIN,9820201,LOCAL,97542,CPT,,,420,RC,GO,Outpatient,,,108.91,71,Aetna Med ADV,Aetna Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
97542 PT WC SEATING EVAL CHARGE,9650037,LOCAL,97542,CPT,,,430,RC,GP|CQ,Outpatient,,,108.91,71,Aetna Med ADV,Aetna Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
"97542 Wheelchair management (eg, assessment, fitting, training), each 15 minutes",9860201,LOCAL,97542,CPT,,,420,RC,GO|CO,Outpatient,,,108.91,71,Aetna Med ADV,Aetna Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
97542 WHEELCHAIR MANAGEMENT CHARGE,9410201,LOCAL,97542,CPT,,,430,RC,GP,Outpatient,,,108.91,71,Aetna Med ADV,Aetna Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
OT Wheelchair Management Assistant Units,7895273,LOCAL,97542,CPT,,,430,RC,CQ,Outpatient,,,108.91,71,Aetna Med ADV,Aetna Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
OT Wheelchair Management Units,1373570,LOCAL,97542,CPT,,,420,RC,GO,Outpatient,,,108.91,71,Aetna Med ADV,Aetna Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
PT Wheelchair Management Assistant Units,9390452,LOCAL,97542,CPT,,,430,RC,CQ,Outpatient,,,108.91,71,Aetna Med ADV,Aetna Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
Wheelchair Charge,7895273,LOCAL,97542,CPT,,,420,RC,GO,Outpatient,,,108.91,71,Aetna Med ADV,Aetna Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
Wheelchair Management Charges,7895931,LOCAL,97542,CPT,,,420,RC,GP,Outpatient,,,108.91,71,Aetna Med ADV,Aetna Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
97551 OT Caregiver Training Ea Add'l 15 Mins,13647370,LOCAL,97551,CPT,,,420,RC,,Outpatient,,,110,,Aetna Med ADV,Aetna Med ADV,20.67,,,,,,,Fee Schedule,20.67,95.93,
97551 PT Caregiver Training Ea Add'l 15 Mins,13645598,LOCAL,97551,CPT,,,420,RC,,Outpatient,,,110,,Aetna Med ADV,Aetna Med ADV,20.67,,,,,,,Fee Schedule,20.67,95.93,
97551 ST Caregiver Training Ea  Addl 15 min,14017194,LOCAL,97551,CPT,,,761,RC,,Outpatient,,,110,,Aetna Med ADV,Aetna Med ADV,20.67,,,,,,,Fee Schedule,20.67,95.93,
Facility Eval and Management Level 1 99211,10633491,LOCAL,99211,CPT,,,761,RC,,Outpatient,,,110,226,Aetna Med ADV,Aetna Med ADV,7.37,,,,,,,Fee Schedule,7.37,7.37,
Medical Day Dressing Change,10633491,LOCAL,99211,CPT,,,420,RC,,Outpatient,,,110,226,Aetna Med ADV,Aetna Med ADV,7.37,,,,,,,Fee Schedule,7.37,7.37,
"OT Caregiver Training, Addl 15 Min Asst",13623455,LOCAL,,,G0542,HCPCS,420,RC,,Outpatient,,,110,,Aetna Med ADV,Aetna Med ADV,25.18,,,,,,,Fee Schedule,25.18,95.93,
"OT Caregiver Training, First 30 Min Asst",13623453,LOCAL,,,G0541,HCPCS,420,RC,,Outpatient,,,110,,Aetna Med ADV,Aetna Med ADV,50.79,,,,,,,Fee Schedule,50.79,95.93,
"SLP Caregiver Training, Addl 15 Min Time",14466886,LOCAL,,,G0542,HCPCS,302,RC,,Outpatient,,,110,,Aetna Med ADV,Aetna Med ADV,25.18,,,,,,,Fee Schedule,25.18,95.93,
% CD19 (B Cells) QSTC,9416397,LOCAL,86355,CPT,,,302,RC,,Outpatient,,,110.25,45.28,Aetna Med ADV,Aetna Med ADV,37.73,,,,,,,Fee Schedule,15.29,37.73,
%CD 16+CD56 (NK Cells) QSTC,9416395,LOCAL,86357,CPT,,,302,RC,,Outpatient,,,110.25,45.28,Aetna Med ADV,Aetna Med ADV,37.73,,,,,,,Fee Schedule,15.29,37.73,
%CD3 Mature T Cells QSTC,9416288,LOCAL,86359,CPT,,,302,RC,,Outpatient,,,110.25,45.28,Aetna Med ADV,Aetna Med ADV,37.73,,,,,,,Fee Schedule,15.29,37.73,
CD4/CD8 Ratio QSTC,8852258,LOCAL,86360,CPT,,,301,RC,,Outpatient,,,110.25,56.38,Aetna Med ADV,Aetna Med ADV,46.98,,,,,,,Fee Schedule,44.29,46.98,
"Parvovirus B19 Antibodies(IgG, IgM) QSTC",8764577,LOCAL,86747,CPT,,,,,,Outpatient,,,110.25,18.04,Aetna Med ADV,Aetna Med ADV,15.03,,,,,,,Fee Schedule,15.03,15.29,
chlorproMAZINE 25 mg/mL injectable solution 1 mL [CULL],11202221,LOCAL,J3230,CPT,,,305,RC,,Outpatient,1,ML,110.9376,,Aetna Med ADV,Aetna Med ADV,23.77,,,,,,,Fee Schedule,23.767,23.767,
CBC w/ Manual Differential,633682,LOCAL,85027,CPT,,,300,RC,,Outpatient,,,111.38,7.76,Aetna Med ADV,Aetna Med ADV,27.03,,,,,,,Fee Schedule,8.21,27.02937879,
CBC without Differential,3798345,LOCAL,85027,CPT,,,,,,Outpatient,,,111.38,7.76,Aetna Med ADV,Aetna Med ADV,27.03,,,,,,,Fee Schedule,8.21,27.02937879,
gentamicin 40 mg/mL injectable solution 20 mL [CULL],11205229,LOCAL,J1580,CPT,,,301,RC,,Outpatient,20,ML,112.2048,,Aetna Med ADV,Aetna Med ADV,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
DNase-B Antibody QSTC,8764548,LOCAL,86215,CPT,,,301,RC,,Outpatient,,,112.5,15.9,Aetna Med ADV,Aetna Med ADV,13.25,,,,,,,Fee Schedule,13.25,15.29,
"Tissue Transglutaminase Ab(IgG,IgA) QSTC",8972930,LOCAL,86364,CPT,,,302,RC,,Outpatient,,,112.5,13.84,Aetna Med ADV,Aetna Med ADV,61.9,,,,,,,Fee Schedule,15.29,61.9,
Cord DAT Gel,8416626,LOCAL,86880,CPT,,,302,RC,,Outpatient,,,112.65,6.47,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,6.29,54.31,
DAT IgG Gel,7906396,LOCAL,86880,CPT,,,302,RC,,Outpatient,,,112.65,6.47,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,6.29,54.31,
Neonatal DAT Gel,13460490,LOCAL,86880,CPT,,,301,RC,,Outpatient,,,112.65,6.47,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,6.29,54.31,
LA Ven - Sepsis 2Hr,8485386,LOCAL,83605,CPT,,,301,RC,,Outpatient,,,113.42,13.88,Aetna Med ADV,Aetna Med ADV,0.9,,,,,,,Fee Schedule,0.901879518,17.73,
Lactic Acid (Venous),3454442,LOCAL,83605,CPT,,,301,RC,,Outpatient,,,113.42,13.88,Aetna Med ADV,Aetna Med ADV,0.9,,,,,,,Fee Schedule,0.901879518,17.73,
Lactic Acid (Venous) - Sepsis,8058058,LOCAL,83605,CPT,,,301,RC,,Outpatient,,,113.42,13.88,Aetna Med ADV,Aetna Med ADV,0.9,,,,,,,Fee Schedule,0.901879518,17.73,
Unstable Hemoglobin QSTC,13864449,LOCAL,83068,CPT,,,420,RC,,Outpatient,,,113.63,11.36,Aetna Med ADV,Aetna Med ADV,9.47,,,,,,,Fee Schedule,7.16,9.47,
97124 MASSAGE CHARGE,9640031,LOCAL,97124,CPT,,,430,RC,GP,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
97124 OT MASSAGE CHARGE,9850029,LOCAL,97124,CPT,,,430,RC,GO,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
97124 OT-MASSAGE EA 15 MIN,9860029,LOCAL,97124,CPT,,,420,RC,GO|CO,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
97124 PT Massage Assistant Units,9650031,LOCAL,97124,CPT,,,430,RC,GP|CQ,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
97140  Manual Therapy 15 min,9850047,LOCAL,97140,CPT,,,420,RC,GO,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,65.85,,,,,,,Fee Schedule,56.44,65.845,
97140 MAN THER EA 15 MIN CHARGES,9640047,LOCAL,97140,CPT,,,430,RC,GP,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,65.85,,,,,,,Fee Schedule,56.44,65.845,
97140 OT Manual Therapy Assistant Units,9860047,LOCAL,97140,CPT,,,420,RC,GO|CO,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,65.85,,,,,,,Fee Schedule,56.44,65.845,
97140 PT Manual Therapy Assistant Units,9650047,LOCAL,97140,CPT,,,420,RC,GP|CQ,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,65.85,,,,,,,Fee Schedule,56.44,65.845,
Manual Therapy Charge Units,7895928,LOCAL,97140,CPT,,,430,RC,GP,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,65.85,,,,,,,Fee Schedule,56.44,65.845,
Manual Traction Charge,7895279,LOCAL,97140,CPT,,,430,RC,GO,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,65.85,,,,,,,Fee Schedule,56.44,65.845,
Massage Charge Units,1041799,LOCAL,97124,CPT,,,420,RC,GO,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
Massage Charge Units,7895954,LOCAL,97124,CPT,,,430,RC,GP,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
OT Manual Therapy Assistant Units,1373444,LOCAL,97140,CPT,,,430,RC,CQ,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,65.85,,,,,,,Fee Schedule,56.44,65.845,
OT Manual Therapy Units,1373444,LOCAL,97140,CPT,,,430,RC,GO,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,65.85,,,,,,,Fee Schedule,56.44,65.845,
OT Massage Assistant Units,1041799,LOCAL,97124,CPT,,,430,RC,CQ,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
OT Massage Charge Units,1041799,LOCAL,97124,CPT,,,430,RC,GO,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
OT Massage Rehab Assist Units,7897698,LOCAL,97124,CPT,,,430,RC,CQ,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
OT Massage Rehab Units,7897698,LOCAL,97124,CPT,,,420,RC,GO,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
PT Manual Therapy Assistant Units,9390440,LOCAL,97140,CPT,,,420,RC,CQ,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,65.85,,,,,,,Fee Schedule,56.44,65.845,
PT Massage Assistant Units,9390438,LOCAL,97124,CPT,,,,,CQ,Outpatient,,,114.56,74,Aetna Med ADV,Aetna Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
methylergonovine 0.2 mg/mL injectable solution 1 mL [CULL],11202918,LOCAL,J2210,CPT,,,311,RC,,Outpatient,1,ML,114.8928,,Aetna Med ADV,Aetna Med ADV,21.36,,,,,,,Fee Schedule,21.363,21.363,
Thinprep TIS Pap QST,9773891,LOCAL,88175,CPT,,,311,RC,,Outpatient,,,115,31.93,Aetna Med ADV,Aetna Med ADV,26.61,,,,,,,Fee Schedule,25.25,26.61,
Thinprep TIS Pap Rfx HPV mRNA E6/E7 QST,9773936,LOCAL,88175,CPT,,,420,RC,,Outpatient,,,115,31.93,Aetna Med ADV,Aetna Med ADV,26.61,,,,,,,Fee Schedule,25.25,26.61,
97033 IONTOPHORESIS CHARGE,9410271,LOCAL,97033,CPT,,,420,RC,GP,Outpatient,,,115.06,75,Aetna Med ADV,Aetna Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
97033 IONTOPHORESIS EA 15 MIN CHARGES,9640077,LOCAL,97033,CPT,,,430,RC,GP,Outpatient,,,115.06,75,Aetna Med ADV,Aetna Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
97033 OT IONTOPHORESIS,9850073,LOCAL,97033,CPT,,,430,RC,GO,Outpatient,,,115.06,75,Aetna Med ADV,Aetna Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
97033 OT IONTOPHORESIS 15 MIN APPL CHARGE,9860073,LOCAL,97033,CPT,,,420,RC,GO|CO,Outpatient,,,115.06,75,Aetna Med ADV,Aetna Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
97033 PT IONTOPHORESIS,9650077,LOCAL,97033,CPT,,,430,RC,GP|CQ,Outpatient,,,115.06,75,Aetna Med ADV,Aetna Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
Iontophoresis Charges,1366374,LOCAL,97033,CPT,,,420,RC,GO,Outpatient,,,115.06,75,Aetna Med ADV,Aetna Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
Iontophoresis Charges,7895927,LOCAL,97033,CPT,,,430,RC,GP,Outpatient,,,115.06,75,Aetna Med ADV,Aetna Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
OT Iontophoresis Assistant Units,1366374,LOCAL,97033,CPT,,,430,RC,CQ,Outpatient,,,115.06,75,Aetna Med ADV,Aetna Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
OT Iontophoresis Assistant Units,1373443,LOCAL,97033,CPT,,,430,RC,CQ,Outpatient,,,115.06,75,Aetna Med ADV,Aetna Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
OT Iontophoresis Charges,1366374,LOCAL,97033,CPT,,,430,RC,GO,Outpatient,,,115.06,75,Aetna Med ADV,Aetna Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
OT Iontophoresis Units,1373443,LOCAL,97033,CPT,,,420,RC,GO,Outpatient,,,115.06,75,Aetna Med ADV,Aetna Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
PT Iontophoresis Assistant Units,9390424,LOCAL,97033,CPT,,,301,RC,CQ,Outpatient,,,115.06,75,Aetna Med ADV,Aetna Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
Allergy Panel13 Stinging Insect Grp QSTC,9063178,LOCAL,86003,CPT,,,302,RC,,Outpatient,,,115.65,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Honey Bee (I1) IgE QST,12866524,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,115.65,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Peanut Component Panel QSTC,8764809,LOCAL,86008,CPT,,,410,RC,,Outpatient,,,115.65,21.52,Aetna Med ADV,Aetna Med ADV,17.93,,,,,,,Fee Schedule,15.29,17.93,
RT CHARGE Chest Physiotherapy -> PEP Therapy Initial,8699752,LOCAL,94668,CPT,,,311,RC,,Outpatient,,,115.89,75,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,76.09,117.85,
"Chlamydia Trachomatis RNA, TMA QST",12762527,LOCAL,87491,CPT,,,312,RC,,Outpatient,,,117,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Mycoplasma Genitalium, rRNA QST",12762530,LOCAL,87563,CPT,,,311,RC,,Outpatient,,,117,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",12762531,LOCAL,87591,CPT,,,311,RC,,Outpatient,,,117,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Trichomonas Vaginalis RNA QST,12762534,LOCAL,87661,CPT,,,301,RC,,Outpatient,,,117,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Ferritin,1628893,LOCAL,82728,CPT,,,420,RC,,Outpatient,,,117.5,16.36,Aetna Med ADV,Aetna Med ADV,50.83,,,,,,,Fee Schedule,17.73,50.82956044,
97750 - Physical performance test or measurement,9640058,LOCAL,97750,CPT,,,420,RC,GP,Outpatient,,,118.17,77,Aetna Med ADV,Aetna Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 FCE-FUNCTIONAL CAPACITY EVAL 1 CHARGE,9640050,LOCAL,97750,CPT,,,430,RC,GP,Outpatient,,,118.17,77,Aetna Med ADV,Aetna Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 OT PERF TEST MEAS 15 MIN CHARGE,9850061,LOCAL,97750,CPT,,,430,RC,GO,Outpatient,,,118.17,77,Aetna Med ADV,Aetna Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 OT Strapping Shoulder Assistant Units,9860061,LOCAL,97750,CPT,,,420,RC,GO|CO,Outpatient,,,118.17,77,Aetna Med ADV,Aetna Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 PRE WORK SCREEN CHARGE,9650058,LOCAL,97750,CPT,,,420,RC,GP|CQ,Outpatient,,,118.17,77,Aetna Med ADV,Aetna Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 PT ISOKINETIC TEST 15 MIN,9640053,LOCAL,97750,CPT,,,420,RC,GP,Outpatient,,,118.17,77,Aetna Med ADV,Aetna Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 PT ISOKINETIC TEST 15 MIN ASST,9650053,LOCAL,97750,CPT,,,420,RC,GP|CQ,Outpatient,,,118.17,77,Aetna Med ADV,Aetna Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 PT PHYSICAL PERFORMANCE TEST CHARGE,9650050,LOCAL,97750,CPT,,,420,RC,GP|CQ,Outpatient,,,118.17,77,Aetna Med ADV,Aetna Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
97761 (PROSTHETIC TRAINING CAWC),9650033,LOCAL,97761,CPT,,,420,RC,GP|CQ,Outpatient,,,118.17,77,Aetna Med ADV,Aetna Med ADV,37.35,,,,,,,Fee Schedule,37.35,56.44,
97761 PROSTHETIC TRAINING 15 MINS,9640033,LOCAL,97761,CPT,,,420,RC,GP,Outpatient,,,118.17,77,Aetna Med ADV,Aetna Med ADV,37.35,,,,,,,Fee Schedule,37.35,56.44,
97761 PT PROSTHETIC TRAINING CHARGE,9410181,LOCAL,97761,CPT,,,420,RC,GP,Outpatient,,,118.17,77,Aetna Med ADV,Aetna Med ADV,37.35,,,,,,,Fee Schedule,37.35,56.44,
Functional Capacity Eval Charge,7895967,LOCAL,97750,CPT,,,430,RC,GP,Outpatient,,,118.17,77,Aetna Med ADV,Aetna Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
OT Physical Performance Test Assistant Units,7895284,LOCAL,97750,CPT,,,430,RC,CQ,Outpatient,,,118.17,77,Aetna Med ADV,Aetna Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
OT Physical Performance Test Charges,7895284,LOCAL,97750,CPT,,,430,RC,GO,Outpatient,,,118.17,77,Aetna Med ADV,Aetna Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
OT Physical Performance Test Units,7897702,LOCAL,97750,CPT,,,420,RC,GO,Outpatient,,,118.17,77,Aetna Med ADV,Aetna Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
Prosthetic Training Charges,7895930,LOCAL,97761,CPT,,,420,RC,GP,Outpatient,,,118.17,77,Aetna Med ADV,Aetna Med ADV,37.35,,,,,,,Fee Schedule,37.35,56.44,
PT Physical Performance Assistant Test,9390432,LOCAL,97750,CPT,,,420,RC,CQ,Outpatient,,,118.17,77,Aetna Med ADV,Aetna Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
PT Physical Performance Test Charges,7895980,LOCAL,97750,CPT,,,420,RC,GP,Outpatient,,,118.17,77,Aetna Med ADV,Aetna Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
"PT Prosthetic Management, Train Assistant Units",9390460,LOCAL,97761,CPT,,,450,RC,CQ,Outpatient,,,118.17,77,Aetna Med ADV,Aetna Med ADV,37.35,,,,,,,Fee Schedule,37.35,56.44,
"29125 Application of short arm splint (forearm to hand); static, right",8584933,LOCAL,29125,CPT,,,311,RC,,Outpatient,,,120,129,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,63.51,863,
"Chlamydia Trachomatis RNA, TMA QST",14747186,LOCAL,87491,CPT,,,301,RC,,Outpatient,,,120,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Cortisol Baseline,7974014,LOCAL,80400,CPT,,,311,RC,,Outpatient,,,120,39.14,Aetna Med ADV,Aetna Med ADV,75.99,,,,,,,Fee Schedule,18.43,75.985,
Cyt Clinical Info QST,14754292,LOCAL,88104,CPT,,,311,RC,,Outpatient,,,120,,Aetna Med ADV,Aetna Med ADV,35.88,,,,,,,Fee Schedule,14.07,35.88,
Cyt Pathologist QST,14754294,LOCAL,88172,CPT,,,311,RC,,Outpatient,,,120,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,58.01,156.67,
Cyt Report Notes QST,14754295,LOCAL,88173,CPT,,,311,RC,,Outpatient,,,120,,Aetna Med ADV,Aetna Med ADV,48.85,,,,,,,Fee Schedule,48.85,53.82,
Cyt Report Type QST,14754291,LOCAL,88121,CPT,,,311,RC,,Outpatient,,,120,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,58.01,156.67,
Cyt Screener QST,14754293,LOCAL,87207,CPT,,,311,RC,,Outpatient,,,120,7.19,Aetna Med ADV,Aetna Med ADV,5.99,,,,,,,Fee Schedule,5.99,10.57,
"Mycoplasma Genitalium, rRNA QST",14747189,LOCAL,87563,CPT,,,311,RC,,Outpatient,,,120,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",14747187,LOCAL,87591,CPT,,,311,RC,,Outpatient,,,120,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Tissue 1A Source QST,14754297,LOCAL,88108,CPT,,,311,RC,,Outpatient,,,120,,Aetna Med ADV,Aetna Med ADV,35.88,,,,,,,Fee Schedule,14.07,35.88,
Tissue 1B Source QST,14754303,LOCAL,88108,CPT,,,311,RC,,Outpatient,,,120,,Aetna Med ADV,Aetna Med ADV,35.88,,,,,,,Fee Schedule,14.07,35.88,
Tissue 1C Source QST,14754321,LOCAL,88108,CPT,,,311,RC,,Outpatient,,,120,,Aetna Med ADV,Aetna Med ADV,35.88,,,,,,,Fee Schedule,14.07,35.88,
Tissue A Clinical Impression QST,14754296,LOCAL,88160,CPT,,,311,RC,,Outpatient,,,120,,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue A Comment QST,14754301,LOCAL,88161,CPT,,,311,RC,,Outpatient,,,120,,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue A Diagnosis QST,14754300,LOCAL,88162,CPT,,,311,RC,,Outpatient,,,120,,Aetna Med ADV,Aetna Med ADV,48.85,,,,,,,Fee Schedule,48.85,58.01,
Tissue A Gross Description QST,14754299,LOCAL,88305,CPT,,,311,RC,,Outpatient,,,120,,Aetna Med ADV,Aetna Med ADV,48.85,,,,,,,Fee Schedule,48.85,59.06,
Tissue B Comment QST,14754307,LOCAL,88161,CPT,,,311,RC,,Outpatient,,,120,,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue B Diagnosis QST,14754306,LOCAL,88162,CPT,,,311,RC,,Outpatient,,,120,,Aetna Med ADV,Aetna Med ADV,48.85,,,,,,,Fee Schedule,48.85,58.01,
Tissue B Gross Description QST,14754305,LOCAL,88305,CPT,,,311,RC,,Outpatient,,,120,,Aetna Med ADV,Aetna Med ADV,48.85,,,,,,,Fee Schedule,48.85,59.06,
Tissue C Clinical Impression QST,14754320,LOCAL,88160,CPT,,,311,RC,,Outpatient,,,120,,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue C Comment QST,14754325,LOCAL,88161,CPT,,,311,RC,,Outpatient,,,120,,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue C Diagnosis QST,14754324,LOCAL,88162,CPT,,,311,RC,,Outpatient,,,120,,Aetna Med ADV,Aetna Med ADV,48.85,,,,,,,Fee Schedule,48.85,58.01,
Tissue C Gross Description QST,14754323,LOCAL,88305,CPT,,,311,RC,,Outpatient,,,120,,Aetna Med ADV,Aetna Med ADV,48.85,,,,,,,Fee Schedule,48.85,59.06,
Trichomonas Vaginalis RNA QST,14747188,LOCAL,87661,CPT,,,,,,Outpatient,,,120,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
naloxone 1 mg/mL injectable solution 2 mL [CULL],11202975,LOCAL,J2312,CPT,,,301,RC,,Outpatient,2,ML,120.384,,Aetna Med ADV,Aetna Med ADV,0.07,,,,,,,Fee Schedule,0.065,0.065,
T. candidus QSTC,9010450,LOCAL,86606,CPT,,,301,RC,,Outpatient,,,120.75,18.06,Aetna Med ADV,Aetna Med ADV,15.05,,,,,,,Fee Schedule,15.05,15.29,
T. vulgaris QSTC,9010456,LOCAL,86609,CPT,,,301,RC,,Outpatient,,,120.75,15.46,Aetna Med ADV,Aetna Med ADV,12.88,,,,,,,Fee Schedule,12.88,15.29,
Trichoderma viride IgG QSTC,9010474,LOCAL,86001,CPT,,,274,RC,,Outpatient,,,120.75,9.38,Aetna Med ADV,Aetna Med ADV,7.82,,,,,,,Fee Schedule,7.82,15.29,
L3925 Fo pip dip jnt/sprng pre ots,9856100,LOCAL,,,L3925,HCPCS,301,RC,,Outpatient,,,121.05,79,Aetna Med ADV,Aetna Med ADV,59.39,,,,,,,Fee Schedule,59.39,59.39,
"Fecal Lipids, Total QSTC",8972795,LOCAL,82710,CPT,,,301,RC,,Outpatient,,,121.19,20.16,Aetna Med ADV,Aetna Med ADV,16.8,,,,,,,Fee Schedule,16.8,17.73,
Oxcarbazepine Metabolite QSTC,8764758,LOCAL,80183,CPT,,,,,,Outpatient,,,121.5,15.9,Aetna Med ADV,Aetna Med ADV,13.25,,,,,,,Fee Schedule,13.25,15.38,
Lactated Ringers Injection 1000 mL [CULL],11281275,LOCAL,J7120,CPT,,,430,RC,,Outpatient,1000,ML,121.6,,Aetna Med ADV,Aetna Med ADV,0.54,,,,,,,Fee Schedule,0.543820225,0.543820225,
97110  SB OT Thera Exer,9850027,LOCAL,97110,CPT,,,420,RC,GO,Outpatient,,,122.28,79,Aetna Med ADV,Aetna Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110  SB PT Thera Exer,9650027,LOCAL,97110,CPT,,,420,RC,GP|CQ,Outpatient,,,122.28,79,Aetna Med ADV,Aetna Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 EXERCISE 1/MORE AREAS CHARGE,9410136,LOCAL,97110,CPT,,,430,RC,GP,Outpatient,,,122.28,79,Aetna Med ADV,Aetna Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 OT Therapeutic Exercise Assistant Units,9860027,LOCAL,97110,CPT,,,420,RC,GO|CO,Outpatient,,,122.28,79,Aetna Med ADV,Aetna Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 PT THERAPEUTIC EXERCISE,9640054,LOCAL,97110,CPT,,,420,RC,GP,Outpatient,,,122.28,79,Aetna Med ADV,Aetna Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 PT Therapeutic Exercise Assistant Units,9650054,LOCAL,97110,CPT,,,420,RC,GP|CQ,Outpatient,,,122.28,79,Aetna Med ADV,Aetna Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 THERAPEUTIC EXER 15 MIN CHARGES,9640027,LOCAL,97110,CPT,,,430,RC,GP,Outpatient,,,122.28,79,Aetna Med ADV,Aetna Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
OT Therapeutic Exercise Assistant Units,750901,LOCAL,97110,CPT,,,430,RC,CQ,Outpatient,,,122.28,79,Aetna Med ADV,Aetna Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
OT Therapeutic Exercise Charges,750901,LOCAL,97110,CPT,,,430,RC,GO,Outpatient,,,122.28,79,Aetna Med ADV,Aetna Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
OT Therapeutic Exercise Rehab Units,7897696,LOCAL,97110,CPT,,,420,RC,GO,Outpatient,,,122.28,79,Aetna Med ADV,Aetna Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
PT Therapeutic Exercise Assistant Units,9390430,LOCAL,97110,CPT,,,430,RC,CQ,Outpatient,,,122.28,79,Aetna Med ADV,Aetna Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
Therapeutic Exercise Charges,750901,LOCAL,97110,CPT,,,420,RC,GO,Outpatient,,,122.28,79,Aetna Med ADV,Aetna Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
Therapeutic Exercise Charges,7895934,LOCAL,97110,CPT,,,301,RC,GP,Outpatient,,,122.28,79,Aetna Med ADV,Aetna Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
Creatine Kinase,633712,LOCAL,82550,CPT,,,306,RC,,Outpatient,,,122.4,7.81,Aetna Med ADV,Aetna Med ADV,23.74,,,,,,,Fee Schedule,7.16,23.7373913,
Genital Culture,633894,LOCAL,87070,CPT,,,306,RC,,Outpatient,,,122.4,10.34,Aetna Med ADV,Aetna Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Respiratory Culture,4123062,LOCAL,87070,CPT,,,306,RC,,Outpatient,,,122.4,10.34,Aetna Med ADV,Aetna Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Sputum Culture,7909553,LOCAL,87070,CPT,,,300,RC,,Outpatient,,,122.4,10.34,Aetna Med ADV,Aetna Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Blood Culture,4122800,LOCAL,87040,CPT,,,300,RC,,Outpatient,,,123.22,12.38,Aetna Med ADV,Aetna Med ADV,19.45,,,,,,,Fee Schedule,10.57,19.45393258,
Blood Unit Culture,7967813,LOCAL,87040,CPT,,,301,RC,,Outpatient,,,123.22,12.38,Aetna Med ADV,Aetna Med ADV,19.45,,,,,,,Fee Schedule,10.57,19.45393258,
Folate Level,1628894,LOCAL,82746,CPT,,,301,RC,,Outpatient,,,123.62,17.64,Aetna Med ADV,Aetna Med ADV,48.81,,,,,,,Fee Schedule,17.73,48.81056075,
Troponin-I,1634892,LOCAL,84484,CPT,,,,,,Outpatient,,,124.52,14.96,Aetna Med ADV,Aetna Med ADV,0.89,,,,,,,Fee Schedule,0.887987013,17.73,
influenza vaccine (Flucelvax PF) vaccine 2025-2026 [CULL],11292050,LOCAL,90661,CPT,,,,,,Outpatient,0.5,ML,124.60032,,Aetna Med ADV,Aetna Med ADV,52.02,,,,,,,Fee Schedule,39.58,52.0225,
methylPREDNISolone 1 g Pow,11201957,LOCAL,J2919,CPT,,,420,RC,,Outpatient,1,EA,124.8,,Aetna Med ADV,Aetna Med ADV,0.21,,,,,,,Fee Schedule,0.21,0.21,
29584 PT APPLICATION OF MULTI-LAYER COMPRESSION SYSTEM,9109668,LOCAL,29584,CPT,,,420,RC,GP,Outpatient,,,125,81,Aetna Med ADV,Aetna Med ADV,144.26,,,,,,,Fee Schedule,63.51,863,
PT MultiLayer Compress Below Knee Charge,7896004,LOCAL,29584,CPT,,,320,RC,GP,Outpatient,,,125,81,Aetna Med ADV,Aetna Med ADV,144.26,,,,,,,Fee Schedule,63.51,863,
XR TMJ Open and Closed Left,9514710,LOCAL,70328,CPT,,,320,RC,LT,Outpatient,,,125,66.83,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR TMJ Open and Closed Right,9514712,LOCAL,70328,CPT,,,301,RC,RT,Outpatient,,,125,66.83,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
Liver Kidney Microsomal LKM1 Ab IgG QSTC,8764790,LOCAL,86376,CPT,,,274,RC,,Outpatient,,,125.19,17.46,Aetna Med ADV,Aetna Med ADV,25.09,,,,,,,Fee Schedule,15.29,25.085,
Medium Cam Walking Boot,9400074,LOCAL,,,L4387,HCPCS,301,RC,,Outpatient,,,125.35,67,Aetna Med ADV,Aetna Med ADV,195.89,,,,,,,Fee Schedule,195.89,195.89,
PTH-Related Protein (PTH-RP) QSTC,8764743,LOCAL,83519,CPT,,,302,RC,,Outpatient,,,126,22.08,Aetna Med ADV,Aetna Med ADV,72.02,,,,,,,Fee Schedule,17.73,72.02,
REF DAT IgG,7939268,LOCAL,86880,CPT,,,302,RC,,Outpatient,,,126,6.47,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,6.29,54.31,
Computer Crossmatch Interp -> Computer XM OK,8142426,LOCAL,86923,CPT,,,302,RC,,Outpatient,,,126.02,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
Serological Immediate Spin -> Compatible,8014366,LOCAL,86920,CPT,,,302,RC,,Outpatient,,,126.02,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
Serological Immediate Spin -> Corrected,10125801,LOCAL,86920,CPT,,,302,RC,,Outpatient,,,126.02,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
Serological Immediate Spin -> Incompatible,9527535,LOCAL,86920,CPT,,,302,RC,,Outpatient,,,126.02,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Gel Interp -> Compatible,8013754,LOCAL,86920,CPT,,,302,RC,,Outpatient,,,126.02,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Gel Interp -> Incompatible,8013753,LOCAL,86920,CPT,,,302,RC,,Outpatient,,,126.02,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Gel Interp -> Least Incompatible,8013752,LOCAL,86920,CPT,,,302,RC,,Outpatient,,,126.02,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Tube Interp -> Compatible,8014220,LOCAL,86920,CPT,,,302,RC,,Outpatient,,,126.02,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Tube Interp -> Incompatible,8014219,LOCAL,86920,CPT,,,302,RC,,Outpatient,,,126.02,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Tube Interp -> Least Incompatible,8014218,LOCAL,86920,CPT,,,301,RC,,Outpatient,,,126.02,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
Alanine aminotransferase,633632,LOCAL,84460,CPT,,,305,RC,,Outpatient,,,126.07,6.36,Aetna Med ADV,Aetna Med ADV,5.3,,,,,,,Fee Schedule,5.3,7.16,
Erythrocyte Sedimentation Rate (ESR),7909828,LOCAL,85652,CPT,,,420,RC,,Outpatient,,,126.07,3.24,Aetna Med ADV,Aetna Med ADV,43.68,,,,,,,Fee Schedule,8.21,43.67975976,
97112 BAL ACT EA 15 MIN CHARGES,9640028,LOCAL,97112,CPT,,,420,RC,GP,Outpatient,,,127.2,83,Aetna Med ADV,Aetna Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
97112 NEUROMUSCULAR RE-EDUCATION CHARGE,9410141,LOCAL,97112,CPT,,,430,RC,GP,Outpatient,,,127.2,83,Aetna Med ADV,Aetna Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
97112 OT NEURO MUSCULAR RE ED EA 15 MIN,9850028,LOCAL,97112,CPT,,,430,RC,GO,Outpatient,,,127.2,83,Aetna Med ADV,Aetna Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
97112 OT Neuromusc Re-education Assistant Units,9860028,LOCAL,97112,CPT,,,420,RC,GO|CO,Outpatient,,,127.2,83,Aetna Med ADV,Aetna Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
97112 PT Neuromuscular Re-Ed Assistant Units,9650028,LOCAL,97112,CPT,,,430,RC,GP|CQ,Outpatient,,,127.2,83,Aetna Med ADV,Aetna Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
Neuromuscular Reeducation Charges,750905,LOCAL,97112,CPT,,,420,RC,GO,Outpatient,,,127.2,83,Aetna Med ADV,Aetna Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
Neuromuscular Reeducation Charges,7895932,LOCAL,97112,CPT,,,430,RC,GP,Outpatient,,,127.2,83,Aetna Med ADV,Aetna Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
OT Neuromuscular Reeducation Assistant Units,750905,LOCAL,97112,CPT,,,430,RC,CQ,Outpatient,,,127.2,83,Aetna Med ADV,Aetna Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
OT Neuromuscular Reeducation Charges,750905,LOCAL,97112,CPT,,,430,RC,GO,Outpatient,,,127.2,83,Aetna Med ADV,Aetna Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
OT Neuromuscular Reeducation Rehab Units,7897697,LOCAL,97112,CPT,,,420,RC,GO,Outpatient,,,127.2,83,Aetna Med ADV,Aetna Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
PT Neuromuscular Reeducation Assistant Units,9390444,LOCAL,97112,CPT,,,306,RC,CQ,Outpatient,,,127.2,83,Aetna Med ADV,Aetna Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
Culture Fungus Smear not Hr Skn Bld QST,10217136,LOCAL,87102,CPT,,,301,RC,,Outpatient,,,127.3,10.09,Aetna Med ADV,Aetna Med ADV,53.14,,,,,,,Fee Schedule,10.57,53.14428571,
Alcohol Level,1503765,LOCAL,,,G0480,HCPCS,305,RC,,Outpatient,,,129.74,84,Aetna Med ADV,Aetna Med ADV,114.43,,,,,,,Fee Schedule,46.74,114.43,
CBC w/ Differential,633683,LOCAL,85025,CPT,,,305,RC,,Outpatient,,,129.74,9.32,Aetna Med ADV,Aetna Med ADV,31.46,,,,,,,Fee Schedule,8.21,31.45666667,
Na Citrate Platelet Count,9472554,LOCAL,85049,CPT,,,305,RC,,Outpatient,,,129.74,5.38,Aetna Med ADV,Aetna Med ADV,33.54,,,,,,,Fee Schedule,8.21,33.535,
Platelet Count,2182297,LOCAL,85049,CPT,,,305,RC,,Outpatient,,,129.74,5.38,Aetna Med ADV,Aetna Med ADV,33.54,,,,,,,Fee Schedule,8.21,33.535,
Platelet Count Manual,7974157,LOCAL,85049,CPT,,,,,,Outpatient,,,129.74,5.38,Aetna Med ADV,Aetna Med ADV,33.54,,,,,,,Fee Schedule,8.21,33.535,
iron dextran 50 mg/mL injectable solution 2 mL [CULL],11205256,LOCAL,J1750,CPT,,,320,RC,,Outpatient,2,ML,129.85728,,Aetna Med ADV,Aetna Med ADV,18.11,,,,,,,Fee Schedule,18.11,122.4,
70030 X-RAY EYE FOR FOREIGN BODY,8658473,LOCAL,70030,CPT,,,320,RC,,Outpatient,,,130,72.6,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Foreign Body Localization Eye,8658473,LOCAL,70030,CPT,,,301,RC,,Outpatient,,,130,72.6,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
TSI(Thyroid Stimulating Immunoglob) QSTC,8764795,LOCAL,84445,CPT,,,300,RC,,Outpatient,,,130.05,61.03,Aetna Med ADV,Aetna Med ADV,89.95,,,,,,,Fee Schedule,47.35,89.95,
Glucose Fasting GTT,8238854,LOCAL,82951,CPT,,,274,RC,,Outpatient,,,130.97,15.44,Aetna Med ADV,Aetna Med ADV,12.87,,,,,,,Fee Schedule,12.87,17.73,
Small Cam Walking Boot,9400073,LOCAL,,,L4387,HCPCS,274,RC,,Outpatient,,,131.56,67,Aetna Med ADV,Aetna Med ADV,195.89,,,,,,,Fee Schedule,195.89,195.89,
L3908 Comfort cool thumb/wrist CMC orthosis,9800210,LOCAL,,,L3908,HCPCS,274,RC,,Outpatient,,,131.58,86,Aetna Med ADV,Aetna Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
L3908 OT WRIST HAND ORTHOSIS,9800211,LOCAL,,,L3908,HCPCS,274,RC,,Outpatient,,,131.58,86,Aetna Med ADV,Aetna Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
Large Cam Walking Boot,9400070,LOCAL,,,L4387,HCPCS,420,RC,,Outpatient,,,131.67,67,Aetna Med ADV,Aetna Med ADV,195.89,,,,,,,Fee Schedule,195.89,195.89,
97535  SB PT Act of Liv 15 m,9640035,LOCAL,97535,CPT,,,430,RC,GP,Outpatient,,,132.09,86,Aetna Med ADV,Aetna Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97535 OT HOME MAKING ACTIVITY CHARGE,9820191,LOCAL,97535,CPT,,,430,RC,GO,Outpatient,,,132.09,86,Aetna Med ADV,Aetna Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97535 OT SELF CARE/HOME MGMT/ADL 15 MIN,9860191,LOCAL,97535,CPT,,,420,RC,GO|CO,Outpatient,,,132.09,86,Aetna Med ADV,Aetna Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97535 PT ADL Training/Self Care Assistant Units,9650035,LOCAL,97535,CPT,,,420,RC,GP|CQ,Outpatient,,,132.09,86,Aetna Med ADV,Aetna Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97535 SELF CARE/HOME MGMT-ADL'S CHARGE,9410191,LOCAL,97535,CPT,,,420,RC,GP,Outpatient,,,132.09,86,Aetna Med ADV,Aetna Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
ADL Training Charge,7895959,LOCAL,97535,CPT,,,430,RC,GP,Outpatient,,,132.09,86,Aetna Med ADV,Aetna Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
ADL Training Charges,1366372,LOCAL,97535,CPT,,,430,RC,GO,Outpatient,,,132.09,86,Aetna Med ADV,Aetna Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
OT ADL Training Charges,1366372,LOCAL,97535,CPT,,,430,RC,GO,Outpatient,,,132.09,86,Aetna Med ADV,Aetna Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
"OT Self Care, Home Management Units",1373569,LOCAL,97535,CPT,,,430,RC,GO,Outpatient,,,132.09,86,Aetna Med ADV,Aetna Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
"OT Self Care, Home Mgmt Assistant Units",1373569,LOCAL,97535,CPT,,,430,RC,CQ,Outpatient,,,132.09,86,Aetna Med ADV,Aetna Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97530  SB OT Thera Act 15,9850032,LOCAL,97530,CPT,,,420,RC,GO,Outpatient,,,133.15,87,Aetna Med ADV,Aetna Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
97530 ACTIVITIES EACH 15 MIN CHARGE,9410270,LOCAL,97530,CPT,,,430,RC,GP,Outpatient,,,133.15,87,Aetna Med ADV,Aetna Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
97530 OT Therapeutic Activities Assistant Units,9860032,LOCAL,97530,CPT,,,420,RC,GO|CO,Outpatient,,,133.15,87,Aetna Med ADV,Aetna Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
97530 PT MAT\BED ACTIVITIES CHARGE,9640034,LOCAL,97530,CPT,,,420,RC,GP,Outpatient,,,133.15,87,Aetna Med ADV,Aetna Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
97530 PT Theraputic Activities Assistant Units,9650034,LOCAL,97530,CPT,,,430,RC,GP|CQ,Outpatient,,,133.15,87,Aetna Med ADV,Aetna Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
OT Therapeutic Activities Assistant Units,750903,LOCAL,97530,CPT,,,430,RC,CQ,Outpatient,,,133.15,87,Aetna Med ADV,Aetna Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
OT Therapeutic Activities Charges,750903,LOCAL,97530,CPT,,,430,RC,GO,Outpatient,,,133.15,87,Aetna Med ADV,Aetna Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
OT Therapeutic Activities Rehab Units,7897699,LOCAL,97530,CPT,,,420,RC,GO,Outpatient,,,133.15,87,Aetna Med ADV,Aetna Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
PT Therapeutic Activity Assistant Units,9390442,LOCAL,97530,CPT,,,420,RC,CQ,Outpatient,,,133.15,87,Aetna Med ADV,Aetna Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
Therapeutic Activities Charge,7895929,LOCAL,97530,CPT,,,430,RC,GP,Outpatient,,,133.15,87,Aetna Med ADV,Aetna Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
Therapeutic Activities Charges,750903,LOCAL,97530,CPT,,,,,GO,Outpatient,,,133.15,87,Aetna Med ADV,Aetna Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
amiodarone 150 mg/100 mL-D5% intravenous solution 100 mL [CULL],11200044,LOCAL,J0283,CPT,,,302,RC,,Outpatient,100,ML,133.2106667,,Aetna Med ADV,Aetna Med ADV,2.53,,,,,,,Fee Schedule,2.529,2.529,
BB CROSSMATCH (AHG),6413027,LOCAL,86922,CPT,,,302,RC,,Outpatient,,,133.82,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
BB CROSSMATCH (XMG INSTRUMENT),6413070,LOCAL,86922,CPT,,,306,RC,,Outpatient,,,133.82,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
Urine Culture,4126493,LOCAL,87086,CPT,,,305,RC,,Outpatient,,,134.64,9.68,Aetna Med ADV,Aetna Med ADV,31.43,,,,,,,Fee Schedule,10.57,31.43235995,
.dRVVT 1:1 Mix QSTC,6230328,LOCAL,85613,CPT,,,301,RC,,Outpatient,,,135,11.5,Aetna Med ADV,Aetna Med ADV,9.58,,,,,,,Fee Schedule,5.42,9.58,
Glomerular Basement Memb. Ab (IgG) QSTC,8853257,LOCAL,83520,CPT,,,301,RC,,Outpatient,,,135,20.72,Aetna Med ADV,Aetna Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Glutamic Acid Decarboxylase-65 Ab QSTC,8764746,LOCAL,86341,CPT,,,301,RC,,Outpatient,,,135,28.28,Aetna Med ADV,Aetna Med ADV,23.57,,,,,,,Fee Schedule,15.29,23.57,
Quad Screen QSTC,8972927,LOCAL,81511,CPT,,,301,RC,,Outpatient,,,135,184.2,Aetna Med ADV,Aetna Med ADV,153.5,,,,,,,Fee Schedule,153.5,173.68,
Ribosomal P Antibody QSTC,8853260,LOCAL,83516,CPT,,,301,RC,,Outpatient,,,135,13.84,Aetna Med ADV,Aetna Med ADV,11.53,,,,,,,Fee Schedule,11.53,17.73,
"Rickettsia RMSF IgG,IgM w rfx Titer QSTC",8764764,LOCAL,86757,CPT,,,301,RC,,Outpatient,,,135,23.22,Aetna Med ADV,Aetna Med ADV,19.35,,,,,,,Fee Schedule,15.29,19.35,
Tryptase QSTC,8764744,LOCAL,83520,CPT,,,260,RC,,Outpatient,,,135,20.72,Aetna Med ADV,Aetna Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
96523 Port Flush,14892040,LOCAL,96523,CPT,,,,,59,Outpatient,,,136,153,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,54.31,64.56,
OLANZapine 10 mg VL [CULL],11240752,LOCAL,J2358,CPT,,,301,RC,,Outpatient,1,EA,136.096,,Aetna Med ADV,Aetna Med ADV,2.92,,,,,,,Fee Schedule,2.92,2.92,
.Endomysial Ab Titer QSTC,8853243,LOCAL,86231,CPT,,,301,RC,,Outpatient,,,136.17,14.51,Aetna Med ADV,Aetna Med ADV,106.94,,,,,,,Fee Schedule,15.29,106.935,
Endomysial (IgG) Antibody Screen and Titer QSTC,10146198,LOCAL,86231,CPT,,,274,RC,,Outpatient,,,136.17,14.51,Aetna Med ADV,Aetna Med ADV,106.94,,,,,,,Fee Schedule,15.29,106.935,
L3808 OT SPLINT - DORSAL HAND SPLINT CHARGE,9856068,LOCAL,,,L3808,HCPCS,274,RC,,Outpatient,,,137.3,89,Aetna Med ADV,Aetna Med ADV,375.59,,,,,,,Fee Schedule,375.59,375.59,
"L3808 WHFO, RIGID W/O JOINTS CHARGE",9856097,LOCAL,,,L3808,HCPCS,450,RC,,Outpatient,,,137.3,89,Aetna Med ADV,Aetna Med ADV,375.59,,,,,,,Fee Schedule,375.59,375.59,
"96361- Hydration, each additional hour",1928298,LOCAL,96361,CPT,,,260,RC,,Outpatient,,,137.66,89,Aetna Med ADV,Aetna Med ADV,42.18,,,,,,,Fee Schedule,42.18,749.76,
96361 IV INFUSION HYDRATION ADDL HR Charge,8049102,LOCAL,96361,CPT,,,771,RC,,Outpatient,,,137.66,89,Aetna Med ADV,Aetna Med ADV,42.18,,,,,,,Fee Schedule,42.18,749.76,
90472 PO IMMUNIZATION ADM EA ADDTL VAC CHARGE,9279753,LOCAL,90472,CPT,,,301,RC,,Outpatient,,,137.77,90,Aetna Med ADV,Aetna Med ADV,14.55,,,,,,,Fee Schedule,14.55,56.18,
Phenytoin Lvl Total,7973985,LOCAL,80185,CPT,,,,,,Outpatient,,,138,15.9,Aetna Med ADV,Aetna Med ADV,75.5,,,,,,,Fee Schedule,15.38,75.495,
aztreonam 1 g injection [CULL],11201222,LOCAL,J0457,CPT,,,301,RC,,Outpatient,1,EA,138.5472,,Aetna Med ADV,Aetna Med ADV,2.23,,,,,,,Fee Schedule,2.233,2.233,
"Allergy Panel 19, Seafood QSTC",13864480,LOCAL,86003,CPT,,,309,RC,,Outpatient,,,138.78,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Crystal Examination Body Fluid,3454316,LOCAL,89060,CPT,,,,,,Outpatient,,,139,8.8,Aetna Med ADV,Aetna Med ADV,21.53,,,,,,,Fee Schedule,14.07,21.53,
Bill Cyto Path Cell Enhance Tech,8489561,LOCAL,88112,CPT,,,311,RC,,Outpatient,,,139.94,,Aetna Med ADV,Aetna Med ADV,48.85,,,,,,,Fee Schedule,42.2,48.85,
Bill FNA Eval Interp & Rpt,8489566,LOCAL,88173,CPT,,,,,,Outpatient,,,139.94,,Aetna Med ADV,Aetna Med ADV,48.85,,,,,,,Fee Schedule,48.85,53.82,
Bill IHC Antibody Additional,14048006,LOCAL,88341,CPT,,,,,,Outpatient,,,139.94,,Aetna Med ADV,Aetna Med ADV,59.04,,,,,,,Fee Schedule,59.04,59.06,
Bill Tissue Exam Level 3,14047998,LOCAL,88304,CPT,,,,,,Outpatient,,,139.94,,Aetna Med ADV,Aetna Med ADV,48.85,,,,,,,Fee Schedule,32.32,48.85,
Bill Tissue Exam Level 4,14036169,LOCAL,88305,CPT,,,320,RC,,Outpatient,,,139.94,,Aetna Med ADV,Aetna Med ADV,48.85,,,,,,,Fee Schedule,48.85,59.06,
70250 X-RAY EXAM OF SKULL,8658523,LOCAL,70250,CPT,,,,,,Outpatient,,,140,286.28,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
hepatitis A pediatric vaccine 25 units/0.5 mL intramuscular suspension 0.5 mL [CULL],11202555,LOCAL,90632,CPT,,,,,,Outpatient,0.5,ML,140.288,,Aetna Med ADV,Aetna Med ADV,73.54,,,,,,,Fee Schedule,39.58,73.542,
medroxyPROGESTERone 150 mg/mL intramuscular suspension 1 mL [CULL],11204480,LOCAL,J1050,CPT,,,302,RC,,Outpatient,1,ML,140.704,,Aetna Med ADV,Aetna Med ADV,50.14,,,,,,,Fee Schedule,50.14,50.14,
"West Nile Ab IgG, CSF QSTC",13872975,LOCAL,86789,CPT,,,302,RC,,Outpatient,,,141.3,17.27,Aetna Med ADV,Aetna Med ADV,14.39,,,,,,,Fee Schedule,14.39,15.29,
"West Nile Ab IgG, Serum QSTC",9010233,LOCAL,86789,CPT,,,302,RC,,Outpatient,,,141.3,17.27,Aetna Med ADV,Aetna Med ADV,14.39,,,,,,,Fee Schedule,14.39,15.29,
"West Nile Ab IgM, CSF QSTC",13872978,LOCAL,86788,CPT,,,302,RC,,Outpatient,,,141.3,20.22,Aetna Med ADV,Aetna Med ADV,16.85,,,,,,,Fee Schedule,15.29,16.85,
"West Nile Ab IgM, Serum QSTC",9010236,LOCAL,86788,CPT,,,311,RC,,Outpatient,,,141.3,20.22,Aetna Med ADV,Aetna Med ADV,16.85,,,,,,,Fee Schedule,15.29,16.85,
"Chlamydia Trachomatis RNA, TMA QST",14718353,LOCAL,87491,CPT,,,311,RC,,Outpatient,,,142,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
HPV MRNA E6/E7 QSTA,14718356,LOCAL,87624,CPT,,,311,RC,,Outpatient,,,142,42.11,Aetna Med ADV,Aetna Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
Thinprep Review Cytotechnologist: QST,14718368,LOCAL,88175,CPT,,,311,RC,,Outpatient,,,142,31.93,Aetna Med ADV,Aetna Med ADV,26.61,,,,,,,Fee Schedule,25.25,26.61,
"Trichomonas vaginalis, Ql TMA, Pap QST",14718355,LOCAL,87661,CPT,,,301,RC,,Outpatient,,,142,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Cardio IQ(R) Lipoprotein Fraction, Ion Mobility QSTC",9039426,LOCAL,83704,CPT,,,301,RC,,Outpatient,,,142.38,41.03,Aetna Med ADV,Aetna Med ADV,34.19,,,,,,,Fee Schedule,34.19,46.74,
Parathyroid Hormone Intact,3455483,LOCAL,83970,CPT,,,301,RC,,Outpatient,,,143,49.54,Aetna Med ADV,Aetna Med ADV,92.84,,,,,,,Fee Schedule,47.35,92.84111111,
"Factor VIII Activity, Clotting QSTC",9039263,LOCAL,85240,CPT,,,301,RC,,Outpatient,,,144,21.48,Aetna Med ADV,Aetna Med ADV,17.9,,,,,,,Fee Schedule,5.42,17.9,
"Sirolimus, LC/MS/MS QSTC",8764819,LOCAL,80195,CPT,,,420,RC,,Outpatient,,,144,16.48,Aetna Med ADV,Aetna Med ADV,13.73,,,,,,,Fee Schedule,13.73,15.38,
97760 ORTHOTICS FIT/TRAIN EA 15MN CHARGE,9410176,LOCAL,97760,CPT,,,430,RC,GP,Outpatient,,,144.44,94,Aetna Med ADV,Aetna Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
97760 ORTHOTICS FITTING & TRAINING CHARGE,9850030,LOCAL,97760,CPT,,,430,RC,GO,Outpatient,,,144.44,94,Aetna Med ADV,Aetna Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
97760 OT Orthotic Mgmt/Train Initial Charge Assistant Units,9860030,LOCAL,97760,CPT,,,420,RC,GO|CO,Outpatient,,,144.44,94,Aetna Med ADV,Aetna Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
97760 PO ORTHOTIC EVALUATION CHARGE,9640032,LOCAL,97760,CPT,,,420,RC,GP,Outpatient,,,144.44,94,Aetna Med ADV,Aetna Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
97760 PO ORTHOTIC FOLLOW UP CHARGE,9650032,LOCAL,97760,CPT,,,430,RC,GP|CQ,Outpatient,,,144.44,94,Aetna Med ADV,Aetna Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
Orthotic Mgmt and Training Charges,7895275,LOCAL,97760,CPT,,,420,RC,GO,Outpatient,,,144.44,94,Aetna Med ADV,Aetna Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
Orthotic Mgmt and Training Charges,7895953,LOCAL,97760,CPT,,,430,RC,GP,Outpatient,,,144.44,94,Aetna Med ADV,Aetna Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
"OT Orthotic Management, Train Assistant Units",1373573,LOCAL,97760,CPT,,,430,RC,CQ,Outpatient,,,144.44,94,Aetna Med ADV,Aetna Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
"OT Orthotic Management, Train Units",1373573,LOCAL,97760,CPT,,,420,RC,GO,Outpatient,,,144.44,94,Aetna Med ADV,Aetna Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
"PT Orthotic Management, Train Assistant Units",9390458,LOCAL,97760,CPT,,,450,RC,CQ,Outpatient,,,144.44,94,Aetna Med ADV,Aetna Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
Urinary Catheter Type:; -> Straight/Intermittent,4610954,LOCAL,51701,CPT,,,480,RC,,Outpatient,,,144.74,94,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,105.27,863,
EVENT MONITOR RECORDING ONLY,8200120,LOCAL,93270,CPT,,,,,,Outpatient,,,145.04,94,Aetna Med ADV,Aetna Med ADV,34.09,,,,,,,Fee Schedule,34.09,99.86,
desmopressin 4 mcg/mL injectable solution 1 mL [CULL],11201582,LOCAL,J2597,CPT,,,302,RC,,Outpatient,1,ML,145.92,,Aetna Med ADV,Aetna Med ADV,3.52,,,,,,,Fee Schedule,3.52,233.26,
% CD3 (Mature T Cells) QSTC,13873423,LOCAL,86359,CPT,,,302,RC,,Outpatient,,,146.25,45.28,Aetna Med ADV,Aetna Med ADV,37.73,,,,,,,Fee Schedule,15.29,37.73,
CD4/CD8 Ratio QSTC,13873439,LOCAL,86360,CPT,,,301,RC,,Outpatient,,,146.25,56.38,Aetna Med ADV,Aetna Med ADV,46.98,,,,,,,Fee Schedule,44.29,46.98,
Beta hCG Qualitative,633663,LOCAL,84703,CPT,,,301,RC,,Outpatient,,,146.88,9.02,Aetna Med ADV,Aetna Med ADV,7.52,,,,,,,Fee Schedule,7.16,7.52,
Serum Pregnancy Qual POCT,10461706,LOCAL,84703,CPT,,,301,RC,,Outpatient,,,146.88,9.02,Aetna Med ADV,Aetna Med ADV,7.52,,,,,,,Fee Schedule,7.16,7.52,
Serum Pregnancy Test Qualitative,7909775,LOCAL,84703,CPT,,,301,RC,,Outpatient,,,146.88,9.02,Aetna Med ADV,Aetna Med ADV,7.52,,,,,,,Fee Schedule,7.16,7.52,
Serum Pregnancy Test Qualitative w/ Reflex,9384303,LOCAL,84703,CPT,,,301,RC,,Outpatient,,,146.88,9.02,Aetna Med ADV,Aetna Med ADV,7.52,,,,,,,Fee Schedule,7.16,7.52,
Urine Pregnancy POCT,8373784,LOCAL,81025,CPT,,,301,RC,,Outpatient,,,146.88,10.33,Aetna Med ADV,Aetna Med ADV,13.38,,,,,,,Fee Schedule,4.02,13.375,
Urine Pregnancy Test Qualitative,7909798,LOCAL,81025,CPT,,,,,,Outpatient,,,146.88,10.33,Aetna Med ADV,Aetna Med ADV,13.38,,,,,,,Fee Schedule,4.02,13.375,
cefTRIAXone 1 g injection [CULL],11201426,LOCAL,J0696,CPT,,,301,RC,,Outpatient,1,EA,147.0368,,Aetna Med ADV,Aetna Med ADV,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
"IgA, Serum QSTC",13873298,LOCAL,82787,CPT,,,301,RC,,Outpatient,,,147.38,9.62,Aetna Med ADV,Aetna Med ADV,8.02,,,,,,,Fee Schedule,7.16,8.02,
IgA1 QSTC,13873292,LOCAL,82784,CPT,,,301,RC,,Outpatient,,,147.38,11.16,Aetna Med ADV,Aetna Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
Tobramycin Level,1634888,LOCAL,80200,CPT,,,410,RC,,Outpatient,,,148.1,19.36,Aetna Med ADV,Aetna Med ADV,16.13,,,,,,,Fee Schedule,15.38,16.13,
Blood Gas Arterial RT,8172944,LOCAL,36600,CPT,,,410,RC,,Outpatient,,,148.2,96,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,85.79,863,
Blood Gas Draw Type -> Arterial (Puncture),5230102,LOCAL,36600,CPT,,,410,RC,,Outpatient,,,148.2,96,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,85.79,863,
RT Arterial Puncture CHARGE,8143881,LOCAL,36600,CPT,,,460,RC,,Outpatient,,,148.2,96,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,85.79,863,
"RT CHARGE PFT -> Maximum breathing capacity, Maximal voluntary ventilation (M",5267133,LOCAL,94200,CPT,,,320,RC,,Outpatient,,,148.2,96,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,54.31,76.09,
XR TMJ Open and Closed Bilateral,1170502,LOCAL,70330,CPT,,,301,RC,,Outpatient,,,150,80.85,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
Diphtheria Antitoxoid QSTC,14129477,LOCAL,86648,CPT,,,301,RC,,Outpatient,,,151,18.25,Aetna Med ADV,Aetna Med ADV,15.21,,,,,,,Fee Schedule,15.21,15.29,
Tetanus Antitoxoid QSTC,14129478,LOCAL,86774,CPT,,,301,RC,,Outpatient,,,151,17.76,Aetna Med ADV,Aetna Med ADV,14.8,,,,,,,Fee Schedule,14.8,15.29,
Hepatic Function Panel,633744,LOCAL,80076,CPT,,,301,RC,,Outpatient,,,151.78,9.8,Aetna Med ADV,Aetna Med ADV,58.59,,,,,,,Fee Schedule,12.14,58.58814815,
Hepatic Panel,633744,LOCAL,80076,CPT,,,301,RC,,Outpatient,,,151.78,9.8,Aetna Med ADV,Aetna Med ADV,58.59,,,,,,,Fee Schedule,12.14,58.58814815,
Dihydrotestosterone QSTC,8853275,LOCAL,82642,CPT,,,360,RC,,Outpatient,,,151.88,35.14,Aetna Med ADV,Aetna Med ADV,29.28,,,,,,,Fee Schedule,18.43,29.28,
36430 BLOOD TRANSFUSION CHARGE,9284603,LOCAL,36430,CPT,,,391,RC,,Outpatient,,,151.98,99,Aetna Med ADV,Aetna Med ADV,399.7,,,,,,,Fee Schedule,399.7,863,
BLOOD ADMINISTRATION Charge,5240125,LOCAL,36430,CPT,,,440,RC,,Outpatient,,,151.98,99,Aetna Med ADV,Aetna Med ADV,399.7,,,,,,,Fee Schedule,399.7,863,
92608 ST EX FOR SPEECH DEVICE RX EACH 30 MIN ADDL TIM,9636007,LOCAL,92608,CPT,,,440,RC,GN,Outpatient,,,152.72,99,Aetna Med ADV,Aetna Med ADV,44.72,,,,,,,Fee Schedule,44.72,337.75,
SLP Speech AAC Eval Addl Half Hour Units,1373854,LOCAL,92608,CPT,,,440,RC,GN,Outpatient,,,152.72,99,Aetna Med ADV,Aetna Med ADV,44.72,,,,,,,Fee Schedule,44.72,337.75,
Speech Generating Device Eval Additional 30 Min,1373854,LOCAL,92608,CPT,,,302,RC,GN,Outpatient,,,152.72,99,Aetna Med ADV,Aetna Med ADV,44.72,,,,,,,Fee Schedule,44.72,337.75,
Bill Only REF Splitting,13514968,LOCAL,86985,CPT,,,301,RC,,Outpatient,,,153,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.88,156.67,
"Quantiferon(R)-TB Gold Plus, 1 Tube QST",9384402,LOCAL,86480,CPT,,,300,RC,,Outpatient,,,153,74.38,Aetna Med ADV,Aetna Med ADV,65.24,,,,,,,Fee Schedule,44.29,65.24390244,
"Quantiferon(R)-TB Gold Plus, 1 Tube QSTC",8983765,LOCAL,86480,CPT,,,420,RC,,Outpatient,,,153,74.38,Aetna Med ADV,Aetna Med ADV,65.24,,,,,,,Fee Schedule,44.29,65.24390244,
97113 AQUATIC THERAPY 15 MINS,9650029,LOCAL,97113,CPT,,,430,RC,GP|CQ,Outpatient,,,153.55,100,Aetna Med ADV,Aetna Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
97113 AQUATIC THERAPY 15 MINS OT,9860051,LOCAL,97113,CPT,,,430,RC,GO|CO,Outpatient,,,153.55,100,Aetna Med ADV,Aetna Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
97113 Occupational Therapy Aquatic charge,9850051,LOCAL,97113,CPT,,,420,RC,GO,Outpatient,,,153.55,100,Aetna Med ADV,Aetna Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
97113 OT AQUATIC THERAPY CHARGE,9640029,LOCAL,97113,CPT,,,430,RC,GP,Outpatient,,,153.55,100,Aetna Med ADV,Aetna Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
Aquatic Charge,7895272,LOCAL,97113,CPT,,,420,RC,GO,Outpatient,,,153.55,100,Aetna Med ADV,Aetna Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
Aquatic Therapy Charges,7895958,LOCAL,97113,CPT,,,430,RC,GP,Outpatient,,,153.55,100,Aetna Med ADV,Aetna Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
OT Aquatic Exercise Assistant Units,7895272,LOCAL,97113,CPT,,,430,RC,CQ,Outpatient,,,153.55,100,Aetna Med ADV,Aetna Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
OT Aquatic Exercise Assistant Units,7898597,LOCAL,97113,CPT,,,430,RC,CQ,Outpatient,,,153.55,100,Aetna Med ADV,Aetna Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
OT Aquatic Exercise Units,7897709,LOCAL,97113,CPT,,,430,RC,GO,Outpatient,,,153.55,100,Aetna Med ADV,Aetna Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
OT Aquatic Exercise Units,7898597,LOCAL,97113,CPT,,,420,RC,GO,Outpatient,,,153.55,100,Aetna Med ADV,Aetna Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
PT Aquatic Assistant Units,9390434,LOCAL,97113,CPT,,,460,RC,CQ,Outpatient,,,153.55,100,Aetna Med ADV,Aetna Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
G0237 PULM REHAB EA 15 MIN,10470027,LOCAL,,,G0237,HCPCS,460,RC,59,Outpatient,,,154.78,101,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,22.39,51.98,
G0239 PULMONARY EXERCISE,10470025,LOCAL,,,G0239,HCPCS,311,RC,,Outpatient,,,154.78,101,Aetna Med ADV,Aetna Med ADV,35.88,,,,,,,Fee Schedule,35.88,51.98,
Calcium Oxalate QSTC,8997193,LOCAL,82340,CPT,,,311,RC,,Outpatient,,,155,7.24,Aetna Med ADV,Aetna Med ADV,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
Sodium Urate QSTC,8997195,LOCAL,84300,CPT,,,311,RC,,Outpatient,,,155,6.07,Aetna Med ADV,Aetna Med ADV,9.74,,,,,,,Fee Schedule,7.16,9.74,
Uric Acid QSTC,8997197,LOCAL,84560,CPT,,,301,RC,,Outpatient,,,155,6.1,Aetna Med ADV,Aetna Med ADV,19.49,,,,,,,Fee Schedule,7.16,19.49,
"LD, Pericardial Fluid QSTC",13864442,LOCAL,83615,CPT,,,761,RC,,Outpatient,,,155.39,7.25,Aetna Med ADV,Aetna Med ADV,21.68,,,,,,,Fee Schedule,7.16,21.675,
"16000 Initial treatment, first degree burn, when no more than local treatment required",9400038,LOCAL,16000,CPT,,,300,RC,,Outpatient,,,155.91,101,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
Diphtheria Antitoxoid QST,13824476,LOCAL,86648,CPT,,,300,RC,,Outpatient,,,156,18.25,Aetna Med ADV,Aetna Med ADV,15.21,,,,,,,Fee Schedule,15.21,15.29,
Tetanus Antitoxoid QST,13824477,LOCAL,86774,CPT,,,301,RC,,Outpatient,,,156,17.76,Aetna Med ADV,Aetna Med ADV,14.8,,,,,,,Fee Schedule,14.8,15.29,
Transferrin,633851,LOCAL,84466,CPT,,,311,RC,,Outpatient,,,156.67,15.31,Aetna Med ADV,Aetna Med ADV,29.64,,,,,,,Fee Schedule,17.73,29.64248366,
CANDIDA GLABRATA QST,12439000,LOCAL,87481,CPT,,,311,RC,,Outpatient,,,157,42.11,Aetna Med ADV,Aetna Med ADV,478.17,,,,,,,Fee Schedule,40.19,478.165,
CANDIDA SPECIES QST,12438999,LOCAL,87481,CPT,,,311,RC,,Outpatient,,,157,42.11,Aetna Med ADV,Aetna Med ADV,478.17,,,,,,,Fee Schedule,40.19,478.165,
"Chlamydia Trachomatis RNA, TMA QST",12439002,LOCAL,87591,CPT,,,311,RC,,Outpatient,,,157,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",12439003,LOCAL,87491,CPT,,,311,RC,,Outpatient,,,157,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
SURESWAB(R) ADV BV QST,12438998,LOCAL,81513,CPT,,,311,RC,,Outpatient,,,157,171.16,Aetna Med ADV,Aetna Med ADV,142.63,,,,,,,Fee Schedule,63.34,142.63,
"TRICHOMONAS VAGINALIS (TV), TMA QST",12439001,LOCAL,87661,CPT,,,311,RC,,Outpatient,,,157,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
CANDIDA GLABRATA QST,12433969,LOCAL,87481,CPT,,,311,RC,,Outpatient,,,157.5,42.11,Aetna Med ADV,Aetna Med ADV,478.17,,,,,,,Fee Schedule,40.19,478.165,
CANDIDA SPECIES QST,12433968,LOCAL,87481,CPT,,,306,RC,,Outpatient,,,157.5,42.11,Aetna Med ADV,Aetna Med ADV,478.17,,,,,,,Fee Schedule,40.19,478.165,
"CRYPTOSPORIDIUM ANTIGEN, EIA QSTC",12500635,LOCAL,87328,CPT,,,301,RC,,Outpatient,,,157.5,16.58,Aetna Med ADV,Aetna Med ADV,13.82,,,,,,,Fee Schedule,10.57,13.82,
"Kappa/LambdaLt Chains,Freew/Ratio,S QSTC",8853285,LOCAL,83521,CPT,,,320,RC,,Outpatient,,,157.5,20.72,Aetna Med ADV,Aetna Med ADV,87.22,,,,,,,Fee Schedule,17.73,87.215,
XR Bone Age Studies,1170014,LOCAL,77072,CPT,,,302,RC,,Outpatient,,,157.72,84.98,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
BB REF ABO DISCREP (RH),6432002,LOCAL,86901,CPT,,,302,RC,,Outpatient,,,159.75,3.59,Aetna Med ADV,Aetna Med ADV,35.88,,,,,,,Fee Schedule,6.29,35.88,
REF ABO/Rh Discrep,13484121,LOCAL,86900,CPT,,,301,RC,,Outpatient,,,159.75,3.59,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,6.29,117.85,
"Ammonia, Plasma",7974187,LOCAL,82140,CPT,,,424,RC,,Outpatient,,,160.34,17.48,Aetna Med ADV,Aetna Med ADV,22.63,,,,,,,Fee Schedule,17.73,22.62909091,
97164 CIS Prgm PT Re-Evaluation 20 min,9650016,LOCAL,97164,CPT,,,424,RC,GP|CQ,Outpatient,,,160.46,104,Aetna Med ADV,Aetna Med ADV,62.94,,,,,,,Fee Schedule,62.94,349.89,
97164 RE-EVALUATION CHARGE,9410061,LOCAL,97164,CPT,,,424,RC,GP,Outpatient,,,160.46,104,Aetna Med ADV,Aetna Med ADV,62.94,,,,,,,Fee Schedule,62.94,349.89,
97164 RE-EVALUATION PT CHARGES,9640016,LOCAL,97164,CPT,,,424,RC,GP,Outpatient,,,160.46,104,Aetna Med ADV,Aetna Med ADV,62.94,,,,,,,Fee Schedule,62.94,349.89,
PT ReEval Time,7896016,LOCAL,97164,CPT,,,301,RC,GP,Outpatient,,,160.46,104,Aetna Med ADV,Aetna Med ADV,62.94,,,,,,,Fee Schedule,62.94,349.89,
Tobramycin Level Peak,1634889,LOCAL,80200,CPT,,,301,RC,,Outpatient,,,163.2,19.36,Aetna Med ADV,Aetna Med ADV,16.13,,,,,,,Fee Schedule,15.38,16.13,
Tobramycin Level Trough,1634890,LOCAL,80200,CPT,,,761,RC,,Outpatient,,,163.2,19.36,Aetna Med ADV,Aetna Med ADV,16.13,,,,,,,Fee Schedule,15.38,16.13,
11719 TRIM NAIL(S) ANY NUMBER WC CHARGE,8726774,LOCAL,11719,CPT,,,300,RC,,Outpatient,,,163.39,106,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,54.31,863,
.C-ANCA Titer QSTC,8764786,LOCAL,86037,CPT,,,300,RC,,Outpatient,,,163.67,14.46,Aetna Med ADV,Aetna Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
.P-ANCA Titer QSTC,6225794,LOCAL,86037,CPT,,,301,RC,,Outpatient,,,163.67,14.46,Aetna Med ADV,Aetna Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
"Methicillin Resistant Staphylococcus aureus,PCR QSTC",9630594,LOCAL,87641,CPT,,,,,,Outpatient,,,164.16,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
phytonadione 10 mg/mL injectable solution 1 mL [CULL],11212150,LOCAL,J3430,CPT,,,,,,Outpatient,1,ML,164.224,,Aetna Med ADV,Aetna Med ADV,2.81,,,,,,,Fee Schedule,2.808,2.808,
Bill Manual Tumor IM Histochem,14049347,LOCAL,88360,CPT,,,,,,Outpatient,,,164.92,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,59.06,156.67,
Bill SB Consult 1st TB w FS SGL SP,14048002,LOCAL,88331,CPT,,,,,,Outpatient,,,164.92,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,53.82,156.67,
Bill IHC Initial Antibody,14049345,LOCAL,88342,CPT,,,450,RC,,Outpatient,,,164.98,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,59.06,156.67,
29105 - Long Arm Splint,9322359,LOCAL,29105,CPT,,,301,RC,,Outpatient,,,165,158,Aetna Med ADV,Aetna Med ADV,144.26,,,,,,,Fee Schedule,63.51,863,
Toxocara Ab (IgG) QSTC,13864452,LOCAL,86682,CPT,,,306,RC,,Outpatient,,,165.38,15.61,Aetna Med ADV,Aetna Med ADV,13.01,,,,,,,Fee Schedule,13.01,15.29,
Tissue Culture,633906,LOCAL,87070,CPT,,,,,,Outpatient,,,166.46,10.34,Aetna Med ADV,Aetna Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
acetaZOLAMIDE 500 mg intravenous injection [CULL],11200001,LOCAL,J1120,CPT,,,420,RC,,Outpatient,1,EA,168.8,,Aetna Med ADV,Aetna Med ADV,25.59,,,,,,,Fee Schedule,25.594,25.594,
97763 OT Orthotic Mgmt/Train Establish Charge,9650038,LOCAL,97763,CPT,,,430,RC,GP|CQ,Outpatient,,,168.9,110,Aetna Med ADV,Aetna Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
97763 OT Orthotic Mgmt/Train Established Assistant Units,9820206,LOCAL,97763,CPT,,,430,RC,GO,Outpatient,,,168.9,110,Aetna Med ADV,Aetna Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
97763 OT Orthotic/Prosthetic Mgmt/Training - each 15 min,9860206,LOCAL,97763,CPT,,,420,RC,GO|CO,Outpatient,,,168.9,110,Aetna Med ADV,Aetna Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
97763 PT ORTHO/PROST MNG/TRAIN EA 15,9410206,LOCAL,97763,CPT,,,420,RC,GP,Outpatient,,,168.9,110,Aetna Med ADV,Aetna Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
97763 PT Orthotic Mgmt/Train Establish Charge,9640038,LOCAL,97763,CPT,,,430,RC,GP,Outpatient,,,168.9,110,Aetna Med ADV,Aetna Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
OT Orthotic Mgmt/Train Est. Assit Units,7965332,LOCAL,97763,CPT,,,430,RC,CQ,Outpatient,,,168.9,110,Aetna Med ADV,Aetna Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
OT Orthotic Mgmt/Train Establish Charge,7965332,LOCAL,97763,CPT,,,430,RC,GO,Outpatient,,,168.9,110,Aetna Med ADV,Aetna Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
OT Orthotic Mgmt/Train Establish Rehab Units,7964942,LOCAL,97763,CPT,,,420,RC,GO,Outpatient,,,168.9,110,Aetna Med ADV,Aetna Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
PT Orthotic Mgmt/Train Establish Charge,7965252,LOCAL,97763,CPT,,,420,RC,GP,Outpatient,,,168.9,110,Aetna Med ADV,Aetna Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
"PT Orthotic/Prosthetic Manage,Train Assistant Units",9390462,LOCAL,97763,CPT,,,301,RC,CQ,Outpatient,,,168.9,110,Aetna Med ADV,Aetna Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
Total Glutathione QST,14799054,LOCAL,82978,CPT,,,,,,Outpatient,,,169,18.54,Aetna Med ADV,Aetna Med ADV,15.45,,,,,,,Fee Schedule,15.45,17.73,
epoetin alfa-epbx 4000 units/mL preservative-free injectable solution 1 mL [CULL],11202396,LOCAL,Q5106,CPT,,,352,RC,,Outpatient,1,ML,169.4208,,Aetna Med ADV,Aetna Med ADV,7.85,,,,,,,Fee Schedule,7.85,525.49,
CT Heart Calcium Scoring,2424782,LOCAL,75571,CPT,,,301,RC,,Outpatient,,,170,90.75,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,170.53,
"Cortisol, LC/MS, Saliva QSTC",8853249,LOCAL,82530,CPT,,,301,RC,,Outpatient,,,171,20.05,Aetna Med ADV,Aetna Med ADV,29.79,,,,,,,Fee Schedule,17.73,29.79,
Factor V (Leiden) Mutation Analysis QSTC,8764652,LOCAL,81241,CPT,,,301,RC,,Outpatient,,,171,88.04,Aetna Med ADV,Aetna Med ADV,73.37,,,,,,,Fee Schedule,63.34,73.37,
"Lyme Disease Ab (IgM), Blot QSTC",8849718,LOCAL,86617,CPT,,,301,RC,,Outpatient,,,171,18.59,Aetna Med ADV,Aetna Med ADV,15.49,,,,,,,Fee Schedule,15.29,15.49,
"Lyme Disease Ab(IgG),Blot QSTC",8849707,LOCAL,86617,CPT,,,301,RC,,Outpatient,,,171,18.59,Aetna Med ADV,Aetna Med ADV,15.49,,,,,,,Fee Schedule,15.29,15.49,
Prothrombin Gene Analysis QSTC,8764653,LOCAL,81240,CPT,,,301,RC,,Outpatient,,,171,78.83,Aetna Med ADV,Aetna Med ADV,65.69,,,,,,,Fee Schedule,63.34,65.69,
Cholesterol HDL,3170344,LOCAL,83718,CPT,,,301,RC,,Outpatient,,,172,9.83,Aetna Med ADV,Aetna Med ADV,8.19,,,,,,,Fee Schedule,7.16,8.19,
Glucagon QSTC,13864528,LOCAL,82943,CPT,,,,,,Outpatient,,,173.7,17.15,Aetna Med ADV,Aetna Med ADV,14.29,,,,,,,Fee Schedule,14.29,18.43,
fondaparinux 2.5 mg/0.5 mL subcutaneous solution 0.5 mL [CULL],11260583,LOCAL,J1652,CPT,,,272,RC,,Outpatient,0.5,ML,174.8864,,Aetna Med ADV,Aetna Med ADV,0.88,,,,,,,Fee Schedule,0.877,0.877,
CULL MG Wire Loc Needle,13721990,LOCAL,10035,CPT,A4648,HCPCS,420,RC,,Outpatient,,,174.99,114,Aetna Med ADV,Aetna Med ADV,643.26,,,,,,,Fee Schedule,643.26,1291,
90912 - Bfb training 1st 15 min.,9442435,LOCAL,90912,CPT,,,430,RC,,Outpatient,,,175,114,Aetna Med ADV,Aetna Med ADV,35.97,,,,,,,Fee Schedule,35.97,233.61,
97129 Cognition Ther Intervent First 15 min,9850048,LOCAL,97129,CPT,,,430,RC,GO,Outpatient,,,175,114,Aetna Med ADV,Aetna Med ADV,18.94,,,,,,,Fee Schedule,18.94,56.44,
97129 Cognition Ther Intervent First 15 min Assistant Units,9860048,LOCAL,97129,CPT,,,430,RC,GO|CO,Outpatient,,,175,114,Aetna Med ADV,Aetna Med ADV,18.94,,,,,,,Fee Schedule,18.94,56.44,
97130 Cognition Ther Intervent Addlt 15 min,9850049,LOCAL,97130,CPT,,,430,RC,GO,Outpatient,,,175,114,Aetna Med ADV,Aetna Med ADV,18.08,,,,,,,Fee Schedule,18.08,56.44,
97130 Cognition Ther Intervent Addlt 15 min Assistant Units,9860049,LOCAL,97130,CPT,,,430,RC,GO|CO,Outpatient,,,175,114,Aetna Med ADV,Aetna Med ADV,18.08,,,,,,,Fee Schedule,18.08,56.44,
"OT Cog Ther Intervent, Addl 15 Min Asst",9401146,LOCAL,97130,CPT,,,430,RC,CQ,Outpatient,,,175,114,Aetna Med ADV,Aetna Med ADV,18.08,,,,,,,Fee Schedule,18.08,56.44,
"OT Cog Ther Intervent, Addl 15 Min Units",9401146,LOCAL,97130,CPT,,,430,RC,GO,Outpatient,,,175,114,Aetna Med ADV,Aetna Med ADV,18.08,,,,,,,Fee Schedule,18.08,56.44,
"OT Cog Ther Intervent, First 15 Min Asst",9401140,LOCAL,97129,CPT,,,430,RC,CQ,Outpatient,,,175,114,Aetna Med ADV,Aetna Med ADV,18.94,,,,,,,Fee Schedule,18.94,56.44,
"OT Cog Ther Intervent,First 15 Min Units",9401140,LOCAL,97129,CPT,,,302,RC,GO,Outpatient,,,175,114,Aetna Med ADV,Aetna Med ADV,18.94,,,,,,,Fee Schedule,18.94,56.44,
Bill Only Pheno Non-Rh EA/Ag,13517193,LOCAL,86905,CPT,,,302,RC,,Outpatient,,,175.5,4.6,Aetna Med ADV,Aetna Med ADV,328.88,,,,,,,Fee Schedule,6.29,328.88,
Bill Only REF Thawing,13514966,LOCAL,86927,CPT,,,302,RC,,Outpatient,,,175.5,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.88,156.67,
Ref Hgb S,9527497,LOCAL,85660,CPT,,,301,RC,,Outpatient,,,175.5,6.61,Aetna Med ADV,Aetna Med ADV,5.51,,,,,,,Fee Schedule,5.51,8.21,
Basic Metabolic Panel,633628,LOCAL,80048,CPT,,,,,,Outpatient,,,176.26,10.15,Aetna Med ADV,Aetna Med ADV,37.17,,,,,,,Fee Schedule,12.14,37.17170492,
gemcitabine 1 g injection [CULL],11292094,LOCAL,J9201,CPT,,,460,RC,,Outpatient,1,EA,176.384,,Aetna Med ADV,Aetna Med ADV,3.59,,,,,,,Fee Schedule,3.59,3.59,
RT CHARGE PFT -> Diffusion (DLCO),5267130,LOCAL,94729,CPT,,,390,RC,,Outpatient,,,176.44,115,Aetna Med ADV,Aetna Med ADV,47.24,,,,,,,Fee Schedule,47.24,76.09,
E0773 Thawed FFP CPD,7267127,LOCAL,,,P9017,HCPCS,390,RC,,Outpatient,,,177,115,Aetna Med ADV,Aetna Med ADV,84.29,,,,,,,Fee Schedule,84.29,217.45,
E1237 Thawed Aph FFP ACDA,7267133,LOCAL,,,P9017,HCPCS,390,RC,,Outpatient,,,177,115,Aetna Med ADV,Aetna Med ADV,84.29,,,,,,,Fee Schedule,84.29,217.45,
E2701 Thawed Plasma CPD <24h,7267161,LOCAL,,,P9017,HCPCS,390,RC,,Outpatient,,,177,115,Aetna Med ADV,Aetna Med ADV,84.29,,,,,,,Fee Schedule,84.29,217.45,
E2737 Thawed Plasma CP2D <24h,7267171,LOCAL,,,P9017,HCPCS,390,RC,,Outpatient,,,177,115,Aetna Med ADV,Aetna Med ADV,84.29,,,,,,,Fee Schedule,84.29,217.45,
E4713 Thawed Aph FFP ACDA 1,7267173,LOCAL,,,P9017,HCPCS,390,RC,,Outpatient,,,177,115,Aetna Med ADV,Aetna Med ADV,84.29,,,,,,,Fee Schedule,84.29,217.45,
E4717 Thawed Aph FFP ACDA 2,7267174,LOCAL,,,P9017,HCPCS,390,RC,,Outpatient,,,177,115,Aetna Med ADV,Aetna Med ADV,84.29,,,,,,,Fee Schedule,84.29,217.45,
E4721 Thawed Aph FFP ACDA 3,7267175,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Aetna Med ADV,Aetna Med ADV,84.29,,,,,,,Fee Schedule,84.29,217.45,
amiodarone 360 mg/200 mL-D5% intravenous solution 200 mL [CULL],11200046,LOCAL,J0283,CPT,,,,,,Outpatient,200,ML,177.1776,,Aetna Med ADV,Aetna Med ADV,2.53,,,,,,,Fee Schedule,2.529,2.529,
protamine 10 mg/mL injectable solution 25 mL [CULL],11211130,LOCAL,J2720,CPT,,,301,RC,,Outpatient,25,ML,178.208,,Aetna Med ADV,Aetna Med ADV,1.57,,,,,,,Fee Schedule,1.571,1.571,
Anti-Mullerian Hormone (AMH) Female QSTC,8972886,LOCAL,82166,CPT,,,311,RC,,Outpatient,,,180,46.34,Aetna Med ADV,Aetna Med ADV,38.62,,,,,,,Fee Schedule,17.73,38.62,
"Chlamydia Trachomatis RNA, TMA QST",14718336,LOCAL,87491,CPT,,,301,RC,,Outpatient,,,180,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Chromogranin A, LC/MS/MS QSTC",10319690,LOCAL,86316,CPT,,,301,RC,,Outpatient,,,180,24.97,Aetna Med ADV,Aetna Med ADV,100.2,,,,,,,Fee Schedule,15.29,100.2,
"Estriol, Serum QSTC",9039351,LOCAL,82677,CPT,,,301,RC,,Outpatient,,,180,29.02,Aetna Med ADV,Aetna Med ADV,24.18,,,,,,,Fee Schedule,18.43,24.18,
H. pylori Urea Breath Test QSTC,8764622,LOCAL,83013,CPT,,,301,RC,,Outpatient,,,180,80.83,Aetna Med ADV,Aetna Med ADV,123.01,,,,,,,Fee Schedule,46.74,123.01,
"Metanephrines, Fract Free LCMSMS, P QSTC",8764672,LOCAL,83835,CPT,,,301,RC,,Outpatient,,,180,20.33,Aetna Med ADV,Aetna Med ADV,98.31,,,,,,,Fee Schedule,18.43,98.305,
Mycophenolic Acid QSTC,9039269,LOCAL,80180,CPT,,,311,RC,,Outpatient,,,180,21.66,Aetna Med ADV,Aetna Med ADV,98.85,,,,,,,Fee Schedule,15.38,98.845,
"Neisseria Gonorrhoeae RNA, TMA QST",14718337,LOCAL,87591,CPT,,,311,RC,,Outpatient,,,180,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Thinprep Review Cytotechnologist: QST,14718350,LOCAL,88175,CPT,,,311,RC,,Outpatient,,,180,31.93,Aetna Med ADV,Aetna Med ADV,26.61,,,,,,,Fee Schedule,25.25,26.61,
"Trichomonas vaginalis, Ql TMA, Pap QST",14718338,LOCAL,87661,CPT,,,301,RC,,Outpatient,,,180,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Galactose-Alpha-1,3-Galactose IgE QSTC",8764840,LOCAL,86008,CPT,,,731,RC,,Outpatient,,,180.09,21.52,Aetna Med ADV,Aetna Med ADV,17.93,,,,,,,Fee Schedule,15.29,17.93,
HOLTER MONITOR  24H,8200090,LOCAL,93225,CPT,,,270,RC,,Outpatient,,,182,198,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,99.86,117.85,
DRAIN TRU-CLOSE 500CC (BUY BY EACH-10/CS,6800045,LOCAL,,,A7048,HCPCS,320,RC,,Outpatient,,,183.26,88,Aetna Med ADV,Aetna Med ADV,60.63,,,,,,,Fee Schedule,60.63,60.63,
FLUORO CENTRAL LINE PLACEMENT,8201221,LOCAL,77001,CPT,,,301,RC,,Outpatient,,,184.82,177.38,Aetna Med ADV,Aetna Med ADV,70.92,,,,,,,Fee Schedule,70.92,262.79,
Vitamin B12 Level,633871,LOCAL,82607,CPT,,,320,RC,,Outpatient,,,184.82,18.1,Aetna Med ADV,Aetna Med ADV,82.43,,,,,,,Fee Schedule,18.43,82.43266533,
XR Port Placement,10460170,LOCAL,77001,CPT,,,410,RC,,Outpatient,,,184.82,177.38,Aetna Med ADV,Aetna Med ADV,70.92,,,,,,,Fee Schedule,70.92,262.79,
RT CHARGE Chest Physiotherapy -> PEP Therapy Subsequent,8699751,LOCAL,94667,CPT,,,410,RC,,Outpatient,,,184.89,120,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,76.09,117.85,
RT CHARGE Mechanical Oscillation -> Yes,10417130,LOCAL,94667,CPT,,,301,RC,,Outpatient,,,184.89,120,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,76.09,117.85,
"Streptococcus pneumoniae Ag, Ur QSTC",13864418,LOCAL,87899,CPT,,,305,RC,,Outpatient,,,185.22,19.28,Aetna Med ADV,Aetna Med ADV,16.07,,,,,,,Fee Schedule,10.57,16.07,
"FVIII Act, Clotting QSTC",13873492,LOCAL,85240,CPT,,,305,RC,,Outpatient,,,186.96,21.48,Aetna Med ADV,Aetna Med ADV,17.9,,,,,,,Fee Schedule,5.42,17.9,
"PTT, Activated QSTC",13873491,LOCAL,85730,CPT,,,305,RC,,Outpatient,,,186.96,7.21,Aetna Med ADV,Aetna Med ADV,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
Ristocetin Cofactor QSTC,13873494,LOCAL,85245,CPT,,,305,RC,,Outpatient,,,186.96,27.53,Aetna Med ADV,Aetna Med ADV,22.94,,,,,,,Fee Schedule,5.42,22.94,
von Willebrand Factor Ag QSTC,13873493,LOCAL,85246,CPT,,,305,RC,,Outpatient,,,186.96,27.53,Aetna Med ADV,Aetna Med ADV,22.94,,,,,,,Fee Schedule,5.42,22.94,
"vWf Ag, Multimeric QSTC",13873495,LOCAL,85247,CPT,,,,,,Outpatient,,,186.96,27.53,Aetna Med ADV,Aetna Med ADV,22.94,,,,,,,Fee Schedule,5.42,22.94,
benztropine 1 mg/mL injectable solution 2 mL [CULL],11202065,LOCAL,J0515,CPT,,,311,RC,,Outpatient,2,ML,188,,Aetna Med ADV,Aetna Med ADV,13.82,,,,,,,Fee Schedule,13.815,13.815,
.T. pallidum Ab QSTC,13864522,LOCAL,86780,CPT,,,301,RC,,Outpatient,,,189,15.89,Aetna Med ADV,Aetna Med ADV,13.24,,,,,,,Fee Schedule,13.24,15.29,
Syphilis Antibody Cascading Reflex QSTC,8972904,LOCAL,86780,CPT,,,274,RC,,Outpatient,,,189,15.89,Aetna Med ADV,Aetna Med ADV,13.24,,,,,,,Fee Schedule,13.24,15.29,
L3923 HFO W/O JOINTS PRE CST CHARGE,9646078,LOCAL,,,L3923,HCPCS,301,RC,,Outpatient,,,191.03,124,Aetna Med ADV,Aetna Med ADV,97.81,,,,,,,Fee Schedule,97.81,97.81,
"MAG-SGPG Ab IgM, EIA QSTC",13864465,LOCAL,83520,CPT,,,,,,Outpatient,,,191.75,20.72,Aetna Med ADV,Aetna Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
amphotericin B 50 mg Pow [CULL],J0285,CPT,,,,,260,RC,,Outpatient,50,ML,192,,Aetna Med ADV,Aetna Med ADV,43.29,,,,,,,Fee Schedule,43.29,43.29,
"96366 IV INFUSION, MEDICATIONS, ADDITIONAL",7904532,LOCAL,96366,CPT,,,450,RC,,Outpatient,,,193,125,Aetna Med ADV,Aetna Med ADV,42.18,,,,,,,Fee Schedule,42.18,749.76,
"96366- IV tx, each additional hour",1928300,LOCAL,96366,CPT,,,260,RC,,Outpatient,,,193,125,Aetna Med ADV,Aetna Med ADV,42.18,,,,,,,Fee Schedule,42.18,749.76,
"96367 IV INFUSION, SEQUENTIAL, NEW OR DIFF",7904533,LOCAL,96367,CPT,,,450,RC,,Outpatient,,,193,125,Aetna Med ADV,Aetna Med ADV,65.07,,,,,,,Fee Schedule,65.07,442.94,
"96367- IV tx, sequential infusion",1928301,LOCAL,96367,CPT,,,450,RC,,Outpatient,,,193,125,Aetna Med ADV,Aetna Med ADV,65.07,,,,,,,Fee Schedule,65.07,442.94,
"96374- IV Injection, single/initial",1928305,LOCAL,96374,CPT,,,260,RC,59,Outpatient,,,193,125,Aetna Med ADV,Aetna Med ADV,192.63,,,,,,,Fee Schedule,64.56,192.63,
96374 IV PUSH MEDS INIT INJ 15 MIN OR LESS,7904536,LOCAL,96374,CPT,,,450,RC,59,Outpatient,,,193,125,Aetna Med ADV,Aetna Med ADV,192.63,,,,,,,Fee Schedule,64.56,192.63,
"96375- IV Injection, add new drug",1928306,LOCAL,96375,CPT,,,260,RC,59,Outpatient,,,193,125,Aetna Med ADV,Aetna Med ADV,42.18,,,,,,,Fee Schedule,42.18,64.56,
"96375 IV PUSH INJECTION ADD, NEW OR DIFF",7904537,LOCAL,96375,CPT,,,260,RC,59,Outpatient,,,193,125,Aetna Med ADV,Aetna Med ADV,42.18,,,,,,,Fee Schedule,42.18,64.56,
INJ IV PUSH THER/PROPH SUBSTANCE INTIAL,8210021,LOCAL,96374,CPT,,,300,RC,59,Outpatient,,,193,125,Aetna Med ADV,Aetna Med ADV,192.63,,,,,,,Fee Schedule,64.56,192.63,
"Beryllium, Serum/Plasma QSTC",10704808,LOCAL,83018,CPT,,,983,RC,,Outpatient,,,194.5,26.35,Aetna Med ADV,Aetna Med ADV,21.96,,,,,,,Fee Schedule,16.07,21.96,
9581626 EEG AWAKE/DROWSY PRO FEE CHARGES,8795941,LOCAL,95816,CPT,,,983,RC,26,Outpatient,,,195,533,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,284.7,466.96,
95819 EEG AWAKE AND ASLEEP PRO-FEE CHARGE,13508139,LOCAL,95819,CPT,,,,,26,Outpatient,,,195,599,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,284.7,466.96,
95822 EEG COMA or SLEEP ONLY PRO,10049176,LOCAL,95822,CPT,,,301,RC,26,Outpatient,,,195,499,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,284.7,466.96,
Vitamin B3 QSTC,8972908,LOCAL,84591,CPT,,,301,RC,,Outpatient,,,195.75,20.47,Aetna Med ADV,Aetna Med ADV,17.06,,,,,,,Fee Schedule,17.06,17.73,
Thyroid Stimulating Hormone,633844,LOCAL,84443,CPT,,,301,RC,,Outpatient,,,195.84,20.16,Aetna Med ADV,Aetna Med ADV,87.64,,,,,,,Fee Schedule,18.43,87.63697303,
TSH with Reflex to FT4,7948309,LOCAL,84439,CPT,,,301,RC,,Outpatient,,,195.84,10.82,Aetna Med ADV,Aetna Med ADV,28.58,,,,,,,Fee Schedule,18.43,28.58065455,
"Mumps Virus Ab IgG, IgM, Diagnostic QSTC",13864479,LOCAL,86735,CPT,,,301,RC,,Outpatient,,,196.07,15.66,Aetna Med ADV,Aetna Med ADV,13.05,,,,,,,Fee Schedule,13.05,15.29,
Deoxycorticosterone QSTC,13864487,LOCAL,82633,CPT,,,301,RC,,Outpatient,,,196.2,37.18,Aetna Med ADV,Aetna Med ADV,30.98,,,,,,,Fee Schedule,18.43,30.98,
Q Fever Ab IgG IgM w/rfx Titers QSTC,13864460,LOCAL,86638,CPT,,,942,RC,,Outpatient,,,196.56,14.54,Aetna Med ADV,Aetna Med ADV,12.12,,,,,,,Fee Schedule,12.12,15.29,
G0108 Diabetes Management Treatment 30 Minutes CHARGE,10255367,LOCAL,,,G0108,HCPCS,460,RC,,Outpatient,,,196.8,128,Aetna Med ADV,Aetna Med ADV,52.41,,,,,,,Fee Schedule,52.41,95.93,
94799 Pulm Function Screen Charge,10440012,LOCAL,94799,CPT,,,434,RC,,Outpatient,,,198.38,129,Aetna Med ADV,Aetna Med ADV,143.05,,,,,,,Fee Schedule,76.09,143.05,
97168 CIS Prgm OT Re-Evaluation 30 min,9850016,LOCAL,97168,CPT,,,434,RC,GO,Outpatient,,,200.91,131,Aetna Med ADV,Aetna Med ADV,63.82,,,,,,,Fee Schedule,63.82,269.95,
97168 RE-EVALUATION CHARGE,9860016,LOCAL,97168,CPT,,,434,RC,GO|CO,Outpatient,,,200.91,131,Aetna Med ADV,Aetna Med ADV,63.82,,,,,,,Fee Schedule,63.82,269.95,
OT ReEval Units,7895298,LOCAL,97168,CPT,,,434,RC,GO,Outpatient,,,200.91,131,Aetna Med ADV,Aetna Med ADV,63.82,,,,,,,Fee Schedule,63.82,269.95,
OT ReEvaluation Units,7897819,LOCAL,97168,CPT,,,301,RC,GO,Outpatient,,,200.91,131,Aetna Med ADV,Aetna Med ADV,63.82,,,,,,,Fee Schedule,63.82,269.95,
Gabapentin QSTC,8764562,LOCAL,80171,CPT,,,301,RC,,Outpatient,,,202.5,26,Aetna Med ADV,Aetna Med ADV,111.87,,,,,,,Fee Schedule,15.38,111.87,
TRAb (TSH Receptor Binding Ab) QSTC,8764674,LOCAL,83520,CPT,,,301,RC,,Outpatient,,,202.5,20.72,Aetna Med ADV,Aetna Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
"Coccidioides Ab, CF w/ ID, CSF QSTC",13864531,LOCAL,86635,CPT,,,306,RC,,Outpatient,,,203.04,13.76,Aetna Med ADV,Aetna Med ADV,11.47,,,,,,,Fee Schedule,11.47,15.29,
Body Fluid Culture,4122803,LOCAL,87070,CPT,,,306,RC,,Outpatient,,,203.18,10.34,Aetna Med ADV,Aetna Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Ear Culture,633890,LOCAL,87070,CPT,,,306,RC,,Outpatient,,,203.18,10.34,Aetna Med ADV,Aetna Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Eye Culture,633892,LOCAL,87070,CPT,,,306,RC,,Outpatient,,,203.18,10.34,Aetna Med ADV,Aetna Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Medical Device Culture,633898,LOCAL,87070,CPT,,,306,RC,,Outpatient,,,203.18,10.34,Aetna Med ADV,Aetna Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Nasal Culture,633900,LOCAL,87070,CPT,,,301,RC,,Outpatient,,,203.18,10.34,Aetna Med ADV,Aetna Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
"Porphyrins, Fract, Quant, Random Ur QSTC",13864457,LOCAL,84120,CPT,,,306,RC,,Outpatient,,,203.18,17.65,Aetna Med ADV,Aetna Med ADV,14.71,,,,,,,Fee Schedule,14.71,17.73,
Stool Culture,633904,LOCAL,87045,CPT,,,306,RC,,Outpatient,,,203.18,11.33,Aetna Med ADV,Aetna Med ADV,79.67,,,,,,,Fee Schedule,10.57,79.665,
Throat Culture,633905,LOCAL,87070,CPT,,,306,RC,,Outpatient,,,203.18,10.34,Aetna Med ADV,Aetna Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Wound Culture,633908,LOCAL,87070,CPT,,,306,RC,,Outpatient,,,203.18,10.34,Aetna Med ADV,Aetna Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Wound Culture Deep,8395521,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Aetna Med ADV,Aetna Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
micafungin 100 mg intravenous injection [CULL],11220353,LOCAL,J2248,CPT,,,301,RC,,Outpatient,1,EA,203.7888,,Aetna Med ADV,Aetna Med ADV,0.25,,,,,,,Fee Schedule,0.249,122.4,
Vitamin K QSTC,8972880,LOCAL,84597,CPT,,,301,RC,,Outpatient,,,203.9,16.46,Aetna Med ADV,Aetna Med ADV,13.72,,,,,,,Fee Schedule,13.72,17.73,
PSA Diagnostic,1634882,LOCAL,84153,CPT,,,301,RC,,Outpatient,,,206.86,22.07,Aetna Med ADV,Aetna Med ADV,104.84,,,,,,,Fee Schedule,17.73,104.8447059,
PSA Screening,4123035,LOCAL,,,G0103,HCPCS,301,RC,,Outpatient,,,206.86,134,Aetna Med ADV,Aetna Med ADV,19.31,,,,,,,Fee Schedule,15.29,19.31,
Chromatin (Nucleosomal) Antibody QSTC,10148609,LOCAL,86235,CPT,,,410,RC,,Outpatient,,,206.91,21.52,Aetna Med ADV,Aetna Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
94640 UDN SPECIAL MED 2 CHARGE,13515633,LOCAL,94640,CPT,,,410,RC,,Outpatient,,,208.54,136,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
94640 UDN SPECIAL MED CHARGE,13522003,LOCAL,94640,CPT,,,410,RC,,Outpatient,,,208.54,136,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE Aerosol Therapy -> Subsequent,5397112,LOCAL,94640,CPT,,,410,RC,,Outpatient,,,208.54,136,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE EZPAP -> Initial,9429159,LOCAL,94640,CPT,,,410,RC,,Outpatient,,,208.54,136,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE EZPAP -> Subsequent,9429160,LOCAL,94640,CPT,,,410,RC,,Outpatient,,,208.54,136,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE MDI -> Initial,12111660,LOCAL,94640,CPT,,,410,RC,,Outpatient,,,208.54,136,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE MDI -> Subsequent,12111659,LOCAL,94640,CPT,,,460,RC,,Outpatient,,,208.54,136,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE Suction -> BBG/Nasopharyngeal,6690655,LOCAL,31720,CPT,,,410,RC,,Outpatient,,,208.54,136,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,863,
RT Continuous Neb Subsequent CHARGE,8144096,LOCAL,94640,CPT,,,410,RC,,Outpatient,,,208.54,136,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT IPV Subsequent CHARGE,8144062,LOCAL,94640,CPT,,,410,RC,,Outpatient,,,208.54,136,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> Cough,13657418,LOCAL,94640,CPT,,,410,RC,,Outpatient,,,208.54,136,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> ET tube,13657417,LOCAL,94640,CPT,,,410,RC,,Outpatient,,,208.54,136,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> Medication aerosol,8846461,LOCAL,94640,CPT,,,410,RC,,Outpatient,,,208.54,136,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> Nasal aspirate,13650046,LOCAL,94640,CPT,,,410,RC,,Outpatient,,,208.54,136,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> Nasal wash,13650044,LOCAL,94640,CPT,,,274,RC,,Outpatient,,,208.54,136,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
L3912 HFO FLEXION,9856101,LOCAL,,,L3912,HCPCS,,,,Outpatient,,,211.05,137,Aetna Med ADV,Aetna Med ADV,108.07,,,,,,,Fee Schedule,108.07,108.07,
"penicillin G potassium 20,000,000 units injection [CULL]",11211080,LOCAL,J2540,CPT,,,302,RC,,Outpatient,1,EA,211.2,,Aetna Med ADV,Aetna Med ADV,0.78,,,,,,,Fee Schedule,0.78,0.78,
REF Antibody Screen,7939320,LOCAL,86850,CPT,,,402,RC,,Outpatient,,,211.5,11.72,Aetna Med ADV,Aetna Med ADV,48.85,,,,,,,Fee Schedule,6.29,48.85,
US Unlisted Procedure,8733482,LOCAL,76999,CPT,,,301,RC,,Outpatient,,,212.54,113.85,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,161.71,
%CDT QSTC,13864781,LOCAL,82373,CPT,,,301,RC,,Outpatient,,,213.75,21.67,Aetna Med ADV,Aetna Med ADV,18.06,,,,,,,Fee Schedule,17.73,18.06,
Transferrin - QSTC,13864778,LOCAL,84466,CPT,,,,,,Outpatient,,,213.75,15.31,Aetna Med ADV,Aetna Med ADV,29.64,,,,,,,Fee Schedule,17.73,29.64248366,
hyaluronidase 150 units/mL injectable solution 1 mL [CULL],11282257,LOCAL,J3470,CPT,,,260,RC,,Outpatient,1,ML,214.272,,Aetna Med ADV,Aetna Med ADV,31.81,,,,,,,Fee Schedule,31.807,122.4,
"96372 INJECTIONS (IM, SC) OP",7904535,LOCAL,96372,CPT,,,450,RC,59,Outpatient,,,214.42,139,Aetna Med ADV,Aetna Med ADV,65.07,,,,,,,Fee Schedule,64.56,65.07,
96372- Subq/IM Injection,1928303,LOCAL,96372,CPT,,,460,RC,59,Outpatient,,,214.42,139,Aetna Med ADV,Aetna Med ADV,65.07,,,,,,,Fee Schedule,64.56,65.07,
RT CHARGE PFT -> Lung Volume,9004829,LOCAL,94727,CPT,,,771,RC,,Outpatient,,,215.73,140,Aetna Med ADV,Aetna Med ADV,143.05,,,,,,,Fee Schedule,76.09,143.05,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,90471,CPT,G0010,HCPCS,,,,Outpatient,,,216.15,140,Aetna Med ADV,Aetna Med ADV,42.18,,,,,,,Fee Schedule,42.18,65.07,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,G0010,CPT,,,402,RC,,Outpatient,,,216.15,,Aetna Med ADV,Aetna Med ADV,42.18,,,,,,,Fee Schedule,42.18,65.07,
CATH LAB US INTRAOPERATIVE,8200550,LOCAL,76998,CPT,,,761,RC,,Outpatient,,,216.65,116.33,Aetna Med ADV,Aetna Med ADV,36.73,,,,,,,Fee Schedule,36.73,165.47,
Bladder Scan,649589,LOCAL,51798,CPT,,,921,RC,,Outpatient,,,216.87,59,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,54.31,863,
DOPP LOWER EXT ARTERIAL/ABI,8200450,LOCAL,93922,CPT,,,761,RC,,Outpatient,,,218,265,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,117.85,161.71,
69209 REM IMPACT CERUMEN REQ IRRIGAT CHARGE,8020086,LOCAL,69209,CPT,,,420,RC,,Outpatient,,,219.69,143,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,54.31,863,
97550 CAREGIVER TRAINING 1ST 30 MIN,14015178,LOCAL,97550,CPT,,,420,RC,,Outpatient,,,220,,Aetna Med ADV,Aetna Med ADV,38.85,,,,,,,Fee Schedule,38.85,95.93,
97550 OT Caregiver Training Init 30 Mins,13649811,LOCAL,97550,CPT,,,420,RC,,Outpatient,,,220,,Aetna Med ADV,Aetna Med ADV,38.85,,,,,,,Fee Schedule,38.85,95.93,
97550 ST Caregiver Training 1st 30 min,14013233,LOCAL,97550,CPT,,,420,RC,,Outpatient,,,220,,Aetna Med ADV,Aetna Med ADV,38.85,,,,,,,Fee Schedule,38.85,95.93,
"SLP Caregiver Training, First 30 Min Time",14466884,LOCAL,,,G0541,HCPCS,302,RC,,Outpatient,,,220,,Aetna Med ADV,Aetna Med ADV,50.79,,,,,,,Fee Schedule,50.79,95.93,
Bill Only ABSC,7936968,LOCAL,86850,CPT,,,301,RC,,Outpatient,,,220.5,11.72,Aetna Med ADV,Aetna Med ADV,48.85,,,,,,,Fee Schedule,6.29,48.85,
"Platelet Antibody Screen, Serum QSTC",10736090,LOCAL,86022,CPT,,,444,RC,,Outpatient,,,220.5,22.04,Aetna Med ADV,Aetna Med ADV,18.37,,,,,,,Fee Schedule,15.29,18.37,
92524 BEHAVIORAL AND QUALITATIVE ANALYSIS OF VOICE AND RESONANCE,9630059,LOCAL,92524,CPT,,,444,RC,GN,Outpatient,,,222.2,144,Aetna Med ADV,Aetna Med ADV,103.27,,,,,,,Fee Schedule,103.27,337.75,
Behav/Qual Analysis of Voice and Resonance Charge,7897211,LOCAL,92524,CPT,,,444,RC,GN,Outpatient,,,222.2,144,Aetna Med ADV,Aetna Med ADV,103.27,,,,,,,Fee Schedule,103.27,337.75,
SLP Analysis of Voice & Resonance Units,7897212,LOCAL,92524,CPT,,,440,RC,GN,Outpatient,,,222.2,144,Aetna Med ADV,Aetna Med ADV,103.27,,,,,,,Fee Schedule,103.27,337.75,
92597 EVAL FOR USE AND/OR FITTING OF VOICE PROSTHETIC TO SUPPLEMENT ORAL SPEECH,9630068,LOCAL,92597,CPT,,,440,RC,GN,Outpatient,,,223.9,146,Aetna Med ADV,Aetna Med ADV,67.18,,,,,,,Fee Schedule,67.18,337.75,
Eval for Use/Fitting of Voice Prosthetic Dvc Chg,1373846,LOCAL,92597,CPT,,,440,RC,GN,Outpatient,,,223.9,146,Aetna Med ADV,Aetna Med ADV,67.18,,,,,,,Fee Schedule,67.18,337.75,
"SLP Use,Fit Speech Prosthetic Eval Units",1373846,LOCAL,92597,CPT,,,361,RC,GN,Outpatient,,,223.9,146,Aetna Med ADV,Aetna Med ADV,67.18,,,,,,,Fee Schedule,67.18,337.75,
64418- Suprascapular nerve block,10452404,LOCAL,64418,CPT,,,320,RC,,Outpatient,,,225,693,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
75809 SHUNTOGRAM PREV PLCMNT INDWELLING NONVASC SHUNT,13650394,LOCAL,75809,CPT,,,301,RC,,Outpatient,,,225,87.45,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,176.48,
"Hantavirus Antibody IgG,IgM QSTC",13864534,LOCAL,86790,CPT,,,301,RC,,Outpatient,,,225,15.46,Aetna Med ADV,Aetna Med ADV,12.88,,,,,,,Fee Schedule,12.88,15.29,
"Histoplasma Quantitative Antigen, EIA QSTC",9752803,LOCAL,87385,CPT,,,301,RC,,Outpatient,,,225,15.9,Aetna Med ADV,Aetna Med ADV,13.25,,,,,,,Fee Schedule,10.57,13.25,
"Potassium w/o Creatinine, Random Ur QSTC",9039260,LOCAL,84133,CPT,,,301,RC,,Outpatient,,,225,5.68,Aetna Med ADV,Aetna Med ADV,19.32,,,,,,,Fee Schedule,7.16,19.32,
Soluble Transferrin Receptor QSTC,9777250,LOCAL,84238,CPT,,,320,RC,,Outpatient,,,225,43.88,Aetna Med ADV,Aetna Med ADV,36.57,,,,,,,Fee Schedule,36.57,46.74,
XR Shunt Series,13650394,LOCAL,75809,CPT,,,302,RC,,Outpatient,,,225,87.45,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,176.48,
Dengue Fever Ab (IgG) QSTC,13873177,LOCAL,86790,CPT,,,302,RC,,Outpatient,,,228,15.46,Aetna Med ADV,Aetna Med ADV,12.88,,,,,,,Fee Schedule,12.88,15.29,
Dengue Fever Ab (IgM) QSTC,13873183,LOCAL,86790,CPT,,,301,RC,,Outpatient,,,228,15.46,Aetna Med ADV,Aetna Med ADV,12.88,,,,,,,Fee Schedule,12.88,15.29,
"Mycoplasma pneumoniae Ab (IgG, IgM) QSTC",8972832,LOCAL,86738,CPT,,,302,RC,,Outpatient,,,228.83,15.89,Aetna Med ADV,Aetna Med ADV,13.24,,,,,,,Fee Schedule,13.24,15.29,
REF DAT Polyspecific,7939270,LOCAL,86880,CPT,,,,,,Outpatient,,,229.5,6.47,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,6.29,54.31,
voriconazole 200 mg intravenous injection [CULL],11211371,LOCAL,J3465,CPT,,,440,RC,,Outpatient,1,EA,230.4,,Aetna Med ADV,Aetna Med ADV,0.75,,,,,,,Fee Schedule,0.751,0.751,
92610  Bedside Swallowing Eval,9630082,LOCAL,92610,CPT,,,440,RC,GN,Outpatient,,,231.76,151,Aetna Med ADV,Aetna Med ADV,55.89,,,,,,,Fee Schedule,55.89,337.75,
Eval of Oral and Pharyngeal Swallowing Fx Chg  nd Pharyngeal Swallowing Fx Chg,7896918,LOCAL,92610,CPT,,,440,RC,GN,Outpatient,,,231.76,151,Aetna Med ADV,Aetna Med ADV,55.89,,,,,,,Fee Schedule,55.89,337.75,
Eval of Oral and Pharyngeal Swallowing Fx Chg  nd Pharyngeal Swallowing Fx Chg -> Yes,7896918,LOCAL,92610,CPT,,,440,RC,GN,Outpatient,,,231.76,151,Aetna Med ADV,Aetna Med ADV,55.89,,,,,,,Fee Schedule,55.89,337.75,
SLP Pharyngeal Swallow Eval Units,1373843,LOCAL,92610,CPT,,,420,RC,GN,Outpatient,,,231.76,151,Aetna Med ADV,Aetna Med ADV,55.89,,,,,,,Fee Schedule,55.89,337.75,
"Caregiver / patient demonstrates understanding of substance abuse, triggers, treatment",4517330,LOCAL,,,G0541,HCPCS,420,RC,,Outpatient,,,235,,Aetna Med ADV,Aetna Med ADV,50.79,,,,,,,Fee Schedule,50.79,95.93,
"Caregiver / patient demonstrates understanding of substance abuse, triggers, treatment",4517330,LOCAL,,,G0541,HCPCS,420,RC,,Outpatient,,,235,,Aetna Med ADV,Aetna Med ADV,50.79,,,,,,,Fee Schedule,50.79,95.93,
PT CAREGIVER TRAINING INT 30 MIN,4517330,LOCAL,,,G0541,HCPCS,761,RC,,Outpatient,,,235,,Aetna Med ADV,Aetna Med ADV,50.79,,,,,,,Fee Schedule,50.79,95.93,
96523 FLUSH VAD CHARGE,8213318,LOCAL,96523,CPT,,,301,RC,,Outpatient,,,235.66,153,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,54.31,64.56,
Follicle Stimulating Hormone Level,3170314,LOCAL,83001,CPT,,,302,RC,,Outpatient,,,238.68,22.3,Aetna Med ADV,Aetna Med ADV,98.8,,,,,,,Fee Schedule,18.43,98.80384615,
Antibody ID,634330,LOCAL,86870,CPT,,,302,RC,,Outpatient,,,238.76,,Aetna Med ADV,Aetna Med ADV,328.88,,,,,,,Fee Schedule,38.27,328.88,
BB THAW FFP,6413062,LOCAL,86931,CPT,,,,,,Outpatient,,,238.76,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.88,156.67,
Bill IHC Multiplex Antibody,14048007,LOCAL,88344,CPT,,,302,RC,,Outpatient,,,238.76,,Aetna Med ADV,Aetna Med ADV,328.88,,,,,,,Fee Schedule,59.06,328.88,
"Bill Only Antigen Type, Patient",8872565,LOCAL,86905,CPT,,,302,RC,,Outpatient,,,238.76,4.6,Aetna Med ADV,Aetna Med ADV,328.88,,,,,,,Fee Schedule,6.29,328.88,
"Bill Only Antigen Type, Product",8872566,LOCAL,86902,CPT,,,,,,Outpatient,,,238.76,7.62,Aetna Med ADV,Aetna Med ADV,328.88,,,,,,,Fee Schedule,6.29,328.88,
Bill Tissue Exam Level 5,14049344,LOCAL,88307,CPT,,,761,RC,,Outpatient,,,238.76,,Aetna Med ADV,Aetna Med ADV,328.88,,,,,,,Fee Schedule,59.06,328.88,
11732 AVULSION OF EACH ADDITIONAL NAIL PLATE,13029593,LOCAL,11732,CPT,,,481,RC,,Outpatient,,,239.9,156,Aetna Med ADV,Aetna Med ADV,14.39,,,,,,,Fee Schedule,14.39,863,
93463 Pharmacologic Agent Administration,8230065,LOCAL,93463,CPT,,,761,RC,,Outpatient,,,240,156,Aetna Med ADV,Aetna Med ADV,79.18,,,,,,,Fee Schedule,64.56,863,
36591 COLLECT BLOOD FROM IMPL VEN DEVICE CHARGE,10451346,LOCAL,36591,CPT,,,761,RC,,Outpatient,,,241.46,157,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,85.79,863,
Central Line Activity. -> Blood drawn,12856467,LOCAL,36592,CPT,,,306,RC,,Outpatient,,,241.46,157,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,85.79,863,
Anaerobic Culture,4122782,LOCAL,87075,CPT,,,302,RC,,Outpatient,,,242.35,11.36,Aetna Med ADV,Aetna Med ADV,50.33,,,,,,,Fee Schedule,10.57,50.328,
Bill Only ABID Panel,7936969,LOCAL,86870,CPT,,,510,RC,,Outpatient,,,243,,Aetna Med ADV,Aetna Med ADV,328.88,,,,,,,Fee Schedule,38.27,328.88,
US OB Greater Than 14 Weeks,1169850,LOCAL,76805,CPT,,,510,RC,,Outpatient,,,243,130.35,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,148.61,
US OB Greater Than 14 Weeks,1169851,LOCAL,76805,CPT,,,320,RC,,Outpatient,,,243,130.35,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,148.61,
FLUOROSCOPY <1 HOUR,8210790,LOCAL,76000,CPT,,,300,RC,,Outpatient,,,246.02,380.33,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,176.48,220.99,
.Hep C Viral RNA Quant RealTime PCR QSTC,8764584,LOCAL,87522,CPT,,,301,RC,,Outpatient,,,247.5,51.41,Aetna Med ADV,Aetna Med ADV,144.75,,,,,,,Fee Schedule,40.19,144.745,
HCV RNA Quan Progress to Genotyping QSTC,9039270,LOCAL,87522,CPT,,,301,RC,,Outpatient,,,247.5,51.41,Aetna Med ADV,Aetna Med ADV,144.75,,,,,,,Fee Schedule,40.19,144.745,
"Hepatitis C, RNA, Quantitative, PCR QSTC",8764755,LOCAL,87522,CPT,,,301,RC,,Outpatient,,,247.5,51.41,Aetna Med ADV,Aetna Med ADV,144.75,,,,,,,Fee Schedule,40.19,144.745,
"HSV Type 1&2 DNA, Qual RT PCR QSTC",8873562,LOCAL,87529,CPT,,,301,RC,,Outpatient,,,247.5,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Pancreatic Elastase-1 QSTC,8764835,LOCAL,82653,CPT,,,302,RC,,Outpatient,,,247.5,27.56,Aetna Med ADV,Aetna Med ADV,22.97,,,,,,,Fee Schedule,17.73,22.97,
REF PLT Screening,13475613,LOCAL,86022,CPT,,,410,RC,,Outpatient,,,247.5,22.04,Aetna Med ADV,Aetna Med ADV,18.37,,,,,,,Fee Schedule,15.29,18.37,
RT CHARGE Aerosol Therapy -> Initial,12502774,LOCAL,94640,CPT,,,410,RC,,Outpatient,,,247.86,136,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT Continuous Neb Initial CHARGE,8144200,LOCAL,94640,CPT,,,410,RC,,Outpatient,,,247.86,136,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT IPV Initial CHARGE,8144187,LOCAL,94640,CPT,,,335,RC,,Outpatient,,,247.86,136,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
96415 CHEMO IV INFUSION EA ADDL HR INF CHARGE,9665726,LOCAL,96415,CPT,,,,,,Outpatient,,,248.22,161,Aetna Med ADV,Aetna Med ADV,65.07,,,,,,,Fee Schedule,65.07,749.76,
aztreonam 2 g injection [CULL],11201229,LOCAL,J0457,CPT,,,301,RC,,Outpatient,1,EA,249.6,,Aetna Med ADV,Aetna Med ADV,2.23,,,,,,,Fee Schedule,2.233,2.233,
"Clobazam and Metabolite, Serum/Plasma QSTC",8764736,LOCAL,80299,CPT,,,920,RC,,Outpatient,,,249.75,22.37,Aetna Med ADV,Aetna Med ADV,18.64,,,,,,,Fee Schedule,15.38,18.64,
95977 - device analysis and complex programming,14685299,LOCAL,95977,CPT,,,300,RC,,Outpatient,,,250,92,Aetna Med ADV,Aetna Med ADV,83.92,,,,,,,Fee Schedule,83.92,214.22,
Hep Acute Pnl,633756,LOCAL,80074,CPT,,,300,RC,,Outpatient,,,250,57.16,Aetna Med ADV,Aetna Med ADV,59.34,,,,,,,Fee Schedule,12.14,59.336,
Hep Acute Pnl Post Exposure,9517262,LOCAL,80074,CPT,,,274,RC,,Outpatient,,,250,57.16,Aetna Med ADV,Aetna Med ADV,59.34,,,,,,,Fee Schedule,12.14,59.336,
COLLAR HARD PED 8 -11,6000015,LOCAL,,,L0172,HCPCS,301,RC,,Outpatient,,,250.75,223,Aetna Med ADV,Aetna Med ADV,175.72,,,,,,,Fee Schedule,175.72,175.72,
Albumin Level,1620877,LOCAL,82040,CPT,,,301,RC,,Outpatient,,,250.92,5.94,Aetna Med ADV,Aetna Med ADV,127.89,,,,,,,Fee Schedule,7.16,127.89,
Luteinizing Hormone,4240834,LOCAL,83002,CPT,,,301,RC,,Outpatient,,,250.92,22.22,Aetna Med ADV,Aetna Med ADV,18.52,,,,,,,Fee Schedule,18.43,18.52,
Rufinamide QSTC,13864436,LOCAL,80210,CPT,,,320,RC,,Outpatient,,,251.6,32.53,Aetna Med ADV,Aetna Med ADV,27.11,,,,,,,Fee Schedule,15.38,27.11,
XR Hand 2 Views Left,1170215,LOCAL,73120,CPT,,,320,RC,LT,Outpatient,,,253.04,135.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Hand 2 Views Right,1170217,LOCAL,73120,CPT,,,320,RC,RT,Outpatient,,,253.04,135.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Lower Extremity Infant 2 Views Bilat,8455866,LOCAL,73592,CPT,,,320,RC,,Outpatient,,,253.13,136.13,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Lower Extremity Infant 2 Views Left,8455869,LOCAL,73592,CPT,,,320,RC,LT,Outpatient,,,253.13,136.13,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Lower Extremity Infant 2 Views Right,8455872,LOCAL,73592,CPT,,,,,RT,Outpatient,,,253.13,136.13,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
hepatitis B adult vaccine 20 mcg/mL intramuscular suspension 1 mL [CULL],11202558,LOCAL,90746,CPT,,,324,RC,,Outpatient,1,ML,253.80864,,Aetna Med ADV,Aetna Med ADV,75.15,,,,,,,Fee Schedule,39.58,75.145,
XR Chest 1 View,8132832,LOCAL,71045,CPT,,,320,RC,,Outpatient,,,253.82,136.13,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Elbow 1 View Left,13554981,LOCAL,73070,CPT,,,320,RC,52|LT,Outpatient,,,254.32,136.13,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Elbow 1 View Right,13554984,LOCAL,73070,CPT,,,761,RC,52|RT,Outpatient,,,254.32,136.13,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
69210 REM IMPACT CERUMEN REQ INSTRU CHARGE,8020194,LOCAL,69210,CPT,,,302,RC,,Outpatient,,,255.9,166,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,54.31,863,
Bill Only Computer Search EA/Ag,13517192,LOCAL,86902,CPT,,,302,RC,,Outpatient,,,256.5,7.62,Aetna Med ADV,Aetna Med ADV,328.88,,,,,,,Fee Schedule,6.29,328.88,
Bill Only Fresh Unit (<5 Days Old),13517198,LOCAL,86999,CPT,,,402,RC,,Outpatient,,,256.5,,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,6.29,22.39,
US Pelvic Ltd,8206967,LOCAL,76857,CPT,,,460,RC,,Outpatient,,,257.05,137.78,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
RT CHARGE PFT -> Spirometry,5274349,LOCAL,94010,CPT,,,424,RC,,Outpatient,,,258.58,168,Aetna Med ADV,Aetna Med ADV,143.05,,,,,,,Fee Schedule,76.09,143.05,
97161  SB PT Eval Low Comp,9640014,LOCAL,97161,CPT,,,424,RC,GP,Outpatient,,,262.16,170,Aetna Med ADV,Aetna Med ADV,46.04,,,,,,,Fee Schedule,46.04162662,349.89,
97161 EVAL - LOW COMPLEXITY CHARGE,9410054,LOCAL,97161,CPT,,,424,RC,GP,Outpatient,,,262.16,170,Aetna Med ADV,Aetna Med ADV,46.04,,,,,,,Fee Schedule,46.04162662,349.89,
97161 PHYSICAL THERAPY EVALUATION CHARGE,9650014,LOCAL,97161,CPT,,,424,RC,GP|CQ,Outpatient,,,262.16,170,Aetna Med ADV,Aetna Med ADV,46.04,,,,,,,Fee Schedule,46.04162662,349.89,
PT Low Complex Units,7896010,LOCAL,97161,CPT,,,301,RC,GP,Outpatient,,,262.16,170,Aetna Med ADV,Aetna Med ADV,46.04,,,,,,,Fee Schedule,46.04162662,349.89,
"Lactoferrin, QL, Stool QSTC",9039266,LOCAL,83630,CPT,,,444,RC,,Outpatient,,,263.25,23.64,Aetna Med ADV,Aetna Med ADV,19.7,,,,,,,Fee Schedule,17.73,19.7,
"92521 EVALUATION OF SPEECH FLUENCY (STUTTERING, CLUTTERING)",9630056,LOCAL,92521,CPT,,,444,RC,GN,Outpatient,,,263.99,172,Aetna Med ADV,Aetna Med ADV,125.86,,,,,,,Fee Schedule,125.86,337.75,
SLP Speech Fluency Eval Units,7897205,LOCAL,92521,CPT,,,444,RC,GN,Outpatient,,,263.99,172,Aetna Med ADV,Aetna Med ADV,125.86,,,,,,,Fee Schedule,125.86,337.75,
Speech Fluency Eval Charge,7897205,LOCAL,92521,CPT,,,,,GN,Outpatient,,,263.99,172,Aetna Med ADV,Aetna Med ADV,125.86,,,,,,,Fee Schedule,125.86,337.75,
methylPREDNISolone 1 g preservative-free Pow,11287452,LOCAL,J2919,CPT,,,440,RC,,Outpatient,1,UN,264.6528,,Aetna Med ADV,Aetna Med ADV,0.21,,,,,,,Fee Schedule,0.21,5685.74,
92526  Treatment of Swallow,9630083,LOCAL,92526,CPT,,,,,GN,Outpatient,,,265.2,172,Aetna Med ADV,Aetna Med ADV,85.25,,,,,,,Fee Schedule,56.44,85.2525,
dihydroergotamine 1 mg/mL injectable solution 1 mL [CULL],11202330,LOCAL,J1110,CPT,,,440,RC,,Outpatient,1,ML,265.2,,Aetna Med ADV,Aetna Med ADV,57.08,,,,,,,Fee Schedule,57.082,57.082,
SLP Swallow Dysfunction Oral Feed Units,1373842,LOCAL,92526,CPT,,,440,RC,GN,Outpatient,,,265.2,172,Aetna Med ADV,Aetna Med ADV,85.25,,,,,,,Fee Schedule,56.44,85.2525,
Treatment of Swallowing Dysfunction Charge,7896917,LOCAL,92526,CPT,,,440,RC,GN,Outpatient,,,265.2,172,Aetna Med ADV,Aetna Med ADV,85.25,,,,,,,Fee Schedule,56.44,85.2525,
Treatment of Swallowing Dysfunction Charge -> Yes,7896917,LOCAL,92526,CPT,,,301,RC,GN,Outpatient,,,265.2,172,Aetna Med ADV,Aetna Med ADV,85.25,,,,,,,Fee Schedule,56.44,85.2525,
RNA Polymerase III Antibody QSTC,10067478,LOCAL,83516,CPT,,,320,RC,,Outpatient,,,265.5,13.84,Aetna Med ADV,Aetna Med ADV,11.53,,,,,,,Fee Schedule,11.53,17.73,
XR Sinuses Paranasal < 3 Views,1170432,LOCAL,70210,CPT,,,320,RC,,Outpatient,,,266.27,142.73,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Pelvis 1 or 2 Views,1170351,LOCAL,72170,CPT,,,301,RC,,Outpatient,,,266.62,142.73,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
Zonisamide QSTC,8764609,LOCAL,80203,CPT,,,301,RC,,Outpatient,,,267.53,15.9,Aetna Med ADV,Aetna Med ADV,13.25,,,,,,,Fee Schedule,13.25,15.38,
"Iodine, U24 QSTC",13864440,LOCAL,82542,CPT,,,301,RC,,Outpatient,,,267.8,28.91,Aetna Med ADV,Aetna Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.09,
.Atypical P-ANCA Titer QSTC,8764788,LOCAL,86037,CPT,,,301,RC,,Outpatient,,,270,14.46,Aetna Med ADV,Aetna Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
"Acylcarnitine, Plasma QSTC",9215425,LOCAL,82017,CPT,,,301,RC,,Outpatient,,,270,20.24,Aetna Med ADV,Aetna Med ADV,16.87,,,,,,,Fee Schedule,16.87,17.73,
C. difficile Toxin B Qual PCR QSTC,13864437,LOCAL,87493,CPT,,,301,RC,,Outpatient,,,270,44.72,Aetna Med ADV,Aetna Med ADV,37.27,,,,,,,Fee Schedule,37.27,40.19,
"Cytomegalovirus DNA, QN, Real-T PCR QSTC",8764608,LOCAL,87497,CPT,,,301,RC,,Outpatient,,,270,51.41,Aetna Med ADV,Aetna Med ADV,42.84,,,,,,,Fee Schedule,40.19,42.84,
"Kappa/Lambda Lght Chn, Free w Rat U QSTC",9039383,LOCAL,83883,CPT,,,301,RC,,Outpatient,,,270,16.32,Aetna Med ADV,Aetna Med ADV,13.6,,,,,,,Fee Schedule,13.6,15.29,
"Kappa/Lambda Light Chains, Tot Ur QSTC",9039383,LOCAL,83883,CPT,,,311,RC,,Outpatient,,,270,16.32,Aetna Med ADV,Aetna Med ADV,13.6,,,,,,,Fee Schedule,13.6,15.29,
"Mycoplasma Genitalium,R-T PCR QST",9773947,LOCAL,87624,CPT,,,302,RC,,Outpatient,,,270,42.11,Aetna Med ADV,Aetna Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
Reference Lab Crossmatch -> Compatible,8185614,LOCAL,86920,CPT,,,302,RC,,Outpatient,,,270,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
Reference Lab Crossmatch -> Incompatible,8185613,LOCAL,86920,CPT,,,302,RC,,Outpatient,,,270,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
Reference Lab Crossmatch -> Least Incompatible,8185612,LOCAL,86920,CPT,,,301,RC,,Outpatient,,,270,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
von Willebrand Factor Ag QSTC,8764731,LOCAL,85246,CPT,,,450,RC,,Outpatient,,,270,27.53,Aetna Med ADV,Aetna Med ADV,22.94,,,,,,,Fee Schedule,5.42,22.94,
99281 Emergency Department Visit. Level 1,2644297,LOCAL,99281,CPT,,,320,RC,25,Outpatient,,,272.36,177,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,80.5,
XR Finger(s) 1 View Left,13554987,LOCAL,73140,CPT,,,320,RC,52|LT,Outpatient,,,272.62,146.03,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Finger(s) 1 View Right,13554990,LOCAL,73140,CPT,,,730,RC,52|RT,Outpatient,,,272.62,146.03,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
Electrocardiogram 12 Lead.,9696149,LOCAL,93005,CPT,,,731,RC,,Outpatient,,,273.98,178,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,38.53,54.31,
93242 Holter 3 to 7 Days Recording,90820010,LOCAL,93242,CPT,,,301,RC,,Outpatient,,,275,179,Aetna Med ADV,Aetna Med ADV,35.88,,,,,,,Fee Schedule,35.88,99.86,
Prolactin Level,3170316,LOCAL,84146,CPT,,,320,RC,,Outpatient,,,275.4,23.26,Aetna Med ADV,Aetna Med ADV,19.38,,,,,,,Fee Schedule,18.43,19.38,
XR Elbow 2 Views Left,1170121,LOCAL,73070,CPT,,,320,RC,LT,Outpatient,,,275.53,136.13,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Elbow 2 Views Right,1170123,LOCAL,73070,CPT,,,300,RC,RT,Outpatient,,,275.53,136.13,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
.TR Interpretation,1173781,LOCAL,86078,CPT,,,300,RC,,Outpatient,,,277.85,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.88,156.67,
BB REF LAB PHYSICIAN INTERP,6413086,LOCAL,86077,CPT,,,302,RC,,Outpatient,,,279,,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,22.39,38.88,
Bill Only Crossmatch IS,8419033,LOCAL,86920,CPT,,,,,,Outpatient,,,279,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
hepatitis B immune globulin intramuscular solution 0.5 mL [CULL],11202561,LOCAL,J1571,CPT,,,320,RC,,Outpatient,0.5,ML,280.064,,Aetna Med ADV,Aetna Med ADV,66.64,,,,,,,Fee Schedule,66.64,771.25,
XR Spine 1 View Specify Level,8058789,LOCAL,72020,CPT,,,320,RC,,Outpatient,,,281.44,150.98,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Knee 1 View Standing AP Bilateral,1170291,LOCAL,73565,CPT,,,301,RC,,Outpatient,,,283.03,151.8,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
Iodine QSTC,13864439,LOCAL,82542,CPT,,,320,RC,,Outpatient,,,283.32,28.91,Aetna Med ADV,Aetna Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.09,
XR Neck Soft Tissue,1170331,LOCAL,70360,CPT,,,424,RC,,Outpatient,,,284.4,152.63,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
97162  SB PT Eval Mod Comp,9640015,LOCAL,97162,CPT,,,424,RC,GP,Outpatient,,,287.16,187,Aetna Med ADV,Aetna Med ADV,42.69,,,,,,,Fee Schedule,42.68861429,349.89,
97162 EVAL - MODERATE COMPLEXITY CHARGE,9410055,LOCAL,97162,CPT,,,424,RC,GP,Outpatient,,,287.16,187,Aetna Med ADV,Aetna Med ADV,42.69,,,,,,,Fee Schedule,42.68861429,349.89,
97162 PT EVAL MOD COMPLEX CHARGES,9650015,LOCAL,97162,CPT,,,424,RC,GP|CQ,Outpatient,,,287.16,187,Aetna Med ADV,Aetna Med ADV,42.69,,,,,,,Fee Schedule,42.68861429,349.89,
PT Moderate Complex Units,7896012,LOCAL,97162,CPT,,,301,RC,GP,Outpatient,,,287.16,187,Aetna Med ADV,Aetna Med ADV,42.69,,,,,,,Fee Schedule,42.68861429,349.89,
Soluble Liver Antigen (SLA) Autoantibody QSTC,10148492,LOCAL,83520,CPT,,,320,RC,,Outpatient,,,288,20.72,Aetna Med ADV,Aetna Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
XR Shoulder 1 View Left,1170409,LOCAL,73020,CPT,,,320,RC,LT,Outpatient,,,289.86,155.1,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Shoulder 1 View Right,1170411,LOCAL,73020,CPT,,,320,RC,RT,Outpatient,,,289.86,155.1,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR AC Joints Bilateral,1169922,LOCAL,73050,CPT,,,320,RC,,Outpatient,,,289.94,155.1,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Calcaneus Limited Left,13554972,LOCAL,73650,CPT,,,320,RC,52|LT,Outpatient,,,290.55,174.9,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Calcaneus Limited Right,13554975,LOCAL,73650,CPT,,,320,RC,52|RT,Outpatient,,,290.55,174.9,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
BD Bone Density DEXA Vert Fracture Assmt,8206345,LOCAL,77086,CPT,,,320,RC,,Outpatient,,,291.16,155.93,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,116.02,
XR Foreign Body Localization Child 1 Vw,1170207,LOCAL,76010,CPT,,,,,,Outpatient,,,291.16,155.93,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
cefTRIAXone 2 g injection [CULL],11202189,LOCAL,J0696,CPT,,,301,RC,,Outpatient,1,EA,292.1824,,Aetna Med ADV,Aetna Med ADV,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
"Cytomegalovirus DNA, QL R-T PCR QSTC",9777223,LOCAL,87496,CPT,,,300,RC,,Outpatient,,,292.5,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Factor IX Activity,Clotting [352X]  QSTC",12534660,LOCAL,85250,CPT,,,301,RC,,Outpatient,,,292.5,22.85,Aetna Med ADV,Aetna Med ADV,19.04,,,,,,,Fee Schedule,5.42,19.04,
"HIV-1 RNA, QN, Real-Time PCR QSTC",8764763,LOCAL,87536,CPT,,,324,RC,,Outpatient,,,292.5,102.12,Aetna Med ADV,Aetna Med ADV,85.1,,,,,,,Fee Schedule,85.1,158.39,
XR Chest Decubitus,1170049,LOCAL,71046,CPT,,,305,RC,,Outpatient,,,292.6,212.85,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
"Factor VIII Inhibitor, EIA QSTC",13873092,LOCAL,85335,CPT,,,305,RC,,Outpatient,,,294.75,15.44,Aetna Med ADV,Aetna Med ADV,12.87,,,,,,,Fee Schedule,5.42,12.87,
"FVIII Act, Clotting QSTC",13873093,LOCAL,85240,CPT,,,320,RC,,Outpatient,,,294.75,21.48,Aetna Med ADV,Aetna Med ADV,17.9,,,,,,,Fee Schedule,5.42,17.9,
XR Upper Extremity Infant 2 Views Left,8455878,LOCAL,73092,CPT,,,320,RC,LT,Outpatient,,,296.99,159.23,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Upper Extremity Infant 2 Views Right,8455881,LOCAL,73092,CPT,,,302,RC,RT,Outpatient,,,296.99,159.23,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
Ref Rh Phenotyping,9527485,LOCAL,86906,CPT,,,440,RC,,Outpatient,,,297,9.3,Aetna Med ADV,Aetna Med ADV,35.88,,,,,,,Fee Schedule,6.29,35.88,
92611 ST VIDEOFLUOR SWALLOW CHARGE,9630067,LOCAL,92611,CPT,,,440,RC,GN,Outpatient,,,297.49,193,Aetna Med ADV,Aetna Med ADV,189.99,,,,,,,Fee Schedule,176.48,189.9866667,
Fluoroscopic Evaluation of Swallow Function Charge,7896919,LOCAL,92611,CPT,,,440,RC,GN,Outpatient,,,297.49,193,Aetna Med ADV,Aetna Med ADV,189.99,,,,,,,Fee Schedule,176.48,189.9866667,
SLP Fluoroscopic Evaluation Units,1373839,LOCAL,92611,CPT,,,434,RC,GN,Outpatient,,,297.49,193,Aetna Med ADV,Aetna Med ADV,189.99,,,,,,,Fee Schedule,176.48,189.9866667,
97165 EVAL -  LOW COMPLEXITY CHARGE,9850014,LOCAL,97165,CPT,,,434,RC,GO,Outpatient,,,297.74,194,Aetna Med ADV,Aetna Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
97165 OT Evaluation Low Complexity 30 min,9860014,LOCAL,97165,CPT,,,434,RC,GO|CO,Outpatient,,,297.74,194,Aetna Med ADV,Aetna Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Evaluation Low Complexity Units,7897807,LOCAL,97165,CPT,,,434,RC,GO,Outpatient,,,297.74,194,Aetna Med ADV,Aetna Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Low Complex Units,7895291,LOCAL,97165,CPT,,,300,RC,GO,Outpatient,,,297.74,194,Aetna Med ADV,Aetna Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
"Aspergillus Antigen, EIA, Serum QSTC",9777227,LOCAL,87305,CPT,,,420,RC,,Outpatient,,,298,14.38,Aetna Med ADV,Aetna Med ADV,11.98,,,,,,,Fee Schedule,10.57,11.98,
29581 PT Lower Extremity Application of Strapping,9640079,LOCAL,29581,CPT,,,420,RC,GP,Outpatient,,,300,195,Aetna Med ADV,Aetna Med ADV,144.26,,,,,,,Fee Schedule,144.26,863,
PT Lymphedema Wrap below Knee Charge,7895901,LOCAL,29581,CPT,,,301,RC,GP,Outpatient,,,300,195,Aetna Med ADV,Aetna Med ADV,144.26,,,,,,,Fee Schedule,144.26,863,
Lacosamide QSTC,8764635,LOCAL,80235,CPT,,,,,,Outpatient,,,301.5,32.53,Aetna Med ADV,Aetna Med ADV,27.11,,,,,,,Fee Schedule,15.38,27.11,
tetanus/diphth/pertussis (Tdap) adult/adol 5 units-2 units-15.5 mcg/0.5 mL intramuscular suspension 0.5 mL [CULL],11202346,LOCAL,90714,CPT,,,320,RC,,Outpatient,0.5,ML,301.632,,Aetna Med ADV,Aetna Med ADV,14.45,,,,,,,Fee Schedule,14.45070423,39.58,
XR Toe(s) 2 PLUS Views Right,1170522,LOCAL,73660,CPT,,,320,RC,RT,Outpatient,,,301.78,161.7,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Toe(s) 2+ Views Left,1170520,LOCAL,73660,CPT,,,,,LT,Outpatient,,,301.78,161.7,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
influenza vaccine (Fluzone HD) vaccine 2025-2026 [CULL],11292055,LOCAL,90662,CPT,,,274,RC,,Outpatient,0.5,ML,303.5392,,Aetna Med ADV,Aetna Med ADV,86.13,,,,,,,Fee Schedule,39.58,86.13,
Large Humeral Fracture Brace,9400080,LOCAL,,,L3982,HCPCS,274,RC,,Outpatient,,,303.88,,Aetna Med ADV,Aetna Med ADV,429.48,,,,,,,Fee Schedule,429.48,429.48,
Medium Humeral Fracture Brace,9400079,LOCAL,,,L3982,HCPCS,731,RC,,Outpatient,,,303.88,,Aetna Med ADV,Aetna Med ADV,429.48,,,,,,,Fee Schedule,429.48,429.48,
CV Holter Monitor Recording up to 48 Hrs,8230053,LOCAL,93225,CPT,,,731,RC,,Outpatient,,,304,198,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,99.86,117.85,
Holter Monitor 48 Hr,8230053,LOCAL,93225,CPT,,,302,RC,,Outpatient,,,304,198,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,99.86,117.85,
Bill Only Rh Phenotyping,7936966,LOCAL,86906,CPT,,,301,RC,,Outpatient,,,306,9.3,Aetna Med ADV,Aetna Med ADV,35.88,,,,,,,Fee Schedule,6.29,35.88,
COV19/Flu/RSV (GeneXpert Plus),10791321,LOCAL,87637,CPT,,,402,RC,,Outpatient,,,306,171.16,Aetna Med ADV,Aetna Med ADV,69.48,,,,,,,Fee Schedule,40.19,69.4761107,
US OB Less Than 14 Weeks,8206952,LOCAL,76801,CPT,,,301,RC,,Outpatient,,,307,165,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,148.61,
Chlamydia/Chlamydophila Ab 2 IgM QSTC,13864537,LOCAL,86632,CPT,,,,,,Outpatient,,,307.13,15.22,Aetna Med ADV,Aetna Med ADV,12.68,,,,,,,Fee Schedule,12.68,15.29,
EPINEPHrine 8 mg/250 mL-NaCl 0.9% Sol [CULL],11200040,LOCAL,J0165,CPT,,,301,RC,,Outpatient,250,ML,307.2,,Aetna Med ADV,Aetna Med ADV,0.43,,,,,,,Fee Schedule,0.433,0.433,
Comprehensive Metabolic Panel,633709,LOCAL,80053,CPT,,,320,RC,,Outpatient,,,307.22,12.67,Aetna Med ADV,Aetna Med ADV,82.76,,,,,,,Fee Schedule,12.14,82.75523053,
XR Ankle 1 View Left,13554963,LOCAL,73600,CPT,,,320,RC,52|LT,Outpatient,,,307.85,165,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ankle 1 View Right,13554966,LOCAL,73600,CPT,,,320,RC,52|RT,Outpatient,,,307.85,165,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Foot 2 Views Left,1170185,LOCAL,73620,CPT,,,320,RC,LT,Outpatient,,,309.19,165.83,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Foot 2 Views Right,1170187,LOCAL,73620,CPT,,,302,RC,RT,Outpatient,,,309.19,165.83,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
"Bill Only ABID Panel, Enzyme (Ab)",13517190,LOCAL,86870,CPT,,,302,RC,,Outpatient,,,310.5,,Aetna Med ADV,Aetna Med ADV,328.88,,,,,,,Fee Schedule,38.27,328.88,
"Bill Only ABID Panel, Enzyme (Ezym)",13517194,LOCAL,86971,CPT,,,301,RC,,Outpatient,,,310.5,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.88,156.67,
Insulin Autoantibody QSTC,8764818,LOCAL,86337,CPT,,,320,RC,,Outpatient,,,310.5,25.69,Aetna Med ADV,Aetna Med ADV,21.41,,,,,,,Fee Schedule,15.29,21.41,
XR Finger(s) 2 Plus Views Left,1170151,LOCAL,73140,CPT,,,320,RC,LT,Outpatient,,,311.14,146.03,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Finger(s) 2 Plus Views Right,1170153,LOCAL,73140,CPT,,,424,RC,RT,Outpatient,,,311.14,146.03,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
97163  SB PT Eval High Comp,9640017,LOCAL,97163,CPT,,,424,RC,GP,Outpatient,,,312.16,203,Aetna Med ADV,Aetna Med ADV,92.25,,,,,,,Fee Schedule,92.25,349.89,
97163 EVAL - HIGH COMPLEXITY CHARGE,9410062,LOCAL,97163,CPT,,,424,RC,GP,Outpatient,,,312.16,203,Aetna Med ADV,Aetna Med ADV,92.25,,,,,,,Fee Schedule,92.25,349.89,
97163 IND EDUCATION EVAL CHARGE,9650017,LOCAL,97163,CPT,,,424,RC,GP|CQ,Outpatient,,,312.16,203,Aetna Med ADV,Aetna Med ADV,92.25,,,,,,,Fee Schedule,92.25,349.89,
PT High Complex Units,7896014,LOCAL,97163,CPT,,,301,RC,GP,Outpatient,,,312.16,203,Aetna Med ADV,Aetna Med ADV,92.25,,,,,,,Fee Schedule,92.25,349.89,
Factor II Activity QSTC,8972859,LOCAL,85210,CPT,,,403,RC,,Outpatient,,,312.8,15.58,Aetna Med ADV,Aetna Med ADV,12.98,,,,,,,Fee Schedule,5.42,12.98,
MG Mammo Implant Screening Lt w/ Tomo.,8146654,LOCAL,77067,CPT,,,403,RC,LT,Outpatient,,,313.11,363,Aetna Med ADV,Aetna Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Implant Screening Rt w/ Tomo.,8146657,LOCAL,77067,CPT,,,403,RC,RT,Outpatient,,,313.11,363,Aetna Med ADV,Aetna Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Screening Left w/ Tomo.,8146660,LOCAL,77067,CPT,,,403,RC,LT,Outpatient,,,313.11,363,Aetna Med ADV,Aetna Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Screening Right w/ Tomo.,8146663,LOCAL,77067,CPT,,,440,RC,RT,Outpatient,,,313.11,363,Aetna Med ADV,Aetna Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
92609 ST USE OF SPEECH DEVICE SERVICES,9636008,LOCAL,92609,CPT,,,440,RC,GN,Outpatient,,,314.48,204,Aetna Med ADV,Aetna Med ADV,95.88,,,,,,,Fee Schedule,56.44,95.88,
SLP Speech-Gen Dev Prog and Mod,7896913,LOCAL,92609,CPT,,,440,RC,GN,Outpatient,,,314.48,204,Aetna Med ADV,Aetna Med ADV,95.88,,,,,,,Fee Schedule,56.44,95.88,
SLP Speech-Gen Dev Prog and Mod Time,1373849,LOCAL,92609,CPT,,,440,RC,GN,Outpatient,,,314.48,204,Aetna Med ADV,Aetna Med ADV,95.88,,,,,,,Fee Schedule,56.44,95.88,
SLP Tx Generating Device Units,1373849,LOCAL,92609,CPT,,,301,RC,GN,Outpatient,,,314.48,204,Aetna Med ADV,Aetna Med ADV,95.88,,,,,,,Fee Schedule,56.44,95.88,
"Factor V Activity, Clotting QSTC",9777239,LOCAL,85220,CPT,,,301,RC,,Outpatient,,,315,21.18,Aetna Med ADV,Aetna Med ADV,17.65,,,,,,,Fee Schedule,5.42,17.65,
Hepatitis B Virus DNA Qnt RT PCR QSTC,8764549,LOCAL,87517,CPT,,,301,RC,,Outpatient,,,315,51.41,Aetna Med ADV,Aetna Med ADV,178.5,,,,,,,Fee Schedule,40.19,178.495,
Inhibin A QSTC,8972775,LOCAL,86336,CPT,,,306,RC,,Outpatient,,,315,18.71,Aetna Med ADV,Aetna Med ADV,15.59,,,,,,,Fee Schedule,15.29,15.59,
"Viral Respiratory, Rapid Culture with Reflex QST",12126195,LOCAL,87140,CPT,,,301,RC,,Outpatient,,,315,6.68,Aetna Med ADV,Aetna Med ADV,5.57,,,,,,,Fee Schedule,5.57,10.57,
"Porphyrins, Total QSTC",13864419,LOCAL,82542,CPT,,,322,RC,,Outpatient,,,315.9,28.91,Aetna Med ADV,Aetna Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.09,
"73040 Radiologic examination, shoulder, arthrography: AddOn",14917589,LOCAL,73040,CPT,,,320,RC,,Outpatient,,,316.12,777.98,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Forearm 1 View Left,13554993,LOCAL,73090,CPT,,,320,RC,52|LT,Outpatient,,,318.62,170.78,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Forearm 1 View Right,13554996,LOCAL,73090,CPT,,,320,RC,52|RT,Outpatient,,,318.62,170.78,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ankle 2 Views Left,1169936,LOCAL,73600,CPT,,,320,RC,LT,Outpatient,,,318.65,165,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ankle 2 Views Right,1169938,LOCAL,73600,CPT,,,,,RT,Outpatient,,,318.65,165,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
tobramycin 1.2 g injection [CULL],11211303,LOCAL,J3260,CPT,,,301,RC,,Outpatient,1,EA,320,,Aetna Med ADV,Aetna Med ADV,2.07,,,,,,,Fee Schedule,2.071,2.071,
Complement Component C1q QSTC,8972752,LOCAL,86160,CPT,,,434,RC,,Outpatient,,,322.65,14.4,Aetna Med ADV,Aetna Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
97166  SB OT Eval Mod Comp,9860015,LOCAL,97166,CPT,,,434,RC,GO|CO,Outpatient,,,322.74,210,Aetna Med ADV,Aetna Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
97166 EVAL -  MODERATE COMPLEXITY CHARGE,9850015,LOCAL,97166,CPT,,,434,RC,GO,Outpatient,,,322.74,210,Aetna Med ADV,Aetna Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Evaluation Moderate Complexity Units,7897808,LOCAL,97166,CPT,,,434,RC,GO,Outpatient,,,322.74,210,Aetna Med ADV,Aetna Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Moderate Complex Units,7895293,LOCAL,97166,CPT,,,320,RC,GO,Outpatient,,,322.74,210,Aetna Med ADV,Aetna Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
XR Calcaneus Left,1170032,LOCAL,73650,CPT,,,320,RC,LT,Outpatient,,,325.42,174.9,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Calcaneus Right,1170034,LOCAL,73650,CPT,,,460,RC,RT,Outpatient,,,325.42,174.9,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
94618 PULM STRESS TEST - 6 MIN WALK CHARGE,10470023,LOCAL,94618,CPT,,,460,RC,59,Outpatient,,,326.86,212,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,76.09,117.85,
94618 PULMONARY STRESS TEST CHARGE,10470022,LOCAL,94618,CPT,,,320,RC,,Outpatient,,,326.86,212,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,76.09,117.85,
XR Hips 2 Views w/AP Pelvis Bilat,7520609,LOCAL,73521,CPT,,,301,RC,,Outpatient,,,327.27,175.73,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
"Neutrophil Funct, Oxidative Burst QSTC",13864519,LOCAL,82657,CPT,,,320,RC,,Outpatient,,,327.6,26.6,Aetna Med ADV,Aetna Med ADV,22.17,,,,,,,Fee Schedule,17.73,22.17,
XR Clavicle Limited Left,13554978,LOCAL,73000,CPT,,,320,RC,52|LT,Outpatient,,,330.84,198.83,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Clavicle Limited Right,13575896,LOCAL,73000,CPT,,,320,RC,52|RT,Outpatient,,,330.84,198.83,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR CV Line Injection,10153535,LOCAL,77001,CPT,,,320,RC,,Outpatient,,,330.88,177.38,Aetna Med ADV,Aetna Med ADV,70.92,,,,,,,Fee Schedule,70.92,262.79,
XR Portogram,8602535,LOCAL,36598,CPT,,,301,RC,,Outpatient,,,330.88,587,Aetna Med ADV,Aetna Med ADV,192.63,,,,,,,Fee Schedule,192.63,863,
"Neuron Specific Enolase, CSF QSTC",13864472,LOCAL,86316,CPT,,,320,RC,,Outpatient,,,335.25,24.97,Aetna Med ADV,Aetna Med ADV,100.2,,,,,,,Fee Schedule,15.29,100.2,
XR Sternum 2+ Views,1170496,LOCAL,71120,CPT,,,301,RC,,Outpatient,,,335.51,179.85,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
"Borrelia species DNA, QL RT PCR QSTC",13864432,LOCAL,87801,CPT,,,301,RC,,Outpatient,,,337.5,84.24,Aetna Med ADV,Aetna Med ADV,70.2,,,,,,,Fee Schedule,40.19,70.2,
"Calprotectin, Stool QSTC",8764641,LOCAL,83993,CPT,,,301,RC,,Outpatient,,,337.5,23.56,Aetna Med ADV,Aetna Med ADV,19.63,,,,,,,Fee Schedule,17.73,19.63,
"Factor VII Activity, Clotting QSTC",12530023,LOCAL,85230,CPT,,,301,RC,,Outpatient,,,337.5,21.48,Aetna Med ADV,Aetna Med ADV,17.9,,,,,,,Fee Schedule,5.42,17.9,
"Rheumatoid Factor (IgA, IgG, IgM) QSTC",9743436,LOCAL,83520,CPT,,,311,RC,,Outpatient,,,337.5,20.72,Aetna Med ADV,Aetna Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
SURESWAB(R) ADV BV QST,12432150,LOCAL,81513,CPT,,,301,RC,,Outpatient,,,338,171.16,Aetna Med ADV,Aetna Med ADV,142.63,,,,,,,Fee Schedule,63.34,142.63,
"Estrogens, Fractionated, LC/MS QSTC",8972883,LOCAL,82671,CPT,,,300,RC,,Outpatient,,,340.29,38.76,Aetna Med ADV,Aetna Med ADV,185.98,,,,,,,Fee Schedule,18.43,185.975,
"86617-Lyme Disease Abs (IgG, IgM) IBL CSF QSTC",14825580,LOCAL,86617,CPT,,,301,RC,,Outpatient,,,342,18.59,Aetna Med ADV,Aetna Med ADV,15.49,,,,,,,Fee Schedule,15.29,15.49,
"BK Virus DNA, Quant, RT PCR QSTC",8853280,LOCAL,87799,CPT,,,301,RC,,Outpatient,,,342,51.41,Aetna Med ADV,Aetna Med ADV,42.84,,,,,,,Fee Schedule,40.19,42.84,
"Lyme Disease Ab Rfx Blot IgG, IgM QSTC",8764732,LOCAL,86618,CPT,,,300,RC,,Outpatient,,,342,20.44,Aetna Med ADV,Aetna Med ADV,17.03,,,,,,,Fee Schedule,15.29,17.03,
"Lyme Disease Abs (IgG, IgM) IBL CSF QSTC",14114578,LOCAL,86617,CPT,,,300,RC,,Outpatient,,,342,18.59,Aetna Med ADV,Aetna Med ADV,15.49,,,,,,,Fee Schedule,15.29,15.49,
"Lyme Disease Antibodies (IgG, IgM), Immunoblot, CSF QST",6232109,LOCAL,86617,CPT,,,,,,Outpatient,,,342,18.59,Aetna Med ADV,Aetna Med ADV,15.49,,,,,,,Fee Schedule,15.29,15.49,
sodium thiosulfate 25% intravenous solution 50 mL [CULL],11260081,LOCAL,J0208,CPT,,,301,RC,,Outpatient,50,ML,342.4,,Aetna Med ADV,Aetna Med ADV,95.11,,,,,,,Fee Schedule,95.11,7537.07,
Chlamydia/Chlamydophila Ab 1 IgG QSTC,13864536,LOCAL,86631,CPT,,,311,RC,,Outpatient,,,342.9,14.18,Aetna Med ADV,Aetna Med ADV,11.82,,,,,,,Fee Schedule,11.82,15.29,
"TRICHOMONAS VAGINALIS (TV), TMA QST",12432301,LOCAL,87661,CPT,,,311,RC,,Outpatient,,,343.11,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
CANDIDA GLABRATA QST,12432300,LOCAL,87481,CPT,,,311,RC,,Outpatient,,,343.13,42.11,Aetna Med ADV,Aetna Med ADV,478.17,,,,,,,Fee Schedule,40.19,478.165,
CANDIDA SPECIES QST,12432293,LOCAL,87481,CPT,,,311,RC,,Outpatient,,,343.13,42.11,Aetna Med ADV,Aetna Med ADV,478.17,,,,,,,Fee Schedule,40.19,478.165,
CANDIDA SPECIES QST,12432299,LOCAL,87481,CPT,,,311,RC,,Outpatient,,,343.13,42.11,Aetna Med ADV,Aetna Med ADV,478.17,,,,,,,Fee Schedule,40.19,478.165,
SURESWAB(R) ADV BV QST,12432298,LOCAL,81513,CPT,,,301,RC,,Outpatient,,,343.13,171.16,Aetna Med ADV,Aetna Med ADV,142.63,,,,,,,Fee Schedule,63.34,142.63,
"EBV DNA, QN PCR QSTC",8764620,LOCAL,87799,CPT,,,320,RC,,Outpatient,,,344.25,51.41,Aetna Med ADV,Aetna Med ADV,42.84,,,,,,,Fee Schedule,40.19,42.84,
XR Wrist 2 Views Left,1170606,LOCAL,73100,CPT,,,320,RC,LT,Outpatient,,,344.56,184.8,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Wrist 2 Views Right,1170608,LOCAL,73100,CPT,,,300,RC,RT,Outpatient,,,344.56,184.8,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
REF LAB IAT CROSSMATCH,13797753,LOCAL,86922,CPT,,,320,RC,,Outpatient,,,347,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
XR Forearm 2 Views Left,1170197,LOCAL,73090,CPT,,,320,RC,LT,Outpatient,,,347.3,170.78,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Forearm 2 Views Right,1170199,LOCAL,73090,CPT,,,434,RC,RT,Outpatient,,,347.3,170.78,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
97167 EVAL -  HIGH COMPLEXITY CHARGE,9850017,LOCAL,97167,CPT,,,434,RC,GO,Outpatient,,,347.74,226,Aetna Med ADV,Aetna Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
97167 IND EDUCATION EVAL CHARGE,9860017,LOCAL,97167,CPT,,,434,RC,GO|CO,Outpatient,,,347.74,226,Aetna Med ADV,Aetna Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Evaluation High Complexity Units,7897809,LOCAL,97167,CPT,,,434,RC,GO,Outpatient,,,347.74,226,Aetna Med ADV,Aetna Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT High Complex Units,7895295,LOCAL,97167,CPT,,,761,RC,GO,Outpatient,,,347.74,226,Aetna Med ADV,Aetna Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
99211 LEVEL I VISIT CHARGE,9319019,LOCAL,99211,CPT,,,761,RC,,Outpatient,,,348.41,226,Aetna Med ADV,Aetna Med ADV,7.37,,,,,,,Fee Schedule,7.37,7.37,
99211 Office Visit Established Pt. Level 1,10168485,LOCAL,99211,CPT,,,320,RC,,Outpatient,,,348.41,226,Aetna Med ADV,Aetna Med ADV,7.37,,,,,,,Fee Schedule,7.37,7.37,
XR Scapula Left,1170401,LOCAL,73010,CPT,,,320,RC,LT,Outpatient,,,348.57,187.28,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Scapula Right,1170403,LOCAL,73010,CPT,,,301,RC,RT,Outpatient,,,348.57,187.28,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
Mycobacterium Slow Grower MIC QST,13864520,LOCAL,87186,CPT,,,301,RC,,Outpatient,,,348.75,10.38,Aetna Med ADV,Aetna Med ADV,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
Mycobacterium Slow Grower MIC QSTC,13864520,LOCAL,87186,CPT,,,410,RC,,Outpatient,,,348.75,10.38,Aetna Med ADV,Aetna Med ADV,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
CPAP Charge -> Subsequent,8365858,LOCAL,94660,CPT,,,761,RC,,Outpatient,,,348.84,279,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,181.37,185.95,
17110 CRYOSURGERY REMOVAL OF LESIONS CHARGE,9038957,LOCAL,17110,CPT,,,948,RC,,Outpatient,,,350,228,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
94625 PHY/QHP OP PULM RHB W/O MNTR,10470028,LOCAL,94625,CPT,,,761,RC,,Outpatient,,,350,407,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,51.98,54.31,
11730 AVULSION OF NAIL PLATE SINGLE,8715870,LOCAL,11730,CPT,,,460,RC,,Outpatient,,,350.01,228,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,95.93,863,
94618 PULMONARY STRESS TEST 6 MINUTE WALK,10440014,LOCAL,94618,CPT,,,,,,Outpatient,,,351.07,212,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,76.09,117.85,
linezolid 2 mg/mL-D5% intravenous solution 300 mL [CULL],11201931,LOCAL,J2020,CPT,,,460,RC,,Outpatient,300,ML,352,,Aetna Med ADV,Aetna Med ADV,2.74,,,,,,,Fee Schedule,2.742,2.742,
RT CHARGE PFT -> Bedside Spirometry,8860673,LOCAL,94060,CPT,,,460,RC,,Outpatient,,,353.43,230,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,149.57,284.7,
RT CHARGE PFT -> Spirometry before & after,5267139,LOCAL,94060,CPT,,,301,RC,,Outpatient,,,353.43,230,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,149.57,284.7,
Alpha Subunit QSTC,9849271,LOCAL,83520,CPT,,,320,RC,,Outpatient,,,354.33,20.72,Aetna Med ADV,Aetna Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
XR Spine Thoracic 2 Views,1170484,LOCAL,72070,CPT,,,,,,Outpatient,,,358.33,192.23,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
micafungin 50 mg intravenous injection [CULL],11220352,LOCAL,J2248,CPT,,,301,RC,,Outpatient,1,EA,359.232,,Aetna Med ADV,Aetna Med ADV,0.25,,,,,,,Fee Schedule,0.249,122.4,
Acetylcholine Recept. Modulating Ab QSTC,13864533,LOCAL,86043,CPT,,,301,RC,,Outpatient,,,360,14.46,Aetna Med ADV,Aetna Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
Adenovirus DNA Qual RT PCR QSTC,10100374,LOCAL,87798,CPT,,,300,RC,,Outpatient,,,360,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"B.pertussis/para DNA,Ql Rl-Time PCR QSTC",8873570,LOCAL,87798,CPT,,,301,RC,,Outpatient,,,360,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Bartonella Sp Ab IgG,IgM w/rf Titer QSTC",9777261,LOCAL,86611,CPT,,,301,RC,,Outpatient,,,360,12.22,Aetna Med ADV,Aetna Med ADV,10.18,,,,,,,Fee Schedule,10.18,15.29,
Copeptin QSTC,9039409,LOCAL,86255,CPT,,,301,RC,,Outpatient,,,360,14.46,Aetna Med ADV,Aetna Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
Hepatitis C Viral RNA Genotype LiPA QSTC,8764578,LOCAL,87902,CPT,,,301,RC,,Outpatient,,,360,308.94,Aetna Med ADV,Aetna Med ADV,257.45,,,,,,,Fee Schedule,158.39,257.45,
Histamine QSTC,13864456,LOCAL,83088,CPT,,,311,RC,,Outpatient,,,360,35.44,Aetna Med ADV,Aetna Med ADV,29.53,,,,,,,Fee Schedule,17.73,29.53,
HSV 1 QST,9775428,LOCAL,87529,CPT,,,311,RC,,Outpatient,,,360,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
HSV 2 QST,9775429,LOCAL,87529,CPT,,,301,RC,,Outpatient,,,360,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Mycobacterium Avium Complex MIC QST,13344174,LOCAL,87186,CPT,,,,,,Outpatient,,,360,10.38,Aetna Med ADV,Aetna Med ADV,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
methylPREDNISolone sodium succinate 2 g injection [CULL],11201958,LOCAL,J2919,CPT,,,320,RC,,Outpatient,1,EA,361.92,,Aetna Med ADV,Aetna Med ADV,0.21,,,,,,,Fee Schedule,0.21,0.21,
XR Mandible Less Than 4 Views,1170303,LOCAL,70100,CPT,,,302,RC,,Outpatient,,,362.58,194.7,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
Babesia microti Ab (IgG) QSTC,13872991,LOCAL,86753,CPT,,,302,RC,,Outpatient,,,367.5,14.87,Aetna Med ADV,Aetna Med ADV,12.39,,,,,,,Fee Schedule,12.39,15.29,
Ehrlichia chaffeensis Ab IgG QSTC,13872999,LOCAL,86753,CPT,,,302,RC,,Outpatient,,,367.5,14.87,Aetna Med ADV,Aetna Med ADV,12.39,,,,,,,Fee Schedule,12.39,15.29,
Lyme Ab Screen QSTC,13872998,LOCAL,86618,CPT,,,320,RC,,Outpatient,,,367.5,20.44,Aetna Med ADV,Aetna Med ADV,17.03,,,,,,,Fee Schedule,15.29,17.03,
XR Clavicle Left,1170075,LOCAL,73000,CPT,,,320,RC,LT,Outpatient,,,370.53,198.83,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Clavicle Right,1170077,LOCAL,73000,CPT,,,320,RC,RT,Outpatient,,,370.53,198.83,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Humerus Limited Left,13554999,LOCAL,73060,CPT,,,320,RC,52|LT,Outpatient,,,372.34,223.58,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Humerus Limited Right,13555002,LOCAL,73060,CPT,,,301,RC,52|RT,Outpatient,,,372.34,223.58,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
Reptilase Clotting Time QSTC,13864513,LOCAL,85635,CPT,,,320,RC,,Outpatient,,,372.42,11.82,Aetna Med ADV,Aetna Med ADV,9.85,,,,,,,Fee Schedule,8.21,9.85,
XR Tibia/Fibula Left,1170516,LOCAL,73590,CPT,,,320,RC,LT,Outpatient,,,373.27,200.48,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Tibia/Fibula Right,1170518,LOCAL,73590,CPT,,,361,RC,RT,Outpatient,,,373.27,200.48,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
27095 INJ PROC FOR HIP ARTHROGRAPHY W/ ANESTH,5661071,LOCAL,27095,CPT,,,361,RC,,Outpatient,,,373.99,,Aetna Med ADV,Aetna Med ADV,64.91,,,,,,,Fee Schedule,64.91,863,
"64454 - Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imagin",12897048,LOCAL,64454,CPT,,,361,RC,,Outpatient,,,375,244,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
"64454 Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging",9520502,LOCAL,64454,CPT,,,,,,Outpatient,,,375,244,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
caspofungin 50 mg intravenous injection [CULL],11201273,LOCAL,J0637,CPT,,,302,RC,,Outpatient,1,EA,376,,Aetna Med ADV,Aetna Med ADV,3.82,,,,,,,Fee Schedule,3.818,3.818,
"Bill Only Adsorption (Pheno, Rest, Wrm)",13517195,LOCAL,86978,CPT,,,302,RC,,Outpatient,,,378,,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,38.88,54.31,
"Bill Only Rare Unit, Outside Search",13517199,LOCAL,86999,CPT,,,,,,Outpatient,,,378,,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,6.29,22.39,
tuberculin purified protein derivative 5 tuberculin units/0.1 mL intradermal solution 1 mL [CULL],11200764,LOCAL,86580,CPT,,,301,RC,,Outpatient,1,ML,379.84,,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,15.29,22.39,
"SureSwab(R) Trich. Vag. RNA,QL TMA QSTC",8853247,LOCAL,87661,CPT,,,301,RC,,Outpatient,,,382.5,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Trichomonas Vaginalis RNA, Ql, TMA QST",8853247,LOCAL,87661,CPT,,,320,RC,,Outpatient,,,382.5,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
XR Femur 1 View Left,7520564,LOCAL,73551,CPT,,,320,RC,LT,Outpatient,,,382.59,205.43,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Femur 1 View Right,7520567,LOCAL,73551,CPT,,,301,RC,RT,Outpatient,,,382.59,205.43,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
Hereditary Hemochroma DNA Mut Analy QSTC,8764601,LOCAL,81256,CPT,,,302,RC,,Outpatient,,,387,78.43,Aetna Med ADV,Aetna Med ADV,65.36,,,,,,,Fee Schedule,63.34,65.36,
Bill Only Absorption,7967780,LOCAL,86978,CPT,,,301,RC,,Outpatient,,,391.5,,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,38.88,54.31,
Food and Tree Nut Allergy Panel QSTC,14884175,LOCAL,86003,CPT,,,450,RC,,Outpatient,,,393.21,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
99282 - Level 2,2644298,LOCAL,99282,CPT,,,274,RC,25,Outpatient,,,393.64,256,Aetna Med ADV,Aetna Med ADV,144.78,,,,,,,Fee Schedule,144.78,144.78,
BRACE COOL X-ACT DON-JOY (USE),4852073,LOCAL,,,L1833,HCPCS,943,RC,,Outpatient,,,394.02,994,Aetna Med ADV,Aetna Med ADV,556.31,,,,,,,Fee Schedule,556.31,556.31,
93797 Cardiac Rehab without ECG monitoring,10411210,LOCAL,93797,CPT,,,943,RC,,Outpatient,,,394.32,256,Aetna Med ADV,Aetna Med ADV,115.11,,,,,,,Fee Schedule,115.11,219.28,
93798 Cardiac Rehab Phase II,10411000,LOCAL,93798,CPT,,,921,RC,,Outpatient,,,394.32,256,Aetna Med ADV,Aetna Med ADV,115.11,,,,,,,Fee Schedule,115.11,219.28,
DUP ARTERIAL & VENOUS MAPPING UNI,8200502,LOCAL,93986,CPT,,,921,RC,,Outpatient,,,395.6,257,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Vein Mapping Lower Extremity Left,12175098,LOCAL,93986,CPT,,,921,RC,LT,Outpatient,,,395.6,257,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Vein Mapping Lower Extremity Right,12175101,LOCAL,93986,CPT,,,921,RC,RT,Outpatient,,,395.6,257,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Vein Mapping Upper Extremity Left,12175107,LOCAL,93986,CPT,,,921,RC,LT,Outpatient,,,395.6,257,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Vein Mapping Upper Extremity Right,12175110,LOCAL,93986,CPT,,,,,RT,Outpatient,,,395.6,257,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
caspofungin 70 mg intravenous injection [CULL],11201274,LOCAL,J0637,CPT,,,324,RC,,Outpatient,1,EA,396,,Aetna Med ADV,Aetna Med ADV,3.82,,,,,,,Fee Schedule,3.818,3.818,
71046 XR Chest 2 Views: AddOn,13632841,LOCAL,71046,CPT,,,324,RC,,Outpatient,,,397.38,212.85,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Chest 2 Views,689607,LOCAL,71046,CPT,,,301,RC,,Outpatient,,,397.38,212.85,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
Heparin Anti-Xa QSTC,8972922,LOCAL,85520,CPT,,,320,RC,,Outpatient,,,400.5,15.71,Aetna Med ADV,Aetna Med ADV,13.09,,,,,,,Fee Schedule,5.42,13.09,
XR Abdomen KUB 1 View,1169926,LOCAL,74018,CPT,,,320,RC,,Outpatient,,,401.12,215.33,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Knee 1 or 2 Views Left,1170263,LOCAL,73560,CPT,,,320,RC,LT,Outpatient,,,401.12,215.33,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Knee 1 or 2 Views Right,1170265,LOCAL,73560,CPT,,,301,RC,RT,Outpatient,,,401.12,215.33,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
21- Hydroxylase Antibody QSTC,9708927,LOCAL,83516,CPT,,,450,RC,,Outpatient,,,402.53,13.84,Aetna Med ADV,Aetna Med ADV,11.53,,,,,,,Fee Schedule,11.53,17.73,
"96360 - Hydration, first hour",1928297,LOCAL,96360,CPT,,,260,RC,,Outpatient,,,403.29,262,Aetna Med ADV,Aetna Med ADV,192.63,,,,,,,Fee Schedule,192.63,442.94,
"96360 IV HYDRATION, INITIAL 31-90 MINS",7904529,LOCAL,96360,CPT,,,301,RC,,Outpatient,,,403.29,262,Aetna Med ADV,Aetna Med ADV,192.63,,,,,,,Fee Schedule,192.63,442.94,
Inhibin B QSTC,6210082,LOCAL,83520,CPT,,,301,RC,,Outpatient,,,405,20.72,Aetna Med ADV,Aetna Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rituxan Sensitivity (CD20) QSTC,13864421,LOCAL,86356,CPT,,,320,RC,,Outpatient,,,405,32.14,Aetna Med ADV,Aetna Med ADV,26.78,,,,,,,Fee Schedule,15.29,26.78,
XR Hip 1 View Left,1170225,LOCAL,73501,CPT,,,320,RC,LT,Outpatient,,,407.12,218.63,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 1 View Right,1170227,LOCAL,73501,CPT,,,301,RC,RT,Outpatient,,,407.12,218.63,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
A. phagocytophilum Ab IgG IgM QSTC,13864527,LOCAL,86666,CPT,,,320,RC,,Outpatient,,,407.25,12.22,Aetna Med ADV,Aetna Med ADV,10.18,,,,,,,Fee Schedule,10.18,15.29,
XR Bone Length Studies Scanograms,1170016,LOCAL,77073,CPT,,,921,RC,,Outpatient,,,407.59,218.63,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
DOP ABI-ANKLE BRACHIAL INDEX,8230017,LOCAL,93922,CPT,,,921,RC,,Outpatient,,,408.25,265,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,117.85,161.71,
US ABI,8206802,LOCAL,93922,CPT,,,921,RC,,Outpatient,,,408.25,265,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,117.85,161.71,
US Segmental Pressures LE 1-2 Lvls Bilat,1169757,LOCAL,93922,CPT,,,320,RC,,Outpatient,,,408.25,265,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,117.85,161.71,
XR Sacrum/Coccyx 2+ Views,1170391,LOCAL,72220,CPT,,,324,RC,,Outpatient,,,408.83,219.45,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Sniff Test,8602547,LOCAL,71046,CPT,,,320,RC,,Outpatient,,,409.11,212.85,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Sternoclavicular Joint(s),1170494,LOCAL,71130,CPT,,,302,RC,,Outpatient,,,411.41,220.28,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
Bill Only Antigen Type Group 1,13517191,LOCAL,86902,CPT,,,301,RC,,Outpatient,,,414,7.62,Aetna Med ADV,Aetna Med ADV,328.88,,,,,,,Fee Schedule,6.29,328.88,
Proinsulin QSTC,8972777,LOCAL,84206,CPT,,,320,RC,,Outpatient,,,414,32.03,Aetna Med ADV,Aetna Med ADV,26.69,,,,,,,Fee Schedule,18.43,26.69,
XR Elbow Complete 3+ Views Left,1170127,LOCAL,73080,CPT,,,320,RC,LT,Outpatient,,,414.29,221.93,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Elbow Complete 3+ Views Right,1170129,LOCAL,73080,CPT,,,921,RC,RT,Outpatient,,,414.29,221.93,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
DOPP ART EXT BIL MULTIPLE,8200300,LOCAL,93923,CPT,,,921,RC,,Outpatient,,,414.94,401,Aetna Med ADV,Aetna Med ADV,143.05,,,,,,,Fee Schedule,143.05,244.97,
DOPP ART EXT BIL W/EXERCISE,8200310,LOCAL,93924,CPT,,,320,RC,,Outpatient,,,414.94,302,Aetna Med ADV,Aetna Med ADV,143.05,,,,,,,Fee Schedule,143.05,161.71,
XR Shoulder Complete 2 Plus Views Left,1170415,LOCAL,73030,CPT,,,320,RC,LT,Outpatient,,,416.12,222.75,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Shoulder Complete 2 Plus Views Right,1170417,LOCAL,73030,CPT,,,320,RC,RT,Outpatient,,,416.12,222.75,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Femur 2 Views Left,7520570,LOCAL,73552,CPT,,,320,RC,LT,Outpatient,,,417.02,223.58,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Femur 2 Views Right,7520573,LOCAL,73552,CPT,,,320,RC,RT,Outpatient,,,417.02,223.58,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Humerus Left,1170245,LOCAL,73060,CPT,,,320,RC,LT,Outpatient,,,417.02,223.58,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Humerus Right,1170247,LOCAL,73060,CPT,,,320,RC,RT,Outpatient,,,417.02,223.58,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 1 View w/ AP Pelvis Left,7520576,LOCAL,73501,CPT,,,320,RC,LT,Outpatient,,,418.32,218.63,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 1 View w/ AP Pelvis Right,7520579,LOCAL,73501,CPT,,,761,RC,RT,Outpatient,,,418.32,218.63,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
15272 APP SKN SUB GRFT TAL 100 SQ CM ADDT FAC CHARGE,12831013,LOCAL,15272,CPT,,,,,,Outpatient,,,419.53,273,Aetna Med ADV,Aetna Med ADV,13.68,,,,,,,Fee Schedule,13.68,2862.92,
"epoetin alfa-epbx 10,000 units/mL preservative-free injectable solution 1 mL [CULL]",11202387,LOCAL,Q5105,CPT,,,761,RC,,Outpatient,1,ML,423.552,,Aetna Med ADV,Aetna Med ADV,0.79,,,,,,,Fee Schedule,0.79,233.26,
"11055 BENIGN LESION PARING/CUTTING, SINGLE",13043366,LOCAL,11055,CPT,,,301,RC,,Outpatient,,,426.97,278,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
"Enterovirus RNA, QL Real-Time PCR QSTC",8873564,LOCAL,87498,CPT,,,483,RC,,Outpatient,,,427.5,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
CULL US Echo Dop w/ Spectr Ltd,13734793,LOCAL,93321,CPT,,,483,RC,,Outpatient,,,428.24,278,Aetna Med ADV,Aetna Med ADV,15.78,,,,,,,Fee Schedule,15.78,678.38,
ECHO DOP W/SPECTR LTD,8200175,LOCAL,93321,CPT,,,410,RC,,Outpatient,,,428.24,278,Aetna Med ADV,Aetna Med ADV,15.78,,,,,,,Fee Schedule,15.78,678.38,
CPAP Charge -> Initial,8365859,LOCAL,94660,CPT,,,300,RC,,Outpatient,,,429.93,279,Aetna Med ADV,Aetna Med ADV,185.95,,,,,,,Fee Schedule,181.37,185.95,
"S. pneumoniae Ab (IgG), MAID QSTC",13864418,LOCAL,87899,CPT,,,320,RC,,Outpatient,,,431.1,19.28,Aetna Med ADV,Aetna Med ADV,16.07,,,,,,,Fee Schedule,10.57,16.07,
XR Foot Complete 3 Plus Views Left,1170191,LOCAL,73630,CPT,,,320,RC,LT,Outpatient,,,431.43,231,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Foot Complete 3 plus Views Right,1170193,LOCAL,73630,CPT,,,402,RC,RT,Outpatient,,,431.43,231,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
ER US VASCULAR ACCESS GUIDANCE,8200565,LOCAL,76937,CPT,,,402,RC,,Outpatient,,,431.69,231.83,Aetna Med ADV,Aetna Med ADV,23.28,,,,,,,Fee Schedule,23.28,165.47,
US VASCULAR ACCESS GUIDANCE,8200560,LOCAL,76937,CPT,,,390,RC,,Outpatient,,,431.69,231.83,Aetna Med ADV,Aetna Med ADV,23.28,,,,,,,Fee Schedule,23.28,165.47,
E0181 RBC CPD 500 LR,7266548,LOCAL,,,P9016,HCPCS,390,RC,,Outpatient,,,434,282,Aetna Med ADV,Aetna Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E0226 RBC CPDA1 500 LR,7266556,LOCAL,,,P9016,HCPCS,390,RC,,Outpatient,,,434,282,Aetna Med ADV,Aetna Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E0366 RBC CP2D AS3 500,7266579,LOCAL,,,P9016,HCPCS,390,RC,,Outpatient,,,434,282,Aetna Med ADV,Aetna Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E0382 RBC CP2D AS3 500 LR,7266659,LOCAL,,,P9016,HCPCS,390,RC,,Outpatient,,,434,282,Aetna Med ADV,Aetna Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E0424 RBC CPD AS5 500 LR,7266667,LOCAL,,,P9016,HCPCS,390,RC,,Outpatient,,,434,282,Aetna Med ADV,Aetna Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E4531 Aph RBC ACDA AS1 LR,7266601,LOCAL,,,P9016,HCPCS,390,RC,,Outpatient,,,434,282,Aetna Med ADV,Aetna Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E4532 Aph RBC ACDA AS1 LR 1,7266602,LOCAL,,,P9016,HCPCS,390,RC,,Outpatient,,,434,282,Aetna Med ADV,Aetna Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E4533 Aph RBC ACDA AS1 LR 2,7266603,LOCAL,,,P9016,HCPCS,390,RC,,Outpatient,,,434,282,Aetna Med ADV,Aetna Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E4543 Aph RBC ACDA AS3 LR,7266613,LOCAL,,,P9016,HCPCS,390,RC,,Outpatient,,,434,282,Aetna Med ADV,Aetna Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E4544 Aph RBC ACDA AS3 LR 1,7266614,LOCAL,,,P9016,HCPCS,390,RC,,Outpatient,,,434,282,Aetna Med ADV,Aetna Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E4545 Aph RBC ACDA AS3 LR 2,7266615,LOCAL,,,P9016,HCPCS,390,RC,,Outpatient,,,434,282,Aetna Med ADV,Aetna Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E5157 RBC CPD AS1 LR LV,8069011,LOCAL,,,P9016,HCPCS,320,RC,,Outpatient,,,434,282,Aetna Med ADV,Aetna Med ADV,182,,,,,,,Fee Schedule,182,217.45,
XR Hip 2-3 Views Left,7520582,LOCAL,73502,CPT,,,320,RC,LT,Outpatient,,,434.37,232.65,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 2-3 Views Right,7520585,LOCAL,73502,CPT,,,,,RT,Outpatient,,,434.37,232.65,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
fondaparinux 7.5 mg/0.6 mL subcutaneous solution 0.6 mL [CULL],11260585,LOCAL,J1652,CPT,,,320,RC,,Outpatient,0.6,ML,434.56,,Aetna Med ADV,Aetna Med ADV,0.88,,,,,,,Fee Schedule,0.877,0.877,
XR Ankle Complete 3 Plus Views Left,1169942,LOCAL,73610,CPT,,,320,RC,LT,Outpatient,,,434.8,233.48,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ankle Complete 3 Plus Views Right,1169944,LOCAL,73610,CPT,,,320,RC,RT,Outpatient,,,434.8,233.48,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hand Complete 3 Plus Views Right,1170223,LOCAL,73130,CPT,,,320,RC,RT,Outpatient,,,438.91,235.13,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hand Complete 3 Views Left,1170221,LOCAL,73130,CPT,,,390,RC,LT,Outpatient,,,438.91,235.13,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
E0336 RBC CPD AS1 500 LR,7266574,LOCAL,,,P9016,HCPCS,761,RC,,Outpatient,,,439,282,Aetna Med ADV,Aetna Med ADV,182,,,,,,,Fee Schedule,182,217.45,
11056 BENIGN LESION PARING(2-4),13029575,LOCAL,11056,CPT,,,761,RC,,Outpatient,,,439.05,285,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
11103 TANGENTIAL BIOP EA ADDT CHARGE,9322081,LOCAL,11103,CPT,,,761,RC,,Outpatient,,,439.05,285,Aetna Med ADV,Aetna Med ADV,16.62,,,,,,,Fee Schedule,16.62,863,
11721 DEBRIDE NAIL 6 OR MORE WC CHARGE,8726776,LOCAL,11721,CPT,,,761,RC,,Outpatient,,,439.05,285,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,54.31,863,
97602 DEBRIDE MAGGOT THERAPY NON-EXC,11633062,LOCAL,97602,CPT,,,761,RC,,Outpatient,,,439.05,285,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,549.61,
97605 Wound VAC <=50 sq cm,10015643,LOCAL,97605,CPT,,,320,RC,,Outpatient,,,439.05,285,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,273.27,
XR Sacroiliac Joints 3+ Views,1170387,LOCAL,72202,CPT,,,320,RC,,Outpatient,,,440.26,235.95,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
BD Bone Density DEXA Axial w/Frac Assess,5017920,LOCAL,77085,CPT,,,402,RC,,Outpatient,,,442.63,237.6,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,116.02,
US PSEUDOANEURYSM COMPRESSION,8200520,LOCAL,76936,CPT,,,402,RC,,Outpatient,,,443.14,237.6,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,262.79,284.7,
US Pseudoaneurysm Compression Repair,7936316,LOCAL,76936,CPT,,,320,RC,,Outpatient,,,443.14,237.6,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,262.79,284.7,
XR Sinuses Paranasal Complete,1170434,LOCAL,70220,CPT,,,444,RC,,Outpatient,,,445.06,238.43,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
92523 SPEECH SOUND LANGUAGE COMPREHENS CHARGE,9630058,LOCAL,92523,CPT,,,444,RC,GN,Outpatient,,,445.57,290,Aetna Med ADV,Aetna Med ADV,214.08,,,,,,,Fee Schedule,214.08,337.75,
SLP Analysis of Voice & Resonance Minutes,7897211,LOCAL,92523,CPT,,,444,RC,GN,Outpatient,,,445.57,290,Aetna Med ADV,Aetna Med ADV,214.08,,,,,,,Fee Schedule,103.27,337.75,
SLP Sound Prod w/ Lang Comp Eval Units,7897209,LOCAL,92523,CPT,,,444,RC,GN,Outpatient,,,445.57,290,Aetna Med ADV,Aetna Med ADV,214.08,,,,,,,Fee Schedule,214.08,337.75,
Speech Sound Prod w/ Language Charge,7896929,LOCAL,92523,CPT,,,320,RC,GN,Outpatient,,,445.57,290,Aetna Med ADV,Aetna Med ADV,214.08,,,,,,,Fee Schedule,214.08,337.75,
XR Hip 2-3 Views w/AP Pelvis Left,7520588,LOCAL,73502,CPT,,,320,RC,LT,Outpatient,,,446.32,232.65,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 2-3 Views w/AP Pelvis Right,7520591,LOCAL,73502,CPT,,,274,RC,RT,Outpatient,,,446.32,232.65,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
L3931 Forearm based radial nerve orthosis,9646083,LOCAL,,,L3931,HCPCS,274,RC,GP,Outpatient,,,447.23,291,Aetna Med ADV,Aetna Med ADV,229.01,,,,,,,Fee Schedule,229.01,229.01,
L3931 OT WRIST HAND FINGER ORTHOSIS,9856104,LOCAL,,,L3931,HCPCS,274,RC,,Outpatient,,,447.23,291,Aetna Med ADV,Aetna Med ADV,229.01,,,,,,,Fee Schedule,229.01,229.01,
L3931 Wrst/thmb Spic Spnt,9800062,LOCAL,,,L3931,HCPCS,402,RC,,Outpatient,,,447.23,291,Aetna Med ADV,Aetna Med ADV,229.01,,,,,,,Fee Schedule,229.01,229.01,
US Breast Limited Left.,8068444,LOCAL,76642,CPT,,,402,RC,LT,Outpatient,,,449.55,240.9,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,161.71,
US Breast Limited Right.,8068447,LOCAL,76642,CPT,,,,,RT,Outpatient,,,449.55,240.9,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,161.71,
pneumococcal 23-polyvalent vaccine injectable solution 0.5 mL [CULL],11212160,LOCAL,90732,CPT,,,301,RC,,Outpatient,0.5,ML,449.59104,,Aetna Med ADV,Aetna Med ADV,133.47,,,,,,,Fee Schedule,39.58,133.472,
Adalimumab Level for IBD QSTC,13864453,LOCAL,80145,CPT,,,301,RC,,Outpatient,,,450,46.28,Aetna Med ADV,Aetna Med ADV,38.57,,,,,,,Fee Schedule,15.38,38.57,
"Amino Acid Analysis, Plasma QSTC",9039235,LOCAL,82139,CPT,,,301,RC,,Outpatient,,,450,20.24,Aetna Med ADV,Aetna Med ADV,16.87,,,,,,,Fee Schedule,16.87,17.73,
"BK Virus DNA, Quant, RT PCR, Ur QSTC",8764640,LOCAL,87799,CPT,,,610,RC,,Outpatient,,,450,51.41,Aetna Med ADV,Aetna Med ADV,42.84,,,,,,,Fee Schedule,40.19,42.84,
CULL CV Nurse MRI Monitoring,14671862,LOCAL,76018,CPT,,,301,RC,,Outpatient,,,450,75.9,Aetna Med ADV,Aetna Med ADV,83.92,,,,,,,Fee Schedule,83.92,83.92,
Histamine Release Chronic Urticaria QSTC,8764646,LOCAL,86343,CPT,,,301,RC,,Outpatient,,,450,14.95,Aetna Med ADV,Aetna Med ADV,12.46,,,,,,,Fee Schedule,12.46,15.29,
Infliximab Anti-drug Antibody for IBD QSTC,12552286,LOCAL,83520,CPT,,,301,RC,,Outpatient,,,450,20.72,Aetna Med ADV,Aetna Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Infliximab Level for IBD QSTC,13864454,LOCAL,80230,CPT,,,301,RC,,Outpatient,,,450,46.28,Aetna Med ADV,Aetna Med ADV,38.57,,,,,,,Fee Schedule,15.38,38.57,
"Interleukin-6 (IL-6), Serum QSTC",9708918,LOCAL,83529,CPT,,,610,RC,,Outpatient,,,450,20.72,Aetna Med ADV,Aetna Med ADV,17.27,,,,,,,Fee Schedule,17.27,17.73,
SJMC 76018 MR Safety Implant Electronics Preparation,14671862,LOCAL,76018,CPT,,,301,RC,,Outpatient,,,450,75.9,Aetna Med ADV,Aetna Med ADV,83.92,,,,,,,Fee Schedule,83.92,83.92,
"VZV DNA, QL RT PCR QSTC",9777241,LOCAL,87798,CPT,,,761,RC,,Outpatient,,,450,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"99202 LEVEL II INITIAL VISIT, FAC CHARGE",12832515,LOCAL,99202,CPT,,,761,RC,,Outpatient,,,452.19,294,Aetna Med ADV,Aetna Med ADV,39.11,,,,,,,Fee Schedule,39.11,39.11,
99202 Office Visit New Pt. Level 2,10168481,LOCAL,99202,CPT,,,761,RC,,Outpatient,,,452.19,294,Aetna Med ADV,Aetna Med ADV,39.11,,,,,,,Fee Schedule,39.11,39.11,
99212 LEVEL II VISIT CHARGE,9319021,LOCAL,99212,CPT,,,761,RC,,Outpatient,,,452.19,294,Aetna Med ADV,Aetna Med ADV,29.48,,,,,,,Fee Schedule,29.48,29.48,
99212 Office Visit Established Pt. Level 2,10168486,LOCAL,99212,CPT,,,761,RC,,Outpatient,,,452.19,294,Aetna Med ADV,Aetna Med ADV,29.48,,,,,,,Fee Schedule,29.48,29.48,
12001 SIMPLE REPAIR OF WOUND TRUNK,13029607,LOCAL,12001,CPT,,,762,RC,,Outpatient,,,454.38,295,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
FIRST HOUR DIRECT OBSERVATION CHARGE,8566355,LOCAL,,,G0379,HCPCS,320,RC,25,Outpatient,,,457.38,297,Aetna Med ADV,Aetna Med ADV,560.53,,,,,,,Fee Schedule,560.53,560.53,
CHOLANGIO W EXIST CATH S&I,8210339,LOCAL,47531,CPT,,,,,,Outpatient,,,458,298,Aetna Med ADV,Aetna Med ADV,3226.48,,,,,,,Fee Schedule,2599,3226.48,
esmolol 10 mg/mL-sterile water Sol 250 mL [CULL],11201727,LOCAL,J1806,CPT,,,301,RC,,Outpatient,250,ML,458.88,,Aetna Med ADV,Aetna Med ADV,0.41,,,,,,,Fee Schedule,0.41,0.41,
Pregabalin QSTC,8853245,LOCAL,80299,CPT,,,761,RC,,Outpatient,,,459,22.37,Aetna Med ADV,Aetna Med ADV,18.64,,,,,,,Fee Schedule,15.38,18.64,
29580 Application of a Paste Boot (Bilateral),12642335,LOCAL,29580,CPT,,,420,RC,,Outpatient,,,462.53,301,Aetna Med ADV,Aetna Med ADV,144.26,,,,,,,Fee Schedule,144.26,863,
29580 PT UNNA BOOT APPL,9410275,LOCAL,29580,CPT,,,402,RC,GP,Outpatient,,,462.53,301,Aetna Med ADV,Aetna Med ADV,144.26,,,,,,,Fee Schedule,144.26,863,
US EXT NONVASC COMPLETE,8230013,LOCAL,76881,CPT,,,402,RC,,Outpatient,,,462.67,248.33,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US EXT NONVASC LIMITED ANATOMIC SPEC,8230014,LOCAL,76882,CPT,,,302,RC,,Outpatient,,,462.67,248.33,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
Bill Only Elution,7967778,LOCAL,86860,CPT,,,320,RC,,Outpatient,,,463.5,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
XR Pelvis Complete 3+ Views,1170353,LOCAL,72190,CPT,,,921,RC,,Outpatient,,,463.51,248.33,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
DOP ART - LEA W/ TREADMILL,8230021,LOCAL,93924,CPT,,,921,RC,,Outpatient,,,465.08,302,Aetna Med ADV,Aetna Med ADV,143.05,,,,,,,Fee Schedule,143.05,161.71,
US Lower Ext Doppler w/ Stress Test,1169765,LOCAL,93924,CPT,,,320,RC,,Outpatient,,,465.08,302,Aetna Med ADV,Aetna Med ADV,143.05,,,,,,,Fee Schedule,143.05,161.71,
XR Osseous Survey Infant,1170020,LOCAL,77076,CPT,,,320,RC,,Outpatient,,,466.03,249.98,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Facial Bones < 3 Views,1170139,LOCAL,70140,CPT,,,320,RC,,Outpatient,,,471.62,253.28,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Orbits Limited,13555005,LOCAL,70140,CPT,,,402,RC,,Outpatient,,,471.62,253.28,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
US Hips Infant Limited/Static,8206871,LOCAL,76886,CPT,,,402,RC,,Outpatient,,,472.34,253.28,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,161.71,
US Spinal Canal,1169879,LOCAL,76800,CPT,,,302,RC,,Outpatient,,,472.34,253.28,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
Bill Only Rare Donor Fee,13517197,LOCAL,86999,CPT,,,450,RC,,Outpatient,,,472.5,,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,6.29,22.39,
96373- Intra-Arterial Injection,1928304,LOCAL,96373,CPT,,,940,RC,59,Outpatient,,,473.98,308,Aetna Med ADV,Aetna Med ADV,192.63,,,,,,,Fee Schedule,64.56,192.63,
96373 S-INJ NON CHEMO IA CHARGE,8049127,LOCAL,96373,CPT,,,921,RC,59,Outpatient,,,473.98,308,Aetna Med ADV,Aetna Med ADV,192.63,,,,,,,Fee Schedule,64.56,192.63,
DOP VENOUS LOWER EXT UNILATERAL,8200430,LOCAL,93971,CPT,,,921,RC,,Outpatient,,,476.32,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
DOP VENOUS UPPER EXT UNI OR LTD,8200431,LOCAL,93971,CPT,,,921,RC,,Outpatient,,,476.32,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUP AO IVC ILIAC LIMITED,8200531,LOCAL,93979,CPT,,,921,RC,,Outpatient,,,476.32,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Aorta IVC Iliac Duplex Limited,1169579,LOCAL,93979,CPT,,,921,RC,,Outpatient,,,476.32,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Venous Duplex Left,1169771,LOCAL,93971,CPT,,,921,RC,LT,Outpatient,,,476.32,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Venous Duplex Right,1169773,LOCAL,93971,CPT,,,921,RC,RT,Outpatient,,,476.32,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Upper Ext Venous Duplex Left,1169903,LOCAL,93971,CPT,,,921,RC,LT,Outpatient,,,476.32,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Upper Ext Venous Duplex Right,1169905,LOCAL,93971,CPT,,,921,RC,RT,Outpatient,,,476.32,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUP AV FISTULA OR DIALYSIS GRAFT,8200500,LOCAL,93990,CPT,,,921,RC,,Outpatient,,,476.33,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUPLEX ARTERAL UPPER EXT UNI OR LTD,8200490,LOCAL,93931,CPT,,,921,RC,,Outpatient,,,476.33,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUPLEX ARTERIAL LOWER EXT UNI OR LTD,8200470,LOCAL,93926,CPT,,,921,RC,,Outpatient,,,476.33,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Hemodialysis Duplex Access Lt,8206865,LOCAL,93990,CPT,,,921,RC,,Outpatient,,,476.33,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Hemodialysis Duplex Access Rt,8206868,LOCAL,93990,CPT,,,921,RC,RT,Outpatient,,,476.33,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Arterial Duplex Left,1169761,LOCAL,93926,CPT,,,921,RC,LT,Outpatient,,,476.33,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Arterial Duplex Right,1169763,LOCAL,93926,CPT,,,921,RC,RT,Outpatient,,,476.33,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Upper Ext Arterial Duplex Left,1169897,LOCAL,93931,CPT,,,921,RC,LT,Outpatient,,,476.33,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Upper Ext Arterial Duplex Right,1169899,LOCAL,93931,CPT,,,,,RT,Outpatient,,,476.33,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
DAPTOmycin 500 mg intravenous injection [CULL],11210536,LOCAL,J0878,CPT,,,360,RC,,Outpatient,1,EA,480,480,Aetna Med ADV,Aetna Med ADV,0.03,,,,,,,Fee Schedule,0.01,122.4,
CULL MG Needle/Wire Loc Breast,13720943,LOCAL,19281,CPT,,,360,RC,,Outpatient,,,481.51,313,Aetna Med ADV,Aetna Med ADV,1481.32,,,,,,,Fee Schedule,1200.99,1496,
MG Mammo Guided Needle Loc Left,8206592,LOCAL,19281,CPT,,,360,RC,LT,Outpatient,,,481.51,313,Aetna Med ADV,Aetna Med ADV,1481.32,,,,,,,Fee Schedule,1200.99,1496,
MG Mammo Guided Needle Loc Right,8206595,LOCAL,19281,CPT,,,,,RT,Outpatient,,,481.51,313,Aetna Med ADV,Aetna Med ADV,1481.32,,,,,,,Fee Schedule,1200.99,1496,
Bill Tissue Exam Level 6,14048000,LOCAL,88309,CPT,,,301,RC,,Outpatient,,,485.96,,Aetna Med ADV,Aetna Med ADV,746.86,,,,,,,Fee Schedule,59.06,746.86,
IA-2 Antibody QSTC,9039410,LOCAL,86341,CPT,,,274,RC,,Outpatient,,,486,28.28,Aetna Med ADV,Aetna Med ADV,23.57,,,,,,,Fee Schedule,15.29,23.57,
Low LSO,9400072,LOCAL,,,L0642,HCPCS,335,RC,,Outpatient,,,486.86,,Aetna Med ADV,Aetna Med ADV,319.33,,,,,,,Fee Schedule,319.33,319.33,
96422 CHEMO ARTERIAL INFUS UP TO 1HR CHARGE,9404492,LOCAL,96422,CPT,,,274,RC,,Outpatient,,,488.94,318,Aetna Med ADV,Aetna Med ADV,303.25,,,,,,,Fee Schedule,303.25,442.94,
L3933 OT FINGER ORTHOSIS,9856060,LOCAL,,,L3933,HCPCS,302,RC,,Outpatient,,,488.97,318,Aetna Med ADV,Aetna Med ADV,239.92,,,,,,,Fee Schedule,239.92,239.92,
Bill Only Reticulocyte Separation,8629513,LOCAL,86972,CPT,,,761,RC,,Outpatient,,,490.5,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.88,156.67,
"11105 Punch Biopsy of Skin, Ea Separate/Additional CRRH_GA",13243078,LOCAL,11105,CPT,,,301,RC,,Outpatient,,,491.38,319,Aetna Med ADV,Aetna Med ADV,19.82,,,,,,,Fee Schedule,19.82,863,
A. phagocytophilum/E chaffeensis Ab QSTC,13864420,LOCAL,86666,CPT,,,320,RC,,Outpatient,,,492.75,12.22,Aetna Med ADV,Aetna Med ADV,10.18,,,,,,,Fee Schedule,10.18,15.29,
XR Spine Cervical 2 or 3 Views,1170452,LOCAL,72040,CPT,,,440,RC,,Outpatient,,,496.68,266.48,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
96125 ST-COGNITIVE TEST PER 1HR,9630086,LOCAL,96125,CPT,,,440,RC,GN,Outpatient,,,497.34,323,Aetna Med ADV,Aetna Med ADV,96.7,,,,,,,Fee Schedule,96.7,846.56,
SLP Cognitive Test Units,7897180,LOCAL,96125,CPT,,,440,RC,GN,Outpatient,,,497.34,323,Aetna Med ADV,Aetna Med ADV,96.7,,,,,,,Fee Schedule,96.7,846.56,
Standardized Cognitive Eval Charge,7897180,LOCAL,96125,CPT,,,361,RC,GN,Outpatient,,,497.34,323,Aetna Med ADV,Aetna Med ADV,96.7,,,,,,,Fee Schedule,96.7,846.56,
"45300 PROCTOSIGMOIDOSCOPY, RIGID, DIAGNOSTIC, W OR W/O COLLECTION BY BRUSHING OR WASHING",8934255,LOCAL,45300,CPT,,,320,RC,,Outpatient,,,498,129,Aetna Med ADV,Aetna Med ADV,833.54,,,,,,,Fee Schedule,833.54,1419.32,
BD Bone Density DEXA Axial Skeleton,1167839,LOCAL,77080,CPT,,,636,RC,,Outpatient,,,499.09,267.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,116.02,
OASIS MATRIX WOUND 3X3.5,13962593,LOCAL,,,Q4102,HCPCS,510,RC,,Outpatient,,,501.86,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
G0463 CR REHAB ASSESSMENT CHARGE,10470016,LOCAL,,,G0463,HCPCS,761,RC,,Outpatient,,,502.12,326,Aetna Med ADV,Aetna Med ADV,117.82,,,,,,,Fee Schedule,117.82,117.82,
G0463 HOSPITAL OP CLINIC VISIT W PROC MCR ONLY,13436347,LOCAL,,,G0463,HCPCS,510,RC,25,Outpatient,,,502.12,326,Aetna Med ADV,Aetna Med ADV,117.82,,,,,,,Fee Schedule,117.82,117.82,
G0463 HOSPITAL OUTPATIENT VISIT CHARGE,10470015,LOCAL,,,G0463,HCPCS,761,RC,25,Outpatient,,,502.12,326,Aetna Med ADV,Aetna Med ADV,117.82,,,,,,,Fee Schedule,117.82,117.82,
G0463 OUTPATIENT CLINIC VISIT,13043743,LOCAL,,,G0463,HCPCS,481,RC,25,Outpatient,,,502.12,326,Aetna Med ADV,Aetna Med ADV,117.82,,,,,,,Fee Schedule,117.82,117.82,
IVUS ADDL VESSEL,8230049,LOCAL,92979,CPT,,,301,RC,,Outpatient,,,506,329,Aetna Med ADV,Aetna Med ADV,130.59,,,,,,,Fee Schedule,130.59,863,
"Susceptibility Aerobic Bacteria,MIC QSTC",9039459,LOCAL,87186,CPT,,,301,RC,,Outpatient,,,506.25,10.38,Aetna Med ADV,Aetna Med ADV,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
"Susceptibility, Aerobic Bacterium QST",8389539,LOCAL,87186,CPT,,,391,RC,,Outpatient,,,506.25,10.38,Aetna Med ADV,Aetna Med ADV,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
Administration of Blood (Bridge),8019084,LOCAL,36430,CPT,,,391,RC,,Outpatient,,,509,99,Aetna Med ADV,Aetna Med ADV,399.7,,,,,,,Fee Schedule,399.7,863,
TRANSFUSE Fresh Frozen Plasma (Bridge),8482691,LOCAL,36430,CPT,,,391,RC,,Outpatient,,,509,99,Aetna Med ADV,Aetna Med ADV,399.7,,,,,,,Fee Schedule,399.7,863,
TRANSFUSE Platelet Product (Bridge),8482692,LOCAL,36430,CPT,,,391,RC,,Outpatient,,,509,99,Aetna Med ADV,Aetna Med ADV,399.7,,,,,,,Fee Schedule,399.7,863,
TRANSFUSE Red Blood Cells Leukoreduced (Bridge),8482690,LOCAL,36430,CPT,,,320,RC,,Outpatient,,,509,99,Aetna Med ADV,Aetna Med ADV,399.7,,,,,,,Fee Schedule,399.7,863,
XR Nasal Bones 3+ Views,1170329,LOCAL,70160,CPT,,,302,RC,,Outpatient,,,510.81,273.9,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
"Bill Only RBC Pretreatment, Chemicals",8629511,LOCAL,86970,CPT,,,302,RC,,Outpatient,,,513,,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,38.88,54.31,
"Bill Only RBC Pretreatment, Enyzme",8629512,LOCAL,86971,CPT,,,360,RC,,Outpatient,,,513,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.88,156.67,
XR Arthrogram Injection Ankle Left,1169950,LOCAL,20605,CPT,,,360,RC,LT,Outpatient,,,517.48,336,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrogram Injection Ankle Right,1169952,LOCAL,20605,CPT,,,360,RC,RT,Outpatient,,,517.48,336,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrogram Injection Elbow Right,1169958,LOCAL,20605,CPT,,,360,RC,RT,Outpatient,,,517.48,336,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrogram Injection Wrist Left,1169996,LOCAL,20605,CPT,,,360,RC,LT,Outpatient,,,517.48,336,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrogram Injection Wrist Right,1169998,LOCAL,20605,CPT,,,636,RC,RT,Outpatient,,,517.48,336,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
IMPLANT ALLODERM 1/2,13962573,LOCAL,,,Q4116,HCPCS,483,RC,,Outpatient,,,517.5,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
ECHO DOP COLOR FLOW MAPPING,8200220,LOCAL,93325,CPT,,,320,RC,,Outpatient,,,517.63,336,Aetna Med ADV,Aetna Med ADV,17.83,,,,,,,Fee Schedule,17.83,161.71,
XR Spine Lumbosacral 2 or 3 Views,1170470,LOCAL,72100,CPT,,,920,RC,,Outpatient,,,520.24,278.85,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
"G0399 HOME SLEEP STUDY, CHARGE",8303751,LOCAL,,,G0399,HCPCS,761,RC,,Outpatient,,,523.26,340,Aetna Med ADV,Aetna Med ADV,143.05,,,,,,,Fee Schedule,143.05,206.62,
11057 BENIGN LESION PARING(4+),13029576,LOCAL,11057,CPT,,,761,RC,,Outpatient,,,523.3,340,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
16030 Dressing/Debridement Large More than one ext or >10% total body,9400041,LOCAL,16030,CPT,,,761,RC,,Outpatient,,,523.3,863,Aetna Med ADV,Aetna Med ADV,365.27,,,,,,,Fee Schedule,365.27,863,
15276 APPL-HC SKSB GRT F/N/H/G-AD 25CM CHARGE,9709030,LOCAL,15276,CPT,,,320,RC,,Outpatient,,,526.26,342,Aetna Med ADV,Aetna Med ADV,20.61,,,,,,,Fee Schedule,20.61,2862.92,
XR Knee 3 Views Left,1170269,LOCAL,73562,CPT,,,320,RC,LT,Outpatient,,,527.77,282.98,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Knee 3 Views Right,1170271,LOCAL,73562,CPT,,,320,RC,RT,Outpatient,,,527.77,282.98,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Barium Swallow,9756897,LOCAL,74220,CPT,,,320,RC,,Outpatient,,,527.78,282.98,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,83.69,162.76,
XR Swallowing Function w/ Speech,1170500,LOCAL,74230,CPT,,,460,RC,,Outpatient,,,527.78,282.98,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
RT CHARGE PFT -> Bronchoprovocation,5267129,LOCAL,94070,CPT,,,,,,Outpatient,,,530,345,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,149.57,284.7,
Ertapenem Sodium 1 gram intravenous injection [CULL],11201820,LOCAL,J1335,CPT,,,320,RC,,Outpatient,1,EA,532.992,,Aetna Med ADV,Aetna Med ADV,9.16,,,,,,,Fee Schedule,9.16,9.16,
XR Mandible Complete 4+ Views,1170301,LOCAL,70110,CPT,,,320,RC,,Outpatient,,,533.23,286.28,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Facial Bones 3+ Views,1170141,LOCAL,70150,CPT,,,320,RC,,Outpatient,,,533.25,286.28,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Skull < 4 Views,1170436,LOCAL,70250,CPT,,,320,RC,,Outpatient,,,533.25,286.28,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Hips 3-4 Views Bilat,7520612,LOCAL,73522,CPT,,,320,RC,,Outpatient,,,534.2,286.28,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Hips 3-4 Views w/AP Pelvis Bilat,7520615,LOCAL,73522,CPT,,,481,RC,,Outpatient,,,534.2,286.28,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
93799 INPATIENT TEACH CARDIAC REHAB CHARGE,8230066,LOCAL,93799,CPT,,,320,RC,,Outpatient,,,535.14,348,Aetna Med ADV,Aetna Med ADV,143.05,,,,,,,Fee Schedule,38.53,863,
XR Wrist Complete 3 Plus Views Right,1170614,LOCAL,73110,CPT,,,320,RC,RT,Outpatient,,,538.7,288.75,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Wrist Complete 3+ Views Left,1170612,LOCAL,73110,CPT,,,300,RC,LT,Outpatient,,,538.7,288.75,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
"COVID-19, Respiratory Panel 2.1(Biofire)",9624028,LOCAL,0202U,CPT,,,302,RC,,Outpatient,,,540,500.14,Aetna Med ADV,Aetna Med ADV,443.38,,,,,,,Fee Schedule,173.68,443.38,
Bill Only Antigen Type Group 2,10312940,LOCAL,86902,CPT,,,320,RC,,Outpatient,,,544.5,7.62,Aetna Med ADV,Aetna Med ADV,328.88,,,,,,,Fee Schedule,6.29,328.88,
XR Abdomen 2 Views,8132826,LOCAL,74019,CPT,,,274,RC,,Outpatient,,,546.49,292.88,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
L3807 Tko Splint,9646038,LOCAL,,,L3807,HCPCS,918,RC,,Outpatient,,,549.15,357,Aetna Med ADV,Aetna Med ADV,281.19,,,,,,,Fee Schedule,281.19,281.19,
96132 NEUROPSYCH TESTING EVAL; FIRST HOUR CHARGE,9496220,LOCAL,96132,CPT,,,320,RC,,Outpatient,,,549.45,357,Aetna Med ADV,Aetna Med ADV,485.11,,,,,,,Fee Schedule,485.11,846.56,
XR Spine Cervical 4 or 5 Views,1170454,LOCAL,72050,CPT,,,,,,Outpatient,,,552.95,296.18,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
albumin human 25% intravenous solution 100 mL [CULL],11281015,LOCAL,P9047,CPT,,,413,RC,,Outpatient,100,ML,552.96,,Aetna Med ADV,Aetna Med ADV,53.08,,,,,,,Fee Schedule,53.077,217.45,
G0277 HBO Full Body 30 Min Interval,10015694,LOCAL,,,G0277,HCPCS,320,RC,,Outpatient,,,553.52,360,Aetna Med ADV,Aetna Med ADV,126.08,,,,,,,Fee Schedule,126.08,549.61,
XR Knee Complete 4 Plus Views Left,1170287,LOCAL,73564,CPT,,,320,RC,LT,Outpatient,,,554.16,297,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Knee Complete 4 Plus Views Right,1170289,LOCAL,73564,CPT,,,,,RT,Outpatient,,,554.16,297,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
"penicillin G benzathine 600,000 units/mL intramuscular suspension 1 mL [CULL]",11202082,LOCAL,J0561,CPT,,,301,RC,,Outpatient,1,ML,558.848,,Aetna Med ADV,Aetna Med ADV,30.01,,,,,,,Fee Schedule,30.01,122.4,
ADAMTS13 Activity w/Rfx Inhibitor QSTC,9777262,LOCAL,85397,CPT,,,311,RC,,Outpatient,,,562.5,37.03,Aetna Med ADV,Aetna Med ADV,30.86,,,,,,,Fee Schedule,26.47,30.86,
"Chromosome Analysis, Blood QSTC",8848485,LOCAL,88262,CPT,,,311,RC,,Outpatient,,,562.5,150.59,Aetna Med ADV,Aetna Med ADV,125.49,,,,,,,Fee Schedule,63.34,125.49,
Clinical Indication: QSTC,8848484,LOCAL,88230,CPT,,,301,RC,,Outpatient,,,562.5,139.79,Aetna Med ADV,Aetna Med ADV,116.49,,,,,,,Fee Schedule,58.01,116.49,
Kleihauer-Betke Stain QSTC,9956031,LOCAL,85460,CPT,,,301,RC,,Outpatient,,,562.5,9.28,Aetna Med ADV,Aetna Med ADV,7.73,,,,,,,Fee Schedule,7.73,8.21,
Respirat. Allergy Profile Region VI QSTC,9039268,LOCAL,86003,CPT,,,301,RC,,Outpatient,,,564.39,6.26,Aetna Med ADV,Aetna Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Respirat. Allergy Profile Region VI QSTC,9041102,LOCAL,82785,CPT,,,301,RC,,Outpatient,,,564.39,19.75,Aetna Med ADV,Aetna Med ADV,203.96,,,,,,,Fee Schedule,17.73,203.9616667,
Respiratory Allergy Panel Region VI with Reflexes QSTC,14884176,LOCAL,82785,CPT,,,320,RC,,Outpatient,,,564.39,19.75,Aetna Med ADV,Aetna Med ADV,203.96,,,,,,,Fee Schedule,17.73,203.9616667,
XR Spine Thoracic 3 Views,1170486,LOCAL,72072,CPT,,,320,RC,,Outpatient,,,567.43,304.43,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Ribs 2 Views Left,1170371,LOCAL,71100,CPT,,,320,RC,LT,Outpatient,,,567.44,304.43,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ribs 2 Views Right,1170373,LOCAL,71100,CPT,,,402,RC,RT,Outpatient,,,567.44,304.43,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
US Breast ABUS Left,8746657,LOCAL,76641,CPT,,,402,RC,LT,Outpatient,,,571.63,306.9,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Breast ABUS Left.,8567804,LOCAL,76641,CPT,,,402,RC,LT,Outpatient,,,571.63,306.9,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Breast ABUS Right.,8567807,LOCAL,76641,CPT,,,402,RC,RT,Outpatient,,,571.63,306.9,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Breast Complete Left.,8068438,LOCAL,76641,CPT,,,402,RC,LT,Outpatient,,,571.63,306.9,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Breast Complete Right.,8068441,LOCAL,76641,CPT,,,730,RC,RT,Outpatient,,,571.63,306.9,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
Electrocardiogram 12 Lead,2322786,LOCAL,93005,CPT,,,450,RC,,Outpatient,,,573,178,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,38.53,54.31,
99283 - Level 3,2644299,LOCAL,99283,CPT,,,,,25,Outpatient,,,578.6,376,Aetna Med ADV,Aetna Med ADV,253.15,,,,,,,Fee Schedule,253.15,253.15,
pneumococcal 21-valent conjugate vaccine (cvx 327) - Sus [CULL],11200021,LOCAL,90684,CPT,,,761,RC,,Outpatient,0.5,ML,579.792,,Aetna Med ADV,Aetna Med ADV,344.25,,,,,,,Fee Schedule,160.4,344.252,
29581 APPL MULTLAY COMPRS LWR LEG,9739188,LOCAL,29581,CPT,,,320,RC,,Outpatient,,,580.2,195,Aetna Med ADV,Aetna Med ADV,144.26,,,,,,,Fee Schedule,144.26,863,
XR Ribs 3 Views Bilateral,1170375,LOCAL,71110,CPT,,,320,RC,,Outpatient,,,580.49,311.03,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Spine Thoracic 4+ Views,1170488,LOCAL,72074,CPT,,,320,RC,,Outpatient,,,581.11,311.85,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Sinus Tract SI,2425614,LOCAL,76080,CPT,,,302,RC,,Outpatient,,,583.56,312.68,Aetna Med ADV,Aetna Med ADV,501.29,,,,,,,Fee Schedule,176.48,501.29,
Bill Only Rare Unit,8196052,LOCAL,86999,CPT,,,360,RC,,Outpatient,,,585,,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,6.29,22.39,
Oviduct chromotubation 58350,9093091,LOCAL,58350,CPT,,,483,RC,,Outpatient,,,585,4936,Aetna Med ADV,Aetna Med ADV,4513.2,,,,,,,Fee Schedule,2599,4513.2,
ER ECHOCARDIOGRAM 2D LIMITED,8200203,LOCAL,93308,CPT,,,480,RC,,Outpatient,,,586,564,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,678.38,
TRANSPAC REUSABLE CABLE 42661-03,8200204,LOCAL,93308,CPT,,,361,RC,,Outpatient,,,586,564,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,678.38,
64445 NERV BLOCK SCIATIC,5661029,LOCAL,64445,CPT,,,310,RC,,Outpatient,,,587.24,382,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
"FISH, Chromosome Specific 1 Pr QSTC",13864683,LOCAL,88271,CPT,,,310,RC,,Outpatient,,,587.34,25.7,Aetna Med ADV,Aetna Med ADV,21.42,,,,,,,Fee Schedule,21.42,63.34,
Specimen Source: FISH Chrom Pr x1 QSTC,13864676,LOCAL,88273,CPT,,,,,,Outpatient,,,587.34,41.77,Aetna Med ADV,Aetna Med ADV,34.81,,,,,,,Fee Schedule,34.81,63.34,
rifAMPin 600 mg intravenous injection [CULL],11211144,LOCAL,J2804,CPT,,,302,RC,,Outpatient,1,EA,587.52,,Aetna Med ADV,Aetna Med ADV,0.15,,,,,,,Fee Schedule,0.153,0.153,
REF Antibody ID,7032173,LOCAL,86870,CPT,,,402,RC,,Outpatient,,,589.5,,Aetna Med ADV,Aetna Med ADV,328.88,,,,,,,Fee Schedule,38.27,328.88,
US Head Newborn,8206862,LOCAL,76506,CPT,,,301,RC,,Outpatient,,,590.44,316.8,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
Very Long Chain Fatty Acids QSTC,8764801,LOCAL,82726,CPT,,,402,RC,,Outpatient,,,590.63,23.7,Aetna Med ADV,Aetna Med ADV,19.75,,,,,,,Fee Schedule,17.73,19.75,
US Fetal Biophysical Profile w/ Non-Str,1169687,LOCAL,76818,CPT,,,761,RC,,Outpatient,,,591.07,316.8,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,148.61,
99203  New Patient-Detailed,12642291,LOCAL,99203,CPT,,,761,RC,,Outpatient,,,595.04,387,Aetna Med ADV,Aetna Med ADV,67.57,,,,,,,Fee Schedule,67.57,67.57,
99203 Office Visit New Pt. Level 3,10168482,LOCAL,99203,CPT,,,,,,Outpatient,,,595.04,387,Aetna Med ADV,Aetna Med ADV,67.57,,,,,,,Fee Schedule,67.57,67.57,
99203 Office Visit New Pt. Level 3,10168482,LOCAL,99203,CPT,,,761,RC,,Outpatient,,,595.04,387,Aetna Med ADV,Aetna Med ADV,67.57,,,,,,,Fee Schedule,67.57,67.57,
99213 Established patient visit- level 3,7947777,LOCAL,99213,CPT,,,,,,Outpatient,,,595.04,387,Aetna Med ADV,Aetna Med ADV,54.77,,,,,,,Fee Schedule,54.77,54.77,
99213 Established patient visit- level 3,7947777,LOCAL,99213,CPT,,,761,RC,,Outpatient,,,595.04,387,Aetna Med ADV,Aetna Med ADV,54.77,,,,,,,Fee Schedule,54.77,54.77,
99213 LEVEL III VISIT CHARGE,9319022,LOCAL,99213,CPT,,,761,RC,,Outpatient,,,595.04,387,Aetna Med ADV,Aetna Med ADV,54.77,,,,,,,Fee Schedule,54.77,54.77,
99213 Office Visit Established Pt. Level 3,10168487,LOCAL,99213,CPT,,,276,RC,,Outpatient,,,595.04,387,Aetna Med ADV,Aetna Med ADV,54.77,,,,,,,Fee Schedule,54.77,54.77,
LENS #SA60AT,4832535,LOCAL,,,V2632,HCPCS,301,RC,,Outpatient,,,599.5,392,Aetna Med ADV,Aetna Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
"Creatinine, Random, Ur QSTC",13873086,LOCAL,82570,CPT,,,301,RC,,Outpatient,,,599.63,6.22,Aetna Med ADV,Aetna Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"N-Methylhistamine, Random, Ur QSTC",13873083,LOCAL,82542,CPT,,,320,RC,,Outpatient,,,599.63,28.91,Aetna Med ADV,Aetna Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.09,
XR Ribs w/ PA Chest Bilateral,1170377,LOCAL,71111,CPT,,,360,RC,,Outpatient,,,601.59,322.58,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
36010 INTRO CATH SUP/INF VENA CAVA,8266890,LOCAL,36010,CPT,,,360,RC,,Outpatient,,,604.59,393,Aetna Med ADV,Aetna Med ADV,87.95,,,,,,,Fee Schedule,87.95,929.12,
INTRO CATH VENA CAVA,8267101,LOCAL,36010,CPT,,,920,RC,,Outpatient,,,604.59,393,Aetna Med ADV,Aetna Med ADV,87.95,,,,,,,Fee Schedule,87.95,929.12,
Antenatal Testing Type -> Contraction stress test,10446024,LOCAL,59020,CPT,,,761,RC,,Outpatient,,,607.55,94,Aetna Med ADV,Aetna Med ADV,183.92,,,,,,,Fee Schedule,183.92,863,
97597 ACTIVE WOUND CARE MANAGEMENT FIRST 20 CM,13048047,LOCAL,97597,CPT,,,420,RC,59,Outpatient,,,608.25,395,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
97597 DEBRIDE SCISSOR/SCAPEL 20SQ CM,9410251,LOCAL,97597,CPT,,,430,RC,GP,Outpatient,,,608.25,395,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
97597 DEBRIDEMENT,9866113,LOCAL,97597,CPT,,,430,RC,GO|CO,Outpatient,,,608.25,395,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
97597 OT SELECT DEBRIDE ME CHARGE,9856113,LOCAL,97597,CPT,,,761,RC,GO,Outpatient,,,608.25,395,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
97598 Debrid Open wound > 20 sq cm charge,12511973,LOCAL,97598,CPT,,,430,RC,,Outpatient,,,608.25,395,Aetna Med ADV,Aetna Med ADV,20.42,,,,,,,Fee Schedule,20.42,1466.58,
OT Removal Devitalized Tissue < 20 cm Units,7897756,LOCAL,97597,CPT,,,430,RC,GO,Outpatient,,,608.25,395,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
OT Removal Tissue <20 Assist Units,7897756,LOCAL,97597,CPT,,,430,RC,CQ,Outpatient,,,608.25,395,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
OT Selective Debridement Charge,7895252,LOCAL,97597,CPT,,,420,RC,GO,Outpatient,,,608.25,395,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
Selective Debridement Charge,7895942,LOCAL,97597,CPT,,,420,RC,GP,Outpatient,,,608.25,395,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
"Selective Debridement Charge -> Yes, total wound surface area, first 20 sq cm or less",8968080,LOCAL,97597,CPT,,,320,RC,GP,Outpatient,,,608.25,395,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
XR Cystogram Limited,13703435,LOCAL,74430,CPT,,,402,RC,52,Outpatient,,,612.55,554.4,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
US Chest,1169635,LOCAL,76604,CPT,,,320,RC,,Outpatient,,,612.93,328.35,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
XR Ribs w/ PA Chest Left,1170379,LOCAL,71101,CPT,,,320,RC,LT,Outpatient,,,615.08,330,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Ribs w/ PA Chest Right,1170381,LOCAL,71101,CPT,,,302,RC,RT,Outpatient,,,615.08,330,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
Strep Pneumoniae Ab IgG 23 Serotypes QST,10217037,LOCAL,86581,CPT,,,302,RC,,Outpatient,,,615.83,,Aetna Med ADV,Aetna Med ADV,92.03,,,,,,,Fee Schedule,44.29,92.03,
"Strep pneumoniae IgG Abs, 23 Serotypes QST",14006318,LOCAL,86581,CPT,,,921,RC,,Outpatient,,,615.83,,Aetna Med ADV,Aetna Med ADV,92.03,,,,,,,Fee Schedule,44.29,92.03,
DUP ARTERIAL & VENOUS MAPPING BIL,8200501,LOCAL,93985,CPT,,,921,RC,,Outpatient,,,616.92,401,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Vein Mapping Lower Extremity Bilat,12175095,LOCAL,93985,CPT,,,921,RC,,Outpatient,,,616.92,401,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Vein Mapping Upper Extremity Bilat,12175104,LOCAL,93985,CPT,,,921,RC,,Outpatient,,,616.92,401,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Vessel Mapping for Hemo Access Bilat,10216429,LOCAL,93985,CPT,,,921,RC,,Outpatient,,,616.92,401,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,161.71,220.99,
DOP ART-LEA WITH ABI SEG PRESSURES,8230018,LOCAL,93923,CPT,,,921,RC,,Outpatient,,,617.64,401,Aetna Med ADV,Aetna Med ADV,143.05,,,,,,,Fee Schedule,143.05,244.97,
DOP ART-UEA W/ PRESSURES UPPER,8230064,LOCAL,93923,CPT,,,921,RC,,Outpatient,,,617.64,401,Aetna Med ADV,Aetna Med ADV,143.05,,,,,,,Fee Schedule,143.05,244.97,
US Segmental Pressures LE 3+ Lvls Bilat,1169755,LOCAL,93923,CPT,,,921,RC,,Outpatient,,,617.64,401,Aetna Med ADV,Aetna Med ADV,143.05,,,,,,,Fee Schedule,143.05,244.97,
US Segmental Pressures UE 3+ Lvls Bilat,9759154,LOCAL,93923,CPT,,,274,RC,,Outpatient,,,617.64,401,Aetna Med ADV,Aetna Med ADV,143.05,,,,,,,Fee Schedule,143.05,244.97,
L3913 Hand finger orthosis (HFO) without joints may include soft interface straps custom fabricated,9856095,LOCAL,,,L3913,HCPCS,274,RC,,Outpatient,,,620.7,403,Aetna Med ADV,Aetna Med ADV,304.58,,,,,,,Fee Schedule,304.58,304.58,
L3913 HFO W/O JOINTS CF CHARGE,9856102,LOCAL,,,L3913,HCPCS,401,RC,,Outpatient,,,620.7,403,Aetna Med ADV,Aetna Med ADV,304.58,,,,,,,Fee Schedule,304.58,304.58,
MG Mammo Diagnostic Left w/ Tomo.,8058649,LOCAL,77065,CPT,,,401,RC,LT,Outpatient,,,623.77,334.13,Aetna Med ADV,Aetna Med ADV,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Diagnostic Right w/ Tomo.,8058652,LOCAL,77065,CPT,,,401,RC,RT,Outpatient,,,623.77,334.13,Aetna Med ADV,Aetna Med ADV,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Digital Diagnostic Left.,7918560,LOCAL,77065,CPT,,,401,RC,LT,Outpatient,,,623.77,334.13,Aetna Med ADV,Aetna Med ADV,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Digital Diagnostic Right.,7918563,LOCAL,77065,CPT,,,401,RC,RT,Outpatient,,,623.77,334.13,Aetna Med ADV,Aetna Med ADV,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Implant Diag Left w/ Tomo.,8058658,LOCAL,77065,CPT,,,401,RC,LT,Outpatient,,,623.77,334.13,Aetna Med ADV,Aetna Med ADV,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Implant Diag Right w/ Tomo.,8058661,LOCAL,77065,CPT,,,401,RC,RT,Outpatient,,,623.77,334.13,Aetna Med ADV,Aetna Med ADV,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Implant Digital Diag Left.,8058667,LOCAL,77065,CPT,,,401,RC,LT,Outpatient,,,623.77,334.13,Aetna Med ADV,Aetna Med ADV,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Implant Digital Diag Right.,8058670,LOCAL,77065,CPT,,,320,RC,RT,Outpatient,,,623.77,334.13,Aetna Med ADV,Aetna Med ADV,75.3,,,,,,,Fee Schedule,74,75.3,
XR Osseous Survey Limited,1170022,LOCAL,77074,CPT,,,948,RC,,Outpatient,,,626.27,335.78,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
94625 OUTPATIENT PULMONARY REHAB W/O CONTINIOUS MONITORING,10470029,LOCAL,94625,CPT,,,300,RC,,Outpatient,,,626.86,407,Aetna Med ADV,Aetna Med ADV,54.31,,,,,,,Fee Schedule,51.98,54.31,
Newborn Screen,8165282,LOCAL,84035,CPT,,,300,RC,,Outpatient,,,629.03,4.78,Aetna Med ADV,Aetna Med ADV,3.98,,,,,,,Fee Schedule,3.98,7.16,
"Phenylketonuria, Blood SO",9565050,LOCAL,84030,CPT,,,300,RC,,Outpatient,,,629.03,6.6,Aetna Med ADV,Aetna Med ADV,5.5,,,,,,,Fee Schedule,5.5,7.16,
"Susceptibility, Yeast, Comp. Panel QSTC",6250013,LOCAL,87186,CPT,,,402,RC,,Outpatient,,,630,10.38,Aetna Med ADV,Aetna Med ADV,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
US OB Limited,1169856,LOCAL,76815,CPT,,,274,RC,,Outpatient,,,632.6,339.08,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,148.61,
"L3702 Elbow orthosis, without joints, may include soft interface, straps, custom fabricated",9646073,LOCAL,,,L3702,HCPCS,274,RC,,Outpatient,,,634.13,412,Aetna Med ADV,Aetna Med ADV,324.72,,,,,,,Fee Schedule,324.72,324.72,
L3702 ELBOW SPLINT,9856096,LOCAL,,,L3702,HCPCS,483,RC,,Outpatient,,,634.13,412,Aetna Med ADV,Aetna Med ADV,324.72,,,,,,,Fee Schedule,324.72,324.72,
CULL US Echo Dop w/ Spectral Complete,13736513,LOCAL,93320,CPT,,,483,RC,,Outpatient,,,636.3,414,Aetna Med ADV,Aetna Med ADV,29.71,,,,,,,Fee Schedule,29.71,678.38,
ECHO DOP W/SPECTRAL COMPLETE,8200180,LOCAL,93320,CPT,,,,,,Outpatient,,,636.3,414,Aetna Med ADV,Aetna Med ADV,29.71,,,,,,,Fee Schedule,29.71,678.38,
"epoetin alfa 10,000 units/mL preservative-free Sol 1 mL [CULL]",11202387,LOCAL,J0885,CPT,,,320,RC,,Outpatient,1,ML,636.672,,Aetna Med ADV,Aetna Med ADV,8.54,,,,,,,Fee Schedule,0.79,233.26,
74248 XR Small Bowel Follow Thru: AddOn,13626886,LOCAL,74248,CPT,,,320,RC,,Outpatient,,,636.99,341.55,Aetna Med ADV,Aetna Med ADV,41.4,,,,,,,Fee Schedule,41.4,176.48,
CULL XR Small Bowel Follow Thru,13626886,LOCAL,74248,CPT,,,361,RC,,Outpatient,,,636.99,341.55,Aetna Med ADV,Aetna Med ADV,41.4,,,,,,,Fee Schedule,41.4,176.48,
64486 TAP BLOCK UNILATERAL BY INJECTION(S),5661023,LOCAL,64486,CPT,,,360,RC,,Outpatient,,,637.75,415,Aetna Med ADV,Aetna Med ADV,46.33,,,,,,,Fee Schedule,46.33,863,
INTRO CATH RT HEART PA,8267102,LOCAL,36013,CPT,,,,,,Outpatient,,,638.52,415,Aetna Med ADV,Aetna Med ADV,104.34,,,,,,,Fee Schedule,104.34,929.12,
alteplase 2 mg injection [CULL],11201047,LOCAL,J2997,CPT,,,301,RC,,Outpatient,1,EA,644.928,,Aetna Med ADV,Aetna Med ADV,94.45,,,,,,,Fee Schedule,94.45,122.4,
"Supersaturation, U24 SO",13938669,LOCAL,83945,CPT,,,761,RC,,Outpatient,,,645.39,17.34,Aetna Med ADV,Aetna Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.085,
10060 DRAINAGE OF SKIN ABSCESS CHARGE,9704026,LOCAL,10060,CPT,,,761,RC,,Outpatient,,,646.72,420,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
10061 I & D COMPLEX,13048116,LOCAL,10061,CPT,,,,,,Outpatient,,,646.72,420,Aetna Med ADV,Aetna Med ADV,365.27,,,,,,,Fee Schedule,239.03,863,
Bill Prostate Biopsy,14048008,LOCAL,,,G0416,HCPCS,320,RC,,Outpatient,,,646.83,,Aetna Med ADV,Aetna Med ADV,328.88,,,,,,,Fee Schedule,59.06,328.88,
XR Spine Thoracolumbar 2 Views,1170490,LOCAL,72080,CPT,,,274,RC,,Outpatient,,,651.93,349.8,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
High LSO,9400071,LOCAL,,,L0648,HCPCS,761,RC,,Outpatient,,,655.66,,Aetna Med ADV,Aetna Med ADV,797.49,,,,,,,Fee Schedule,797.49,797.49,
"11102 Tangential Biopsy of Skin, 1 lesion",9620037,LOCAL,11102,CPT,,,761,RC,,Outpatient,,,656.43,427,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
16020 BURN DEBRIDEMENT/DRESSING INITIAL OR SUB,13043448,LOCAL,16020,CPT,,,761,RC,,Outpatient,,,656.43,427,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
16020 Chemical Canterizaiton,9400039,LOCAL,16020,CPT,,,761,RC,,Outpatient,,,656.43,427,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
17250 CAUTERY OF WOUND (ELECTRICAL),13033473,LOCAL,17250,CPT,,,761,RC,,Outpatient,,,656.43,427,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
97606 Wound VAC >50 sq cm HBO,10015644,LOCAL,97606,CPT,,,302,RC,,Outpatient,,,656.43,427,Aetna Med ADV,Aetna Med ADV,365.27,,,,,,,Fee Schedule,365.27,549.61,
REF ABO Discrep (ABSC),13481254,LOCAL,86850,CPT,,,732,RC,,Outpatient,,,657,11.72,Aetna Med ADV,Aetna Med ADV,48.85,,,,,,,Fee Schedule,6.29,48.85,
TELEMETRY DAILY CHARGE,9341351,LOCAL,93229,CPT,,,360,RC,,Outpatient,,,659,311,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,99.86,284.7,
13133 >  Each additional 5 cm or less (List separately in addition to primary procedure),12788295,LOCAL,13133,CPT,,,360,RC,,Outpatient,,,660,,Aetna Med ADV,Aetna Med ADV,95.58,,,,,,,Fee Schedule,95.58,863,
"13133-Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; e",14746903,LOCAL,13133,CPT,,,300,RC,,Outpatient,,,660,,Aetna Med ADV,Aetna Med ADV,95.58,,,,,,,Fee Schedule,95.58,863,
82570 QST,14798876,LOCAL,82570,CPT,,,300,RC,,Outpatient,,,662,6.22,Aetna Med ADV,Aetna Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Leukotriene E4, Random, Urine QST",14798876,LOCAL,82542,CPT,,,302,RC,,Outpatient,,,662.05,28.91,Aetna Med ADV,Aetna Med ADV,24.09,,,,,,,Fee Schedule,7.16,40.97514925,
Bill Only Antigen Type Group 3,10312933,LOCAL,86902,CPT,,,301,RC,,Outpatient,,,666,7.62,Aetna Med ADV,Aetna Med ADV,328.88,,,,,,,Fee Schedule,6.29,328.88,
"JC Polyoma Virus DNA, Qual PCR CSF QSTC",10170129,LOCAL,87798,CPT,,,320,RC,,Outpatient,,,666,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
XR Skull Complete,1170438,LOCAL,70260,CPT,,,302,RC,,Outpatient,,,672.73,360.53,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
Bill Only REF Washing,13514969,LOCAL,86999,CPT,,,402,RC,,Outpatient,,,675,,Aetna Med ADV,Aetna Med ADV,22.39,,,,,,,Fee Schedule,6.29,22.39,
US AAA Screening,8058767,LOCAL,76706,CPT,,,402,RC,,Outpatient,,,675.12,362.18,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Abdomen Limited,1169569,LOCAL,76705,CPT,,,402,RC,,Outpatient,,,675.12,362.18,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Renal,7936319,LOCAL,76770,CPT,,,402,RC,,Outpatient,,,675.12,362.18,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,245.49,
US Retroperitoneal Complete,1169867,LOCAL,76770,CPT,,,403,RC,,Outpatient,,,675.12,362.18,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,245.49,
MG Mammo Digital Screening Bilateral.,7918566,LOCAL,77067,CPT,,,403,RC,,Outpatient,,,676.43,363,Aetna Med ADV,Aetna Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Digital Screening Left.,7949062,LOCAL,77067,CPT,,,403,RC,52|LT,Outpatient,,,676.43,363,Aetna Med ADV,Aetna Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Digital Screening Right.,7949065,LOCAL,77067,CPT,,,403,RC,52|RT,Outpatient,,,676.43,363,Aetna Med ADV,Aetna Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Implant Digital Screening Bil.,8058673,LOCAL,77067,CPT,,,403,RC,,Outpatient,,,676.43,363,Aetna Med ADV,Aetna Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Implant Screening Bil w/ Tomo.,8058682,LOCAL,77067,CPT,,,403,RC,,Outpatient,,,676.43,363,Aetna Med ADV,Aetna Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Screening Bilateral w/ Tomo.,8058685,LOCAL,77067,CPT,,,361,RC,,Outpatient,,,676.43,363,Aetna Med ADV,Aetna Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
64450 INJECTION PERIPHERAL NERVE OR BRANCH,5661030,LOCAL,64450,CPT,,,360,RC,,Outpatient,,,680,1613,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
57105 - BIOPSY VAGINAL MUCOSA EXTENSIVE,14749499,LOCAL,57105,CPT,,,,,,Outpatient,,,685,3180,Aetna Med ADV,Aetna Med ADV,2906.92,,,,,,,Fee Schedule,2315,3558.77,
adenosine 3 mg/mL intravenous solution 30 mL [CULL],11201017,LOCAL,J0153,CPT,,,301,RC,,Outpatient,30,ML,686.4,,Aetna Med ADV,Aetna Med ADV,0.53,,,,,,,Fee Schedule,0.529,0.529,
"Immunoglobulins Panel, CSF QSTC",13864507,LOCAL,82784,CPT,,,276,RC,,Outpatient,,,687.2,11.16,Aetna Med ADV,Aetna Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
LENS PRELOADED #PCB00,4851541,LOCAL,,,V2630,HCPCS,276,RC,,Outpatient,,,687.5,410,Aetna Med ADV,Aetna Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
LENS PRELOADED DCB00,4855985,LOCAL,,,V2630,HCPCS,402,RC,,Outpatient,,,687.5,410,Aetna Med ADV,Aetna Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
US Fetal Biophysical Profile w/o N-Str,1169689,LOCAL,76819,CPT,,,310,RC,,Outpatient,,,688.53,369.6,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,148.61,
"FISH, Prenatal Scr Interp QSTC",13864670,LOCAL,88274,CPT,,,310,RC,,Outpatient,,,690.75,50.86,Aetna Med ADV,Aetna Med ADV,42.38,,,,,,,Fee Schedule,42.38,63.34,
"FISH, Prenatal Screen QSTC",13864673,LOCAL,88271,CPT,,,,,,Outpatient,,,690.75,25.7,Aetna Med ADV,Aetna Med ADV,21.42,,,,,,,Fee Schedule,21.42,63.34,
zoledronic acid 4 mg/100 mL intravenous solution 100 mL [CULL],11211397,LOCAL,J3489,CPT,,,761,RC,,Outpatient,100,ML,691.2,,Aetna Med ADV,Aetna Med ADV,5.08,,,,,,,Fee Schedule,5.082,5.082,
11104 Punch Biopsy,10017193,LOCAL,11104,CPT,,,320,RC,,Outpatient,,,691.38,449,Aetna Med ADV,Aetna Med ADV,365.27,,,,,,,Fee Schedule,365.27,863,
XR Abdomen Series Chest 1 View,1169932,LOCAL,74022,CPT,,,320,RC,,Outpatient,,,691.86,53.63,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Osseous Survey Complete,1170018,LOCAL,77075,CPT,,,320,RC,,Outpatient,,,694.85,372.9,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,176.48,
XR Spine Cervical 6+ Views,1170461,LOCAL,72052,CPT,,,260,RC,,Outpatient,,,701.96,376.2,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
"96365 IV INFUSION, MEDS, INITIAL 16-90 MINS",7904531,LOCAL,96365,CPT,,,450,RC,,Outpatient,,,702.66,457,Aetna Med ADV,Aetna Med ADV,192.63,,,,,,,Fee Schedule,192.63,442.94,
"96365- IV tx, first hour",1928299,LOCAL,96365,CPT,,,402,RC,,Outpatient,,,702.66,457,Aetna Med ADV,Aetna Med ADV,192.63,,,,,,,Fee Schedule,192.63,442.94,
US Aorta,7936256,LOCAL,76775,CPT,,,402,RC,,Outpatient,,,702.79,377.03,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Retroperitoneal Limited,1169869,LOCAL,76775,CPT,,,323,RC,,Outpatient,,,702.79,377.03,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
F/U EMBOLIZATION/INFUSION,8210730,LOCAL,75898,CPT,,,402,RC,,Outpatient,,,707.78,379.5,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,1231.66,2877.63,
US Extremity Nonvascular Limited Left,2425338,LOCAL,76882,CPT,,,402,RC,LT,Outpatient,,,708.51,248.33,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Extremity Nonvascular Limited Right,2425341,LOCAL,76882,CPT,,,402,RC,RT,Outpatient,,,708.51,248.33,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Head/Neck Soft Tissue,1169729,LOCAL,76536,CPT,,,320,RC,,Outpatient,,,708.51,380.33,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
76000 XR Fluoroscopy Under 1 Hour: AddOn,13658083,LOCAL,76000,CPT,,,361,RC,,Outpatient,,,709.31,380.33,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,176.48,220.99,
64495 - INJ PARAVERT F JNT L/S 3 LEV,5661079,LOCAL,64495,CPT,,,360,RC,,Outpatient,,,710.23,462,Aetna Med ADV,Aetna Med ADV,42.72,,,,,,,Fee Schedule,42.72,1250.53,
INTRO CAROTID VERTEBRAL ARTERY,8267188,LOCAL,36100,CPT,,,320,RC,,Outpatient,,,710.94,462,Aetna Med ADV,Aetna Med ADV,122.25,,,,,,,Fee Schedule,122.25,929.12,
XR Urography Retrograde,10454609,LOCAL,74420,CPT,,,761,RC,,Outpatient,,,714.75,383.63,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
97607 Disp NP Wound Tx <=50 Sq Cm.,10017200,LOCAL,97607,CPT,,,300,RC,,Outpatient,,,716.42,466,Aetna Med ADV,Aetna Med ADV,365.27,,,,,,,Fee Schedule,365.27,549.61,
".Thyroglobulin, LC/MS/MS QSTC",13864486,LOCAL,84432,CPT,,,482,RC,,Outpatient,,,720,19.27,Aetna Med ADV,Aetna Med ADV,46.24,,,,,,,Fee Schedule,18.43,46.235,
93017 CARDIAC STRESS TEST CHARGE,7938407,LOCAL,93017,CPT,,,482,RC,,Outpatient,,,721.43,469,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,244.97,284.7,
CARDIAC STRESS W/TRACING,8200041,LOCAL,93017,CPT,,,482,RC,,Outpatient,,,721.43,469,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,244.97,284.7,
NM Stress Test Trace,2426005,LOCAL,93017,CPT,,,360,RC,,Outpatient,,,721.43,469,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,244.97,284.7,
64405 Occipital Nerve Block Unilateral,5661077,LOCAL,64405,CPT,,,610,RC,,Outpatient,,,724.33,879,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
MRI 3D Reconstruction w/o Workstation,8108472,LOCAL,76376,CPT,,,302,RC,,Outpatient,,,730.14,391.88,Aetna Med ADV,Aetna Med ADV,13.93,,,,,,,Fee Schedule,13.93,13.93,
Bill Only REF Thawing & Washing RBC,13514967,LOCAL,86931,CPT,,,274,RC,,Outpatient,,,733.5,,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,38.88,156.67,
L3808 Forearm based orthosis w/o dynamic,9856093,LOCAL,,,L3808,HCPCS,274,RC,,Outpatient,,,733.5,89,Aetna Med ADV,Aetna Med ADV,375.59,,,,,,,Fee Schedule,375.59,375.59,
OT CARPAL TUNNEL SPLINTS,9646074,LOCAL,,,L3808,HCPCS,302,RC,,Outpatient,,,733.5,89,Aetna Med ADV,Aetna Med ADV,375.59,,,,,,,Fee Schedule,375.59,375.59,
REF HLA ABSC,13484120,LOCAL,86829,CPT,,,302,RC,,Outpatient,,,733.5,77.03,Aetna Med ADV,Aetna Med ADV,64.19,,,,,,,Fee Schedule,6.29,64.19,
REF HPA-1 Typing,13481256,LOCAL,81105,CPT,,,481,RC,,Outpatient,,,733.5,146.66,Aetna Med ADV,Aetna Med ADV,122.22,,,,,,,Fee Schedule,63.34,122.22,
93571 Cor Flow Wire 1st Measure,8230055,LOCAL,93571,CPT,,,276,RC,,Outpatient,,,734.27,477,Aetna Med ADV,Aetna Med ADV,143.66,,,,,,,Fee Schedule,143.66,2669.67,
LENS #ACU0T0,4853561,LOCAL,,,V2630,HCPCS,276,RC,,Outpatient,,,737,410,Aetna Med ADV,Aetna Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
LENS #SN60WF,4891100,LOCAL,,,V2630,HCPCS,361,RC,,Outpatient,,,737,410,Aetna Med ADV,Aetna Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
XR Arthrocentesis Asp/Inj Intmed Jt Lt,14807134,LOCAL,20605,CPT,,,361,RC,LT,Outpatient,,,740,336,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Intmed Jt Rt,14807137,LOCAL,20605,CPT,,,361,RC,RT,Outpatient,,,740,336,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Major Jt Bilat,14807140,LOCAL,20610,CPT,,,361,RC,50,Outpatient,,,740,650,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Major Jt Lt,14807143,LOCAL,20610,CPT,,,361,RC,LT,Outpatient,,,740,650,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Major Jt Rt,14807146,LOCAL,20610,CPT,,,361,RC,RT,Outpatient,,,740,650,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Small Jt Lt,14807149,LOCAL,20600,CPT,,,361,RC,LT,Outpatient,,,740,295,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Small Jt Rt,14807152,LOCAL,20600,CPT,,,320,RC,RT,Outpatient,,,740,295,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Colon Barium Enema,9427624,LOCAL,74270,CPT,,,921,RC,,Outpatient,,,740.46,396.83,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
DOP VENOUS LOWER EXT BILATERAL,8200420,LOCAL,93970,CPT,,,921,RC,,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
DOP VENOUS UPPER EXT BIL,8200421,LOCAL,93970,CPT,,,921,RC,,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP AO IVC ILIAC COMPLETE,8200530,LOCAL,93978,CPT,,,921,RC,,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP CAROTID BILATERAL,8200370,LOCAL,93880,CPT,,,921,RC,,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP CAROTID UNI,8200380,LOCAL,93882,CPT,,,921,RC,,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUP HEPATOPORTAL INFLOW/OUTFLOW COMP,8200434,LOCAL,93975,CPT,,,921,RC,,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP MESENTERIC/CELIAC ARTERY IN/OUT COMP,8200433,LOCAL,93975,CPT,,,921,RC,,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP RENAL ARTERIES INFLOW/OUTFLOW COMP,8200432,LOCAL,93975,CPT,,,921,RC,,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUPLEX ARTERIAL LOWER EXT BIL,8200460,LOCAL,93925,CPT,,,921,RC,,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUPLEX ARTERIAL UPPER EXT BIL,8200480,LOCAL,93930,CPT,,,921,RC,,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Abdomen Vascular Limited,8206811,LOCAL,93975,CPT,,,921,RC,,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Aorta IVC Iliac Duplex Complete,1169577,LOCAL,93978,CPT,,,921,RC,,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Art/Vein Abd/Pelvis/Scrotal Complete,1169581,LOCAL,93975,CPT,,,921,RC,,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Carotid Duplex Bilateral,1169631,LOCAL,93880,CPT,,,921,RC,,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Carotid Duplex Left,8814383,LOCAL,93882,CPT,,,921,RC,LT,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Carotid Duplex Right,8814386,LOCAL,93882,CPT,,,921,RC,RT,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Arterial Duplex Bilateral,1169759,LOCAL,93925,CPT,,,921,RC,,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Lower Ext Venous Duplex Bilateral,1169769,LOCAL,93970,CPT,,,921,RC,,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Renal Artery Duplex Bilateral,4246822,LOCAL,93975,CPT,,,921,RC,,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Upper Ext Arterial Duplex Bilateral,1169895,LOCAL,93930,CPT,,,921,RC,,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Upper Ext Venous Duplex Bilateral,1169901,LOCAL,93970,CPT,,,921,RC,,Outpatient,,,742.12,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP RENAL ARTERIES UNI,8200585,LOCAL,93976,CPT,,,921,RC,,Outpatient,,,742.13,482,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,245.49,
US Renal Artery Duplex Left,4246828,LOCAL,93976,CPT,,,921,RC,LT,Outpatient,,,742.13,482,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,245.49,
US Renal Artery Duplex Right,4246843,LOCAL,93976,CPT,,,301,RC,RT,Outpatient,,,742.13,482,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,245.49,
Acetylcholine Receptor Binding Ab QSTC,8853232,LOCAL,86041,CPT,,,320,RC,,Outpatient,,,743,22.08,Aetna Med ADV,Aetna Med ADV,18.4,,,,,,,Fee Schedule,15.29,18.4,
XR Small Bowel Series,12908279,LOCAL,74250,CPT,,,306,RC,,Outpatient,,,748.74,401.78,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
Chlamydophila pneumoniae QSTC,9727429,LOCAL,87486,CPT,,,306,RC,,Outpatient,,,750,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Human RSV A QSTC,9727398,LOCAL,87633,CPT,,,306,RC,,Outpatient,,,750,500.14,Aetna Med ADV,Aetna Med ADV,610.31,,,,,,,Fee Schedule,158.39,610.305625,
Mycoplasma pneumoniae QSTC,9727431,LOCAL,87581,CPT,,,302,RC,,Outpatient,,,750,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
REF Antibody Titer,7943112,LOCAL,86886,CPT,,,361,RC,,Outpatient,,,756,6.22,Aetna Med ADV,Aetna Med ADV,156.67,,,,,,,Fee Schedule,6.29,156.67,
64494 - INJ PARAVERT F JNT L/S 2 LEV,5661036,LOCAL,64494,CPT,,,302,RC,,Outpatient,,,761,495,Aetna Med ADV,Aetna Med ADV,41.55,,,,,,,Fee Schedule,41.55,1250.53,
REF HLA PLT ABSC,13479160,LOCAL,86829,CPT,,,302,RC,,Outpatient,,,767.25,77.03,Aetna Med ADV,Aetna Med ADV,64.19,,,,,,,Fee Schedule,6.29,64.19,
REF PLT ABSC,13484122,LOCAL,86022,CPT,,,740,RC,,Outpatient,,,767.25,22.04,Aetna Med ADV,Aetna Med ADV,18.37,,,,,,,Fee Schedule,15.29,18.37,
95822 EEG COMA OR SLEEP ONLY CHARGE,8687098,LOCAL,95822,CPT,,,740,RC,,Outpatient,,,768.44,499,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,284.7,466.96,
EEG EXTENDED 41-60 MINUTES CHARGE,13515636,LOCAL,95812,CPT,,,401,RC,,Outpatient,,,768.44,499,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,284.7,740.58,
MG Mammo Diagnostic Bilateral w/ Tomo.,8058646,LOCAL,77066,CPT,,,401,RC,,Outpatient,,,770.81,413.33,Aetna Med ADV,Aetna Med ADV,96.53,,,,,,,Fee Schedule,74,96.53,
MG Mammo Digital Diagnostic Bilat.,7918557,LOCAL,77066,CPT,,,401,RC,,Outpatient,,,770.81,413.33,Aetna Med ADV,Aetna Med ADV,96.53,,,,,,,Fee Schedule,74,96.53,
MG Mammo Implant Diag Bilateral w/ Tomo.,8058655,LOCAL,77066,CPT,,,,,,Outpatient,,,770.81,413.33,Aetna Med ADV,Aetna Med ADV,96.53,,,,,,,Fee Schedule,11.11,96.53,
MG Mammo Implant Diag Bilateral w/ Tomo.,8058655,LOCAL,G0279,CPT,,,401,RC,,Outpatient,,,770.81,,Aetna Med ADV,Aetna Med ADV,11.11,,,,,,,Fee Schedule,11.11,96.53,
MG Mammo Implant Digital Diag Bilateral.,8058664,LOCAL,77066,CPT,,,,,,Outpatient,,,770.81,413.33,Aetna Med ADV,Aetna Med ADV,96.53,,,,,,,Fee Schedule,74,96.53,
Pen G Benz/Proc (Bicillin CR) [CULL],11202075,LOCAL,J0558,CPT,,,761,RC,,Outpatient,2,ML,771.5488,,Aetna Med ADV,Aetna Med ADV,19.52,,,,,,,Fee Schedule,19.52,122.4,
97608 Disp NP Wound Tx >50 Sq Cm.,10017187,LOCAL,97608,CPT,,,302,RC,,Outpatient,,,777.46,505,Aetna Med ADV,Aetna Med ADV,365.27,,,,,,,Fee Schedule,365.27,549.61,
Bill Only Antigen Type Group 4,10312939,LOCAL,86902,CPT,,,361,RC,,Outpatient,,,778.5,7.62,Aetna Med ADV,Aetna Med ADV,328.88,,,,,,,Fee Schedule,6.29,328.88,
64491 INJ PARAVER CERV/THOR 2ND LEVEL,5661064,LOCAL,64491,CPT,,,361,RC,,Outpatient,,,782.44,509,Aetna Med ADV,Aetna Med ADV,48.01,,,,,,,Fee Schedule,48.01,1250.53,
64492 FACET CERV/THOR 3RD ADDTL LEVEL CHARGE,5661080,LOCAL,64492,CPT,,,310,RC,,Outpatient,,,782.44,509,Aetna Med ADV,Aetna Med ADV,48.5,,,,,,,Fee Schedule,48.5,1250.53,
"FISH, Locus Specific X2 100 QSTC",13864693,LOCAL,88271,CPT,,,636,RC,,Outpatient,,,787.5,25.7,Aetna Med ADV,Aetna Med ADV,21.42,,,,,,,Fee Schedule,21.42,63.34,
KERECIS OMEGA 3 - DISK 14MM 2,13962583,LOCAL,,,Q4158,HCPCS,301,RC,,Outpatient,,,787.5,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
"Liver Fibrosis, Fibro-ActiTest Pnl QSTC",8764813,LOCAL,81596,CPT,,,310,RC,,Outpatient,,,787.5,86.63,Aetna Med ADV,Aetna Med ADV,429.13,,,,,,,Fee Schedule,63.34,429.125,
Specimen Source: FISH Locus Pr x2 QSTC,13864687,LOCAL,88275,CPT,,,481,RC,,Outpatient,,,787.5,61.43,Aetna Med ADV,Aetna Med ADV,51.19,,,,,,,Fee Schedule,51.19,63.34,
ICD DFT TESTING,8231015,LOCAL,93641,CPT,,,761,RC,,Outpatient,,,788,512,Aetna Med ADV,Aetna Med ADV,205.74,,,,,,,Fee Schedule,205.74,9059.73,
99204 New patient-level 4 specialty clinic,13538609,LOCAL,,,G0463,HCPCS,761,RC,,Outpatient,,,788.5,326,Aetna Med ADV,Aetna Med ADV,117.82,,,,,,,Fee Schedule,117.82,117.82,
99204 Office Visit New Pt. Level 4,10168483,LOCAL,99204,CPT,,,,,,Outpatient,,,788.5,513,Aetna Med ADV,Aetna Med ADV,110.67,,,,,,,Fee Schedule,110.67,110.67,
99204 Office Visit New Pt. Level 4,10168483,LOCAL,99204,CPT,,,761,RC,,Outpatient,,,788.5,513,Aetna Med ADV,Aetna Med ADV,110.67,,,,,,,Fee Schedule,110.67,110.67,
99214 LEVEL IV VISIT CHARGE,9319023,LOCAL,99214,CPT,,,761,RC,,Outpatient,,,788.5,513,Aetna Med ADV,Aetna Med ADV,80.51,,,,,,,Fee Schedule,80.51,80.51,
99214 Office Visit Established Pt. Level 4,10168488,LOCAL,99214,CPT,,,761,RC,,Outpatient,,,788.5,513,Aetna Med ADV,Aetna Med ADV,80.51,,,,,,,Fee Schedule,80.51,80.51,
New Patient Level 4,13436278,LOCAL,99204,CPT,,,,,25,Outpatient,,,788.5,513,Aetna Med ADV,Aetna Med ADV,110.67,,,,,,,Fee Schedule,110.67,117.82,
New Patient Level 4,13436278,LOCAL,G0463,CPT,,,360,RC,25,Outpatient,,,788.5,326,Aetna Med ADV,Aetna Med ADV,117.82,,,,,,,Fee Schedule,110.67,117.82,
36593 DECLOT IMPLANT DEVICE/CATHETER CHARGE,8700839,LOCAL,36593,CPT,,,510,RC,,Outpatient,,,794.92,517,Aetna Med ADV,Aetna Med ADV,303.25,,,,,,,Fee Schedule,303.25,863,
64590  Insertion or replacement of peripheral or gastric neurostimulator pulse generator,8529396,LOCAL,64590,CPT,,,402,RC,,Outpatient,,,798,519,Aetna Med ADV,Aetna Med ADV,19605.75,,,,,,,Fee Schedule,9233,30196.67,
US Transvaginal Non-OB,1169889,LOCAL,76830,CPT,,,301,RC,,Outpatient,,,798,428.18,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
JAK2 V617F Mutation Analysis QSTC,9039438,LOCAL,81270,CPT,,,301,RC,,Outpatient,,,810,109.99,Aetna Med ADV,Aetna Med ADV,449.92,,,,,,,Fee Schedule,63.34,449.915,
TPMT Genotype QSTC,10168397,LOCAL,81335,CPT,,,276,RC,,Outpatient,,,810,209.77,Aetna Med ADV,Aetna Med ADV,174.81,,,,,,,Fee Schedule,173.68,174.81,
LENS CLAREON CCA0T0,4802028,LOCAL,,,V2630,HCPCS,276,RC,,Outpatient,,,819.5,410,Aetna Med ADV,Aetna Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
LENS CLAREON CNA0T0,4890000,LOCAL,,,V2630,HCPCS,740,RC,,Outpatient,,,819.5,410,Aetna Med ADV,Aetna Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
95816 EEG AWAKE AND DROWSY CHARGE,8303772,LOCAL,95816,CPT,,,360,RC,,Outpatient,,,820.05,533,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,284.7,466.96,
ADD'L ART 2ND/3RD ABD,8267115,LOCAL,36248,CPT,,,320,RC,,Outpatient,,,820.1,533,Aetna Med ADV,Aetna Med ADV,39.09,,,,,,,Fee Schedule,39.09,929.12,
XR Spine Lumbosacral 4 Plus Views,1170476,LOCAL,72110,CPT,,,301,RC,,Outpatient,,,823.1,441.38,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
"GAD65, IA-2 and Insulin Autoantibody QSTC",14105691,LOCAL,86337,CPT,,,301,RC,,Outpatient,,,823.5,25.69,Aetna Med ADV,Aetna Med ADV,21.41,,,,,,,Fee Schedule,15.29,21.41,
"GAD65, IA-2 and Insulin Autoantibody QSTC.",14621959,LOCAL,86337,CPT,,,276,RC,,Outpatient,,,823.5,25.69,Aetna Med ADV,Aetna Med ADV,21.41,,,,,,,Fee Schedule,15.29,21.41,
LENS #DIB00,4803761,LOCAL,,,V2630,HCPCS,481,RC,,Outpatient,,,825,410,Aetna Med ADV,Aetna Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
92978 Cath IVUS First Vessel,8230048,LOCAL,92978,CPT,,,,,,Outpatient,,,828.2,538,Aetna Med ADV,Aetna Med ADV,164.22,,,,,,,Fee Schedule,164.22,863,
"Rho D Immune Globulin, Human, full dose, 300 micrograms, INJ",90620010,LOCAL,J2790,CPT,,,322,RC,,Outpatient,,,829.08,,Aetna Med ADV,Aetna Med ADV,80.53,,,,,,,Fee Schedule,80.532,122.4,
XR Arthrogram Knee SI Left,2425410,LOCAL,73580,CPT,,,322,RC,LT,Outpatient,,,834.05,447.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Arthrogram Knee SI Right,2425413,LOCAL,73580,CPT,,,311,RC,RT,Outpatient,,,834.05,447.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
Abeta 40 - QST,13874686,LOCAL,82233,CPT,,,311,RC,,Outpatient,,,844,,Aetna Med ADV,Aetna Med ADV,128.92,,,,,,,Fee Schedule,128.92,173.68,
Abeta 42 - QST,13874685,LOCAL,82234,CPT,,,274,RC,,Outpatient,,,844,,Aetna Med ADV,Aetna Med ADV,128.92,,,,,,,Fee Schedule,128.92,173.68,
PASSY-MUIR PMV2001- 703-2001,8800100,LOCAL,,,L8501,HCPCS,,,,Outpatient,,,846.95,,Aetna Med ADV,Aetna Med ADV,179.42,,,,,,,Fee Schedule,179.42,179.42,
"epoetin alfa-epbx 20,000 units/mL injectable solution 1 mL [CULL]",11202388,LOCAL,Q5106,CPT,,,481,RC,,Outpatient,1,ML,847.104,,Aetna Med ADV,Aetna Med ADV,7.85,,,,,,,Fee Schedule,7.85,525.49,
36005 Venogram Injection,8212037,LOCAL,36005,CPT,,,,,,Outpatient,,,847.39,551,Aetna Med ADV,Aetna Med ADV,38.76,,,,,,,Fee Schedule,38.76,929.12,
levothyroxine 40 mcg (0.04 mg)/mL intravenous solution 5 mL [CULL],11202740,LOCAL,J0650,CPT,,,320,RC,,Outpatient,5,ML,851.392,,Aetna Med ADV,Aetna Med ADV,5.98,,,,,,,Fee Schedule,5.983,122.4,
XR Upper GI w/ Air Contrast,1170566,LOCAL,74246,CPT,,,320,RC,,Outpatient,,,862.77,492.53,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
XR Upper GI w/ Air w/ Small Bowel,1170570,LOCAL,74246,CPT,,,,,,Outpatient,,,862.77,492.53,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
EPINEPHrine 1 mg/mL injectable solution 30 mL [CULL],11202381,LOCAL,J0165,CPT,,,402,RC,,Outpatient,30,ML,864,,Aetna Med ADV,Aetna Med ADV,0.43,,,,,,,Fee Schedule,0.433,0.433,
US Scrotum (Contents),8206982,LOCAL,76870,CPT,,,402,RC,,Outpatient,,,864.82,463.65,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US OB Transvaginal,1169861,LOCAL,76817,CPT,,,483,RC,,Outpatient,,,865.47,464.48,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,148.61,
93308 LMTD STUDENT ECHOCARDIOGRAM CHARGE,6011002,LOCAL,93308,CPT,,,483,RC,,Outpatient,,,867.64,564,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,678.38,
ECHO 2D LTD,8200150,LOCAL,93308,CPT,,,483,RC,,Outpatient,,,867.64,564,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,678.38,
US Echo 2D Limited,8071400,LOCAL,93308,CPT,,,300,RC,,Outpatient,,,867.64,564,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,678.38,
Pneumonia Panel (Biofire),9594219,LOCAL,87633,CPT,,,,,,Outpatient,,,868.73,500.14,Aetna Med ADV,Aetna Med ADV,610.31,,,,,,,Fee Schedule,158.39,610.305625,
tbo-filgrastim 300 mcg/0.5 mL subcutaneous solution 0.5 mL [CULL],11202449,LOCAL,J1447,CPT,,,320,RC,,Outpatient,0.5,ML,872.2368,,Aetna Med ADV,Aetna Med ADV,0.28,,,,,,,Fee Schedule,0.28,525.49,
XR Colon Barium Enema w/ Air Contrast,9427627,LOCAL,74280,CPT,,,480,RC,,Outpatient,,,872.33,467.78,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
CARDIAC THROMBOLYTICS IV,8267127,LOCAL,92977,CPT,,,341,RC,,Outpatient,,,874.14,568,Aetna Med ADV,Aetna Med ADV,303.25,,,,,,,Fee Schedule,303.25,863,
NM Thyroid Imaging,2426008,LOCAL,78013,CPT,A9512,HCPCS,440,RC,,Outpatient,,,879.12,471.08,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
92612 - ENDOSCOPY SWALLOW TST (FEES),9636010,LOCAL,92612,CPT,,,440,RC,GN,Outpatient,,,884,575,Aetna Med ADV,Aetna Med ADV,52.01,,,,,,,Fee Schedule,52.01,162.41,
92612 Fiber Endo Eval Swallow Video Charge,9410192,LOCAL,92612,CPT,,,440,RC,GN,Outpatient,,,884,575,Aetna Med ADV,Aetna Med ADV,52.01,,,,,,,Fee Schedule,52.01,162.41,
SLP Fiberoptic Swallow Eval Units,1373844,LOCAL,92612,CPT,,,440,RC,GN,Outpatient,,,884,575,Aetna Med ADV,Aetna Med ADV,52.01,,,,,,,Fee Schedule,52.01,162.41,
Speech Fiberoptic Swallow Eval Charge,1373844,LOCAL,92612,CPT,,,450,RC,GN,Outpatient,,,884,575,Aetna Med ADV,Aetna Med ADV,52.01,,,,,,,Fee Schedule,52.01,162.41,
99284 - Level 4,2644300,LOCAL,99284,CPT,,,301,RC,25,Outpatient,,,886.65,576,Aetna Med ADV,Aetna Med ADV,389.31,,,,,,,Fee Schedule,389.31,389.31,
3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase (HMGCR) Antibody (IgG) QSTC,13864471,LOCAL,83520,CPT,,,320,RC,,Outpatient,,,888.75,20.72,Aetna Med ADV,Aetna Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
XR Hips 5+ Views Bilat,7520618,LOCAL,73523,CPT,,,320,RC,,Outpatient,,,890.34,477.68,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Hips 5+ Views w/AP Pelvis Bilat,7520621,LOCAL,73523,CPT,,,320,RC,,Outpatient,,,890.34,477.68,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Barium Swallow w/ Upper GI + KUB,8912828,LOCAL,74240,CPT,,,320,RC,,Outpatient,,,891.48,477.68,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
XR Upper GI,1170562,LOCAL,74240,CPT,,,320,RC,,Outpatient,,,891.48,477.68,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
XR Upper GI w/ Small Bowel,1170574,LOCAL,74240,CPT,,,,,,Outpatient,,,891.48,477.68,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
ceftaroline 600 mg intravenous injection [CULL],11201425,LOCAL,J0712,CPT,,,301,RC,,Outpatient,1,EA,896.73216,,Aetna Med ADV,Aetna Med ADV,4.23,,,,,,,Fee Schedule,4.23,233.26,
"ANNA3 Ab, IFA, CSF QSTC",13873554,LOCAL,86255,CPT,,,301,RC,,Outpatient,,,900,14.46,Aetna Med ADV,Aetna Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
"GAD65 Ab, IFA, CSF QSTC",13873575,LOCAL,86341,CPT,,,301,RC,,Outpatient,,,900,28.28,Aetna Med ADV,Aetna Med ADV,23.57,,,,,,,Fee Schedule,15.29,23.57,
TPMT Activity QSTC,8764663,LOCAL,84433,CPT,,,360,RC,,Outpatient,,,900,26.6,Aetna Med ADV,Aetna Med ADV,22.17,,,,,,,Fee Schedule,17.73,22.17,
CATH PL 1ST ORDER VENOUS,8267186,LOCAL,36011,CPT,,,360,RC,,Outpatient,,,908.34,590,Aetna Med ADV,Aetna Med ADV,126.74,,,,,,,Fee Schedule,126.74,929.12,
VENOGRAM INJ BILATERAL,8267755,LOCAL,36005,CPT,,,320,RC,,Outpatient,,,914.51,551,Aetna Med ADV,Aetna Med ADV,38.76,,,,,,,Fee Schedule,38.76,929.12,
XR Barium Swallow w/ Upper GI w/ Air,13554969,LOCAL,74246,CPT,,,740,RC,,Outpatient,,,918.22,492.53,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
95819 EEG AWAKE & ASLEEP CHARGE,8704890,LOCAL,95819,CPT,,,402,RC,,Outpatient,,,922.13,599,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,284.7,466.96,
US Biopsy Abdomen/Retroperitoneal Mass,8565247,LOCAL,76942,CPT,,,402,RC,,Outpatient,,,927.16,497.48,Aetna Med ADV,Aetna Med ADV,28.54,,,,,,,Fee Schedule,28.54,165.47,
US Biopsy Liver,1169599,LOCAL,76942,CPT,,,360,RC,,Outpatient,,,927.16,497.48,Aetna Med ADV,Aetna Med ADV,28.54,,,,,,,Fee Schedule,28.54,165.47,
US Breast Needle Loc Left,7936259,LOCAL,19285,CPT,,,360,RC,LT,Outpatient,,,927.16,603,Aetna Med ADV,Aetna Med ADV,643.26,,,,,,,Fee Schedule,643.26,1291,
US Breast Needle Loc Right,7936262,LOCAL,19285,CPT,,,402,RC,RT,Outpatient,,,927.16,603,Aetna Med ADV,Aetna Med ADV,643.26,,,,,,,Fee Schedule,643.26,1291,
US NEEDLE PLACEMENT CVS,8200510,LOCAL,76942,CPT,,,360,RC,,Outpatient,,,927.16,497.48,Aetna Med ADV,Aetna Med ADV,28.54,,,,,,,Fee Schedule,28.54,165.47,
XR Cholangiogram T-Tube Check,8207012,LOCAL,47531,CPT,,,636,RC,,Outpatient,,,927.38,298,Aetna Med ADV,Aetna Med ADV,3226.48,,,,,,,Fee Schedule,2599,3226.48,
KERECIS OMEGA 3 - DISK 16MM 2,13962585,LOCAL,,,Q4158,HCPCS,322,RC,,Outpatient,,,929.25,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
XR Arthrogram Elbow SI Left,2425398,LOCAL,73085,CPT,,,322,RC,LT,Outpatient,,,934.13,500.78,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Arthrogram Elbow SI Right,2425401,LOCAL,73085,CPT,,,301,RC,RT,Outpatient,,,934.13,500.78,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
"Bartonella DNA, Qual, RT PCR QSTC",13864512,LOCAL,87471,CPT,,,410,RC,,Outpatient,,,940.5,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
BiPAP Charge -> Subsequent,2678299,LOCAL,94003,CPT,,,341,RC,,Outpatient,,,943.5,613,Aetna Med ADV,Aetna Med ADV,604.42,,,,,,,Fee Schedule,604.42,941,
NM Lung Perfusion Imaging,1169328,LOCAL,78580,CPT,A9540,HCPCS,360,RC,,Outpatient,,,948.45,508.2,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,1409.71,
64999 PERI-INFILTRATION HARDWARE,5661083,LOCAL,64999,CPT,,,274,RC,,Outpatient,,,953.35,620,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
L3806 OT WRIST HAND FINGER ORTHOSIS,9856094,LOCAL,,,L3806,HCPCS,,,,Outpatient,,,966.78,628,Aetna Med ADV,Aetna Med ADV,510.8,,,,,,,Fee Schedule,510.8,510.8,
"penicillin G benzathine 1,200,000 units/2 mL intramuscular suspension 2 mL [CULL]",11202076,LOCAL,J0561,CPT,,,360,RC,,Outpatient,2,ML,967.8944,,Aetna Med ADV,Aetna Med ADV,30.01,,,,,,,Fee Schedule,30.01,122.4,
ADD'L ART 2ND/3RD THORAC,8267111,LOCAL,36218,CPT,,,360,RC,,Outpatient,,,970.36,631,Aetna Med ADV,Aetna Med ADV,42.55,,,,,,,Fee Schedule,42.55,929.12,
CATH PLACE SEG SUBSEG PA,8267104,LOCAL,36015,CPT,,,402,RC,,Outpatient,,,980.22,637,Aetna Med ADV,Aetna Med ADV,139.57,,,,,,,Fee Schedule,139.57,929.12,
US Abdomen Complete,1169567,LOCAL,76700,CPT,,,410,RC,,Outpatient,,,984.47,528,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,245.49,
BiPAP Charge -> Initial,2678300,LOCAL,94002,CPT,,,410,RC,,Outpatient,,,990,663,Aetna Med ADV,Aetna Med ADV,604.42,,,,,,,Fee Schedule,604.42,941,
BiPAP/CPAP Mode -> NIMV,2678300,LOCAL,94002,CPT,,,483,RC,,Outpatient,,,990,663,Aetna Med ADV,Aetna Med ADV,604.42,,,,,,,Fee Schedule,604.42,941,
ECHOCARDIOGRAM 2D W/STRESS,8200440,LOCAL,93350,CPT,,,761,RC,,Outpatient,,,990,644,Aetna Med ADV,Aetna Med ADV,501.29,,,,,,,Fee Schedule,501.29,678.38,
16025 DRESS AN/OR DEBMT BURN INI MED CHARGE,8020080,LOCAL,16025,CPT,,,352,RC,,Outpatient,,,991.5,644,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
CT Angio Heart/Coronary Arteries,9515210,LOCAL,75574,CPT,,,361,RC,,Outpatient,,,992.21,532.13,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,565.59,
20610 INJECT MAJOR JOINT,5661087,LOCAL,20610,CPT,,,,,,Outpatient,,,1000,650,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
methylene blue 5 mg/mL intravenous solution 10 mL [CULL],11202913,LOCAL,Q9968,CPT,,,636,RC,,Outpatient,10,ML,1000.0512,,Aetna Med ADV,Aetna Med ADV,8.73,,,,,,,Fee Schedule,8.73,8.73,
OASIS MATRIX WOUND 3 X 7 CM,13962592,LOCAL,,,Q4102,HCPCS,341,RC,,Outpatient,,,1003.01,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
NM Parathyroid Imaging w/ Spect Inj/Scan,2425984,LOCAL,78071,CPT,A9500,HCPCS,322,RC,,Outpatient,,,1004.58,331.65,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
XR Arthrogram Hip SI Left,2425404,LOCAL,73525,CPT,,,322,RC,LT,Outpatient,,,1004.84,538.73,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Arthrogram Hip SI Right,2425407,LOCAL,73525,CPT,,,360,RC,RT,Outpatient,,,1004.84,538.73,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
INTRO EXTREMITY ARTERY,8267105,LOCAL,36140,CPT,,,320,RC,,Outpatient,,,1022.12,664,Aetna Med ADV,Aetna Med ADV,72.34,,,,,,,Fee Schedule,72.34,929.12,
PERC CHANGE TUBE OR DRAINAGE CATH S&I,8210742,LOCAL,75984,CPT,,,320,RC,,Outpatient,,,1029.19,551.93,Aetna Med ADV,Aetna Med ADV,49.58,,,,,,,Fee Schedule,49.58,262.79,
XR Drainage Perc Cath Replace,9343679,LOCAL,75984,CPT,,,761,RC,,Outpatient,,,1029.19,551.93,Aetna Med ADV,Aetna Med ADV,49.58,,,,,,,Fee Schedule,49.58,262.79,
11107 INCAL BX SKN EA SEP/ADDL CHARGE,9704096,LOCAL,11107,CPT,,,320,RC,,Outpatient,,,1030.62,670,Aetna Med ADV,Aetna Med ADV,23.51,,,,,,,Fee Schedule,23.51,863,
CYSTOGRAM S&I,8211185,LOCAL,74430,CPT,,,320,RC,,Outpatient,,,1033.41,554.4,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Cystogram,4126362,LOCAL,74430,CPT,,,360,RC,,Outpatient,,,1033.41,554.4,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
US Joint/Bursa Lw Int Arth/Asp/Inj Left,3148332,LOCAL,20606,CPT,,,360,RC,LT,Outpatient,,,1035.43,673,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
US Joint/Bursa Lw Int Arth/Asp/Inj Right,3148335,LOCAL,20606,CPT,,,360,RC,RT,Outpatient,,,1035.43,673,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
US Joint/Bursa Lw Maj Arth/Asp/Inj Left,3148338,LOCAL,20611,CPT,,,360,RC,LT,Outpatient,,,1035.43,673,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Lw Maj Arth/Asp/Inj Right,3148341,LOCAL,20611,CPT,,,360,RC,RT,Outpatient,,,1035.43,673,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Lw Sm Arth/Asp/Inj Left,6130396,LOCAL,20604,CPT,,,360,RC,LT,Outpatient,,,1035.43,673,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Lw Sm Arth/Asp/Inj Right,6130399,LOCAL,20604,CPT,,,360,RC,RT,Outpatient,,,1035.43,673,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Up Int Arth/Asp/Inj Left,2425353,LOCAL,20606,CPT,,,360,RC,LT,Outpatient,,,1035.43,673,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
US Joint/Bursa Up Int Arth/Asp/Inj Right,2425356,LOCAL,20606,CPT,,,360,RC,RT,Outpatient,,,1035.43,673,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
US Joint/Bursa Up Maj Arth/Asp/Inj Left,2425359,LOCAL,20611,CPT,,,360,RC,LT,Outpatient,,,1035.43,673,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Up Maj Arth/Asp/Inj Right,2425362,LOCAL,20611,CPT,,,360,RC,RT,Outpatient,,,1035.43,673,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Up Sm Arth/Asp/Inj Left,6130402,LOCAL,20604,CPT,,,360,RC,LT,Outpatient,,,1035.43,673,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Up Sm Arth/Asp/Inj Right,6130405,LOCAL,20604,CPT,,,360,RC,RT,Outpatient,,,1035.43,673,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
GASTRO-JEJUNOSTOMY TUBE REPLACEMENT,8200254,LOCAL,49452,CPT,,,301,RC,,Outpatient,,,1040.53,676,Aetna Med ADV,Aetna Med ADV,857.17,,,,,,,Fee Schedule,857.17,1496,
"Chikungunya Virus RNA, Qual RT PCR QSTC",13864475,LOCAL,87798,CPT,,,360,RC,,Outpatient,,,1050.75,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
ARTERIAL LINE PLACEMENT,8210320,LOCAL,36620,CPT,,,341,RC,,Outpatient,,,1052.64,684,Aetna Med ADV,Aetna Med ADV,38.92,,,,,,,Fee Schedule,38.92,929.12,
NM Hepatobiliary Imaging,2425957,LOCAL,78226,CPT,,,278,RC,,Outpatient,,,1059,567.6,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
DART FIRE EDGE SCREW,4810328,LOCAL,,,C1716,HCPCS,320,RC,,Outpatient,,,1062.93,,Aetna Med ADV,Aetna Med ADV,868.33,,,,,,,Fee Schedule,612.6,868.33,
NEPHROSTOGRAM S&I,8212039,LOCAL,74425,CPT,,,,,,Outpatient,,,1072.47,575.03,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
glucagon 1 mg injection [CULL],11282210,LOCAL,J1610,CPT,,,761,RC,,Outpatient,1,EA,1075.2,,Aetna Med ADV,Aetna Med ADV,182.45,,,,,,,Fee Schedule,182.45,233.26,
99205 LEVEL V INITIAL VISIT FAC CHARGE,12832503,LOCAL,99205,CPT,,,761,RC,,Outpatient,,,1078.84,701,Aetna Med ADV,Aetna Med ADV,151.18,,,,,,,Fee Schedule,151.18,151.18,
99205 New patient-level 5 specialty clinic,13538610,LOCAL,,,G0463,HCPCS,761,RC,,Outpatient,,,1078.84,326,Aetna Med ADV,Aetna Med ADV,117.82,,,,,,,Fee Schedule,117.82,117.82,
99205 Office Visit New Pt. Level 5,10168484,LOCAL,99205,CPT,,,,,,Outpatient,,,1078.84,701,Aetna Med ADV,Aetna Med ADV,151.18,,,,,,,Fee Schedule,151.18,151.18,
99205 Office Visit New Pt. Level 5,10168484,LOCAL,99205,CPT,,,761,RC,,Outpatient,,,1078.84,701,Aetna Med ADV,Aetna Med ADV,151.18,,,,,,,Fee Schedule,151.18,151.18,
99215 LEVEL V VISIT CHARGE,9322144,LOCAL,99215,CPT,,,761,RC,,Outpatient,,,1078.84,701,Aetna Med ADV,Aetna Med ADV,119.41,,,,,,,Fee Schedule,119.41,119.41,
99215 Office Visit Established Pt. Level 5,10168489,LOCAL,99215,CPT,,,301,RC,,Outpatient,,,1078.84,701,Aetna Med ADV,Aetna Med ADV,119.41,,,,,,,Fee Schedule,119.41,119.41,
"Leptospira DNA, Qual RT PCR QSTC",13864445,LOCAL,87798,CPT,,,301,RC,,Outpatient,,,1096.88,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Fungal Sequencing, ITS Region QSTC",13864438,LOCAL,87153,CPT,,,301,RC,,Outpatient,,,1102.5,138.43,Aetna Med ADV,Aetna Med ADV,115.36,,,,,,,Fee Schedule,115.36,158.39,
"Cortisol, Free, LC/MS, Serum QSTC",8972878,LOCAL,82530,CPT,,,,,,Outpatient,,,1104.43,20.05,Aetna Med ADV,Aetna Med ADV,29.79,,,,,,,Fee Schedule,17.73,29.79,
acetylcysteine 20% intravenous solution 30 mL [CULL],11200013,LOCAL,J0132,CPT,,,301,RC,,Outpatient,30,ML,1120.00032,,Aetna Med ADV,Aetna Med ADV,0.37,,,,,,,Fee Schedule,0.367,0.367,
"Pneumocystis jirovecii,Qual Real-Time PCR QSTC",9215420,LOCAL,87798,CPT,,,360,RC,,Outpatient,,,1120.91,42.11,Aetna Med ADV,Aetna Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
CATH PL 2ND ORDER VENOUS,8267187,LOCAL,36012,CPT,,,341,RC,,Outpatient,,,1122.44,730,Aetna Med ADV,Aetna Med ADV,142.32,,,,,,,Fee Schedule,142.32,929.12,
NM Gastrointestinal Blood Loss Imaging,1169242,LOCAL,78278,CPT,A9512,HCPCS,301,RC,,Outpatient,,,1123.93,603.08,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,1409.71,
Bird Fancier's Precipitin Panel I QSTC,13864443,LOCAL,86331,CPT,,,450,RC,,Outpatient,,,1133.1,14.38,Aetna Med ADV,Aetna Med ADV,11.98,,,,,,,Fee Schedule,11.98,15.29,
99285 - Level 5,2644301,LOCAL,99285,CPT,,,,,25,Outpatient,,,1135.13,738,Aetna Med ADV,Aetna Med ADV,560.53,,,,,,,Fee Schedule,560.53,560.53,
chlorothiazide 0.5 g intravenous injection [CULL],11240810,LOCAL,J1205,CPT,,,402,RC,,Outpatient,1,EA,1143.168,,Aetna Med ADV,Aetna Med ADV,58.13,,,,,,,Fee Schedule,58.126,58.126,
US Breast ABUS Bilateral.,13939856,LOCAL,76641,CPT,,,320,RC,50,Outpatient,,,1143.26,306.9,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
XR ERCP Biliary,8649296,LOCAL,74328,CPT,,,320,RC,,Outpatient,,,1143.36,612.98,Aetna Med ADV,Aetna Med ADV,121.3,,,,,,,Fee Schedule,121.3,262.79,
XR ERCP Pancreatic,8649299,LOCAL,74329,CPT,,,,,,Outpatient,,,1143.36,612.98,Aetna Med ADV,Aetna Med ADV,23.05,,,,,,,Fee Schedule,23.05,262.79,
amphotericin B liposomal 50 mg intravenous injection [CULL],11202015,LOCAL,J0289,CPT,,,320,RC,,Outpatient,1,EA,1152.16,,Aetna Med ADV,Aetna Med ADV,21.48,,,,,,,Fee Schedule,21.48,1293.51,
GUIDED PERC DRAIN W CATH S&I,8210333,LOCAL,75989,CPT,,,402,RC,,Outpatient,,,1153.62,618.75,Aetna Med ADV,Aetna Med ADV,50.75,,,,,,,Fee Schedule,50.75,262.79,
US Pelvic Comp,8206964,LOCAL,76856,CPT,,,761,RC,,Outpatient,,,1159.45,622.05,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,245.49,
29445 APPL RIGID LEG CAST,9739196,LOCAL,29445,CPT,,,342,RC,,Outpatient,,,1160.76,266,Aetna Med ADV,Aetna Med ADV,242.81,,,,,,,Fee Schedule,242.81,863,
NM Hyperthyroid Therapy,8567789,LOCAL,79005,CPT,A9517,HCPCS,320,RC,,Outpatient,,,1161.71,622.88,Aetna Med ADV,Aetna Med ADV,23.13,,,,,,,Fee Schedule,23.13,456.65,
XR Spine Scoliosis 1 View,7520627,LOCAL,72081,CPT,,,322,RC,,Outpatient,,,1170.74,627.83,Aetna Med ADV,Aetna Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Arthrogram Wrist SI Left,2425422,LOCAL,73115,CPT,,,322,RC,LT,Outpatient,,,1176.56,631.13,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Arthrogram Wrist SI Right,2425425,LOCAL,73115,CPT,,,390,RC,RT,Outpatient,,,1176.56,631.13,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
E3077 Aph Plt ACDA LR,7266775,LOCAL,,,P9035,HCPCS,390,RC,,Outpatient,,,1182,768,Aetna Med ADV,Aetna Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E3087 Aph Plt ACDA LR 1,7266780,LOCAL,,,P9035,HCPCS,390,RC,,Outpatient,,,1182,768,Aetna Med ADV,Aetna Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E3088 Aph Plt ACDA LR 2,7266781,LOCAL,,,P9035,HCPCS,390,RC,,Outpatient,,,1182,768,Aetna Med ADV,Aetna Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E3089 Aph Plt ACDA LR 3,7266782,LOCAL,,,P9035,HCPCS,390,RC,,Outpatient,,,1182,768,Aetna Med ADV,Aetna Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E4643 Aph Plt ACDA LR <3E11,7266909,LOCAL,,,P9035,HCPCS,390,RC,,Outpatient,,,1182,768,Aetna Med ADV,Aetna Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5030 Aph Plt ACDA LR BM,8058823,LOCAL,,,P9035,HCPCS,390,RC,,Outpatient,,,1182,768,Aetna Med ADV,Aetna Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5032 Aph Plt ACDA LR BM 2,8029134,LOCAL,,,P9035,HCPCS,390,RC,,Outpatient,,,1182,768,Aetna Med ADV,Aetna Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5033 Aph Plt ACDA LR BM 3,8058812,LOCAL,,,P9035,HCPCS,390,RC,,Outpatient,,,1182,768,Aetna Med ADV,Aetna Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5036 Aph Plt ACDA LR Irr BM 2,8029108,LOCAL,,,P9035,HCPCS,390,RC,,Outpatient,,,1182,768,Aetna Med ADV,Aetna Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5075 Aph Plt ACDA LR <3E11 BM,8058809,LOCAL,,,P9035,HCPCS,390,RC,,Outpatient,,,1182,768,Aetna Med ADV,Aetna Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E9232 Aph Plt ACDA LR BT6,10074919,LOCAL,,,P9035,HCPCS,390,RC,,Outpatient,,,1182,768,Aetna Med ADV,Aetna Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5031  Aph Plt ACDA LR BM 1,8029138,LOCAL,,,P9035,HCPCS,361,RC,,Outpatient,,,1188,768,Aetna Med ADV,Aetna Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
64480 CERVICAL THORACIC TRANSFORAMINAL EACH AD,5661052,LOCAL,64480,CPT,,,730,RC,,Outpatient,,,1193.14,776,Aetna Med ADV,Aetna Med ADV,50.22,,,,,,,Fee Schedule,50.22,1250.53,
95824 EEG CEREBRAL DEATH EVALUATION ONLY CHARGE,9646722,LOCAL,95824,CPT,,,278,RC,,Outpatient,,,1194.07,776,Aetna Med ADV,Aetna Med ADV,485.11,,,,,,,Fee Schedule,466.96,485.11,
BREAST SIZER SMOOTH ROUND HIGH 565CC,4850931,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,1210,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE 505HP,4840154,LOCAL,,,L8600,HCPCS,410,RC,,Outpatient,,,1210,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
"RT CHARGE Ventilator Restart, Ongoing -> Yes",12109384,LOCAL,94003,CPT,,,636,RC,,Outpatient,,,1224,613,Aetna Med ADV,Aetna Med ADV,604.42,,,,,,,Fee Schedule,604.42,941,
KERECIS OMEGA 3 - 1.75 X 1.75CM,13962575,LOCAL,,,Q4158,HCPCS,300,RC,,Outpatient,,,1228.5,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
"Prostaglandin D2 (Pg D2), Urine QST",12667576,LOCAL,84150,CPT,,,761,RC,,Outpatient,,,1230,50.12,Aetna Med ADV,Aetna Med ADV,41.77,,,,,,,Fee Schedule,41.77,47.35,
15274 App Skin Sub Graft (TWSA>100cm2) t/s/l ; add 100 cm 2,12642329,LOCAL,15274,CPT,,,761,RC,,Outpatient,,,1230.36,800,Aetna Med ADV,Aetna Med ADV,35.4,,,,,,,Fee Schedule,35.4,2862.92,
15278 APPL-HC SKSB GRT F/N/H/G-KD A100 CHARGE,9709036,LOCAL,15278,CPT,,,761,RC,,Outpatient,,,1230.36,800,Aetna Med ADV,Aetna Med ADV,44.7,,,,,,,Fee Schedule,44.7,2862.92,
11106 INCAL BX SKN SINGLE LES CHARGE,9704095,LOCAL,11106,CPT,,,301,RC,,Outpatient,,,1230.62,800,Aetna Med ADV,Aetna Med ADV,559.65,,,,,,,Fee Schedule,559.65,1291,
"Aquaporin-4 (AQP4) (NMO-IgG) Antibody with Reflex to Titer, Serum QSTC",10041610,LOCAL,86052,CPT,,,301,RC,,Outpatient,,,1237.5,14.46,Aetna Med ADV,Aetna Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
"JC Polyoma Virus DNA, Qnt PCR, Serum QSTC",10274092,LOCAL,87799,CPT,,,301,RC,,Outpatient,,,1237.5,51.41,Aetna Med ADV,Aetna Med ADV,42.84,,,,,,,Fee Schedule,40.19,42.84,
"NMO Spectrum Eval (AQP4 w/Rflx toMOG), Serum QSTC",10274088,LOCAL,86052,CPT,,,360,RC,,Outpatient,,,1237.5,14.46,Aetna Med ADV,Aetna Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
"64520 Injection Lumbar or Thoracic, Paravertebral Sympathetic",5661043,LOCAL,64520,CPT,,,335,RC,,Outpatient,,,1239.7,806,Aetna Med ADV,Aetna Med ADV,813.96,,,,,,,Fee Schedule,813.96,1291,
96413 CHEMO IV INFUSION 1ST HR INF CHARGE,9665725,LOCAL,96413,CPT,,,302,RC,,Outpatient,,,1244.66,809,Aetna Med ADV,Aetna Med ADV,303.25,,,,,,,Fee Schedule,303.25,442.94,
REF Genetic RBC Phenotyping,13481257,LOCAL,81403,CPT,,,341,RC,,Outpatient,,,1246.5,222.24,Aetna Med ADV,Aetna Med ADV,185.2,,,,,,,Fee Schedule,173.68,185.2,
NM Liver/Spleen Imaging Injection/Scan,1169286,LOCAL,78215,CPT,A9541,HCPCS,301,RC,,Outpatient,,,1248.36,669.08,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,1409.71,
"CBFB/MYH11 inv(16), Quant RT PCR QSTC",13864502,LOCAL,81401,CPT,,,302,RC,,Outpatient,,,1260,164.4,Aetna Med ADV,Aetna Med ADV,137,,,,,,,Fee Schedule,63.34,137,
REF PLT Crossmatch,13481259,LOCAL,86022,CPT,,,,,,Outpatient,,,1269,22.04,Aetna Med ADV,Aetna Med ADV,18.37,,,,,,,Fee Schedule,15.29,18.37,
epoetin alfa 20000 units/mL Sol 1 mL [CULL],11202388,LOCAL,J0885,CPT,,,301,RC,,Outpatient,1,ML,1273.344,,Aetna Med ADV,Aetna Med ADV,8.54,,,,,,,Fee Schedule,7.85,525.49,
Admark Phospho Tau/Ttl Ab42 Comments QST,13877904,LOCAL,83520,CPT,,,301,RC,,Outpatient,,,1277.25,20.72,Aetna Med ADV,Aetna Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Admark Phospho Tau/Ttl Ab42 Interp QST,13877902,LOCAL,83520,CPT,,,301,RC,,Outpatient,,,1277.25,20.72,Aetna Med ADV,Aetna Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Admark Phospho Tau/Ttl Ab42 Methods QST,13877905,LOCAL,83520,CPT,,,360,RC,,Outpatient,,,1277.25,20.72,Aetna Med ADV,Aetna Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
62320 Cervical/Thoracic Epidural without Fluor,5661014,LOCAL,62320,CPT,,,761,RC,,Outpatient,,,1284.42,835,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
11042 DEB SQ TISSUE-1ST 20SQCM/< CHARGE,9704056,LOCAL,11042,CPT,,,761,RC,,Outpatient,,,1286.64,836,Aetna Med ADV,Aetna Med ADV,365.27,,,,,,,Fee Schedule,365.27,863,
11043 DEB MUS/FASCIA-1ST 20SQCM/< CHARGE,9704059,LOCAL,11043,CPT,,,761,RC,,Outpatient,,,1286.64,836,Aetna Med ADV,Aetna Med ADV,559.65,,,,,,,Fee Schedule,549.61,863,
11045 Debrid bone 1st 20 sq cm charge,12510099,LOCAL,11045,CPT,,,761,RC,,Outpatient,,,1286.64,836,Aetna Med ADV,Aetna Med ADV,20.61,,,,,,,Fee Schedule,20.61,1466.58,
11045 Debrid Sub Tissue > 20 sq cm charge,12511974,LOCAL,11045,CPT,,,761,RC,,Outpatient,,,1286.64,836,Aetna Med ADV,Aetna Med ADV,20.61,,,,,,,Fee Schedule,20.61,1466.58,
11046 DEB MUS/FASCIA-EA ADDL 20SQCM CHARGE,9704068,LOCAL,11046,CPT,,,320,RC,,Outpatient,,,1286.64,836,Aetna Med ADV,Aetna Med ADV,44.01,,,,,,,Fee Schedule,44.01,1466.58,
XR Urethrocystography Retrograde,1170578,LOCAL,74450,CPT,,,301,RC,,Outpatient,,,1300.84,697.95,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,176.48,220.99,
MTB Complex Rifampin Resist PCR Sput QSTC,8873578,LOCAL,87801,CPT,,,402,RC,,Outpatient,,,1316.25,84.24,Aetna Med ADV,Aetna Med ADV,70.2,,,,,,,Fee Schedule,40.19,70.2,
US OB Greater Than 14 Weeks Single,8583651,LOCAL,76805,CPT,,,341,RC,,Outpatient,,,1319.46,130.35,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,148.61,
NM Parathyroid Imaging Injection/Scan,1169316,LOCAL,78070,CPT,A9500,HCPCS,341,RC,,Outpatient,,,1324.92,710.33,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,1409.71,
NM Bone Marrow Imaging Whole Body,1169186,LOCAL,78104,CPT,A9541,HCPCS,761,RC,,Outpatient,,,1327.01,711.98,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
16030 DRESS AN/OR DEBMT BURN INI LG CHARGE,8020081,LOCAL,16030,CPT,,,481,RC,,Outpatient,,,1328,863,Aetna Med ADV,Aetna Med ADV,365.27,,,,,,,Fee Schedule,365.27,863,
93660 STRESS TILT TABLE CHARGE,8200435,LOCAL,93660,CPT,,,360,RC,,Outpatient,,,1338.01,870,Aetna Med ADV,Aetna Med ADV,485.11,,,,,,,Fee Schedule,244.97,863,
JEJUNOSTOMY PERC,8200251,LOCAL,49441,CPT,,,301,RC,,Outpatient,,,1339,870,Aetna Med ADV,Aetna Med ADV,1734.34,,,,,,,Fee Schedule,983.02,1734.34,
Bacterial 16S rDNA Sequencing QSTC,8873571,LOCAL,87153,CPT,,,361,RC,,Outpatient,,,1344.6,138.43,Aetna Med ADV,Aetna Med ADV,115.36,,,,,,,Fee Schedule,115.36,158.39,
64620 DESTR INTERCOSTAL NERVE,5661066,LOCAL,64620,CPT,,,361,RC,,Outpatient,,,1345.12,874,Aetna Med ADV,Aetna Med ADV,813.96,,,,,,,Fee Schedule,813.96,1695.82,
64634 DESTR FACET CRV/THR EA ADL LVL,5661058,LOCAL,64634,CPT,,,761,RC,,Outpatient,,,1345.12,874,Aetna Med ADV,Aetna Med ADV,54.71,,,,,,,Fee Schedule,54.71,1250.53,
15002 SITE PREP -100 SQCM(TAL),12625535,LOCAL,15002,CPT,,,360,RC,,Outpatient,,,1348.68,877,Aetna Med ADV,Aetna Med ADV,1672.39,,,,,,,Fee Schedule,1466.58,1672.39,
64405 OCCIPITAL - BILATERAL CHARGE,5661078,LOCAL,64405,CPT,,,,,,Outpatient,,,1352.9,879,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
conjugated estrogens 25 mg injection [CULL],11201516,LOCAL,J1410,CPT,,,761,RC,,Outpatient,1,EA,1372.1472,,Aetna Med ADV,Aetna Med ADV,392.06,,,,,,,Fee Schedule,233.26,392.06,
10120 Incision & removal of Foreign Body Simple,9620024,LOCAL,10120,CPT,,,361,RC,,Outpatient,,,1373.45,893,Aetna Med ADV,Aetna Med ADV,365.27,,,,,,,Fee Schedule,239.03,863,
62321 CERVICAL THORACIC EPIDURAL,5661016,LOCAL,62321,CPT,,,361,RC,,Outpatient,,,1375.34,894,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
64520 LUMBAR OR THORACIC Sympathetic Charge,5661033,LOCAL,64520,CPT,,,361,RC,,Outpatient,,,1375.34,806,Aetna Med ADV,Aetna Med ADV,813.96,,,,,,,Fee Schedule,813.96,1291,
64490 INJ PARAVER CERV/THOR 1ST LEVEL,5661063,LOCAL,64490,CPT,,,360,RC,,Outpatient,,,1376.78,895,Aetna Med ADV,Aetna Med ADV,813.96,,,,,,,Fee Schedule,813.96,1291,
INTRO CATH AORTA,8267107,LOCAL,36200,CPT,,,,,,Outpatient,,,1379.82,897,Aetna Med ADV,Aetna Med ADV,112.42,,,,,,,Fee Schedule,112.42,929.12,
tbo-filgrastim 480 mcg/0.8 mL subcutaneous solution 0.8 mL [CULL],11202451,LOCAL,J1447,CPT,,,361,RC,,Outpatient,0.8,ML,1395.9776,,Aetna Med ADV,Aetna Med ADV,0.28,,,,,,,Fee Schedule,0.28,525.49,
64479 CERVICAL THORACIC TRANSFORAMINAL EPIDRL,5661051,LOCAL,64479,CPT,,,,,,Outpatient,,,1397.93,909,Aetna Med ADV,Aetna Med ADV,813.96,,,,,,,Fee Schedule,813.96,1291,
BUPivacaine liposome 1.3% (13.3 mg/mL) injectable suspension 20 mL [CULL],11202119,LOCAL,J0666,CPT,,,361,RC,,Outpatient,20,ML,1402.224,,Aetna Med ADV,Aetna Med ADV,1.34,,,,,,,Fee Schedule,1.34,1.34,
62323 LUMBAR OR CAUDAL EPIDURAL,5661015,LOCAL,62323,CPT,,,360,RC,,Outpatient,,,1408.03,915,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
PERC ASPIRATION DISC,8230054,LOCAL,62267,CPT,,,636,RC,,Outpatient,,,1409.73,916,Aetna Med ADV,Aetna Med ADV,643.26,,,,,,,Fee Schedule,643.26,1291,
EPIFIX SKIN SUBSTITUTE 14MM,13962560,LOCAL,,,Q4186,HCPCS,361,RC,,Outpatient,,,1410.75,1755,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
64510 NERV BLK STELLATE GANGLION,5661032,LOCAL,64510,CPT,,,361,RC,,Outpatient,,,1418.86,922,Aetna Med ADV,Aetna Med ADV,813.96,,,,,,,Fee Schedule,813.96,1695.82,
"64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when per",9520503,LOCAL,64624,CPT,,,361,RC,,Outpatient,,,1425,926,Aetna Med ADV,Aetna Med ADV,1785.34,,,,,,,Fee Schedule,1695.82,2315,
64640 DESTR OTH PERIPHERAL NERVE/BRCH,5661065,LOCAL,64640,CPT,,,361,RC,,Outpatient,,,1425.83,927,Aetna Med ADV,Aetna Med ADV,813.96,,,,,,,Fee Schedule,813.96,1695.82,
62290 INJ DISKOGRAPH LUMBAR EA LVL,5661062,LOCAL,62290,CPT,,,761,RC,,Outpatient,,,1432.9,931,Aetna Med ADV,Aetna Med ADV,134.34,,,,,,,Fee Schedule,134.34,863,
11400 EXC BENIGN LES-T/A/L 0.5CM OR < CHARGE FACILITY,9704107,LOCAL,11400,CPT,,,360,RC,,Outpatient,,,1438,935,Aetna Med ADV,Aetna Med ADV,643.26,,,,,,,Fee Schedule,643.26,1291,
PLACE ART 2ND ABD & BELOW,8267113,LOCAL,36246,CPT,,,341,RC,,Outpatient,,,1441.95,937,Aetna Med ADV,Aetna Med ADV,203.35,,,,,,,Fee Schedule,203.35,929.12,
NM Kidney Imaging Single w/ Pharm,1169262,LOCAL,78708,CPT,A9562,HCPCS,450,RC,,Outpatient,,,1446.62,775.5,Aetna Med ADV,Aetna Med ADV,492.12,,,,,,,Fee Schedule,492.12,560.96,
"92950 Cardiopulmonary resuscitation (eg, in cardiac arrest)",7968980,LOCAL,92950,CPT,,,481,RC,,Outpatient,,,1448.28,941,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,284.7,1328.28,
92950 Cardiopulmonary Resuscitation Cath Lab,8212013,LOCAL,92950,CPT,,,480,RC,,Outpatient,,,1448.28,941,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,284.7,1328.28,
92950 CARDIOPULMONARY RESUSCITATION CHARGE,8207219,LOCAL,92950,CPT,,,410,RC,,Outpatient,,,1448.28,941,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,284.7,1328.28,
RT CHARGE Ventilator Initiate -> Yes,12109383,LOCAL,94002,CPT,,,341,RC,,Outpatient,,,1453.5,663,Aetna Med ADV,Aetna Med ADV,604.42,,,,,,,Fee Schedule,604.42,941,
NM Inflammation Loc Limited,1226092,LOCAL,78800,CPT,,,341,RC,,Outpatient,,,1461.78,783.75,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,1409.71,
NM Inflammation Loc Limited - Ceretec,1169144,LOCAL,78800,CPT,A9521,HCPCS,761,RC,,Outpatient,,,1461.78,783.75,Aetna Med ADV,Aetna Med ADV,802.34,,,,,,,Fee Schedule,802.34,1409.71,
11402 EXC BENIGN LES-T/A/L 1.1-2.0 CM CHARGE,9704151,LOCAL,11402,CPT,,,361,RC,,Outpatient,,,1481.17,963,Aetna Med ADV,Aetna Med ADV,643.26,,,,,,,Fee Schedule,643.26,1291,
62273 BLOOD PATCH,5661017,LOCAL,62273,CPT,,,360,RC,,Outpatient,,,1494.18,971,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
"13131-Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1",14749500,LOCAL,13131,CPT,,,610,RC,,Outpatient,,,1505,400,Aetna Med ADV,Aetna Med ADV,365.27,,,,,,,Fee Schedule,365.27,863,
MRI Fingers w/ Contrast Left,9343664,LOCAL,73219,CPT,,,610,RC,LT,Outpatient,,,1516.46,813.45,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Fingers w/ Contrast Right,9343667,LOCAL,73219,CPT,,,610,RC,RT,Outpatient,,,1516.46,813.45,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Forearm w/ Contrast Left,8206725,LOCAL,73219,CPT,,,610,RC,LT,Outpatient,,,1516.46,813.45,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Forearm w/ Contrast Right,8206727,LOCAL,73219,CPT,,,610,RC,RT,Outpatient,,,1516.46,813.45,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hand w/ Contrast Left,1168924,LOCAL,73219,CPT,,,610,RC,LT,Outpatient,,,1516.46,813.45,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hand w/ Contrast Right,1168926,LOCAL,73219,CPT,,,610,RC,RT,Outpatient,,,1516.46,813.45,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Humerus w/ Contrast Left,8206756,LOCAL,73219,CPT,,,610,RC,LT,Outpatient,,,1516.46,813.45,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Humerus w/ Contrast Right,8206758,LOCAL,73219,CPT,,,610,RC,RT,Outpatient,,,1516.46,813.45,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Scapula w/ Contrast Left,12912778,LOCAL,73219,CPT,,,610,RC,LT,Outpatient,,,1516.46,813.45,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Scapula w/ Contrast Right,12912781,LOCAL,73219,CPT,,,341,RC,RT,Outpatient,,,1516.46,813.45,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
NM Intestine Imaging Meckels,1169254,LOCAL,78290,CPT,A9512,HCPCS,320,RC,,Outpatient,,,1535.86,823.35,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
XR Spine Scoliosis 2-3 Views,7520630,LOCAL,72082,CPT,,,320,RC,,Outpatient,,,1542.91,827.48,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR ERCP Biliary and Pancreatic,8207021,LOCAL,74330,CPT,,,320,RC,,Outpatient,,,1543.36,827.48,Aetna Med ADV,Aetna Med ADV,151.62,,,,,,,Fee Schedule,151.62,262.79,
XR IVP,1170251,LOCAL,74400,CPT,,,361,RC,,Outpatient,,,1550,831.6,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
64493 - INJ PARAVERT F JNT L/S 1 LEV,5661035,LOCAL,64493,CPT,,,361,RC,,Outpatient,,,1563.68,1016,Aetna Med ADV,Aetna Med ADV,813.96,,,,,,,Fee Schedule,813.96,1291,
G0260 INJ SACRO JNT ARTHR ANEST/STER,8132863,LOCAL,G0260,CPT,,,341,RC,,Outpatient,,,1564.95,1017,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
NM Bone Imaging Limited Injection,1169176,LOCAL,78300,CPT,,,361,RC,,Outpatient,,,1566.92,839.85,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
"62272 SPINAL PUNC, THERAP",5661019,LOCAL,62272,CPT,,,361,RC,,Outpatient,,,1587.32,693,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
64425 NERV BLK ILIOINGUINAL,5661024,LOCAL,64425,CPT,,,361,RC,,Outpatient,,,1587.32,1032,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
64483 TRANS INJ LUMB/SACR-UNILATERAL CHARGE,5661053,LOCAL,64483,CPT,,,361,RC,,Outpatient,,,1587.72,1812,Aetna Med ADV,Aetna Med ADV,813.96,,,,,,,Fee Schedule,813.96,1291,
64484 TRANS INJ LUMB/SACR EA ADD UIL CHARGE,5661054,LOCAL,64484,CPT,,,483,RC,,Outpatient,,,1587.72,1812,Aetna Med ADV,Aetna Med ADV,41.55,,,,,,,Fee Schedule,41.55,1250.53,
ECHO COMPLETE W/ DOPPLER,8200137,LOCAL,93306,CPT,,,483,RC,,Outpatient,,,1593.2,1036,Aetna Med ADV,Aetna Med ADV,501.29,,,,,,,Fee Schedule,501.29,678.38,
ECHOCARDIOGRAM 2D COMPLETE,8200140,LOCAL,93307,CPT,,,483,RC,,Outpatient,,,1593.2,1036,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,678.38,
US Echo Doppler Complete,7936277,LOCAL,93306,CPT,,,320,RC,,Outpatient,,,1593.2,1036,Aetna Med ADV,Aetna Med ADV,501.29,,,,,,,Fee Schedule,501.29,678.38,
XR Spine Scoliosis 4-5 Views,7520624,LOCAL,72083,CPT,,,,,,Outpatient,,,1597.41,856.35,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
phentolamine 5 mg injection [CULL],11211090,LOCAL,J2760,CPT,,,274,RC,,Outpatient,1,EA,1605.12,,Aetna Med ADV,Aetna Med ADV,432.02,,,,,,,Fee Schedule,122.4,432.02,
TLSO,9400067,LOCAL,,,L0648,HCPCS,361,RC,,Outpatient,,,1611.78,,Aetna Med ADV,Aetna Med ADV,797.49,,,,,,,Fee Schedule,797.49,797.49,
64636 DESTR FACET LUM/SAC EA ADL LVL,5661056,LOCAL,64636,CPT,,,761,RC,,Outpatient,,,1614.14,1049,Aetna Med ADV,Aetna Med ADV,48.01,,,,,,,Fee Schedule,48.01,1250.53,
"12020 SIMP CLOSURE, SUPERF WOUND CHARGE",9303466,LOCAL,12020,CPT,,,,,,Outpatient,,,1615.12,1050,Aetna Med ADV,Aetna Med ADV,559.65,,,,,,,Fee Schedule,549.61,863,
"rabies vaccine, human diploid cell 2.5 intl units intramuscular injection [CULL]",11212261,LOCAL,90675,CPT,,,300,RC,,Outpatient,1,EA,1633.664,328,Aetna Med ADV,Aetna Med ADV,313.68,,,,,,,Fee Schedule,160.4,313.68,
BAL Fluid Count with Differential,12449847,LOCAL,0202U,CPT,,,320,RC,,Outpatient,,,1642.5,500.14,Aetna Med ADV,Aetna Med ADV,443.38,,,,,,,Fee Schedule,173.68,443.38,
XR Spine Scoliosis 6+ Views,7520633,LOCAL,72084,CPT,,,341,RC,,Outpatient,,,1651.91,886.05,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
NM Non-Cardiac Vascular Flow Imaging,1169314,LOCAL,78445,CPT,,,361,RC,,Outpatient,,,1652.88,886.05,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
63650 IMPLANT NEURSTIM ELEC EPIDURAL,10283945,LOCAL,63650,CPT,,,361,RC,,Outpatient,,,1660,6563,Aetna Med ADV,Aetna Med ADV,6000.2,,,,,,,Fee Schedule,5787,8672.71,
63650 IMPLANT NEURSTIM ELEC EPIDURAL,8132877,LOCAL,63650,CPT,,,361,RC,,Outpatient,,,1660,6563,Aetna Med ADV,Aetna Med ADV,6000.2,,,,,,,Fee Schedule,5787,8672.71,
63650-IMPLANT NEURSTIM ELEC EPIDURAL,8132877,LOCAL,63650,CPT,,,,,,Outpatient,,,1660,6563,Aetna Med ADV,Aetna Med ADV,6000.2,,,,,,,Fee Schedule,5787,8672.71,
"rabies vaccine, human diploid cell 2.5 intl units Pow [CULL]",11212261,LOCAL,90675,CPT,,,361,RC,,Outpatient,1,EA,1665.824,328,Aetna Med ADV,Aetna Med ADV,313.68,,,,,,,Fee Schedule,160.4,313.68,
XR Nephrostogram,8115644,LOCAL,50430,CPT,,,361,RC,,Outpatient,,,1670,1389,Aetna Med ADV,Aetna Med ADV,610.24,,,,,,,Fee Schedule,555.55,1291,
XR Nephrostogram Existing Access,10454588,LOCAL,50431,CPT,,,360,RC,,Outpatient,,,1670,1389,Aetna Med ADV,Aetna Med ADV,610.24,,,,,,,Fee Schedule,555.55,1291,
36568 INTRO CATH VENA CAVA PICC CHARGE,13709100,LOCAL,36568,CPT,,,360,RC,,Outpatient,,,1678,1091,Aetna Med ADV,Aetna Med ADV,1420.25,,,,,,,Fee Schedule,1291,1644.1,
REPOSITION CVL UNDER FLUORO,8210300,LOCAL,36597,CPT,,,,,,Outpatient,,,1678,1091,Aetna Med ADV,Aetna Med ADV,1420.25,,,,,,,Fee Schedule,1068.64,1420.25,
omadacycline 100 mg injection [CULL],11290183,LOCAL,J0121,CPT,,,761,RC,,Outpatient,1,EA,1678.2144,,Aetna Med ADV,Aetna Med ADV,4.02,,,,,,,Fee Schedule,4.02,2110.36,
15271 APP SKN SUB GRFT T/A/L 100 SQ CM FAC CHARGE,12831012,LOCAL,15271,CPT,,,761,RC,,Outpatient,,,1680.09,1092,Aetna Med ADV,Aetna Med ADV,1672.39,,,,,,,Fee Schedule,1496,2862.92,
"15275 App Skin Sub Graft (TWSA<100cm2) f/a/h-ft/aig; 1""25 sp cm",12641291,LOCAL,15275,CPT,,,301,RC,,Outpatient,,,1680.09,1092,Aetna Med ADV,Aetna Med ADV,1672.39,,,,,,,Fee Schedule,1496,2862.92,
"Zika Virus RNA, Qual TMA QSTC",13864496,LOCAL,87662,CPT,,,483,RC,,Outpatient,,,1687.5,61.57,Aetna Med ADV,Aetna Med ADV,51.31,,,,,,,Fee Schedule,40.19,51.31,
CATH LAB STRESS ECHO,8200161,LOCAL,93351,CPT,,,483,RC,,Outpatient,,,1697.74,1104,Aetna Med ADV,Aetna Med ADV,501.29,,,,,,,Fee Schedule,501.29,678.38,
US Stress Echo,7936322,LOCAL,93351,CPT,,,510,RC,,Outpatient,,,1697.74,1104,Aetna Med ADV,Aetna Med ADV,501.29,,,,,,,Fee Schedule,501.29,678.38,
64581 Incision for implantation of neurostimulator electrode array; sacral nerve,8603595,LOCAL,64581,CPT,,,301,RC,,Outpatient,,,1704,1108,Aetna Med ADV,Aetna Med ADV,6000.2,,,,,,,Fee Schedule,6000.2,8672.71,
CASPR2 Ab QSTC,13864490,LOCAL,86255,CPT,,,278,RC,,Outpatient,,,1704.38,14.46,Aetna Med ADV,Aetna Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
IMPLANT 625CC 350-1695,4802349,LOCAL,,,L8600,HCPCS,301,RC,,Outpatient,,,1710.5,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
"KIT D816, Mutation Analysis  QSTC",13864489,LOCAL,81273,CPT,,,301,RC,,Outpatient,,,1721.25,149.84,Aetna Med ADV,Aetna Med ADV,124.87,,,,,,,Fee Schedule,63.34,124.87,
Ganglioside Ab Panel 6 QSTC,13864481,LOCAL,83520,CPT,,,361,RC,,Outpatient,,,1734.26,20.72,Aetna Med ADV,Aetna Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
64418 - suprascapular nerve block,10452404,LOCAL,64418,CPT,,,361,RC,,Outpatient,,,1735,693,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
64420 NERV BLK INTERCSTL NERV SNGL,5661025,LOCAL,64420,CPT,,,361,RC,,Outpatient,,,1735,693,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
64454 Genicular block,13776911,LOCAL,64454,CPT,,,361,RC,,Outpatient,,,1735,244,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
64461 THORACIC PARAVERTEBRAL BLOCK,13786726,LOCAL,64461,CPT,,,361,RC,,Outpatient,,,1735,50,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
Injection Blood Patch Epidural,7633812,LOCAL,62273,CPT,,,301,RC,,Outpatient,,,1735,971,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
LGI1 Ab QSTC,13864491,LOCAL,86255,CPT,,,481,RC,,Outpatient,,,1738.13,14.46,Aetna Med ADV,Aetna Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
PULM ANGIO DURING CORONARIES,8230012,LOCAL,93568,CPT,,,450,RC,,Outpatient,,,1744,1134,Aetna Med ADV,Aetna Med ADV,37.1,,,,,,,Fee Schedule,37.1,863,
92960 ELEC CARDIOVERSION/DEFIBRILATION OP Tech Fee,7969852,LOCAL,92960,CPT,,,481,RC,,Outpatient,,,1759.91,1144,Aetna Med ADV,Aetna Med ADV,598.27,,,,,,,Fee Schedule,598.27,1291,
Perc Cor Stent-Drug Eluding LD,4221012,LOCAL,92960,CPT,,,361,RC,,Outpatient,,,1759.91,1144,Aetna Med ADV,Aetna Med ADV,598.27,,,,,,,Fee Schedule,598.27,1291,
10030 FLUID DRAIN SOFT TIS PERC GUID,8266849,LOCAL,10030,CPT,,,341,RC,,Outpatient,,,1760,704,Aetna Med ADV,Aetna Med ADV,643.26,,,,,,,Fee Schedule,643.26,1605.05,
NM Thyroid Uptake Single/Multi,2426011,LOCAL,78014,CPT,,,341,RC,,Outpatient,,,1775.09,952.05,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
NM Thyroid w/ Uptake Single,12109219,LOCAL,78014,CPT,A9516,HCPCS,636,RC,,Outpatient,,,1775.09,952.05,Aetna Med ADV,Aetna Med ADV,482.33,,,,,,,Fee Schedule,482.3325,560.96,
NUSHIELD 1.6CM DISC,13962586,LOCAL,,,Q4160,HCPCS,320,RC,,Outpatient,,,1777.5,1155,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
MG Surgical Specimen,9437784,LOCAL,76098,CPT,,,360,RC,,Outpatient,,,1778.77,953.7,Aetna Med ADV,Aetna Med ADV,501.29,,,,,,,Fee Schedule,176.48,501.29,
GASTROSTOMY TUBE REPLACEMENT,8200253,LOCAL,49450,CPT,,,360,RC,,Outpatient,,,1793.73,1166,Aetna Med ADV,Aetna Med ADV,857.17,,,,,,,Fee Schedule,857.17,1496,
JEJUNOSTOMY REPLACEMENT PERC,8200252,LOCAL,49451,CPT,,,450,RC,,Outpatient,,,1793.73,1166,Aetna Med ADV,Aetna Med ADV,857.17,,,,,,,Fee Schedule,857.17,1496,
Critical Care Ill/Injured Patient Init 30-74 Min 99291,2389455,LOCAL,99291,CPT,,,360,RC,25,Outpatient,,,1816.43,1181,Aetna Med ADV,Aetna Med ADV,770.36,,,,,,,Fee Schedule,770.36,770.36,
"13132 -Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet;",14751269,LOCAL,13132,CPT,,,341,RC,,Outpatient,,,1830,612,Aetna Med ADV,Aetna Med ADV,559.65,,,,,,,Fee Schedule,559.65,863,
NM Myocardial Planar Single Study,2425978,LOCAL,78481,CPT,A9500,HCPCS,610,RC,,Outpatient,,,1832.02,982.58,Aetna Med ADV,Aetna Med ADV,492.12,,,,,,,Fee Schedule,492.12,560.96,
MRI Breast w/o Contrast Left.,9386272,LOCAL,77046,CPT,,,610,RC,LT,Outpatient,,,1833.89,983.4,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Breast w/o Contrast Right.,9386275,LOCAL,77046,CPT,,,402,RC,RT,Outpatient,,,1833.89,983.4,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
CULL US OB Greater Than 14 Wks Add'l Gest,13579115,LOCAL,76810,CPT,,,402,RC,,Outpatient,,,1847.31,990.83,Aetna Med ADV,Aetna Med ADV,36.14,,,,,,,Fee Schedule,36.14,148.61,
US OB Greater Than 14 Weeks Multi,8108499,LOCAL,76810,CPT,,,341,RC,,Outpatient,,,1847.31,990.83,Aetna Med ADV,Aetna Med ADV,36.14,,,,,,,Fee Schedule,36.14,148.61,
NM Tumor Loc Limited,1169410,LOCAL,78800,CPT,,,341,RC,,Outpatient,,,1850.54,783.75,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,1409.71,
NM Tumor Loc Multiple Areas,1169412,LOCAL,78801,CPT,,,320,RC,,Outpatient,,,1850.54,2895.75,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,1409.71,
PARACENTESIS ABDOMINAL WITH IMAGING,8267134,LOCAL,49083,CPT,,,341,RC,,Outpatient,,,1857.81,1208,Aetna Med ADV,Aetna Med ADV,857.17,,,,,,,Fee Schedule,857.17,1496,
NM Cardiac MUGA,1169208,LOCAL,78472,CPT,A9512,HCPCS,306,RC,,Outpatient,,,1861.6,998.25,Aetna Med ADV,Aetna Med ADV,1118.05,,,,,,,Fee Schedule,560.96,1118.045,
Meningitis Panel (BioFire),7909558,LOCAL,87483,CPT,,,360,RC,,Outpatient,,,1875.71,500.14,Aetna Med ADV,Aetna Med ADV,416.78,,,,,,,Fee Schedule,158.39,416.78,
PLACE ART 1ST ABD & BELOW,8267112,LOCAL,36245,CPT,,,636,RC,,Outpatient,,,1882.73,1224,Aetna Med ADV,Aetna Med ADV,191.24,,,,,,,Fee Schedule,191.24,929.12,
GRAFIX PRIME 16MM,13962570,LOCAL,,,Q4133,HCPCS,360,RC,,Outpatient,,,1883.25,3671,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
PLACE ART 1ST THORAC/BRAC,8267108,LOCAL,36215,CPT,,,360,RC,,Outpatient,,,1917.07,1246,Aetna Med ADV,Aetna Med ADV,175.13,,,,,,,Fee Schedule,175.13,929.12,
PLACE ART 2ND THORAC/BRAC,8267109,LOCAL,36216,CPT,,,360,RC,,Outpatient,,,1917.07,1246,Aetna Med ADV,Aetna Med ADV,222.85,,,,,,,Fee Schedule,222.85,929.12,
PLACE ART 3RD THORAC/BRAC,8267110,LOCAL,36217,CPT,,,341,RC,,Outpatient,,,1917.07,1246,Aetna Med ADV,Aetna Med ADV,273.71,,,,,,,Fee Schedule,273.71,929.12,
NM Lung Vent/Perf Imaging,2425966,LOCAL,78582,CPT,A9540,HCPCS,360,RC,,Outpatient,,,1919.6,1029.6,Aetna Med ADV,Aetna Med ADV,492.12,,,,,,,Fee Schedule,492.12,1409.71,
PLACE ART 3RD ABD & BELOW,8267114,LOCAL,36247,CPT,,,341,RC,,Outpatient,,,1927.08,1253,Aetna Med ADV,Aetna Med ADV,240.87,,,,,,,Fee Schedule,240.87,929.12,
NM Lymphoscintigraphy Injection/Scan,1169292,LOCAL,78195,CPT,,,301,RC,,Outpatient,,,1928.84,1034.55,Aetna Med ADV,Aetna Med ADV,492.12,,,,,,,Fee Schedule,492.12,1409.71,
Alpha-Globin Gene Deletion/Dupl. QSTC,13864435,LOCAL,81269,CPT,,,341,RC,,Outpatient,,,1940.63,242.88,Aetna Med ADV,Aetna Med ADV,202.4,,,,,,,Fee Schedule,173.68,202.4,
NM Kidney Imaging Single w/o Pharm,1169264,LOCAL,78707,CPT,A9562,HCPCS,302,RC,,Outpatient,,,1959.43,1051.05,Aetna Med ADV,Aetna Med ADV,492.12,,,,,,,Fee Schedule,492.12,560.96,
REF HLA Antibody ID,13479161,LOCAL,86830,CPT,,,360,RC,,Outpatient,,,1962,114.62,Aetna Med ADV,Aetna Med ADV,95.52,,,,,,,Fee Schedule,38.27,95.52,
PERICARDIOCENTESIS INITIAL,8230050,LOCAL,33016,CPT,,,360,RC,,Outpatient,,,1966.67,1278,Aetna Med ADV,Aetna Med ADV,1420.25,,,,,,,Fee Schedule,1291,1420.25,
REMOVAL BILIARY DRAIN CATH,8200538,LOCAL,47537,CPT,,,301,RC,,Outpatient,,,1966.67,1278,Aetna Med ADV,Aetna Med ADV,857.17,,,,,,,Fee Schedule,291.97,1496,
"Apolipoprotein E Isoform, CSF QST",12677744,LOCAL,82542,CPT,,,636,RC,,Outpatient,,,1975.5,28.91,Aetna Med ADV,Aetna Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.09,
KERECIS OMEGA 3 - DISK 14MM,13962582,LOCAL,,,Q4158,HCPCS,323,RC,,Outpatient,,,1975.5,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
CULL Selective Add'l Vessel S&I,13635231,LOCAL,75774,CPT,,,323,RC,,Outpatient,,,1975.99,1059.3,Aetna Med ADV,Aetna Med ADV,44.32,,,,,,,Fee Schedule,44.32,6018.68,
SELECTIVE ADD'L VESSEL S&I,8210640,LOCAL,75774,CPT,,,360,RC,,Outpatient,,,1975.99,1059.3,Aetna Med ADV,Aetna Med ADV,44.32,,,,,,,Fee Schedule,44.32,6018.68,
CATH PLACE LT RT PA,8267103,LOCAL,36014,CPT,,,,,,Outpatient,,,1986.67,1291,Aetna Med ADV,Aetna Med ADV,121.59,,,,,,,Fee Schedule,121.59,929.12,
remdesivir 100 mg Injection [CULL],11201128,LOCAL,J0248,CPT,,,483,RC,,Outpatient,1,EA,1996.8,,Aetna Med ADV,Aetna Med ADV,6.73,,,,,,,Fee Schedule,6.73,771.25,
ECHO LIMITED WITH CONTRAST,8200178,LOCAL,,,C8924,HCPCS,483,RC,,Outpatient,,,2022.58,1315,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,678.38,
US Echo 2D Limited w/ Contrast,7936274,LOCAL,93308,CPT,C8924,HCPCS,301,RC,,Outpatient,,,2022.58,564,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,678.38,
".MOG Ab, CBA, Serum QSTC",10274091,LOCAL,86362,CPT,,,300,RC,,Outpatient,,,2025,14.46,Aetna Med ADV,Aetna Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
"Myelin Oligodendrocyte Glycoprotein w/Rfx Titer, Serum QSTC",12613098,LOCAL,86362,CPT,,,636,RC,,Outpatient,,,2025,14.46,Aetna Med ADV,Aetna Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
PURAPLY AM COMMERCIAL 1.6CM DISC,13962603,LOCAL,,,Q4196,HCPCS,761,RC,,Outpatient,,,2025,3861,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
36589 - Removal of tunneled central venous catheter,12431092,LOCAL,36589,CPT,,,481,RC,,Outpatient,,,2025.12,1316,Aetna Med ADV,Aetna Med ADV,565.25,,,,,,,Fee Schedule,565.25,1291,
37253 Invasc US Each Addl Vessel,8230057,LOCAL,37253,CPT,,,361,RC,,Outpatient,,,2035,1323,Aetna Med ADV,Aetna Med ADV,57.61,,,,,,,Fee Schedule,57.61,2669.67,
"64449 N BLOCK INJ, LUMBAR PLEXUS",8882246,LOCAL,64449,CPT,,,301,RC,,Outpatient,,,2035,890,Aetna Med ADV,Aetna Med ADV,813.96,,,,,,,Fee Schedule,813.96,1695.82,
"CRMP5/CV2 Ab, LB QSTC",13873513,LOCAL,84182,CPT,,,301,RC,,Outpatient,,,2036.25,35.05,Aetna Med ADV,Aetna Med ADV,29.21,,,,,,,Fee Schedule,15.29,29.21,
"GAD65 Ab, LB QSTC",13873519,LOCAL,86341,CPT,,,,,,Outpatient,,,2036.25,28.28,Aetna Med ADV,Aetna Med ADV,23.57,,,,,,,Fee Schedule,15.29,23.57,
tocilizumab 20 mg/mL Sol 4 mL [CULL],11260558,LOCAL,J3262,CPT,,,450,RC,,Outpatient,4,ML,2039.6544,,Aetna Med ADV,Aetna Med ADV,5.71,,,,,,,Fee Schedule,5.71,1641.22,
92953 TRANSCUTANEOUS PACING TechFee,8057710,LOCAL,92953,CPT,,,481,RC,,Outpatient,,,2060.2,1339,Aetna Med ADV,Aetna Med ADV,598.27,,,,,,,Fee Schedule,598.27,1291,
92953-Temp transcutaneous pacing Charge,8212036,LOCAL,92953,CPT,,,480,RC,,Outpatient,,,2060.2,1339,Aetna Med ADV,Aetna Med ADV,598.27,,,,,,,Fee Schedule,598.27,1291,
EXTERNAL PACER,4221033,LOCAL,92953,CPT,,,341,RC,,Outpatient,,,2060.2,1339,Aetna Med ADV,Aetna Med ADV,598.27,,,,,,,Fee Schedule,598.27,1291,
NM Testicular Imaging w/ Vasc Flow,8733473,LOCAL,78761,CPT,A9512,HCPCS,761,RC,,Outpatient,,,2063.03,1106.33,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
11750 EXCISION NAIL MATRIX PERMANENT CHARGE,9303447,LOCAL,11750,CPT,,,481,RC,,Outpatient,,,2064.41,1342,Aetna Med ADV,Aetna Med ADV,365.27,,,,,,,Fee Schedule,365.27,863,
33967 Insertion Intra-aortic Percutaneous Device Charge,8211150,LOCAL,33967,CPT,,,636,RC,,Outpatient,,,2102.51,1367,Aetna Med ADV,Aetna Med ADV,205.15,,,,,,,Fee Schedule,205.15,12132.94,
KERECIS OMEGA 3 - 3 X 3.5CM,13962577,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,2106,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
ibutilide 0.1 mg/mL intravenous solution 10 mL [CULL],11201842,LOCAL,J1742,CPT,,,341,RC,,Outpatient,10,ML,2107.584,,Aetna Med ADV,Aetna Med ADV,172.31,,,,,,,Fee Schedule,172.31,233.26,
NM Hepatobiliary Imaging w/ Drug,2425957,LOCAL,78226,CPT,A9537,HCPCS,341,RC,,Outpatient,,,2134.97,567.6,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
NM Hepatobiliary Imaging w/ EF,12894248,LOCAL,78227,CPT,A9537,HCPCS,320,RC,,Outpatient,,,2134.97,1145.1,Aetna Med ADV,Aetna Med ADV,1384.56,,,,,,,Fee Schedule,560.96,1384.5568,
VENOGRAM BILATERAL EXT S&I,8211110,LOCAL,75822,CPT,,,320,RC,,Outpatient,,,2159,1157.48,Aetna Med ADV,Aetna Med ADV,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
XR Venogram Extremity Bilateral,13085158,LOCAL,75822,CPT,,,636,RC,,Outpatient,,,2159,1157.48,Aetna Med ADV,Aetna Med ADV,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
NUSHIELD 1.6CM DISC,10510071,LOCAL,,,Q4160,HCPCS,361,RC,,Outpatient,,,2172.5,1155,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
64633 DESTR FACET CERV/THOR SNG LVL,5661057,LOCAL,64633,CPT,,,361,RC,,Outpatient,,,2179,1416,Aetna Med ADV,Aetna Med ADV,1785.34,,,,,,,Fee Schedule,1250.53,2315,
64635 DESTR FACET LUM/SAC SINGLE LVL,5661055,LOCAL,64635,CPT,,,481,RC,,Outpatient,,,2179,1416,Aetna Med ADV,Aetna Med ADV,1785.34,,,,,,,Fee Schedule,1250.53,2315,
93567 Inj Supra Aortography,8230011,LOCAL,93567,CPT,,,341,RC,,Outpatient,,,2187.66,1422,Aetna Med ADV,Aetna Med ADV,29.54,,,,,,,Fee Schedule,29.54,863,
NM Gastric Emptying Study,1169236,LOCAL,78264,CPT,,,341,RC,,Outpatient,,,2193.29,1176.45,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
NM Bone Spect,1169188,LOCAL,78803,CPT,,,761,RC,,Outpatient,,,2202.35,1181.4,Aetna Med ADV,Aetna Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
APPLY SKIN SUB 1ST 255Q CM LEG UP TO 100,13531303,LOCAL,15271,CPT,,,352,RC,25,Outpatient,,,2221.65,1092,Aetna Med ADV,Aetna Med ADV,1672.39,,,,,,,Fee Schedule,1496,2862.92,
CT Ankle w/o Contrast Left,1167903,LOCAL,73700,CPT,,,352,RC,LT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Ankle w/o Contrast Right,1167905,LOCAL,73700,CPT,,,352,RC,RT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Clavicle w/o Contrast Left,12885310,LOCAL,73200,CPT,,,352,RC,LT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Clavicle w/o Contrast Right,12885313,LOCAL,73200,CPT,,,352,RC,RT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Elbow w/o Contrast Left,1168002,LOCAL,73200,CPT,,,352,RC,LT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Elbow w/o Contrast Right,1168004,LOCAL,73200,CPT,,,352,RC,RT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Femur w/o Contrast Left,8202922,LOCAL,73700,CPT,,,352,RC,LT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Femur w/o Contrast Right,8202924,LOCAL,73700,CPT,,,352,RC,RT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Foot w/o Contrast Left,1168040,LOCAL,73700,CPT,,,352,RC,LT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Foot w/o Contrast Right,1168042,LOCAL,73700,CPT,,,352,RC,RT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Forearm w/o Contrast Left,8202950,LOCAL,73200,CPT,,,352,RC,LT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Forearm w/o Contrast Right,8202952,LOCAL,73200,CPT,,,352,RC,RT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Hand w/o Contrast Left,1168086,LOCAL,73200,CPT,,,352,RC,LT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Hand w/o Contrast Right,1168088,LOCAL,73200,CPT,,,352,RC,RT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Hip w/o Contrast Left,1168116,LOCAL,73700,CPT,,,352,RC,LT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Hip w/o Contrast Right,1168118,LOCAL,73700,CPT,,,352,RC,RT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Humerus w/o Contrast Left,8202997,LOCAL,73200,CPT,,,352,RC,LT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Humerus w/o Contrast Right,8202999,LOCAL,73200,CPT,,,352,RC,RT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Knee w/o Contrast Left,1168158,LOCAL,73700,CPT,,,352,RC,LT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Knee w/o Contrast Right,1168160,LOCAL,73700,CPT,,,352,RC,RT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Shoulder w/o Contrast Left,1168220,LOCAL,73200,CPT,,,352,RC,LT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Shoulder w/o Contrast Right,1168222,LOCAL,73200,CPT,,,352,RC,RT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Tibia/Fibula w/o Contrast Left,8203045,LOCAL,73700,CPT,,,352,RC,LT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Tibia/Fibula w/o Contrast Right,8203047,LOCAL,73700,CPT,,,352,RC,RT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Wrist w/o Contrast Left,1168341,LOCAL,73200,CPT,,,352,RC,LT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Wrist w/o Contrast Right,1168343,LOCAL,73200,CPT,,,352,RC,RT,Outpatient,,,2221.86,1191.3,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Angio Abdomen Aorta + Iliofemoral,1167851,LOCAL,75635,CPT,,,481,RC,,Outpatient,,,2242.64,1202.85,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
37252 Invasc US Initial Vessel,8230056,LOCAL,37252,CPT,,,761,RC,,Outpatient,,,2252.25,1464,Aetna Med ADV,Aetna Med ADV,72.79,,,,,,,Fee Schedule,72.79,2669.67,
15277 App Skin Sub Graft(TWSA>100cm2 f/a/h-ft diag add 100 cm2,12635466,LOCAL,15277,CPT,,,483,RC,,Outpatient,,,2263.33,1471,Aetna Med ADV,Aetna Med ADV,1672.39,,,,,,,Fee Schedule,1496,2862.92,
93312 TEE 2D MM COMPLETE WO CHARGE,8200160,LOCAL,93312,CPT,,,483,RC,,Outpatient,,,2279.37,1482,Aetna Med ADV,Aetna Med ADV,501.29,,,,,,,Fee Schedule,501.29,678.38,
US Echo Transesophageal,7936283,LOCAL,93312,CPT,,,481,RC,,Outpatient,,,2279.37,1482,Aetna Med ADV,Aetna Med ADV,501.29,,,,,,,Fee Schedule,501.29,678.38,
G0278-CL ILIAC/FEM ANGIO FOR CLOSURE Charge,8212025,LOCAL,,,G0278,HCPCS,341,RC,,Outpatient,,,2301.79,1496,Aetna Med ADV,Aetna Med ADV,10.66,,,,,,,Fee Schedule,10.66,6018.68,
NM Gastric Emptying w/ SB,10110882,LOCAL,78265,CPT,,,,,,Outpatient,,,2302.29,1234.2,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
onabotulinumtoxinA 100 units injection [CULL],11212323,LOCAL,J0585,CPT,,,610,RC,,Outpatient,1,EA,2307.84,,Aetna Med ADV,Aetna Med ADV,6.5,,,,,,,Fee Schedule,6.5,771.25,
MRI Brachial Plexus w/o Contrast Lt,8784911,LOCAL,73221,CPT,,,610,RC,LT,Outpatient,,,2317.56,1242.45,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Brachial Plexus w/o Contrast Rt,8784914,LOCAL,73221,CPT,,,610,RC,RT,Outpatient,,,2317.56,1242.45,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Clavicle w/o Contrast Left,9647312,LOCAL,71550,CPT,,,610,RC,LT,Outpatient,,,2317.56,1765.5,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Clavicle w/o Contrast Right,9647315,LOCAL,71550,CPT,,,610,RC,RT,Outpatient,,,2317.56,1765.5,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Fingers w/o Contrast Left,8513078,LOCAL,73218,CPT,,,610,RC,LT,Outpatient,,,2317.56,1242.45,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Fingers w/o Contrast Right,8513081,LOCAL,73218,CPT,,,610,RC,RT,Outpatient,,,2317.56,1242.45,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Forearm w/o Contrast Lt,8058719,LOCAL,73218,CPT,,,610,RC,LT,Outpatient,,,2317.56,1242.45,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Forearm w/o Contrast Rt,8058722,LOCAL,73218,CPT,,,610,RC,RT,Outpatient,,,2317.56,1242.45,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Hand w/o Contrast Left,1168930,LOCAL,73218,CPT,,,610,RC,LT,Outpatient,,,2317.56,1242.45,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Hand w/o Contrast Right,1168932,LOCAL,73218,CPT,,,610,RC,RT,Outpatient,,,2317.56,1242.45,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Humerus w/o Contrast Left,8203080,LOCAL,73218,CPT,,,610,RC,LT,Outpatient,,,2317.56,1242.45,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Humerus w/o Contrast Right,8203082,LOCAL,73218,CPT,,,610,RC,RT,Outpatient,,,2317.56,1242.45,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Scapula w/o Contrast Left,9647339,LOCAL,73218,CPT,,,610,RC,LT,Outpatient,,,2317.56,1242.45,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Scapula w/o Contrast Right,9647342,LOCAL,73218,CPT,,,615,RC,RT,Outpatient,,,2317.56,1242.45,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRA Neck w/o Contrast,1168683,LOCAL,70547,CPT,,,636,RC,,Outpatient,,,2317.57,1242.45,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,729.93,
KERECIS OMEGA 3 - DISK 16MM,13962584,LOCAL,,,Q4158,HCPCS,610,RC,,Outpatient,,,2331,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRA Pelvis w/o Contrast,1168691,LOCAL,72198,CPT,,,,,,Outpatient,,,2338.16,1767.15,Aetna Med ADV,Aetna Med ADV,222.29,,,,,,,Fee Schedule,220.99,729.93,
MRA Pelvis w/o Contrast,1168691,LOCAL,C8919,CPT,,,320,RC,,Outpatient,,,2338.16,,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,729.93,
XR Myelogram Cervical Spine,1170319,LOCAL,62302,CPT,,,320,RC,,Outpatient,,,2349.36,1527,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,722.32,1291,
XR Myelogram Thoracic Spine,1170327,LOCAL,62303,CPT,,,612,RC,,Outpatient,,,2349.36,1527,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,722.32,1291,
MRI Spine Thoracic w/o Contrast,1169066,LOCAL,72146,CPT,,,360,RC,,Outpatient,,,2365.31,1268.03,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
ILR REMOVAL,8267777,LOCAL,33286,CPT,,,352,RC,,Outpatient,,,2381.18,1548,Aetna Med ADV,Aetna Med ADV,643.26,,,,,,,Fee Schedule,643.26,2484.2,
CT Spine Lumbar w/o Contrast,1168246,LOCAL,72131,CPT,,,341,RC,,Outpatient,,,2398.23,1286.18,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
NM Bone Three Phase Study Injection/Scan,1169190,LOCAL,78315,CPT,,,481,RC,,Outpatient,,,2428.11,1301.85,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
36002 Pseudoanrsm Repair W Thrombin Us Gud,8212049,LOCAL,36002,CPT,,,360,RC,,Outpatient,,,2429.28,1579,Aetna Med ADV,Aetna Med ADV,565.25,,,,,,,Fee Schedule,565.25,1291,
AV FISTULAGRAM S&I,8210332,LOCAL,36901,CPT,,,301,RC,,Outpatient,,,2442.76,1588,Aetna Med ADV,Aetna Med ADV,1420.25,,,,,,,Fee Schedule,1420.25,2669.67,
"CRMP5/CV2 Ab, LB, CSF QSTC",13873605,LOCAL,84182,CPT,,,301,RC,,Outpatient,,,2443.5,35.05,Aetna Med ADV,Aetna Med ADV,29.21,,,,,,,Fee Schedule,15.29,29.21,
"GAD65 Ab, LB, CSF QSTC",13873611,LOCAL,86341,CPT,,,323,RC,,Outpatient,,,2443.5,28.28,Aetna Med ADV,Aetna Med ADV,23.57,,,,,,,Fee Schedule,15.29,23.57,
INTERNAL MAMMARY S&I,8210631,LOCAL,75756,CPT,,,323,RC,,Outpatient,,,2455.14,1316.7,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
PULMONARY NONSELECTIVE S&I,8210620,LOCAL,75746,CPT,,,352,RC,,Outpatient,,,2455.14,1316.7,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
CT Angio Pelvis,1167881,LOCAL,72191,CPT,,,350,RC,,Outpatient,,,2457.05,1317.53,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Thoracentesis w/ CT Guidance,2424869,LOCAL,77012,CPT,,,636,RC,,Outpatient,,,2458.4,1318.35,Aetna Med ADV,Aetna Med ADV,48.7,,,,,,,Fee Schedule,48.7,136.03,
KERECIS OMEGA 3 - 1.75 X 1.75 CM,13962574,LOCAL,,,Q4158,HCPCS,351,RC,,Outpatient,,,2475,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
CT Neck Soft Tissue w/o Contrast,1168234,LOCAL,70490,CPT,,,761,RC,,Outpatient,,,2479.06,1329.08,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
64450 INJECTION ANESTHETIC AGENT PERIPHERAL NE,13437921,LOCAL,64450,CPT,,,,,,Outpatient,,,2482.29,1613,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
tetanus immune globulin 250 units/mL intramuscular solution 1 mL [CULL],11212346,LOCAL,J1670,CPT,,,352,RC,,Outpatient,1,ML,2492.8,,Aetna Med ADV,Aetna Med ADV,593,,,,,,,Fee Schedule,525.49,593,
CT Ankle w/ Contrast Left,1167897,LOCAL,73701,CPT,,,352,RC,LT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Ankle w/ Contrast Right,1167899,LOCAL,73701,CPT,,,352,RC,RT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Clavicle w/ Contrast Left,12885304,LOCAL,73201,CPT,,,352,RC,LT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Clavicle w/ Contrast Right,12885307,LOCAL,73201,CPT,,,352,RC,RT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Elbow w/ Contrast Left,1167996,LOCAL,73201,CPT,,,352,RC,LT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Elbow w/ Contrast Right,1167998,LOCAL,73201,CPT,,,352,RC,RT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Femur w/ Contrast Left,8202918,LOCAL,73701,CPT,,,352,RC,LT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Femur w/ Contrast Right,8202920,LOCAL,73701,CPT,,,352,RC,RT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Foot w/ Contrast Left,1168034,LOCAL,73701,CPT,,,352,RC,LT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Foot w/ Contrast Right,1168036,LOCAL,73701,CPT,,,352,RC,RT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Forearm w/ Contrast Left,8202943,LOCAL,73201,CPT,,,352,RC,LT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Forearm w/ Contrast Right,8202945,LOCAL,73201,CPT,,,352,RC,RT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Hand w/ Contrast Left,1168080,LOCAL,73201,CPT,,,352,RC,LT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Hand w/ Contrast Right,1168082,LOCAL,73201,CPT,,,352,RC,RT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Hip w/ Contrast Left,1168110,LOCAL,73701,CPT,,,352,RC,LT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hip w/ Contrast Right,1168112,LOCAL,73701,CPT,,,352,RC,RT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Humerus w/ Contrast Left,8202990,LOCAL,73201,CPT,,,352,RC,LT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Humerus w/ Contrast Right,8202992,LOCAL,73201,CPT,,,352,RC,RT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Knee w/ Contrast Left,1168152,LOCAL,73701,CPT,,,352,RC,LT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Knee w/ Contrast Right,1168154,LOCAL,73701,CPT,,,352,RC,RT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Shoulder w/ Contrast Left,1168214,LOCAL,73201,CPT,,,352,RC,LT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Shoulder w/ Contrast Right,1168216,LOCAL,73201,CPT,,,352,RC,RT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Tibia/Fibula w/ Contrast Left,8203041,LOCAL,73701,CPT,,,352,RC,LT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Tibia/Fibula w/ Contrast Right,8203043,LOCAL,73701,CPT,,,352,RC,RT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Wrist w/ Contrast Left,1168335,LOCAL,73201,CPT,,,352,RC,LT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Wrist w/ Contrast Right,1168337,LOCAL,73201,CPT,,,361,RC,RT,Outpatient,,,2495.32,1338.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
64454 - Injection of anesthetic agent into genicular nerve branches including imaging guidance.,14144343,LOCAL,64454,CPT,,,361,RC,,Outpatient,,,2500,244,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
"64624 Destruction by neurolytic agent, genicular nerve branches",9487180,LOCAL,64624,CPT,,,361,RC,,Outpatient,,,2500,926,Aetna Med ADV,Aetna Med ADV,1785.34,,,,,,,Fee Schedule,1695.82,2315,
64421 NERVE BLOCK INTERCOSTAL MULTIPLE NERVES,5661026,LOCAL,64421,CPT,,,761,RC,,Outpatient,,,2501.54,890,Aetna Med ADV,Aetna Med ADV,813.96,,,,,,,Fee Schedule,813.96,1695.82,
15273 ACELLULAR DERM REPL LTH 100 SQ CM,8716218,LOCAL,15273,CPT,,,636,RC,,Outpatient,,,2508.54,1631,Aetna Med ADV,Aetna Med ADV,3347.08,,,,,,,Fee Schedule,2599,3347.08,
PRIMATRIX 3X3,13962595,LOCAL,,,Q4110,HCPCS,,,,Outpatient,,,2528.69,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
dimethyl sulfoxide 50% irrigation solution 50 mL [CULL],11205390,LOCAL,J1212,CPT,,,360,RC,,Outpatient,50,ML,2541.664,,Aetna Med ADV,Aetna Med ADV,748.85,,,,,,,Fee Schedule,525.49,748.85,
INJ PERC CHOL W EXIS CATH,8210336,LOCAL,47531,CPT,,,610,RC,,Outpatient,,,2566.23,298,Aetna Med ADV,Aetna Med ADV,3226.48,,,,,,,Fee Schedule,2599,3226.48,
MRI Elbow w/o Contrast Left,1168848,LOCAL,73221,CPT,,,610,RC,LT,Outpatient,,,2584.17,1242.45,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Elbow w/o Contrast Right,1168850,LOCAL,73221,CPT,,,610,RC,RT,Outpatient,,,2584.17,1242.45,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Shoulder w/o Contrast Left,1169044,LOCAL,73221,CPT,,,610,RC,LT,Outpatient,,,2584.17,1242.45,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Shoulder w/o Contrast Right,1169046,LOCAL,73221,CPT,,,610,RC,RT,Outpatient,,,2584.17,1242.45,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Wrist w/o Contrast Left,1169140,LOCAL,73221,CPT,,,610,RC,LT,Outpatient,,,2584.17,1242.45,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Wrist w/o Contrast Right,1169142,LOCAL,73221,CPT,,,360,RC,RT,Outpatient,,,2584.17,1242.45,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
ASPIRATION / INJECTION OF RENAL PELVIS,8210655,LOCAL,50390,CPT,,,610,RC,,Outpatient,,,2587.86,1682,Aetna Med ADV,Aetna Med ADV,643.26,,,,,,,Fee Schedule,555.55,1291,
MRI Femur w/o Contrast Lt,8058707,LOCAL,73718,CPT,,,610,RC,LT,Outpatient,,,2591.03,1389.3,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Femur w/o Contrast Rt,8058710,LOCAL,73718,CPT,,,610,RC,RT,Outpatient,,,2591.03,1389.3,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Foot w/o Contrast Left,1168890,LOCAL,73718,CPT,,,610,RC,LT,Outpatient,,,2591.03,1389.3,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Foot w/o Contrast Right,1168892,LOCAL,73718,CPT,,,610,RC,RT,Outpatient,,,2591.03,1389.3,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Tibia/Fibula w/o Contrast Left,8206789,LOCAL,73718,CPT,,,610,RC,LT,Outpatient,,,2591.03,1389.3,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Tibia/Fibula w/o Contrast Right,8206791,LOCAL,73718,CPT,,,615,RC,RT,Outpatient,,,2591.03,1389.3,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRA Neck w/ Contrast,1168681,LOCAL,70548,CPT,,,636,RC,,Outpatient,,,2591.04,1389.3,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,729.93,
AMNIOEXCEL SKIN SUBSTITUTE 18MM,13962552,LOCAL,,,Q4137,HCPCS,276,RC,,Outpatient,,,2593.13,3028,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
LENS TORIC #SA6AT4,4853560,LOCAL,,,V2630,HCPCS,276,RC,,Outpatient,,,2596,410,Aetna Med ADV,Aetna Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
LENS TORIC ABSORBING SA6AT5,4853594,LOCAL,,,V2630,HCPCS,320,RC,,Outpatient,,,2596,410,Aetna Med ADV,Aetna Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
IR Venogram Cava Superior1,8071895,LOCAL,75827,CPT,,,320,RC,,Outpatient,,,2596.75,1392.6,Aetna Med ADV,Aetna Med ADV,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
SUPERIOR VENA CAVA S&I,8210670,LOCAL,75827,CPT,,,320,RC,,Outpatient,,,2596.75,1392.6,Aetna Med ADV,Aetna Med ADV,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
VENOGRAM UNILATERAL EXT S&I,8211100,LOCAL,75820,CPT,,,320,RC,,Outpatient,,,2596.75,1392.6,Aetna Med ADV,Aetna Med ADV,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
XR Venogram Extremity Left,8115647,LOCAL,75820,CPT,,,320,RC,LT,Outpatient,,,2596.75,1392.6,Aetna Med ADV,Aetna Med ADV,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
XR Venogram Extremity Right,8115650,LOCAL,75820,CPT,,,360,RC,RT,Outpatient,,,2596.75,1392.6,Aetna Med ADV,Aetna Med ADV,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
Procedure Performed. -> Paracentesis,9739222,LOCAL,49082,CPT,,,610,RC,,Outpatient,,,2601.5,1691,Aetna Med ADV,Aetna Med ADV,857.17,,,,,,,Fee Schedule,857.17,1496,
MRA Pelvis w/ Contrast,1168689,LOCAL,72198,CPT,,,,,,Outpatient,,,2611.62,1767.15,Aetna Med ADV,Aetna Med ADV,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Pelvis w/ Contrast,1168689,LOCAL,C8918,CPT,,,341,RC,,Outpatient,,,2611.62,,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,222.29,729.93,
NM Bone Imaging Whole Body Injection,1169180,LOCAL,78306,CPT,,,352,RC,,Outpatient,,,2623.86,1407.45,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
CT Angio Lower Extremity Bilateral,8058637,LOCAL,73706,CPT,,,352,RC,,Outpatient,,,2637.85,1414.88,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Lower Extremity Left,1167875,LOCAL,73706,CPT,,,352,RC,LT,Outpatient,,,2637.85,1414.88,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Lower Extremity Right,1167877,LOCAL,73706,CPT,,,612,RC,RT,Outpatient,,,2637.85,1414.88,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
MRI Spine Thoracic w/ Contrast,1169064,LOCAL,72147,CPT,,,636,RC,,Outpatient,,,2638.77,1414.88,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
AMNIOEXCEL PLUS 17MM,13962547,LOCAL,,,Q4137,HCPCS,483,RC,,Outpatient,,,2639.25,3028,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
C8925 TEE COMPLETE 2D WWO CHARGE,8200184,LOCAL,,,C8925,HCPCS,483,RC,,Outpatient,,,2643.51,1718,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,678.38,722.32,
ECHO COMPLETE WITH DOP/CONTRAST,8200176,LOCAL,,,C8929,HCPCS,483,RC,,Outpatient,,,2643.51,1718,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,678.38,722.32,
US Echo Doppler Complete w/ Contrast,13780988,LOCAL,93306,CPT,C8929,HCPCS,920,RC,,Outpatient,,,2643.51,1036,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,678.38,722.32,
95805 MAINTENANCE OF WAKEFULNESS CHARGE,9569825,LOCAL,95805,CPT,,,920,RC,,Outpatient,,,2652.34,1724,Aetna Med ADV,Aetna Med ADV,485.11,,,,,,,Fee Schedule,485.11,1113.98,
95805 MSLT CHARGES,8795717,LOCAL,95805,CPT,,,920,RC,,Outpatient,,,2652.34,1724,Aetna Med ADV,Aetna Med ADV,485.11,,,,,,,Fee Schedule,485.11,1113.98,
95805 MSLT/MWT CHARGES,9442365,LOCAL,95805,CPT,,,301,RC,,Outpatient,,,2652.34,1724,Aetna Med ADV,Aetna Med ADV,485.11,,,,,,,Fee Schedule,485.11,1113.98,
".MOG Ab, Titer QSTC",13864468,LOCAL,86362,CPT,,,636,RC,,Outpatient,,,2653.38,14.46,Aetna Med ADV,Aetna Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
PURAPLY AM 2X2 COMMERCIAL 4SQ CM,13962597,LOCAL,,,Q4196,HCPCS,352,RC,,Outpatient,,,2664,3861,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
CT Spine Lumbar w/ Contrast,1168244,LOCAL,72132,CPT,,,615,RC,,Outpatient,,,2671.69,1433.03,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
MRA Brain/Head w/o Contrast,1168653,LOCAL,70544,CPT,,,610,RC,,Outpatient,,,2690.84,1442.93,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,729.93,
MRA Lower Extremity w/ + w/o Cnt Left,1168663,LOCAL,73725,CPT,,,610,RC,LT,Outpatient,,,2690.84,1442.93,Aetna Med ADV,Aetna Med ADV,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Lower Extremity w/ + w/o Cnt Right,1168665,LOCAL,73725,CPT,,,615,RC,RT,Outpatient,,,2690.84,1442.93,Aetna Med ADV,Aetna Med ADV,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRV Head w/o Contrast,8450965,LOCAL,70544,CPT,,,352,RC,,Outpatient,,,2690.84,1442.93,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,729.93,
CT Clavicle w/ + w/o Contrast Left,12885298,LOCAL,73202,CPT,,,352,RC,LT,Outpatient,,,2695.32,1445.4,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Clavicle w/ + w/o Contrast Right,12885301,LOCAL,73202,CPT,,,352,RC,RT,Outpatient,,,2695.32,1445.4,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Elbow w/ + w/o Contrast Left,8202901,LOCAL,73202,CPT,,,352,RC,LT,Outpatient,,,2695.32,1445.4,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Elbow w/ + w/o Contrast Right,8202903,LOCAL,73202,CPT,,,352,RC,RT,Outpatient,,,2695.32,1445.4,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Forearm w/ + w/o Contrast Left,8202936,LOCAL,73202,CPT,,,352,RC,LT,Outpatient,,,2695.32,1445.4,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Forearm w/ + w/o Contrast Right,8202938,LOCAL,73202,CPT,,,352,RC,RT,Outpatient,,,2695.32,1445.4,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hand w/ + w/o Contrast Left,8202957,LOCAL,73202,CPT,,,352,RC,LT,Outpatient,,,2695.32,1445.4,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hand w/ + w/o Contrast Right,8202959,LOCAL,73202,CPT,,,352,RC,RT,Outpatient,,,2695.32,1445.4,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Humerus w/ + w/o Contrast Left,8202983,LOCAL,73202,CPT,,,352,RC,LT,Outpatient,,,2695.32,1445.4,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Humerus w/ + w/o Contrast Right,8202985,LOCAL,73202,CPT,,,352,RC,RT,Outpatient,,,2695.32,1445.4,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Shoulder w/ + w/o Contrast Left,8203023,LOCAL,73202,CPT,,,352,RC,LT,Outpatient,,,2695.32,1445.4,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Shoulder w/ + w/o Contrast Right,8203025,LOCAL,73202,CPT,,,352,RC,RT,Outpatient,,,2695.32,1445.4,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Wrist w/ + w/o Contrast Left,8203057,LOCAL,73202,CPT,,,352,RC,LT,Outpatient,,,2695.32,1445.4,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Wrist w/ + w/o Contrast Right,8203059,LOCAL,73202,CPT,,,352,RC,RT,Outpatient,,,2695.32,1445.4,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Spine Thoracic w/o Contrast,1168252,LOCAL,72128,CPT,,,352,RC,,Outpatient,,,2704.58,1450.35,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Spine Cervical w/o Contrast,1168240,LOCAL,72125,CPT,,,352,RC,,Outpatient,,,2712.02,1454.48,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Abdomen w/ Oral Contrast Only,8206354,LOCAL,74150,CPT,,,352,RC,,Outpatient,,,2720.92,1459.43,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Abdomen w/o Contrast,1167849,LOCAL,74150,CPT,,,352,RC,,Outpatient,,,2720.92,1459.43,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Pelvis w/ Oral Contrast Only,8206452,LOCAL,72192,CPT,,,352,RC,,Outpatient,,,2720.92,1459.43,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Pelvis w/o Contrast,1168198,LOCAL,72192,CPT,,,610,RC,,Outpatient,,,2720.92,1459.43,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
MRI Ankle w/o Contrast Left,1168750,LOCAL,73721,CPT,,,610,RC,LT,Outpatient,,,2733.23,1466.03,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Ankle w/o Contrast Right,1168752,LOCAL,73721,CPT,,,610,RC,RT,Outpatient,,,2733.23,1466.03,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Hip w/o Contrast Left,1168948,LOCAL,73721,CPT,,,610,RC,LT,Outpatient,,,2733.23,1466.03,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Hip w/o Contrast Right,1168950,LOCAL,73721,CPT,,,610,RC,RT,Outpatient,,,2733.23,1466.03,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Knee w/o Contrast Left,1168984,LOCAL,73721,CPT,,,610,RC,LT,Outpatient,,,2733.23,1466.03,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Knee w/o Contrast Right,1168986,LOCAL,73721,CPT,,,351,RC,RT,Outpatient,,,2733.23,1466.03,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Neck Soft Tissue w/ Contrast,1168232,LOCAL,70491,CPT,,,610,RC,,Outpatient,,,2752.53,1475.93,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRA Abdomen w/o Contrast,1168639,LOCAL,74185,CPT,,,361,RC,,Outpatient,,,2786.55,2017.13,Aetna Med ADV,Aetna Med ADV,221.41,,,,,,,Fee Schedule,221.41,729.93,
64483 TRANS INJ LUMB/SACR-BILATERAL CHARGE,5661040,LOCAL,64483,CPT,,,361,RC,,Outpatient,,,2788.44,1812,Aetna Med ADV,Aetna Med ADV,813.96,,,,,,,Fee Schedule,813.96,1291,
64484 TRANS INJ LUMB/SACR EA ADD BIL CHARGE,5661049,LOCAL,64484,CPT,,,610,RC,,Outpatient,,,2788.44,1812,Aetna Med ADV,Aetna Med ADV,41.55,,,,,,,Fee Schedule,41.55,1250.53,
MRA Chest w/o Contrast,1168647,LOCAL,71555,CPT,,,,,,Outpatient,,,2794.75,1645.05,Aetna Med ADV,Aetna Med ADV,220.24,,,,,,,Fee Schedule,220.24,729.93,
MRA Chest w/o Contrast,1168647,LOCAL,C8910,CPT,,,610,RC,,Outpatient,,,2794.75,,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.24,729.93,
MRI Abdomen w/o Contrast,1168734,LOCAL,74181,CPT,,,610,RC,,Outpatient,,,2804.32,1503.98,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI MRCP w/o Contrast,8203102,LOCAL,74181,CPT,,,612,RC,,Outpatient,,,2804.32,1503.98,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Spine Cervical w/o Contrast,1169054,LOCAL,72141,CPT,,,612,RC,,Outpatient,,,2804.32,1503.98,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Spine Lumbar w/o Contrast,1169060,LOCAL,72148,CPT,,,351,RC,,Outpatient,,,2804.32,1503.98,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Brain/Head Stroke Alert,8202967,LOCAL,70450,CPT,,,351,RC,,Outpatient,,,2816.63,1510.58,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,461.98,
CT Brain/Head w/o Contrast,1168094,LOCAL,70450,CPT,,,360,RC,,Outpatient,,,2816.63,1510.58,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,461.98,
PLACE CENTRAL VENOUS LINE,8210290,LOCAL,36556,CPT,,,610,RC,,Outpatient,,,2850.87,1853,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,1291,2877.63,
MRI Brachial Plexus w/ Contrast Lt,10558521,LOCAL,73222,CPT,,,610,RC,LT,Outpatient,,,2857.63,1532.03,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Brachial Plexus w/ Contrast Rt,10558524,LOCAL,73222,CPT,,,610,RC,RT,Outpatient,,,2857.63,1532.03,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Clavicle w/ Contrast Left,12912772,LOCAL,71551,CPT,,,610,RC,LT,Outpatient,,,2857.63,1532.03,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Clavicle w/ Contrast Right,12912775,LOCAL,71551,CPT,,,610,RC,RT,Outpatient,,,2857.63,1532.03,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Elbow w/ Contrast Left,1168842,LOCAL,73222,CPT,,,610,RC,LT,Outpatient,,,2857.63,1532.03,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Elbow w/ Contrast Right,1168844,LOCAL,73222,CPT,,,610,RC,RT,Outpatient,,,2857.63,1532.03,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Shoulder w/ Contrast Left,1169038,LOCAL,73222,CPT,,,610,RC,LT,Outpatient,,,2857.63,1532.03,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Shoulder w/ Contrast Right,1169040,LOCAL,73222,CPT,,,610,RC,RT,Outpatient,,,2857.63,1532.03,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Wrist w/ Contrast Left,1169134,LOCAL,73222,CPT,,,610,RC,LT,Outpatient,,,2857.63,1532.03,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Wrist w/ Contrast Right,1169136,LOCAL,73222,CPT,,,636,RC,RT,Outpatient,,,2857.63,1532.03,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
AMNIOEXCEL SKIN SUBSTITUTE 1.5CM X 1.5CM,13962551,LOCAL,,,Q4137,HCPCS,610,RC,,Outpatient,,,2862.09,3028,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRI Femur w/ Contrast Left,8206704,LOCAL,73719,CPT,,,610,RC,LT,Outpatient,,,2864.49,1536.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Femur w/ Contrast Right,8206706,LOCAL,73719,CPT,,,610,RC,RT,Outpatient,,,2864.49,1536.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Foot w/ Contrast Left,1168884,LOCAL,73719,CPT,,,610,RC,LT,Outpatient,,,2864.49,1536.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Foot w/ Contrast Right,1168886,LOCAL,73719,CPT,,,610,RC,RT,Outpatient,,,2864.49,1536.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Tibia/Fibula w/ Contrast Left,8206783,LOCAL,73719,CPT,,,610,RC,LT,Outpatient,,,2864.49,1536.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Tibia/Fibula w/ Contrast Right,8206785,LOCAL,73719,CPT,,,352,RC,RT,Outpatient,,,2864.49,1536.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Angio Chest,1167863,LOCAL,71275,CPT,,,761,RC,,Outpatient,,,2871.32,1539.45,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
20220 BIOPSY BONE TROC/NDL SUPERFICL CHARGE,9709066,LOCAL,20220,CPT,,,351,RC,,Outpatient,,,2874.06,1868,Aetna Med ADV,Aetna Med ADV,1481.32,,,,,,,Fee Schedule,923.18,1481.32,
CT Orbit Sella etc. or IAC w/o Cont,8362458,LOCAL,70480,CPT,,,920,RC,,Outpatient,,,2874.06,1541.1,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
Antenatal Testing Type -> Non-Stress test,9848446,LOCAL,59025,CPT,,,920,RC,,Outpatient,,,2886.2,1876,Aetna Med ADV,Aetna Med ADV,183.92,,,,,,,Fee Schedule,183.92,863,
Non Stress Test Charge,9919812,LOCAL,59025,CPT,,,301,RC,,Outpatient,,,2886.2,1876,Aetna Med ADV,Aetna Med ADV,183.92,,,,,,,Fee Schedule,183.92,863,
Abeta 40 QST,13873829,LOCAL,82542,CPT,,,301,RC,,Outpatient,,,2925,28.91,Aetna Med ADV,Aetna Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.09,
Abeta 42/40 Ratio QST,13873830,LOCAL,82172,CPT,,,610,RC,,Outpatient,,,2925,25.31,Aetna Med ADV,Aetna Med ADV,37.52,,,,,,,Fee Schedule,17.73,37.515,
MRI Pelvis w/o Contrast,1169028,LOCAL,72195,CPT,,,610,RC,,Outpatient,,,2958.83,1586.48,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRA Lower Extremity w/o Contrast Left,1168675,LOCAL,73725,CPT,,,610,RC,LT,Outpatient,,,2964.3,1442.93,Aetna Med ADV,Aetna Med ADV,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Lower Extremity w/o Contrast Right,1168677,LOCAL,73725,CPT,,,352,RC,RT,Outpatient,,,2964.3,1442.93,Aetna Med ADV,Aetna Med ADV,222.29,,,,,,,Fee Schedule,222.29,729.93,
CT Angio Abdomen,1167853,LOCAL,74175,CPT,,,610,RC,,Outpatient,,,2965.92,1590.6,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
MRI TMJ,1169068,LOCAL,70336,CPT,,,352,RC,,Outpatient,,,2973.87,1594.73,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Spine Thoracic w/ Contrast,1168250,LOCAL,72129,CPT,,,352,RC,,Outpatient,,,2978.05,1597.2,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Spine Cervical w/ Contrast,1168238,LOCAL,72126,CPT,,,341,RC,,Outpatient,,,2985.5,1601.33,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
NM Cisternography Injection,1169226,LOCAL,78630,CPT,A9548,HCPCS,350,RC,,Outpatient,,,2985.52,1601.33,Aetna Med ADV,Aetna Med ADV,715.29,,,,,,,Fee Schedule,715.29,1409.71,
CT Angio Brain/Head,1167871,LOCAL,70496,CPT,,,352,RC,,Outpatient,,,2990.01,1603.8,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Upper Extremity Bilateral,8058640,LOCAL,73206,CPT,,,352,RC,,Outpatient,,,2990.01,1603.8,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Upper Extremity Left,1167885,LOCAL,73206,CPT,,,352,RC,LT,Outpatient,,,2990.01,1603.8,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Upper Extremity Right,1167887,LOCAL,73206,CPT,,,352,RC,RT,Outpatient,,,2990.01,1603.8,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Abdomen w/ Contrast,1167847,LOCAL,74160,CPT,,,352,RC,,Outpatient,,,2994.38,1605.45,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Abdomen w/ Contrast + Oral,13452972,LOCAL,74160,CPT,,,352,RC,,Outpatient,,,2994.38,1605.45,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Pelvis w/ Contrast,1168196,LOCAL,72193,CPT,,,352,RC,,Outpatient,,,2994.38,1605.45,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Pelvis w/ Contrast + Oral,13554960,LOCAL,72193,CPT,,,610,RC,,Outpatient,,,2994.38,1605.45,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRI Ankle w/ Contrast Left,1168744,LOCAL,73722,CPT,,,610,RC,LT,Outpatient,,,3006.69,1612.05,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Ankle w/ Contrast Right,1168746,LOCAL,73722,CPT,,,610,RC,RT,Outpatient,,,3006.69,1612.05,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Hip w/ Contrast Left,1168942,LOCAL,73722,CPT,,,610,RC,LT,Outpatient,,,3006.69,1612.05,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Hip w/ Contrast Right,1168944,LOCAL,73722,CPT,,,610,RC,RT,Outpatient,,,3006.69,1612.05,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Knee w/ Contrast Left,1168978,LOCAL,73722,CPT,,,610,RC,LT,Outpatient,,,3006.69,1612.05,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Knee w/ Contrast Right,1168980,LOCAL,73722,CPT,,,278,RC,RT,Outpatient,,,3006.69,1612.05,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
IMPLANT BREAST 360CC,4850676,LOCAL,,,L8600,HCPCS,350,RC,,Outpatient,,,3025,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
CT Angio Neck,1167879,LOCAL,70498,CPT,,,352,RC,,Outpatient,,,3039.77,1630.2,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Chest High Resolution,8658939,LOCAL,71250,CPT,,,352,RC,,Outpatient,,,3049.07,1635.15,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,461.98,
CT Chest High Resolution w/o Contrast,8658939,LOCAL,71250,CPT,,,352,RC,,Outpatient,,,3049.07,1635.15,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,461.98,
CT Chest w/o Contrast,8071395,LOCAL,71250,CPT,,,352,RC,,Outpatient,,,3049.07,1635.15,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Low Dose Lung Screening,8090304,LOCAL,71271,CPT,,,610,RC,,Outpatient,,,3049.07,1635.15,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
MRA Abdomen w/ Contrast,1168637,LOCAL,74185,CPT,,,610,RC,,Outpatient,,,3060.01,2017.13,Aetna Med ADV,Aetna Med ADV,221.41,,,,,,,Fee Schedule,221.41,729.93,
MRA Chest w/ Contrast,1168645,LOCAL,71555,CPT,,,,,,Outpatient,,,3068.21,1645.05,Aetna Med ADV,Aetna Med ADV,220.24,,,,,,,Fee Schedule,220.24,729.93,
MRA Chest w/ Contrast,1168645,LOCAL,C8909,CPT,,,610,RC,,Outpatient,,,3068.21,,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,220.24,729.93,
MRI Abdomen w/ Contrast,1168732,LOCAL,74182,CPT,,,612,RC,,Outpatient,,,3077.78,1650.83,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Spine Cervical w/ Contrast,1169052,LOCAL,72142,CPT,,,612,RC,,Outpatient,,,3077.78,1650.83,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Spine Lumbar w/ Contrast,1169058,LOCAL,72149,CPT,,,351,RC,,Outpatient,,,3077.78,1650.83,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Brain/Head w/ Contrast,1168092,LOCAL,70460,CPT,,,,,,Outpatient,,,3090.07,1657.43,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
immune globulin intravenous and subcutaneous 10% injectable solution 50 mL [CULL],11205108,LOCAL,J1561,CPT,,,351,RC,,Outpatient,50,ML,3099.84,,Aetna Med ADV,Aetna Med ADV,48.96,,,,,,,Fee Schedule,48.96,2110.36,
CT Maxillofacial w/o Contrast,1168186,LOCAL,70486,CPT,,,360,RC,,Outpatient,,,3131.11,1678.88,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
Central Line Access Type. -> Peripherally inserted central catheter (PICC),9344166,LOCAL,36569,CPT,,,351,RC,,Outpatient,,,3141.6,2042,Aetna Med ADV,Aetna Med ADV,1420.25,,,,,,,Fee Schedule,1291,1644.1,
CT Orbit Sella etc. or IAC w/ Cont,8362455,LOCAL,70481,CPT,,,341,RC,,Outpatient,,,3147.52,1687.95,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
NM Tumor Loc Whole Body 2+ Days,1169416,LOCAL,78804,CPT,,,341,RC,,Outpatient,,,3150.27,1689.6,Aetna Med ADV,Aetna Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
NM Tumor Loc Whole Body 2+ Days Gallium,1169418,LOCAL,78804,CPT,A9556,HCPCS,352,RC,,Outpatient,,,3150.27,1689.6,Aetna Med ADV,Aetna Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
CT Ankle w/ + w/o Contrast Left,8202894,LOCAL,73702,CPT,,,352,RC,LT,Outpatient,,,3178.96,1704.45,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Ankle w/ + w/o Contrast Right,8202896,LOCAL,73702,CPT,,,352,RC,RT,Outpatient,,,3178.96,1704.45,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Femur w/ + w/o Contrast Left,8202914,LOCAL,73702,CPT,,,352,RC,LT,Outpatient,,,3178.96,1704.45,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Femur w/ + w/o Contrast Right,8202916,LOCAL,73702,CPT,,,352,RC,RT,Outpatient,,,3178.96,1704.45,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Foot w/ + w/o Contrast Left,8202926,LOCAL,73702,CPT,,,352,RC,LT,Outpatient,,,3178.96,1704.45,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Foot w/ + w/o Contrast Right,8202928,LOCAL,73702,CPT,,,352,RC,RT,Outpatient,,,3178.96,1704.45,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hip w/ + w/o Contrast Left,8202973,LOCAL,73702,CPT,,,352,RC,LT,Outpatient,,,3178.96,1704.45,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hip w/ + w/o Contrast Right,8202975,LOCAL,73702,CPT,,,352,RC,RT,Outpatient,,,3178.96,1704.45,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Knee w/ + w/o Contrast Left,8203007,LOCAL,73702,CPT,,,352,RC,LT,Outpatient,,,3178.96,1704.45,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Knee w/ + w/o Contrast Right,8203009,LOCAL,73702,CPT,,,352,RC,RT,Outpatient,,,3178.96,1704.45,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Tibia/Fibula w/ + w/o Contrast Left,8203037,LOCAL,73702,CPT,,,352,RC,LT,Outpatient,,,3178.96,1704.45,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Tibia/Fibula w/ + w/o Contrast Right,8203039,LOCAL,73702,CPT,,,360,RC,RT,Outpatient,,,3178.96,1704.45,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CHOLECYSTOSTOMY DRAIN PLACEMENT,8267773,LOCAL,47490,CPT,,,761,RC,,Outpatient,,,3200,2080,Aetna Med ADV,Aetna Med ADV,3226.48,,,,,,,Fee Schedule,2599,3682.65,
"11047  Debridement Sub-Q, bone each add l 20sq cm",10013082,LOCAL,11047,CPT,,,761,RC,,Outpatient,,,3218.96,2092,Aetna Med ADV,Aetna Med ADV,78.26,,,,,,,Fee Schedule,78.26,1466.58,
11047 Debrid bone > 20 sq cm charge,12508109,LOCAL,11047,CPT,,,350,RC,,Outpatient,,,3218.96,2092,Aetna Med ADV,Aetna Med ADV,78.26,,,,,,,Fee Schedule,78.26,1466.58,
CT Guided Perc Drain/Placement,7936217,LOCAL,75989,CPT,,,320,RC,,Outpatient,,,3232.87,618.75,Aetna Med ADV,Aetna Med ADV,50.75,,,,,,,Fee Schedule,50.75,262.79,
XR Drainage Perc Cath Placement,8058781,LOCAL,75989,CPT,,,276,RC,,Outpatient,,,3232.87,618.75,Aetna Med ADV,Aetna Med ADV,50.75,,,,,,,Fee Schedule,50.75,262.79,
LENS DIU450,4852298,LOCAL,,,V2630,HCPCS,615,RC,,Outpatient,,,3272.5,410,Aetna Med ADV,Aetna Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
MRA Neck w/ + w/o Contrast,1168679,LOCAL,70549,CPT,,,610,RC,,Outpatient,,,3274.68,1756.43,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,729.93,
MRI Brachial Plexus w/ + w/o Contrast Lt,8784905,LOCAL,73223,CPT,,,610,RC,LT,Outpatient,,,3274.68,1756.43,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Brachial Plexus w/ + w/o Contrast Rt,8784908,LOCAL,73223,CPT,,,610,RC,RT,Outpatient,,,3274.68,1756.43,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Clavicle w/ + w/o Contrast Left,9647306,LOCAL,71552,CPT,,,610,RC,LT,Outpatient,,,3274.68,2131.8,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Clavicle w/ + w/o Contrast Right,9647309,LOCAL,71552,CPT,,,610,RC,RT,Outpatient,,,3274.68,2131.8,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Fingers w/ + w/o Contrast Left,8513072,LOCAL,73220,CPT,,,610,RC,LT,Outpatient,,,3274.68,1756.43,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Fingers w/ + w/o Contrast Right,8513075,LOCAL,73220,CPT,,,610,RC,RT,Outpatient,,,3274.68,1756.43,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Forearm w/ + w/o Contrast Lt,8058713,LOCAL,73220,CPT,,,610,RC,LT,Outpatient,,,3274.68,1756.43,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Forearm w/ + w/o Contrast Rt,8058716,LOCAL,73220,CPT,,,610,RC,RT,Outpatient,,,3274.68,1756.43,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hand w/ + w/o Contrast Left,1168918,LOCAL,73220,CPT,,,610,RC,LT,Outpatient,,,3274.68,1756.43,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hand w/ + w/o Contrast Right,1168920,LOCAL,73220,CPT,,,610,RC,RT,Outpatient,,,3274.68,1756.43,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Humerus w/ + w/o Contrast Left,8203076,LOCAL,73220,CPT,,,610,RC,LT,Outpatient,,,3274.68,1756.43,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Humerus w/ + w/o Contrast Right,8203078,LOCAL,73220,CPT,,,610,RC,RT,Outpatient,,,3274.68,1756.43,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Scapula w/ + w/o Contrast Left,9647333,LOCAL,73220,CPT,,,610,RC,LT,Outpatient,,,3274.68,1756.43,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Scapula w/ + w/o Contrast Right,9647336,LOCAL,73220,CPT,,,320,RC,RT,Outpatient,,,3274.68,1756.43,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
XR Myelogram 2 or More Regions,10386814,LOCAL,62305,CPT,,,610,RC,,Outpatient,,,3282.36,2134,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,722.32,1291,
MRI Chest w/o Contrast,1168824,LOCAL,71550,CPT,,,610,RC,,Outpatient,,,3292.3,1765.5,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRA Pelvis w/ + w/o Contrast,1168687,LOCAL,72198,CPT,,,,,,Outpatient,,,3295.27,1767.15,Aetna Med ADV,Aetna Med ADV,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Pelvis w/ + w/o Contrast,1168687,LOCAL,C8920,CPT,,,352,RC,,Outpatient,,,3295.27,,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,222.29,729.93,
CT Chest w/ Contrast,8071392,LOCAL,71260,CPT,,,483,RC,,Outpatient,,,3322.53,1782,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,162.76,
US Echo Transesophag w/ Cont,13770878,LOCAL,93312,CPT,C8925,HCPCS,360,RC,,Outpatient,,,3329.37,1482,Aetna Med ADV,Aetna Med ADV,722.32,,,,,,,Fee Schedule,678.38,722.32,
PERC PLEURAL INSERTION/DRAINAGE AND S&I,8230068,LOCAL,32557,CPT,,,636,RC,,Outpatient,,,3332.77,2166,Aetna Med ADV,Aetna Med ADV,1420.25,,,,,,,Fee Schedule,1291,1420.25,
GRAFIX PRIME 1.5 X 2CM,13962569,LOCAL,,,Q4133,HCPCS,636,RC,,Outpatient,,,3348,3671,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 18MM,13962561,LOCAL,,,Q4186,HCPCS,352,RC,,Outpatient,,,3350.25,1755,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
CT Spine Lumbar w/ + w/o Contrast,1168242,LOCAL,72133,CPT,,,636,RC,,Outpatient,,,3355.34,1799.33,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
EPIFIX SKIN SUBSTITUTE 18MM,10510009,LOCAL,,,Q4186,HCPCS,301,RC,,Outpatient,,,3359.95,1755,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
"Poliovirus 1, 3 Ab, Neutralization QSTC",13864497,LOCAL,86382,CPT,,,610,RC,,Outpatient,,,3375,20.29,Aetna Med ADV,Aetna Med ADV,16.91,,,,,,,Fee Schedule,15.29,16.91,
MRA Lower Extremity w/ Contrast Left,90720012,LOCAL,73725,CPT,,,610,RC,LT,Outpatient,,,3383,1442.93,Aetna Med ADV,Aetna Med ADV,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Lower Extremity w/ Contrast Right,90720013,LOCAL,73725,CPT,,,610,RC,RT,Outpatient,,,3383,1442.93,Aetna Med ADV,Aetna Med ADV,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Upper Extremity w/ Contrast Left,90720010,LOCAL,73225,CPT,,,610,RC,LT,Outpatient,,,3383,2038.58,Aetna Med ADV,Aetna Med ADV,214.69,,,,,,,Fee Schedule,214.69,729.93,
MRA Upper Extremity w/ Contrast Right,90720011,LOCAL,73225,CPT,,,610,RC,RT,Outpatient,,,3383,2038.58,Aetna Med ADV,Aetna Med ADV,214.69,,,,,,,Fee Schedule,214.69,729.93,
MRI Face Neck Orbit w/o Contrast,1168856,LOCAL,70540,CPT,,,351,RC,,Outpatient,,,3383.36,1814.18,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Maxillofacial w/ Contrast,1168184,LOCAL,70487,CPT,,,636,RC,,Outpatient,,,3404.57,1825.73,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
KERECIS OMEGA 3 - 3 X 3.5 CM,13962576,LOCAL,,,Q4158,HCPCS,320,RC,,Outpatient,,,3406.5,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
TRANSCATH EMBOLIZATION S&I,8267120,LOCAL,75894,CPT,,,351,RC,,Outpatient,,,3428.95,1838.93,Aetna Med ADV,Aetna Med ADV,165.4,,,,,,,Fee Schedule,165.4,262.79,
CT Neck Soft Tissue w/ + w/o Contrast,1168230,LOCAL,70492,CPT,,,351,RC,,Outpatient,,,3436.18,1843.05,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Parathyroid 4-Phase Study,13554957,LOCAL,70492,CPT,,,611,RC,,Outpatient,,,3436.18,1843.05,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRI Brain + IAC w/o Contrast,9427804,LOCAL,70551,CPT,,,611,RC,,Outpatient,,,3446.61,1848,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Brain w/o Contrast,1168800,LOCAL,70551,CPT,,,611,RC,,Outpatient,,,3446.61,1848,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Pituitary w/o Contrast,8203111,LOCAL,70551,CPT,,,320,RC,,Outpatient,,,3446.61,1848,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
DISKOGRAM LUMBAR S & I,8299004,LOCAL,72295,CPT,,,341,RC,,Outpatient,,,3452,1851.3,Aetna Med ADV,Aetna Med ADV,1785.34,,,,,,,Fee Schedule,857.13,1785.34,
NM Tumor Loc Spect,1169408,LOCAL,78803,CPT,,,341,RC,,Outpatient,,,3466,1181.4,Aetna Med ADV,Aetna Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
NM Tumor Loc Whole Body 1 Day,1169414,LOCAL,78802,CPT,,,636,RC,,Outpatient,,,3466,2870.18,Aetna Med ADV,Aetna Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
NUSHIELD 2X3CM,13962587,LOCAL,,,Q4160,HCPCS,761,RC,,Outpatient,,,3487.5,1155,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
28090 EXCISION GANGLION CYST FOOT,13436341,LOCAL,28090,CPT,,,360,RC,,Outpatient,,,3532.98,2296,Aetna Med ADV,Aetna Med ADV,1463.19,,,,,,,Fee Schedule,1463.19,3153.58,
ICD REMOVAL SC/DC LEAD TV EXTRACT,8231010,LOCAL,33244,CPT,,,610,RC,,Outpatient,,,3541,2302,Aetna Med ADV,Aetna Med ADV,3327.27,,,,,,,Fee Schedule,2484.2,3327.27,
MRI Elbow w/ + w/o Contrast Left,1168836,LOCAL,73223,CPT,,,610,RC,LT,Outpatient,,,3541.3,1756.43,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Elbow w/ + w/o Contrast Right,1168838,LOCAL,73223,CPT,,,610,RC,RT,Outpatient,,,3541.3,1756.43,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Shoulder w/ + w/o Contrast Left,1169032,LOCAL,73223,CPT,,,610,RC,LT,Outpatient,,,3541.3,1756.43,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Shoulder w/ + w/o Contrast Right,1169034,LOCAL,73223,CPT,,,610,RC,RT,Outpatient,,,3541.3,1756.43,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Wrist w/ + w/o Contrast Left,1169128,LOCAL,73223,CPT,,,610,RC,LT,Outpatient,,,3541.3,1756.43,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Wrist w/ + w/o Contrast Right,1169130,LOCAL,73223,CPT,,,610,RC,RT,Outpatient,,,3541.3,1756.43,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Femur w/ + w/o Contrast Lt,8058701,LOCAL,73720,CPT,,,610,RC,LT,Outpatient,,,3548.14,1902.45,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Femur w/ + w/o Contrast Rt,8058704,LOCAL,73720,CPT,,,610,RC,RT,Outpatient,,,3548.14,1902.45,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Foot w/ + w/o Contrast Left,1168878,LOCAL,73720,CPT,,,610,RC,LT,Outpatient,,,3548.14,1902.45,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Foot w/ + w/o Contrast Right,1168880,LOCAL,73720,CPT,,,610,RC,RT,Outpatient,,,3548.14,1902.45,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Tibia/Fibula w/ + w/o Contrast Left,8206777,LOCAL,73720,CPT,,,610,RC,LT,Outpatient,,,3548.14,1902.45,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Tibia/Fibula w/ + w/o Contrast Right,8206779,LOCAL,73720,CPT,,,636,RC,RT,Outpatient,,,3548.14,1902.45,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
THERASKIN 1.75 X 1.75,13962605,LOCAL,,,Q4121,HCPCS,274,RC,,Outpatient,,,3577.5,2431,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
L3900 WHFO DYNAMIC,9856098,LOCAL,,,L3900,HCPCS,274,RC,,Outpatient,,,3580.05,2327,Aetna Med ADV,Aetna Med ADV,1756.7,,,,,,,Fee Schedule,1756.7,1756.7,
"L3900 Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger",9856099,LOCAL,,,L3900,HCPCS,761,RC,,Outpatient,,,3580.05,2327,Aetna Med ADV,Aetna Med ADV,1756.7,,,,,,,Fee Schedule,1756.7,1756.7,
11044 DEBRID BONE FIRST 20SQ CM OR < CHARGE,8019965,LOCAL,11044,CPT,,,611,RC,,Outpatient,,,3581.67,2328,Aetna Med ADV,Aetna Med ADV,1481.32,,,,,,,Fee Schedule,1291,1481.32,
MRI Face Neck Orbit w/ Contrast,1168854,LOCAL,70542,CPT,,,,,,Outpatient,,,3633.36,1948.65,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
bivalirudin 250 mg intravenous injection [CULL],11220339,LOCAL,J0583,CPT,,,610,RC,,Outpatient,1,EA,3639.2608,,Aetna Med ADV,Aetna Med ADV,0.16,,,,,,,Fee Schedule,0.157,233.26,
MRI Pelvis w/ + w/o Contrast,1169024,LOCAL,72197,CPT,,,610,RC,,Outpatient,,,3642.47,1953.6,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Prostate w/ + w/o Contrast,4126347,LOCAL,72197,CPT,,,352,RC,,Outpatient,,,3642.47,1953.6,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Spine Thoracic w/ + w/o Contrast,1168248,LOCAL,72130,CPT,,,610,RC,,Outpatient,,,3661.7,1963.5,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRI Breast w/o Contrast Bilateral.,8784923,LOCAL,77047,CPT,,,352,RC,,Outpatient,,,3667.77,1966.8,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Spine Cervical w/ + w/o Contrast,1168236,LOCAL,72127,CPT,,,352,RC,,Outpatient,,,3669.14,1967.63,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Abdomen w/ + w/o Contrast,1167845,LOCAL,74170,CPT,,,352,RC,,Outpatient,,,3678.03,1972.58,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Pelvis w/ + w/o Contrast,1168194,LOCAL,72194,CPT,,,761,RC,,Outpatient,,,3678.03,1972.58,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
28190 Appy Rigid Leg Cast (Professional Charge only if Provider Applies),12642333,LOCAL,28190,CPT,,,610,RC,,Outpatient,,,3680.71,2392,Aetna Med ADV,Aetna Med ADV,643.26,,,,,,,Fee Schedule,643.26,1291,
MRI Ankle w/ + w/o Contrast Left,1168738,LOCAL,73723,CPT,,,610,RC,LT,Outpatient,,,3690.34,1979.18,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Ankle w/ + w/o Contrast Right,1168740,LOCAL,73723,CPT,,,610,RC,RT,Outpatient,,,3690.34,1979.18,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hip w/ + w/o Contrast Left,1168936,LOCAL,73723,CPT,,,610,RC,LT,Outpatient,,,3690.34,1979.18,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hip w/ + w/o Contrast Right,1168938,LOCAL,73723,CPT,,,610,RC,RT,Outpatient,,,3690.34,1979.18,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Knee w/ + w/o Contrast Left,1168972,LOCAL,73723,CPT,,,610,RC,LT,Outpatient,,,3690.34,1979.18,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Knee w/ + w/o Contrast Right,1168974,LOCAL,73723,CPT,,,278,RC,RT,Outpatient,,,3690.34,1979.18,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
IMPLANT BREAST #350-2004BC,4802098,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,3690.5,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-3004 300cc,4801298,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,3690.5,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-3504bc,4801299,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,3690.5,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-4754BC,4852770,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,3690.5,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-5504BC,4803723,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,3690.5,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-6501BC,4805039,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,3690.5,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST 445ML,4855517,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,3690.5,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST GEL 700CC,4850683,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,3690.5,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST MEMORY GEL 510CC,4853454,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,3690.5,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT MEMORY GEL 225CC,4830332,LOCAL,,,L8600,HCPCS,615,RC,,Outpatient,,,3690.5,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
MRA Brain/Head w/ + w/o Contrast,1168649,LOCAL,70546,CPT,,,611,RC,,Outpatient,,,3690.84,1979.18,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,729.93,
MRI Brain + IAC w/ Contrast,9427801,LOCAL,70552,CPT,,,611,RC,,Outpatient,,,3720.07,1994.85,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Brain w/ Contrast,1168798,LOCAL,70552,CPT,,,636,RC,,Outpatient,,,3720.07,1994.85,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
THERASKIN 2.5 X 2.5 CM,13962606,LOCAL,,,Q4121,HCPCS,610,RC,,Outpatient,,,3739.5,2431,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRA Abdomen w/ + w/o Contrast,1168635,LOCAL,74185,CPT,,,610,RC,,Outpatient,,,3761.43,2017.13,Aetna Med ADV,Aetna Med ADV,221.41,,,,,,,Fee Schedule,221.41,729.93,
MRI Abdomen w/ + w/o Contrast,1168730,LOCAL,74183,CPT,,,351,RC,,Outpatient,,,3761.43,2017.13,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Brain/Head w/ + w/o Contrast,1168090,LOCAL,70470,CPT,,,761,RC,,Outpatient,,,3773.72,2023.73,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
10140 DRAINAGE OF HEMATOMA,8715913,LOCAL,10140,CPT,,,610,RC,,Outpatient,,,3775.02,2454,Aetna Med ADV,Aetna Med ADV,1481.32,,,,,,,Fee Schedule,1481.32,1605.05,
MRA Upper Extremity w/ + w/o Cnt Left,1168704,LOCAL,73225,CPT,,,,,LT,Outpatient,,,3801.65,2038.58,Aetna Med ADV,Aetna Med ADV,214.69,,,,,,,Fee Schedule,214.69,729.93,
MRA Upper Extremity w/ + w/o Cnt Left,1168704,LOCAL,C8936,CPT,,,610,RC,LT,Outpatient,,,3801.65,,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,214.69,729.93,
MRA Upper Extremity w/ + w/o Cnt Right,1168707,LOCAL,73225,CPT,,,,,RT,Outpatient,,,3801.65,2038.58,Aetna Med ADV,Aetna Med ADV,214.69,,,,,,,Fee Schedule,214.69,729.93,
MRA Upper Extremity w/ + w/o Cnt Right,1168707,LOCAL,C8936,CPT,,,351,RC,RT,Outpatient,,,3801.65,,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,214.69,729.93,
CT Orbit Sella etc. or IAC w/ + w/o Cont,8362452,LOCAL,70482,CPT,,,278,RC,,Outpatient,,,3831.16,2054.25,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
IMPLANT BREAST #350-2504 250CC,4801300,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,3844.5,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-3501BC,4803006,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,3844.5,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST 565CC,4851020,LOCAL,,,L8600,HCPCS,352,RC,,Outpatient,,,3850,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
CT Abdomen and Pelvis w/ Oral Contrast,8206351,LOCAL,74176,CPT,,,352,RC,,Outpatient,,,3869.45,2074.88,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,461.98,
CT Abdomen and Pelvis w/o Contrast,2424650,LOCAL,74176,CPT,,,636,RC,,Outpatient,,,3869.45,2074.88,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,461.98,
AMNIOEXCEL SKIN SUBSTITUTE 2CM X 3CM,13962553,LOCAL,,,Q4137,HCPCS,761,RC,,Outpatient,,,3902.85,3028,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
11404 EXCISION BENIGN LESION 3.1 CM TO 4.0 CM CHARGE,8726719,LOCAL,11404,CPT,,,636,RC,,Outpatient,,,3913.86,2544,Aetna Med ADV,Aetna Med ADV,1481.32,,,,,,,Fee Schedule,1481.32,1679.75,
OASIS ULTRA THIN DRESSING 7 X 10 CM,13962594,LOCAL,,,Q4124,HCPCS,636,RC,,Outpatient,,,3937.5,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
KERECIS OMEGA 3 - 3 X 7CM,13962579,LOCAL,,,Q4158,HCPCS,610,RC,,Outpatient,,,3960,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRI Chest w/ + w/o Contrast,1168820,LOCAL,71552,CPT,,,278,RC,,Outpatient,,,3975.96,2131.8,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
IMPLANT BREAST #350-3754BC,4804163,LOCAL,,,L8600,HCPCS,352,RC,,Outpatient,,,3982,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
CT Chest High Resolution w/ + w/o Contrast,8658939,LOCAL,71270,CPT,,,352,RC,,Outpatient,,,4006.18,2148.3,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,97.22,461.98,
CT Chest w/ + w/o Contrast,8071389,LOCAL,71270,CPT,,,610,RC,,Outpatient,,,4006.18,2148.3,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRI Breast w/ + w/o Contrast Left.,8784917,LOCAL,77048,CPT,,,,,LT,Outpatient,,,4030.86,2161.5,Aetna Med ADV,Aetna Med ADV,207.49,,,,,,,Fee Schedule,207.49,652.35,
MRI Breast w/ + w/o Contrast Left.,8784917,LOCAL,C8905,CPT,,,610,RC,LT,Outpatient,,,4030.86,,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,207.49,652.35,
MRI Breast w/ + w/o Contrast Right.,8784920,LOCAL,77048,CPT,,,,,RT,Outpatient,,,4030.86,2161.5,Aetna Med ADV,Aetna Med ADV,207.49,,,,,,,Fee Schedule,207.49,652.35,
MRI Breast w/ + w/o Contrast Right.,8784920,LOCAL,C8905,CPT,,,360,RC,RT,Outpatient,,,4030.86,,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,207.49,652.35,
PACEMAKER POCKET,8210140,LOCAL,33222,CPT,,,636,RC,,Outpatient,,,4031.48,2620,Aetna Med ADV,Aetna Med ADV,1672.39,,,,,,,Fee Schedule,1496,2484.2,
PURAPLY AM 2X4 COMMERCIAL 8SQ CM,13962598,LOCAL,,,Q4196,HCPCS,636,RC,,Outpatient,,,4032,3861,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
AMNIOEXCEL PLUS 2CMX2CM,13962548,LOCAL,,,Q4137,HCPCS,611,RC,,Outpatient,,,4050,3028,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRI Face Neck Orbit w/ + w/o Contrast,1168852,LOCAL,70543,CPT,,,351,RC,,Outpatient,,,4067.02,2181.3,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Maxillofacial w/ + w/o Contrast,1168182,LOCAL,70488,CPT,,,361,RC,,Outpatient,,,4088.22,2192.03,Aetna Med ADV,Aetna Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
"64625 Radiofrequency ablation, nerves innervating the SI joint",5661090,LOCAL,64625,CPT,,,352,RC,,Outpatient,,,4100,2665,Aetna Med ADV,Aetna Med ADV,1785.34,,,,,,,Fee Schedule,1785.34,2315,
CT Abdomen and Pelvis w/ Contrast,2424647,LOCAL,74177,CPT,,,352,RC,,Outpatient,,,4142.9,2221.73,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Abdomen and Pelvis w/ Contrast + Oral,13452969,LOCAL,74177,CPT,,,920,RC,,Outpatient,,,4142.9,2221.73,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
95808 SLEEP STAGING CHARGE,13485403,LOCAL,95808,CPT,,,636,RC,,Outpatient,,,4155.71,2701,Aetna Med ADV,Aetna Med ADV,930.16,,,,,,,Fee Schedule,930.16,1113.98,
PRIMATRIX 4X4 MESH,13962596,LOCAL,,,Q4110,HCPCS,636,RC,,Outpatient,,,4162.5,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
THERASKIN 2.5 X 5.1 CM,13962607,LOCAL,,,Q4121,HCPCS,301,RC,,Outpatient,,,4167,2431,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
"Beta Amyloid 42/40 Ratio, CSF QST",13873765,LOCAL,82542,CPT,,,320,RC,,Outpatient,,,4168.13,28.91,Aetna Med ADV,Aetna Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.09,
INSERTION OF INTRAPERITONEAL CATHETER,8267131,LOCAL,49418,CPT,,,320,RC,,Outpatient,,,4189,2723,Aetna Med ADV,Aetna Med ADV,3226.48,,,,,,,Fee Schedule,2599,5444.44,
US Insert Tun IP Cath Perc,10460131,LOCAL,49418,CPT,,,636,RC,,Outpatient,,,4189,2723,Aetna Med ADV,Aetna Med ADV,3226.48,,,,,,,Fee Schedule,2599,5444.44,
AMNIOEXCEL SKIN SUBSTITUTE 3.5CM X 3.5CM,13962554,LOCAL,,,Q4137,HCPCS,636,RC,,Outpatient,,,4213.58,3028,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
NUSHIELD 2X3CM,10510072,LOCAL,,,Q4160,HCPCS,636,RC,,Outpatient,,,4262.5,1155,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
NUSHIELD 2X4CM,13962588,LOCAL,,,Q4160,HCPCS,610,RC,,Outpatient,,,4275,1155,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRI Breast w/ + w/o Contrast Bilateral.,8145272,LOCAL,77049,CPT,,,361,RC,,Outpatient,,,4351.43,2333.1,Aetna Med ADV,Aetna Med ADV,204.56,,,,,,,Fee Schedule,204.56,652.35,
IR Nephro Plcmt New Access W Cath,8267190,LOCAL,50432,CPT,,,361,RC,,Outpatient,,,4351.75,2829,Aetna Med ADV,Aetna Med ADV,1872.87,,,,,,,Fee Schedule,1872.87,2315,
NEPHROSTOGRAM CATHETER PLACEMENT S&I,8267190,LOCAL,50432,CPT,,,360,RC,,Outpatient,,,4351.75,2829,Aetna Med ADV,Aetna Med ADV,1872.87,,,,,,,Fee Schedule,1872.87,2315,
EXCHANGE NEPHROSTOMY TUBE,8212021,LOCAL,50435,CPT,,,335,RC,,Outpatient,,,4357.87,2833,Aetna Med ADV,Aetna Med ADV,1872.87,,,,,,,Fee Schedule,1291,2206.55,
ACTIGRAFT PRO-RD2301,10510000,LOCAL,,,G0460,HCPCS,611,RC,,Outpatient,,,4400,,Aetna Med ADV,Aetna Med ADV,1672.39,,,,,,,Fee Schedule,1466.58,1672.39,
MRI Brain + IAC w/ + w/o Contrast,9427798,LOCAL,70553,CPT,,,611,RC,,Outpatient,,,4403.72,2361.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Brain w/ + w/o Contrast,1168796,LOCAL,70553,CPT,,,611,RC,,Outpatient,,,4403.72,2361.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Pituitary w/ + w/o Contrast,8058740,LOCAL,70553,CPT,,,636,RC,,Outpatient,,,4403.72,2361.15,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
AMNIOEXCEL SKIN SUBSTITUTE 4CM X 4CM,13962555,LOCAL,,,Q4137,HCPCS,323,RC,,Outpatient,,,4423.23,3028,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
PULMONARY UNILATERAL S&I,8210600,LOCAL,75741,CPT,,,320,RC,,Outpatient,,,4485,2404.88,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
VENOUS SAMPLING WO/W ANGIO,8210720,LOCAL,75893,CPT,,,323,RC,,Outpatient,,,4485,2404.88,Aetna Med ADV,Aetna Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
VISCERAL S&I,8210570,LOCAL,75726,CPT,,,352,RC,,Outpatient,,,4485,2404.88,Aetna Med ADV,Aetna Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
CT Angio Abdomen and Pelvis,2424686,LOCAL,74174,CPT,,,636,RC,,Outpatient,,,4538.98,2433.75,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,565.59,
THERASKIN 2.5 X 2.5 CM,10510018,LOCAL,,,Q4121,HCPCS,278,RC,,Outpatient,,,4570.5,2431,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
IMPLANT BREAST #350-4004BC,4803833,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,4598,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-4504BC,4841089,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,4598,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT MEMORY GEL 300CC,4852825,LOCAL,,,L8600,HCPCS,636,RC,,Outpatient,,,4598,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
GRAFIX PRIME 2 X 3CM,13962571,LOCAL,,,Q4133,HCPCS,360,RC,,Outpatient,,,4612.5,3671,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
PTA URETERAL STRICTURE WITH IMAGING,8267792,LOCAL,50706,CPT,,,612,RC,,Outpatient,,,4747.36,3086,Aetna Med ADV,Aetna Med ADV,147.16,,,,,,,Fee Schedule,147.16,10138.5,
MRI Spine Cervical w/ + w/o Contrast,1169050,LOCAL,72156,CPT,,,636,RC,,Outpatient,,,4747.92,2545.95,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
EPIFIX SKIN SUBSTITUTE 2 X 2 CM,13962562,LOCAL,,,Q4186,HCPCS,352,RC,,Outpatient,,,4790.25,1755,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
CT Abdomen and Pelvis w/ + w/o Contrast,2424644,LOCAL,74178,CPT,,,352,RC,,Outpatient,,,4826.55,2588.03,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Urogram,8203051,LOCAL,74178,CPT,,,636,RC,,Outpatient,,,4826.55,2588.03,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
EPIFIX SKIN SUBSTITUTE 2 X 2 CM,10510011,LOCAL,,,Q4186,HCPCS,341,RC,,Outpatient,,,4950,1755,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
NM Inflammation Loc Spect,1169158,LOCAL,78803,CPT,,,,,,Outpatient,,,5051.75,1181.4,Aetna Med ADV,Aetna Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
antivenin (Crotalidae equine) polyvalent intravenous injection [CULL],11250856,LOCAL,J0841,CPT,,,636,RC,,Outpatient,1,EA,5068.8,,Aetna Med ADV,Aetna Med ADV,1045.15,,,,,,,Fee Schedule,1045.15,11608.84,
THERASKIN 2.5 X 5.1 CM,10510019,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,5093,2431,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
tocilizumab 20 mg/mL Sol 10 mL [CULL],11260565,LOCAL,J3262,CPT,,,612,RC,,Outpatient,10,ML,5099.1744,,Aetna Med ADV,Aetna Med ADV,5.71,,,,,,,Fee Schedule,5.71,1641.22,
MRI Spine Thoracic w/ + w/o Contrast,1169062,LOCAL,72157,CPT,,,360,RC,,Outpatient,,,5102.75,2736.53,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
CATH LAB INSERTION OF PLEURAL CATHETER,8230067,LOCAL,32550,CPT,,,920,RC,,Outpatient,,,5132.46,3336,Aetna Med ADV,Aetna Med ADV,3226.48,,,,,,,Fee Schedule,1392.67,3226.48,
95782 PEDI POLYSOMNOGRAPHY (<6YO) CHARGE,9303178,LOCAL,95782,CPT,,,920,RC,,Outpatient,,,5141.48,3342,Aetna Med ADV,Aetna Med ADV,930.16,,,,,,,Fee Schedule,930.16,1113.98,
95810 POLYSOMNOGRAPHY CHARGE.,8303749,LOCAL,95810,CPT,,,636,RC,,Outpatient,,,5141.48,3342,Aetna Med ADV,Aetna Med ADV,930.16,,,,,,,Fee Schedule,930.16,1113.98,
NUSHIELD 2X4CM,10510073,LOCAL,,,Q4160,HCPCS,341,RC,,Outpatient,,,5225,1155,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
NM Cardiac Amyloid PYP Spect,9955566,LOCAL,78803,CPT,A9538,HCPCS,612,RC,,Outpatient,,,5230.76,1181.4,Aetna Med ADV,Aetna Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
MRI Spine Lumbar w/ + w/o Contrast,1169056,LOCAL,72158,CPT,,,920,RC,,Outpatient,,,5301.01,2842.95,Aetna Med ADV,Aetna Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
95783 POLYSOM <6 YRS SLP W/CPAP CHARGE,10732463,LOCAL,95783,CPT,,,920,RC,,Outpatient,,,5349.1,3477,Aetna Med ADV,Aetna Med ADV,930.16,,,,,,,Fee Schedule,930.16,1113.98,
95811 POLYSOMMOGRAPHY w/ CPAP CHARGE,8303770,LOCAL,95811,CPT,,,341,RC,,Outpatient,,,5349.1,3477,Aetna Med ADV,Aetna Med ADV,930.16,,,,,,,Fee Schedule,930.16,930.16,
NM Inflammation Loc Whole Body - Ceretec,1169152,LOCAL,78802,CPT,A9521,HCPCS,636,RC,,Outpatient,,,5351.75,2870.18,Aetna Med ADV,Aetna Med ADV,802.34,,,,,,,Fee Schedule,802.34,1409.71,
EPIFIX SKIN SUBSTITUTE 2 X 3 CM,13962563,LOCAL,,,Q4186,HCPCS,341,RC,,Outpatient,,,5377.5,1755,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
NM Inflammation Loc Limited - Indium,1169148,LOCAL,78801,CPT,,,341,RC,,Outpatient,,,5399.5,2895.75,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,1409.71,
NM Inflammation Loc Multi,12113627,LOCAL,78801,CPT,,,636,RC,,Outpatient,,,5399.5,2895.75,Aetna Med ADV,Aetna Med ADV,367.38,,,,,,,Fee Schedule,367.38,1409.71,
AMNIOEXCEL PLUS 3X3,13962549,LOCAL,,,Q4137,HCPCS,360,RC,,Outpatient,,,5400,3028,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY VENOUS ADDL,8210394,LOCAL,37188,CPT,,,636,RC,,Outpatient,,,5419.5,3523,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2599,5228.12,
KERECIS OMEGA 3 - 3 X 7,13962578,LOCAL,,,Q4158,HCPCS,636,RC,,Outpatient,,,5436,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
THERASKIN 5.1 X 7.6 CM,13962608,LOCAL,,,Q4121,HCPCS,360,RC,,Outpatient,,,5449.5,2431,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
NEW ACCESS NEPHROSTOMY TUBE,8200537,LOCAL,50433,CPT,,,360,RC,,Outpatient,,,5454.2,3545,Aetna Med ADV,Aetna Med ADV,3153.26,,,,,,,Fee Schedule,2315,4301.28,
PTA RENAL ARTERY (ADD'L),8210240,LOCAL,37247,CPT,,,278,RC,,Outpatient,,,5488.12,3567,Aetna Med ADV,Aetna Med ADV,140.82,,,,,,,Fee Schedule,140.82,8616.54,
IMPLANT BREAST #350-6504BC 650CC,4801608,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,5500,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-8004BC,4803074,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,5500,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST 700CC #350-7004BC MENTOR,4803075,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,5500,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST SILICONE 500CC,4805180,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,5500,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT SILICONE 750CC,4851569,LOCAL,,,L8600,HCPCS,636,RC,,Outpatient,,,5500,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
PURAPLY AM 3.76 CM X 4.76 CM,13962601,LOCAL,,,Q4196,HCPCS,761,RC,,Outpatient,,,5512.5,3861,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
27603 DRAIN LOWER LEG LESION,13043453,LOCAL,27603,CPT,,,341,RC,LT,Outpatient,,,5526.21,3592,Aetna Med ADV,Aetna Med ADV,2616.66,,,,,,,Fee Schedule,2315,2616.66,
NM Myocardial Planar Rest and Stress,2425972,LOCAL,78454,CPT,A9500,HCPCS,636,RC,,Outpatient,,,5593.52,2999.7,Aetna Med ADV,Aetna Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
EPIFIX SKIN SUBSTITUTE 3.5 X 3.5 CM,13962565,LOCAL,,,Q4186,HCPCS,636,RC,,Outpatient,,,5602.5,1755,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
GRAFIX PRIME 2 X 3CM,10510014,LOCAL,,,Q4133,HCPCS,636,RC,,Outpatient,,,5637.5,3671,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
GRAFIX PL 3.0 X 4.0CM,13962568,LOCAL,,,Q4133,HCPCS,360,RC,,Outpatient,,,5647.5,3671,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
REVISION REPLACE GENERATOR  BLADDER,8268108,LOCAL,64595,CPT,,,360,RC,,Outpatient,,,5690.13,3699,Aetna Med ADV,Aetna Med ADV,3144.15,,,,,,,Fee Schedule,2599,5487.33,
REVISION REPLACE LEAD BLADDER STIMULATOR,8268107,LOCAL,64585,CPT,,,636,RC,,Outpatient,,,5690.13,3699,Aetna Med ADV,Aetna Med ADV,3144.15,,,,,,,Fee Schedule,2599,5487.33,
AMNIOEXCEL PLUS 2CMX2CM,10510060,LOCAL,,,Q4137,HCPCS,360,RC,,Outpatient,,,5693.33,3028,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
INTRO AV SHUNT W S&I,8267106,LOCAL,36902,CPT,,,636,RC,,Outpatient,,,5734.69,11107,Aetna Med ADV,Aetna Med ADV,5212.67,,,,,,,Fee Schedule,5212.67,5787,
APLIGRAF-COM,13962557,LOCAL,,,Q4101,HCPCS,636,RC,,Outpatient,,,5737.5,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 4 X 4.5 CM,13962566,LOCAL,,,Q4186,HCPCS,636,RC,,Outpatient,,,5737.5,1755,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 4 X 4.5CM,13962567,LOCAL,,,Q4186,HCPCS,761,RC,,Outpatient,,,5737.5,1755,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
15120 SKN SPLT A-GRFT FAC/NCK/HF/G 100 SQ CM/1% BA,10006441,LOCAL,15120,CPT,,,360,RC,,Outpatient,,,5746.86,3735,Aetna Med ADV,Aetna Med ADV,3347.08,,,,,,,Fee Schedule,2599,3347.08,
REPOSITION IVC FILTER,8267129,LOCAL,37192,CPT,,,636,RC,,Outpatient,,,5771.49,3751,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2599,5228.12,
EPICORD 2CM X 3CM,13962558,LOCAL,,,Q4187,HCPCS,360,RC,,Outpatient,,,5827.5,3788,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
VENOUS PTA EACH ADD'L,8267100,LOCAL,37249,CPT,,,636,RC,,Outpatient,,,5876.95,3820,Aetna Med ADV,Aetna Med ADV,118.76,,,,,,,Fee Schedule,118.76,8616.54,
PURAPLY AM 3 CM X 4 CM,13962599,LOCAL,,,Q4196,HCPCS,636,RC,,Outpatient,,,5940,3861,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
PURAPLY AM 3 X 4CM FEN FINISHED PROD,13962600,LOCAL,,,Q4196,HCPCS,360,RC,,Outpatient,,,5940,3861,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
Central Line Access Type. -> Tunneled,13449753,LOCAL,36810,CPT,,,636,RC,,Outpatient,,,5960.36,3874,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2599,3211.33,
NUSHIELD 3X4CM,13962589,LOCAL,,,Q4160,HCPCS,636,RC,,Outpatient,,,5962.5,1155,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
NUSHIELD 4X4CM,13962590,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,5962.5,1155,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
prothrombin complex - Pow [CULL],11220535,LOCAL,J7168,CPT,,,636,RC,,Outpatient,1,EA,6048,,Aetna Med ADV,Aetna Med ADV,2.14,,,,,,,Fee Schedule,2.14,3347.61,
AFFINITY 1.5 CM X 1.5 CM,10500119,LOCAL,,,Q4159,HCPCS,636,RC,,Outpatient,,,6075,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 2 X 4 CM,13962564,LOCAL,,,Q4186,HCPCS,481,RC,,Outpatient,,,6075,1755,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
33215 Reposition Pacing Defibrillator Lead,8212027,LOCAL,33215,CPT,,,360,RC,,Outpatient,,,6104.24,3968,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2484.2,2877.63,
ICD REMOVAL ONLY,8231005,LOCAL,33241,CPT,,,323,RC,,Outpatient,,,6104.24,3968,Aetna Med ADV,Aetna Med ADV,3327.27,,,,,,,Fee Schedule,2599,10220.8,
EXTREMITY UNILATERAL S&I,8210530,LOCAL,75710,CPT,,,323,RC,,Outpatient,,,6132.32,3288.45,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
XR Angio Extremity in OR SI Left,2425383,LOCAL,75710,CPT,,,323,RC,LT,Outpatient,,,6132.32,3288.45,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
XR Angio Extremity in OR SI Right,2425386,LOCAL,75710,CPT,,,,,RT,Outpatient,,,6132.32,3288.45,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
immune globulin intravenous and subcutaneous 10% injectable solution 100 mL [CULL],11205089,LOCAL,J1561,CPT,,,360,RC,,Outpatient,100,ML,6199.68,,Aetna Med ADV,Aetna Med ADV,48.96,,,,,,,Fee Schedule,48.96,2110.36,
TRANSCATH THER.ART.INF.(FINAL DAY),8210027,LOCAL,37214,CPT,,,278,RC,,Outpatient,,,6313.68,4104,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,1291,5228.12,
BULKAMID URETHRAL BULKING SYSTEM,4830058,LOCAL,,,L8603,HCPCS,278,RC,,Outpatient,,,6325,3364,Aetna Med ADV,Aetna Med ADV,536.91,,,,,,,Fee Schedule,536.91,536.91,
EXPANDER TISSUE 750-900ML,4854109,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,6325,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE DERMASPAN 600-720CC,4805041,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,6325,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE LPP-FH13S,4832956,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,6325,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE LPP-FH14S,4803623,LOCAL,,,L8600,HCPCS,481,RC,,Outpatient,,,6325,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
93503 INSERTION OF SWAN GANZ CHARGE,8210870,LOCAL,93503,CPT,,,481,RC,,Outpatient,,,6394.68,4157,Aetna Med ADV,Aetna Med ADV,1420.25,,,,,,,Fee Schedule,1291,1644.1,
PA CATHETER SV02,4221129,LOCAL,93503,CPT,,,360,RC,,Outpatient,,,6394.68,4157,Aetna Med ADV,Aetna Med ADV,1420.25,,,,,,,Fee Schedule,1291,1644.1,
GENERATOR REMOVAL ONLY,8210160,LOCAL,33233,CPT,,,,,,Outpatient,,,6446.76,4190,Aetna Med ADV,Aetna Med ADV,7566.4,,,,,,,Fee Schedule,2599,10220.8,
fomepizole 1 g/mL intravenous solution 1.5 mL [CULL],11290124,LOCAL,J1451,CPT,,,341,RC,,Outpatient,1.5,ML,6649.376,,Aetna Med ADV,Aetna Med ADV,6.28,,,,,,,Fee Schedule,6.28,525.49,
NM Myocardial SPECT Drug Stress Multi,8567792,LOCAL,78452,CPT,,,341,RC,,Outpatient,,,6759.97,3625.05,Aetna Med ADV,Aetna Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
NM Myocardial SPECT Rest and Stress,2425975,LOCAL,78452,CPT,,,,,,Outpatient,,,6759.97,3625.05,Aetna Med ADV,Aetna Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
dalbavancin 500 mg Pow [CULL],11287452,LOCAL,J0875,CPT,,,278,RC,,Outpatient,1,UN,6831.8592,4440,Aetna Med ADV,Aetna Med ADV,15.61,,,,,,,Fee Schedule,0.21,5685.74,
IMPLANT BREAST SHPB-235,4852442,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,6875,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST SHPB-585,4851979,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,6875,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST SHPB-635,4805161,LOCAL,,,L8600,HCPCS,636,RC,,Outpatient,,,6875,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
GRAFIX PL 3.0 X 4.0CM,10510066,LOCAL,,,Q4133,HCPCS,360,RC,,Outpatient,,,6902.5,3671,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
PERC URETERAL STENT REMOVAL & REPLACE,8210741,LOCAL,50382,CPT,,,343,RC,,Outpatient,,,6922.86,4500,Aetna Med ADV,Aetna Med ADV,1872.87,,,,,,,Fee Schedule,1872.87,2315,
CULL NM TC99M Ceretec Per Dose,13644947,LOCAL,,,A9521,HCPCS,636,RC,,Outpatient,,,6990.26,4544,Aetna Med ADV,Aetna Med ADV,802.34,,,,,,,Fee Schedule,802.34,802.34,
EPICORD 2CM X 3CM,10510051,LOCAL,,,Q4187,HCPCS,278,RC,,Outpatient,,,7122.5,3788,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
IMPLANT BREAST 775,4850675,LOCAL,,,L8600,HCPCS,301,RC,,Outpatient,,,7150,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
"BRCAvantage(R), Comprehensive QSTC",9039435,LOCAL,81162,CPT,,,636,RC,,Outpatient,,,7200,2189.86,Aetna Med ADV,Aetna Med ADV,1824.88,,,,,,,Fee Schedule,590.67,1824.88,
PURAPLY AM 3 X 4CM FEN FINISHED PROD,10510076,LOCAL,,,Q4196,HCPCS,636,RC,,Outpatient,,,7260,3861,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
NUSHIELD 4X4CM,10510075,LOCAL,,,Q4160,HCPCS,360,RC,,Outpatient,,,7287.5,1155,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY ARTERIAL SECONDARY PERC,8210390,LOCAL,37186,CPT,,,761,RC,,Outpatient,,,7383.75,4799,Aetna Med ADV,Aetna Med ADV,199.65,,,,,,,Fee Schedule,199.65,16037.41,
"15100 AUTO-SPLIT THICK T/A/L, 1ST 100 SQCM CHARGE",12816476,LOCAL,15100,CPT,,,636,RC,,Outpatient,,,7387.97,4802,Aetna Med ADV,Aetna Med ADV,1672.39,,,,,,,Fee Schedule,1496,2862.92,
AFFINITY 1.5CM X 1.5CM,10500119,LOCAL,,,Q4159,HCPCS,360,RC,,Outpatient,,,7425,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY VENOUS PRIMARY,8210393,LOCAL,37187,CPT,,,636,RC,,Outpatient,,,7579,4926,Aetna Med ADV,Aetna Med ADV,10368.23,,,,,,,Fee Schedule,5228.12,10368.23,
GRAFT STRAVIX 2 X 4,13962572,LOCAL,,,Q4132,HCPCS,636,RC,,Outpatient,,,7650,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 4 X 4.5 CM,10510064,LOCAL,,,Q4186,HCPCS,360,RC,,Outpatient,,,7672.5,1755,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
EXCHANGE OF BILIARY DRAIN CATH,8267769,LOCAL,47536,CPT,,,360,RC,,Outpatient,,,7882.57,5124,Aetna Med ADV,Aetna Med ADV,3226.48,,,,,,,Fee Schedule,2599,3682.65,
PLACEMENT BILIARY DRAIN CATH INT/EXT,8201219,LOCAL,47534,CPT,,,481,RC,,Outpatient,,,7882.57,5124,Aetna Med ADV,Aetna Med ADV,3226.48,,,,,,,Fee Schedule,2599,3682.65,
36253 Insertion Of Cath Renal Arterial 2Nd Unilateral,8212045,LOCAL,36253,CPT,,,360,RC,,Outpatient,,,8050.63,5233,Aetna Med ADV,Aetna Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
CERVICOCEREBRAL S&I,8201615,LOCAL,36221,CPT,,,360,RC,,Outpatient,,,8050.63,5233,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2599,6018.68,
COMMON CAROTID UNI S&I,8201600,LOCAL,36223,CPT,,,360,RC,,Outpatient,,,8050.63,5233,Aetna Med ADV,Aetna Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
EXTERNAL CAROTID UNI S&I,8201610,LOCAL,36222,CPT,,,320,RC,,Outpatient,,,8050.63,5233,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2599,6018.68,
INFERIOR VENA CAVA S&I,8210660,LOCAL,75825,CPT,,,323,RC,,Outpatient,,,8050.63,4317.23,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
IR Angio Pulmonary Bilateral,7949335,LOCAL,75743,CPT,,,323,RC,,Outpatient,,,8050.63,4317.23,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
PULMONARY BILATERAL S&I,8210610,LOCAL,75743,CPT,,,360,RC,,Outpatient,,,8050.63,4317.23,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
RENAL UNILATERAL PLACEMENT & SI,8210550,LOCAL,36251,CPT,,,360,RC,,Outpatient,,,8050.63,5233,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2599,6018.68,
VERTEBRAL SUBCLAVIAN OR INNOMINATE,8201625,LOCAL,36225,CPT,,,320,RC,,Outpatient,,,8050.63,5233,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2599,6018.68,
XR Venogram Cava Inferior,10386826,LOCAL,75825,CPT,,,761,RC,,Outpatient,,,8050.63,4317.23,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
25040 FOREIGN BODY REMOVAL FOREARM LEFT,13416875,LOCAL,25040,CPT,,,481,RC,LT,Outpatient,,,8076.78,5250,Aetna Med ADV,Aetna Med ADV,2966.42,,,,,,,Fee Schedule,2528.75,2966.42,
FOREIGN BODY RETRIEVAL,8201630,LOCAL,37197,CPT,,,481,RC,,Outpatient,,,8080.32,5252,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2599,5228.12,
FOREIGN BODY RETRIEVAL S&I,8201635,LOCAL,37197,CPT,,,360,RC,,Outpatient,,,8080.32,5252,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2599,5228.12,
REMOVAL IVC FILTER,8267130,LOCAL,37193,CPT,,,343,RC,,Outpatient,,,8080.32,5252,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2599,5228.12,
CULL NM Indium WBC Per 0.5 MCI,13644939,LOCAL,,,A9547,HCPCS,343,RC,,Outpatient,,,8102.03,5266,Aetna Med ADV,Aetna Med ADV,772.64,,,,,,,Fee Schedule,772.64,772.64,
CULL NM Kinevac Per 5 MCG Vial,13644941,LOCAL,,,A9547,HCPCS,360,RC,,Outpatient,,,8102.03,5266,Aetna Med ADV,Aetna Med ADV,772.64,,,,,,,Fee Schedule,772.64,772.64,
PERC INTRO CATH/STENT URETERAL PREEXIST,8200532,LOCAL,50693,CPT,,,360,RC,,Outpatient,,,8122.9,5280,Aetna Med ADV,Aetna Med ADV,3153.26,,,,,,,Fee Schedule,2599,4301.28,
PERC INTRO URETERAL NEW ACCESS W CATH,8200534,LOCAL,50695,CPT,,,360,RC,,Outpatient,,,8122.9,5280,Aetna Med ADV,Aetna Med ADV,3153.26,,,,,,,Fee Schedule,2599,4301.28,
PERC INTRO URETERAL NEW ACCESS WO CATH,8200533,LOCAL,50694,CPT,,,360,RC,,Outpatient,,,8122.9,5280,Aetna Med ADV,Aetna Med ADV,3153.26,,,,,,,Fee Schedule,2599,4301.28,
VERTEBROPLASTY ADDL THOR/LUMB,8267765,LOCAL,22512,CPT,,,360,RC,,Outpatient,,,8365.99,5438,Aetna Med ADV,Aetna Med ADV,167.55,,,,,,,Fee Schedule,167.55,6803.47,
VERTEBROPLASTY LUMBAR,8211170,LOCAL,22511,CPT,,,360,RC,,Outpatient,,,8365.99,5438,Aetna Med ADV,Aetna Med ADV,2966.42,,,,,,,Fee Schedule,2599,6803.47,
VERTEBROPLASTY THORACIC,8211160,LOCAL,22510,CPT,,,360,RC,,Outpatient,,,8365.99,5438,Aetna Med ADV,Aetna Med ADV,2966.42,,,,,,,Fee Schedule,2599,6803.47,
RENAL BILATERAL PLACEMENT & SI,8210560,LOCAL,36252,CPT,,,481,RC,,Outpatient,,,8539.16,5550,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2599,6018.68,
93452 Left Heart Cath,8230003,LOCAL,93452,CPT,,,360,RC,,Outpatient,,,8778,5706,Aetna Med ADV,Aetna Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
TEMP SACRAL ELECTRODE WITH IMAGING,8268102,LOCAL,64561,CPT,,,761,RC,,Outpatient,,,8900,5785,Aetna Med ADV,Aetna Med ADV,6000.2,,,,,,,Fee Schedule,5787,8672.71,
27372 FOREIGN BODY REMOVAL KNEE,13435628,LOCAL,27372,CPT,,,278,RC,,Outpatient,,,8946.89,5815,Aetna Med ADV,Aetna Med ADV,2616.66,,,,,,,Fee Schedule,2315,2616.66,
IMPLANT BREAST ARTOURA 455CC SMOOTH,4853890,LOCAL,,,L8600,HCPCS,323,RC,,Outpatient,,,8976,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
75630-IR Aortogram Abdominal + Iliofemoral1,8071871,LOCAL,75630,CPT,,,323,RC,,Outpatient,,,9016.7,4835.33,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
AORTO ABD+ILIOFEMORAL SERIAL,8210430,LOCAL,75630,CPT,,,323,RC,,Outpatient,,,9016.7,4835.33,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
AORTOGRAM THORACIC S&I,8210410,LOCAL,75605,CPT,,,323,RC,,Outpatient,,,9016.7,4835.33,Aetna Med ADV,Aetna Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
EXTREMITY BILATERAL S&I,8210540,LOCAL,75716,CPT,,,323,RC,,Outpatient,,,9016.7,4835.33,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
IR Aortogram Thoracic w/ Serialography,7949377,LOCAL,75605,CPT,,,323,RC,,Outpatient,,,9016.7,4835.33,Aetna Med ADV,Aetna Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
XR Angio Extremity in OR SI Bilat,9343676,LOCAL,75716,CPT,,,761,RC,,Outpatient,,,9016.7,4835.33,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
20240 BIOPSY BONE EXCISIONAL SUPERFI CHARGE,8020082,LOCAL,20240,CPT,,,761,RC,,Outpatient,,,9171.4,5961,Aetna Med ADV,Aetna Med ADV,2616.66,,,,,,,Fee Schedule,2315,2616.66,
20240-BIOPSY BONE EXCISIONAL SUPERFI CHARGE,8020082,LOCAL,20240,CPT,,,278,RC,,Outpatient,,,9171.4,5961,Aetna Med ADV,Aetna Med ADV,2616.66,,,,,,,Fee Schedule,2315,2616.66,
EXPANDER TISSUE ALLOX2,4850383,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,9350,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE ALLOX2-15SE,4800802,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,9350,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE ALLOX2-FH13E,4800497,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,9350,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE ALLOX2-FH14E,4840653,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,9350,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
TISSUE EXPANDER ALLOX2-FH15E,4810961,LOCAL,,,L8600,HCPCS,636,RC,,Outpatient,,,9350,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
AMINOFIX 7CM X 6CM,13962545,LOCAL,,,Q4137,HCPCS,636,RC,,Outpatient,,,9515.25,3028,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
AMNIOEXCEL PLUS  3 X 4CM,13962546,LOCAL,,,Q4137,HCPCS,481,RC,,Outpatient,,,9548.1,3028,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
"93451 Catheterization, Right Heart",8230000,LOCAL,93451,CPT,,,481,RC,,Outpatient,,,9609.02,6246,Aetna Med ADV,Aetna Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
93453 Combined Left and Right Heart Cath,8230006,LOCAL,93453,CPT,,,636,RC,,Outpatient,,,9609.02,6246,Aetna Med ADV,Aetna Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
AMNIOFIX 4X6CM,13962556,LOCAL,,,Q4137,HCPCS,360,RC,,Outpatient,,,9654.75,3028,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY ARTERIAL ADDL,8210392,LOCAL,37185,CPT,,,481,RC,,Outpatient,,,9751.88,6339,Aetna Med ADV,Aetna Med ADV,130.9,,,,,,,Fee Schedule,130.9,8616.54,
93454 HT Left Heart Cath WO LV,8210890,LOCAL,93454,CPT,,,481,RC,,Outpatient,,,9833.36,6392,Aetna Med ADV,Aetna Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
92973 PTC Thromebectomy Add On,8200030,LOCAL,92973,CPT,,,636,RC,,Outpatient,,,9838.19,6395,Aetna Med ADV,Aetna Med ADV,74.32,,,,,,,Fee Schedule,74.32,12572.64,
NUSHIELD 6CM X 6CM,13962591,LOCAL,,,Q4160,HCPCS,360,RC,,Outpatient,,,10012.5,1155,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
TRANSCATH THER ART INFUSION FOR THROM,8210026,LOCAL,37211,CPT,,,360,RC,,Outpatient,,,10140.58,6591,Aetna Med ADV,Aetna Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,5787,
CATH LAB IVC FILTER PLACEMENT,8210330,LOCAL,37191,CPT,,,360,RC,,Outpatient,,,10180.79,6618,Aetna Med ADV,Aetna Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,5787,
INSERTION IVC FILTER,8267128,LOCAL,37191,CPT,,,360,RC,,Outpatient,,,10180.79,6618,Aetna Med ADV,Aetna Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,5787,
PERC PLACE IVC FILTER S&I,8210740,LOCAL,37191,CPT,,,,,,Outpatient,,,10180.79,6618,Aetna Med ADV,Aetna Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,5787,
leuprolide 45 mg/6 months Pow [CULL],11299002,LOCAL,J9217,CPT,,,343,RC,,Outpatient,1,ML,10406.8992,,Aetna Med ADV,Aetna Med ADV,176.45,,,,,,,Fee Schedule,176.45,733.68,
CULL NM Indium DTPA Per 0.5 MCI,13644937,LOCAL,,,A9548,HCPCS,636,RC,,Outpatient,,,10432.89,6781,Aetna Med ADV,Aetna Med ADV,715.29,,,,,,,Fee Schedule,715.29,715.29,
KERECIS OMEGA 3 - 7 X 10CM,13962581,LOCAL,,,Q4158,HCPCS,360,RC,,Outpatient,,,10552.5,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY ARTERIAL PRIMARY,8210391,LOCAL,37184,CPT,,,323,RC,,Outpatient,,,10806,7024,Aetna Med ADV,Aetna Med ADV,16417.11,,,,,,,Fee Schedule,5787,16417.11,
AORTOGRAM ABDOMEN S&I,8210420,LOCAL,75625,CPT,,,323,RC,,Outpatient,,,10898.6,5844.3,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
IR Aortogram Abdominal w/ Serialography1,8071874,LOCAL,75625,CPT,,,323,RC,,Outpatient,,,10898.6,5844.3,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
XR Aorta Abdomen Catheter in OR SI,2425389,LOCAL,75625,CPT,,,636,RC,,Outpatient,,,10898.6,5844.3,Aetna Med ADV,Aetna Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
PURAPLY AM 5 CM X 5 CM,13962602,LOCAL,,,Q4196,HCPCS,278,RC,,Outpatient,,,11025,3861,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
EXPANDER BREAST TISSUE ARTOURA 375CC,4853226,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,11385,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE ARTOURA SDC100UH,4803722,LOCAL,,,L8600,HCPCS,278,RC,,Outpatient,,,11385,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDERS TISSUE 475CC SDC-130H,4852707,LOCAL,,,L8600,HCPCS,360,RC,,Outpatient,,,11385,644,Aetna Med ADV,Aetna Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
TRANSCATH STENT CERV CAROTID WITH DEVICE,8210025,LOCAL,37215,CPT,,,360,RC,,Outpatient,,,11474.94,7459,Aetna Med ADV,Aetna Med ADV,802.87,,,,,,,Fee Schedule,802.87,16429.41,
VERTEBRAL CERVICAL/CRANIAL S&I,8201620,LOCAL,36226,CPT,,,360,RC,,Outpatient,,,11520.61,7488,Aetna Med ADV,Aetna Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
LEAD REPLACEMENT DUAL,8210110,LOCAL,33217,CPT,,,360,RC,,Outpatient,,,11951.06,7768,Aetna Med ADV,Aetna Med ADV,7566.4,,,,,,,Fee Schedule,2484.2,7566.4,
LEAD REPLACEMENT SGL,8210100,LOCAL,33216,CPT,,,,,,Outpatient,,,11951.06,7768,Aetna Med ADV,Aetna Med ADV,7566.4,,,,,,,Fee Schedule,2484.2,7566.4,
calcitonin 200 intl units/mL Sol [CULL],J0630,CPT,,,,,481,RC,,Outpatient,200,ML,12023.04,,Aetna Med ADV,Aetna Med ADV,484.97,,,,,,,Fee Schedule,484.97,2110.36,
93455 HT Left Cath W Cor Inj WO LV,8230002,LOCAL,93455,CPT,,,,,,Outpatient,,,12026.07,7817,Aetna Med ADV,Aetna Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
immune globulin intravenous and subcutaneous 10% injectable solution 200 mL [CULL],11205107,LOCAL,J1561,CPT,,,278,RC,,Outpatient,200,ML,12399.36,,Aetna Med ADV,Aetna Med ADV,48.96,,,,,,,Fee Schedule,48.96,2110.36,
ALLOGRAFT DERMAPURE 7X10CM,4810278,LOCAL,Q4152,CPT,Q4152,HCPCS,481,RC,,Outpatient,,,12446.5,,Aetna Med ADV,Aetna Med ADV,111.35,,,,,,,Fee Schedule,111.35,111.35,
93458 HT Cath Left W LV and Cor Angio,8230004,LOCAL,93458,CPT,,,481,RC,,Outpatient,,,12512.89,8133,Aetna Med ADV,Aetna Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
93460 HT Cath L or R W LV and Cor Angio,8230007,LOCAL,93460,CPT,,,360,RC,,Outpatient,,,12512.89,8133,Aetna Med ADV,Aetna Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
33210 INSERTION TEMP PACEMAKER SINGLE CHAMBER CHARGE,13707085,LOCAL,33210,CPT,,,360,RC,,Outpatient,,,12542.69,8153,Aetna Med ADV,Aetna Med ADV,7566.4,,,,,,,Fee Schedule,2484.2,7566.4,
TEMP PACEMAKER SGL CHAMBER,8210050,LOCAL,33210,CPT,,,481,RC,,Outpatient,,,12542.69,8153,Aetna Med ADV,Aetna Med ADV,7566.4,,,,,,,Fee Schedule,2484.2,7566.4,
92920 PTCA 1st Vessel,8201256,LOCAL,92920,CPT,,,360,RC,,Outpatient,,,12766.62,8298,Aetna Med ADV,Aetna Med ADV,5212.67,,,,,,,Fee Schedule,5212.67,12572.64,
PTA RENAL ARTERY (INITIAL),8267124,LOCAL,37246,CPT,,,481,RC,,Outpatient,,,12766.62,17592,Aetna Med ADV,Aetna Med ADV,5212.67,,,,,,,Fee Schedule,5212.67,5787,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ANGIO CPLX 1,8230034,LOCAL,37224,CPT,,,481,RC,,Outpatient,,,12766.62,8298,Aetna Med ADV,Aetna Med ADV,5212.67,,,,,,,Fee Schedule,5212.67,5787,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS IVT ANGIO CPLX1,8230030,LOCAL,37220,CPT,,,481,RC,,Outpatient,,,12766.62,8298,Aetna Med ADV,Aetna Med ADV,5212.67,,,,,,,Fee Schedule,5212.67,5787,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS TPVT ANGIO SF 1ST,8230022,LOCAL,37228,CPT,,,636,RC,,Outpatient,,,12766.62,8298,Aetna Med ADV,Aetna Med ADV,10368.23,,,,,,,Fee Schedule,5787,10368.23,
THERASKIN 7.6 X 15.2 CM,13962609,LOCAL,,,Q4121,HCPCS,481,RC,,Outpatient,,,12802.5,2431,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
93459 HT Cath Left W LV and Cor Grf Angio,8230005,LOCAL,93459,CPT,,,481,RC,,Outpatient,,,13484.51,8765,Aetna Med ADV,Aetna Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
93461 HT Cath L or R W LV Cor Grf Angio,8230008,LOCAL,93461,CPT,,,,,,Outpatient,,,13484.51,8765,Aetna Med ADV,Aetna Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
riTUXimab pvvr 10 mg/mL Sol 50 mL [CULL],11211085,LOCAL,Q5119,CPT,,,,,,Outpatient,50,ML,13762.56,,Aetna Med ADV,Aetna Med ADV,27.85,,,,,,,Fee Schedule,27.85,7537.07,
"C1 esterase inhibitor, human 500 intl units intravenous kit [CULL]",11201256,LOCAL,J0597,CPT,,,636,RC,,Outpatient,1,EA,13903.4496,,Aetna Med ADV,Aetna Med ADV,75.86,,,,,,,Fee Schedule,75.86,5685.74,
AMNIOEXCEL PLUS 4X5CM,13962550,LOCAL,,,Q4137,HCPCS,480,RC,,Outpatient,,,13974.52,3028,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
ATHERECTOMY ABD AORTA,8230043,LOCAL,0236T,CPT,,,480,RC,,Outpatient,,,14443,9388,Aetna Med ADV,Aetna Med ADV,10368.23,,,,,,,Fee Schedule,6417,16037.41,
ATHERECTOMY BRACHIOCEPHALIC & BRANCHES,8230044,LOCAL,0237T,CPT,,,480,RC,,Outpatient,,,14443,9388,Aetna Med ADV,Aetna Med ADV,10368.23,,,,,,,Fee Schedule,6417,16037.41,
ATHERECTOMY ILIAC EACH,8230045,LOCAL,0238T,CPT,,,480,RC,,Outpatient,,,14443,12175,Aetna Med ADV,Aetna Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
ATHERECTOMY RENAL,8230041,LOCAL,0234T,CPT,,,480,RC,,Outpatient,,,14443,9388,Aetna Med ADV,Aetna Med ADV,10368.23,,,,,,,Fee Schedule,6417,26140.53,
ATHERECTOMY VISCERAL,8230042,LOCAL,0235T,CPT,,,636,RC,,Outpatient,,,14443,9388,Aetna Med ADV,Aetna Med ADV,515.34,,,,,,,Fee Schedule,515.34,8616.54,
EPICORD 3 X 5,13962559,LOCAL,,,Q4187,HCPCS,360,RC,,Outpatient,,,14445,3788,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
INTERNAL CAROTID UNI S&I,8201636,LOCAL,36224,CPT,,,481,RC,,Outpatient,,,14812.21,9628,Aetna Med ADV,Aetna Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
37239 STENT ANGIO VEIN EA ADDL CHARGE,8230063,LOCAL,37239,CPT,,,481,RC,,Outpatient,,,15683.4,10194,Aetna Med ADV,Aetna Med ADV,121.17,,,,,,,Fee Schedule,121.17,16037.41,
ARTERY STENT ADD'L (NONCORONARY),8230061,LOCAL,37237,CPT,,,481,RC,,Outpatient,,,15683.4,10194,Aetna Med ADV,Aetna Med ADV,171.21,,,,,,,Fee Schedule,171.21,16037.41,
93456 Right Heart Catheterization With Angiography,8230009,LOCAL,93456,CPT,,,360,RC,,Outpatient,,,16019.61,10413,Aetna Med ADV,Aetna Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
33285 Implant Pt Activated Cardiac Event Recorder,8267776,LOCAL,33285,CPT,,,481,RC,,Outpatient,,,16029.82,10419,Aetna Med ADV,Aetna Med ADV,7566.4,,,,,,,Fee Schedule,6417,12132.94,
92928 Trnscath Plcmnt Metal Single,8201254,LOCAL,92928,CPT,,,343,RC,,Outpatient,,,16620.58,10803,Aetna Med ADV,Aetna Med ADV,10368.23,,,,,,,Fee Schedule,5787,12572.64,
CULL Octreotide,14874647,LOCAL,,,A9572,HCPCS,,,,Outpatient,,,16720.11,,Aetna Med ADV,Aetna Med ADV,1914.61,,,,,,,Fee Schedule,1914.61,1914.61,
alteplase 50 mg intravenous injection [CULL],11201048,LOCAL,J2997,CPT,,,481,RC,,Outpatient,1,ML,16896.704,,Aetna Med ADV,Aetna Med ADV,94.45,,,,,,,Fee Schedule,94.45,122.4,
93457 Right or Left Heart Cath with No LV Gram Charge,8230010,LOCAL,93457,CPT,,,360,RC,,Outpatient,,,16991.23,11044,Aetna Med ADV,Aetna Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
AV FISTULAGRAM WITH ANGIOPLASTY,8210331,LOCAL,36902,CPT,,,481,RC,,Outpatient,,,17087.76,11107,Aetna Med ADV,Aetna Med ADV,5212.67,,,,,,,Fee Schedule,5212.67,5787,
"C9764 Revasculation, Endovascular, With Intravascular Lithotripsy, Includes Angioplasty",8230070,LOCAL,,,C9764,HCPCS,,,,Outpatient,,,17339,11270,Aetna Med ADV,Aetna Med ADV,10368.23,,,,,,,Fee Schedule,5228.12,10368.23,
digoxin immune FAB 40 mg intravenous injection [CULL],11201675,LOCAL,J1162,CPT,,,636,RC,,Outpatient,1,EA,17660.16,,Aetna Med ADV,Aetna Med ADV,5168.23,,,,,,,Fee Schedule,5168.23,7537.07,
KERECIS OMEGA 3 - 7 X 10,13962580,LOCAL,,,Q4158,HCPCS,360,RC,,Outpatient,,,17959.5,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
GENERATOR ONLY SGL CHAMBER INSERTION,8210070,LOCAL,33212,CPT,,,360,RC,,Outpatient,,,17985.84,11691,Aetna Med ADV,Aetna Med ADV,7566.4,,,,,,,Fee Schedule,6417,12132.94,
PACEMAKER REMOVAL SINGLE,8210171,LOCAL,33227,CPT,,,,,,Outpatient,,,17985.84,11691,Aetna Med ADV,Aetna Med ADV,7566.4,,,,,,,Fee Schedule,6417,12132.94,
immune globulin intravenous and subcutaneous 10% injectable solution 300 mL [CULL],11205109,LOCAL,J1561,CPT,,,481,RC,,Outpatient,300,ML,18599.04,,Aetna Med ADV,Aetna Med ADV,48.96,,,,,,,Fee Schedule,48.96,2110.36,
0238T Iliac Athrectomy with or without PTA,8230069,LOCAL,0238T,CPT,,,360,RC,,Outpatient,,,18730.19,12175,Aetna Med ADV,Aetna Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
INSERTION NEUROSTIMULATOR GENERATOR,8268101,LOCAL,64590,CPT,,,360,RC,,Outpatient,,,19804,519,Aetna Med ADV,Aetna Med ADV,19605.75,,,,,,,Fee Schedule,9233,30196.67,
GENERATOR REMOVAL AND REPLACEMENT DUAL,8210172,LOCAL,33228,CPT,,,481,RC,,Outpatient,,,20984.23,13640,Aetna Med ADV,Aetna Med ADV,9568.03,,,,,,,Fee Schedule,6417,12132.94,
C9604 Revasc thru Bypass Single Vessel w DES (M'care),8201640,LOCAL,,,C9604,HCPCS,481,RC,,Outpatient,,,21116.1,13725,Aetna Med ADV,Aetna Med ADV,10368.23,,,,,,,Fee Schedule,6417,12572.64,
C9607 Revasc CTO Single Vessel w DES (M'care),8201642,LOCAL,,,C9607,HCPCS,481,RC,,Outpatient,,,21116.1,13725,Aetna Med ADV,Aetna Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
PERQ BM STENT ADD ON  RAMUS,8201252,LOCAL,,,C9600,HCPCS,360,RC,,Outpatient,,,21116.1,13725,Aetna Med ADV,Aetna Med ADV,10368.23,,,,,,,Fee Schedule,6417,12572.64,
TIB/PER REVASC W/ATHER ADD ON  LT,8210020,LOCAL,33206,CPT,,,481,RC,,Outpatient,,,21534.36,13997,Aetna Med ADV,Aetna Med ADV,9568.03,,,,,,,Fee Schedule,6417,12132.94,
C9772 Revasc Lithotrip Tibi/Peroneal Artery (Shockwave IVL),8230074,LOCAL,,,C9772,HCPCS,360,RC,,Outpatient,,,22157.75,14403,Aetna Med ADV,Aetna Med ADV,10368.23,,,,,,,Fee Schedule,6417,10368.23,
PTA VENOUS PERC W S&I,8267099,LOCAL,37248,CPT,,,360,RC,,Outpatient,,,22271.43,14476,Aetna Med ADV,Aetna Med ADV,5212.67,,,,,,,Fee Schedule,5212.67,5787,
VENTRICULAR PACEMAKER IMPLANT INS OR REP,8210030,LOCAL,33207,CPT,,,481,RC,,Outpatient,,,22386.25,14551,Aetna Med ADV,Aetna Med ADV,9568.03,,,,,,,Fee Schedule,6417,12132.94,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ATHRC CPLX 1,8230035,LOCAL,37225,CPT,,,481,RC,,Outpatient,,,23546.83,15305,Aetna Med ADV,Aetna Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ST CPLX 1ST,8230036,LOCAL,37226,CPT,,,481,RC,,Outpatient,,,23546.83,15305,Aetna Med ADV,Aetna Med ADV,10368.23,,,,,,,Fee Schedule,6417,10368.23,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS IVT ST CPLX 1ST,8230031,LOCAL,37221,CPT,,,481,RC,,Outpatient,,,23546.83,15305,Aetna Med ADV,Aetna Med ADV,10368.23,,,,,,,Fee Schedule,6417,10368.23,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS TPVT ATHRC CPLX 1,8230023,LOCAL,37229,CPT,,,360,RC,,Outpatient,,,23546.83,15305,Aetna Med ADV,Aetna Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
VASC EMBOLIZE OCCLUDE ARTERY,8210362,LOCAL,37242,CPT,,,360,RC,,Outpatient,,,23819.19,15482,Aetna Med ADV,Aetna Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
VASC EMBOLIZE OCCLUDE BLEED,8210364,LOCAL,37244,CPT,,,360,RC,,Outpatient,,,23819.19,15482,Aetna Med ADV,Aetna Med ADV,10368.23,,,,,,,Fee Schedule,6417,16037.41,
VASC EMBOLIZE OCCLUDE ORGAN,8210363,LOCAL,37243,CPT,,,360,RC,,Outpatient,,,23819.19,15482,Aetna Med ADV,Aetna Med ADV,10368.23,,,,,,,Fee Schedule,6417,16037.41,
VASC EMBOLIZE OCCLUDE VENOUS,8210361,LOCAL,37241,CPT,,,481,RC,,Outpatient,,,23819.19,15482,Aetna Med ADV,Aetna Med ADV,10368.23,,,,,,,Fee Schedule,6417,16037.41,
37238 STENT ANGIO VEIN INITIAL CHARGE,8230062,LOCAL,37238,CPT,,,481,RC,,Outpatient,,,24322.23,15809,Aetna Med ADV,Aetna Med ADV,10368.23,,,,,,,Fee Schedule,6417,16037.41,
37236 Stent Angioplasty Artery Int,8230060,LOCAL,37236,CPT,,,360,RC,,Outpatient,,,24565.45,15968,Aetna Med ADV,Aetna Med ADV,10368.23,,,,,,,Fee Schedule,6417,16037.41,
SACRAL NERVE (TRANSFORAMINAL PLACEMENT),8268100,LOCAL,64581,CPT,,,274,RC,,Outpatient,,,25121.42,1108,Aetna Med ADV,Aetna Med ADV,6000.2,,,,,,,Fee Schedule,6000.2,8672.71,
SHOULDER SYSTEMHEAD DWF041,4811086,LOCAL,,,L3975,HCPCS,360,RC,,Outpatient,,,25817,,Aetna Med ADV,Aetna Med ADV,1889.33,,,,,,,Fee Schedule,1889.33,1889.33,
PTA BRACHIOCEPHALIC TRUNK W S&I,8210280,LOCAL,37246,CPT,,,360,RC,,Outpatient,,,27065.23,17592,Aetna Med ADV,Aetna Med ADV,5212.67,,,,,,,Fee Schedule,5212.67,5787,
A V PACEMAKER IMPLANT INS OR REPLACE,8210040,LOCAL,33208,CPT,,,360,RC,,Outpatient,,,27707.8,18010,Aetna Med ADV,Aetna Med ADV,9568.03,,,,,,,Fee Schedule,8379,12132.94,
UPGRADE SGL DUAL LEAD/CHAMBER,8210090,LOCAL,33214,CPT,,,481,RC,,Outpatient,,,27707.8,18010,Aetna Med ADV,Aetna Med ADV,9568.03,,,,,,,Fee Schedule,8379,12132.94,
C9773 Revasc Lithotrip-Stent Tib/Peroneal Atr (Shockwave IVL),8230075,LOCAL,,,C9773,HCPCS,481,RC,,Outpatient,,,28353.6,18430,Aetna Med ADV,Aetna Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
C9774 Revasc Lithotr-Ather Tib/Peroneal Atr (Shockwave IVL),8230076,LOCAL,,,C9774,HCPCS,481,RC,,Outpatient,,,28353.6,18430,Aetna Med ADV,Aetna Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
C9775 Revasc Lithotr-Stent-Ather-Peroneal Atr (Shockwave IVL),8230077,LOCAL,,,C9775,HCPCS,481,RC,,Outpatient,,,28353.6,18430,Aetna Med ADV,Aetna Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
"C9765 Revasculation, Endovascular, With Intravascular Lithotripsy, With Stent Placement Includes Ang",8230071,LOCAL,,,C9765,HCPCS,481,RC,,Outpatient,,,29724,19321,Aetna Med ADV,Aetna Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
"C9766 Revasculation, Endovascular, With Intravascular Lithotripsy, Includes Atherectomy",8230072,LOCAL,,,C9766,HCPCS,,,,Outpatient,,,29724,19321,Aetna Med ADV,Aetna Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
tenecteplase 50 mg intravenous injection [CULL],11211269,LOCAL,J3101,CPT,,,480,RC,,Outpatient,1,EA,31861.472,,Aetna Med ADV,Aetna Med ADV,172.22,,,,,,,Fee Schedule,172.22,7537.07,
PTA STENT TIBPERONEAL INITIAL,8230024,LOCAL,37230,CPT,,,481,RC,,Outpatient,,,32737,21279,Aetna Med ADV,Aetna Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ST ATHRC CPX 1,8230037,LOCAL,37227,CPT,,,,,,Outpatient,,,33085.18,21505,Aetna Med ADV,Aetna Med ADV,16417.11,,,,,,,Fee Schedule,9233,16417.11,
alteplase 100 mg intravenous injection [CULL],11201042,LOCAL,J2997,CPT,,,636,RC,,Outpatient,1,ML,33793.376,,Aetna Med ADV,Aetna Med ADV,94.45,,,,,,,Fee Schedule,94.45,122.4,
SIMPLIDERM ACELLULAR DERMAL,13962604,LOCAL,,,Q4116,HCPCS,481,RC,,Outpatient,,,38160,,Aetna Med ADV,Aetna Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
"C9767 Revasculation, Endovascular, With Intravascular Lithotripsy, With Stent Placement And Atherect",8230073,LOCAL,,,C9767,HCPCS,278,RC,,Outpatient,,,39850,25903,Aetna Med ADV,Aetna Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
IMPLANTABLE STIM 2-LEAD EBI 10-1335M,4802519,LOCAL,,,E0749,HCPCS,480,RC,,Outpatient,,,43032,22885,Aetna Med ADV,Aetna Med ADV,347.98,,,,,,,Fee Schedule,347.98,347.98,
PTA ARTHRECTOMY STENT TIBPERONEAL INITIA,8230025,LOCAL,37231,CPT,,,360,RC,,Outpatient,,,50564,32867,Aetna Med ADV,Aetna Med ADV,16417.11,,,,,,,Fee Schedule,9233,16417.11,
ICD INSERTION WITH EXISTING SINGLE LEAD,8231000,LOCAL,33240,CPT,,,360,RC,,Outpatient,,,51027.88,33168,Aetna Med ADV,Aetna Med ADV,20521.65,,,,,,,Fee Schedule,12499,36378.11,
ICD REMOVAL&REPLACE SINGLE,8267790,LOCAL,33262,CPT,,,360,RC,,Outpatient,,,65510.7,42582,Aetna Med ADV,Aetna Med ADV,20521.65,,,,,,,Fee Schedule,12499,36378.11,
ICD REMOVAL&REPLACE DUAL LEAD,8267778,LOCAL,33263,CPT,,,360,RC,,Outpatient,,,67510.7,43882,Aetna Med ADV,Aetna Med ADV,20521.65,,,,,,,Fee Schedule,12499,36378.11,
ICD REMOVAL&REPLACE MULTIPLE,8267791,LOCAL,33264,CPT,,,,,,Outpatient,,,70510.7,45832,Aetna Med ADV,Aetna Med ADV,29312.62,,,,,,,Fee Schedule,12499,36378.11,
"45300 Proctosigmoidoscopy, rigid; diagnostic, w/ or w/o collection by brushing or washing",7962380,LOCAL,45300,CPT,,,771,RC,,Outpatient,,,198,129,Aetna Med ADV,Aetna Med ADV,833.54,,,,,,,Fee Schedule,833.54,1419.32,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,90471,CPT,,,,,,Outpatient,,,216.15,140,Aetna Med ADV,Aetna Med ADV,65.07,,,,,,,Fee Schedule,42.18,65.07,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,G0010,CPT,,,,,,Outpatient,,,216.15,,Aetna Med ADV,Aetna Med ADV,42.18,,,,,,,Fee Schedule,42.18,65.07,
"25105 ARTHROTOMY, WRIST JOINT WITH SYNOVECTOMY",14130163,LOCAL,25105,CPT,,,972,RC,,Outpatient,,,895,3245,Aetna Med ADV,Aetna Med ADV,2966.42,,,,,,,Fee Schedule,2528.75,2966.42,
PC DOPP ART BIL REST MULTIPLE/SINGLE,8230015,LOCAL,93923,CPT,,,960,RC,26,Outpatient,,,57.19,401,Aetna Med ADV,Aetna Med ADV,143.05,,,,,,,Fee Schedule,143.05,244.97,
PC DOPP ART W/TREADMILL,8230020,LOCAL,93924,CPT,,,960,RC,26,Outpatient,,,241,302,Aetna Med ADV,Aetna Med ADV,143.05,,,,,,,Fee Schedule,143.05,161.71,
PC DOPP LEA LIMITED,8230019,LOCAL,93922,CPT,,,972,RC,26,Outpatient,,,150,265,Aetna Med ADV,Aetna Med ADV,117.85,,,,,,,Fee Schedule,117.85,161.71,
PC DUP ABD RENAL COMPLETE,8200571,LOCAL,93975,CPT,,,972,RC,26,Outpatient,,,229.11,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP ABD RENAL LIMITED,8200581,LOCAL,93976,CPT,,,972,RC,26,Outpatient,,,134.88,482,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,245.49,
PC DUP AO IVC COMPLETE,8200570,LOCAL,93978,CPT,,,972,RC,26,Outpatient,,,74.95,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP AO IVC LIMITED,8200580,LOCAL,93979,CPT,,,972,RC,26,Outpatient,,,50.12,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP CAROTID BILATERAL,8200229,LOCAL,93880,CPT,,,972,RC,26,Outpatient,,,76.13,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP CAROTID UNILATERAL,8200228,LOCAL,93882,CPT,,,972,RC,26,Outpatient,,,46.65,482,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP HEMODIALYSIS ACCESS,8200582,LOCAL,93990,CPT,,,972,RC,26,Outpatient,,,29.64,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP LEA BIL,8200577,LOCAL,93925,CPT,,,972,RC,26,Outpatient,,,66.27,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP LEA UNI,8200576,LOCAL,93926,CPT,,,972,RC,26,Outpatient,,,45.08,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP UPPER ART BIL,8200575,LOCAL,93930,CPT,,,972,RC,26,Outpatient,,,53.18,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,161.71,220.99,
PC DUP UPPER ART UNI,8200574,LOCAL,93931,CPT,,,972,RC,26,Outpatient,,,35.48,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP VENOUS BIL,8200573,LOCAL,93970,CPT,,,972,RC,26,Outpatient,,,87.58,482,Aetna Med ADV,Aetna Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP VENOUS UNI,8200572,LOCAL,93971,CPT,,,972,RC,26,Outpatient,,,57.12,310,Aetna Med ADV,Aetna Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC US PSEUDOANEURYSM COMPRESSION REPAIR,8200583,LOCAL,76936,CPT,,,942,RC,26,Outpatient,,,285.6,237.6,Aetna Med ADV,Aetna Med ADV,284.7,,,,,,,Fee Schedule,262.79,284.7,
97802 MEDICAL NUTRITIONAL THERAPY PROF CHARGE,13475611,LOCAL,97802,CPT,,,942,RC,,Outpatient,,,70,55,Aetna Med ADV,Aetna Med ADV,25.2,,,,,,,Fee Schedule,25.2,287.34,
97803 MEDICAL NUTRITIONAL RE-ASSESSMENT PROF CHARG,13481228,LOCAL,97803,CPT,,,511,RC,,Outpatient,,,60,48,Aetna Med ADV,Aetna Med ADV,21.06,,,,,,,Fee Schedule,21.06,287.34,
"64640 Destruction by neurolytic agent, other perip",13959658,LOCAL,64640,CPT,,,510,RC,,Outpatient,,,500,927,Aetna Med ADV,Aetna Med ADV,813.96,,,,,,,Fee Schedule,813.96,1695.82,
10060 PROFEE Drainage of skin abscess,13954453,LOCAL,10060,CPT,,,510,RC,,Outpatient,,,220,420,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
10061  I&D abscess complicated/multiple Profee,13769279,LOCAL,10061,CPT,,,510,RC,,Outpatient,,,385,420,Aetna Med ADV,Aetna Med ADV,365.27,,,,,,,Fee Schedule,239.03,863,
10120 Incision & Removal Foreign Body Simp PROFEE,14006132,LOCAL,10120,CPT,,,510,RC,,Outpatient,,,285,893,Aetna Med ADV,Aetna Med ADV,365.27,,,,,,,Fee Schedule,239.03,863,
"11042 PROFEE Debride subcutaneous tissue, 1st 20 s",13962336,LOCAL,11042,CPT,,,510,RC,,Outpatient,,,145,836,Aetna Med ADV,Aetna Med ADV,365.27,,,,,,,Fee Schedule,365.27,863,
11043 PROFEE DEB MUSC/FASCIA 20 SQ CM/<,13967660,LOCAL,11043,CPT,,,510,RC,,Outpatient,,,340,836,Aetna Med ADV,Aetna Med ADV,559.65,,,,,,,Fee Schedule,549.61,863,
"11044 Debride bone, 1st 20 sq cm or less Pro Fee",11221020,LOCAL,11044,CPT,,,510,RC,,Outpatient,,,465,2328,Aetna Med ADV,Aetna Med ADV,1481.32,,,,,,,Fee Schedule,1291,1481.32,
"11045 Debride subq tissue, ea addl 20 sq cm Pro Fe",11221021,LOCAL,11045,CPT,,,510,RC,,Outpatient,,,50,836,Aetna Med ADV,Aetna Med ADV,20.61,,,,,,,Fee Schedule,20.61,1466.58,
11046 PROFEE Debride muscle and/or fascia; ea addl,13954830,LOCAL,11046,CPT,,,510,RC,,Outpatient,,,128,836,Aetna Med ADV,Aetna Med ADV,44.01,,,,,,,Fee Schedule,44.01,1466.58,
"11047 PROFEE Debridement, sus tissue each add 20 s",13967661,LOCAL,11047,CPT,,,510,RC,,Outpatient,,,195,2092,Aetna Med ADV,Aetna Med ADV,78.26,,,,,,,Fee Schedule,78.26,1466.58,
11104 Punch Biopsy of Skin; Single Lesion ProFee,8768419,LOCAL,11104,CPT,,,510,RC,,Outpatient,,,243.42,449,Aetna Med ADV,Aetna Med ADV,365.27,,,,,,,Fee Schedule,365.27,863,
11106  Incisional biopsy of skin single lesion Pro,13759967,LOCAL,11106,CPT,,,510,RC,,Outpatient,,,296,800,Aetna Med ADV,Aetna Med ADV,559.65,,,,,,,Fee Schedule,559.65,1291,
"11400 EXCISION, BENIGN LESION INCLUDING MARGINS, E",7929974,LOCAL,11400,CPT,,,510,RC,,Outpatient,,,160,935,Aetna Med ADV,Aetna Med ADV,643.26,,,,,,,Fee Schedule,643.26,1291,
"11406 EXCISION, BENIGN LESION INCLUDING MARGINS, E",7929979,LOCAL,11406,CPT,,,510,RC,,Outpatient,,,470,1620,Aetna Med ADV,Aetna Med ADV,1481.32,,,,,,,Fee Schedule,1481.32,2584.84,
"11604 EXCISION, MALIGNANT LESION INCLUDING MARGINS",7930002,LOCAL,11604,CPT,,,510,RC,,Outpatient,,,410,704,Aetna Med ADV,Aetna Med ADV,643.26,,,,,,,Fee Schedule,643.26,1679.75,
"11730 PROFEE Avulsion nail plate simple, single",13967650,LOCAL,11730,CPT,,,510,RC,,Outpatient,,,195,228,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,95.93,863,
"11750 PROFEE Excision of nail and nail matrix, par",13954836,LOCAL,11750,CPT,,,510,RC,,Outpatient,,,305,1342,Aetna Med ADV,Aetna Med ADV,365.27,,,,,,,Fee Schedule,365.27,863,
15271 PROFEE Application of skin substitute graft,13967652,LOCAL,15271,CPT,,,510,RC,,Outpatient,,,296,1092,Aetna Med ADV,Aetna Med ADV,1672.39,,,,,,,Fee Schedule,1496,2862.92,
15275 PROFEE APPLICATION OF SKIN SUBSTITUTE GRAFT,13954832,LOCAL,15275,CPT,,,510,RC,,Outpatient,,,306,1092,Aetna Med ADV,Aetna Med ADV,1672.39,,,,,,,Fee Schedule,1496,2862.92,
"28810 AMPUTATION, METATARSAL, WITH TOE, SINGLE Pro",7931853,LOCAL,28810,CPT,,,510,RC,,Outpatient,,,820,3245,Aetna Med ADV,Aetna Med ADV,2966.42,,,,,,,Fee Schedule,2315,7645.84,
29445 PROFEE APPLICATION OF RIGID TOTAL CONTACT LE,13962328,LOCAL,29445,CPT,,,510,RC,,Outpatient,,,200,266,Aetna Med ADV,Aetna Med ADV,242.81,,,,,,,Fee Schedule,242.81,863,
31502 Tracheotomy tube change prior to establishme,14397259,LOCAL,31502,CPT,,,510,RC,,Outpatient,,,80,232,Aetna Med ADV,Aetna Med ADV,212.31,,,,,,,Fee Schedule,162.41,863,
"31899 UNLISTED PROCEDURE, TRACHEA, BRONCHI ProFee",7932202,LOCAL,31899,CPT,,,510,RC,,Outpatient,,,91,194,Aetna Med ADV,Aetna Med ADV,177.49,,,,,,,Fee Schedule,177.49,2400.33,
"58573 LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTO",14831670,LOCAL,58573,CPT,,,983,RC,,Outpatient,,,2172,10411,Aetna Med ADV,Aetna Med ADV,9518.56,,,,,,,Fee Schedule,5787,9518.56,
64454 Genicular Nerve Block Profee,13911832,LOCAL,64454,CPT,,,,,,Outpatient,,,227,244,Aetna Med ADV,Aetna Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
64999 XX UNLISTED NERVOUS SYSTEM INJECTION,7939552,LOCAL,64999,CPT,,,976,RC,,Outpatient,,,250,620,Aetna Med ADV,Aetna Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
93010 EKG INTERPRETATION,7939709,LOCAL,93010,CPT,,,975,RC,,Outpatient,,,65,,Aetna Med ADV,Aetna Med ADV,10.44,,,,,,,Fee Schedule,10.44333333,38.53,
93451 RIGHT HEART CATHERIZATION (OR),8192212,LOCAL,93451,CPT,,,510,RC,26,Outpatient,,,1008,6246,Aetna Med ADV,Aetna Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
97597 WOUND DEBRIDEMENT ProFee,7935939,LOCAL,97597,CPT,,,510,RC,,Outpatient,,,188.32,395,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
97598 DEBRID SELCT EA ADD20SQCM ProFee,7935940,LOCAL,97598,CPT,,,983,RC,,Outpatient,,,83,395,Aetna Med ADV,Aetna Med ADV,20.42,,,,,,,Fee Schedule,20.42,1466.58,
97605 Negative pressure wound therapy less than 50,14327888,LOCAL,97605,CPT,,,510,RC,,Outpatient,,,80,285,Aetna Med ADV,Aetna Med ADV,181.66,,,,,,,Fee Schedule,181.66,273.27,
99183 HBO PER SESSION ProFee,7935966,LOCAL,99183,CPT,,,510,RC,,Outpatient,,,210,,Aetna Med ADV,Aetna Med ADV,145.15,,,,,,,Fee Schedule,145.1479032,145.1479032,
99202 LEVEL 2 VISIT NEW PT ProFee,7935970,LOCAL,99202,CPT,,,510,RC,,Outpatient,,,140,294,Aetna Med ADV,Aetna Med ADV,39.11,,,,,,,Fee Schedule,39.11,39.11,
99203 LEVEL 3 VISIT NEW PT ProFee,7935971,LOCAL,99203,CPT,,,510,RC,,Outpatient,,,200,387,Aetna Med ADV,Aetna Med ADV,67.57,,,,,,,Fee Schedule,67.57,67.57,
99204 LEVEL 4 NEW PT PROF CHARGE,8700762,LOCAL,99204,CPT,,,510,RC,,Outpatient,,,305,513,Aetna Med ADV,Aetna Med ADV,110.67,,,,,,,Fee Schedule,110.67,110.67,
99205 PROFEE OFFICE VISIT LEV 5 NEW PT,13962366,LOCAL,99205,CPT,,,510,RC,,Outpatient,,,385,701,Aetna Med ADV,Aetna Med ADV,151.18,,,,,,,Fee Schedule,151.18,151.18,
99211 LEVEL 1 EST PT PROF CHARGE,8700763,LOCAL,99211,CPT,,,510,RC,,Outpatient,,,40,226,Aetna Med ADV,Aetna Med ADV,7.37,,,,,,,Fee Schedule,7.37,7.37,
99212 LEVEL 2 EST PT PROF CHARGE,8700764,LOCAL,99212,CPT,,,510,RC,,Outpatient,,,100,294,Aetna Med ADV,Aetna Med ADV,29.48,,,,,,,Fee Schedule,29.48,29.48,
99213 LEVEL 3 EST PT PROF CHARGE,8700765,LOCAL,99213,CPT,,,510,RC,,Outpatient,,,135,387,Aetna Med ADV,Aetna Med ADV,54.77,,,,,,,Fee Schedule,54.77,54.77,
99214 LEVEL 4 EST PT PROF CHARGE,8700766,LOCAL,99214,CPT,,,510,RC,,Outpatient,,,200,513,Aetna Med ADV,Aetna Med ADV,80.51,,,,,,,Fee Schedule,80.51,80.51,
99215 LEVEL 5 EST PT PROF CHARGE,8700767,LOCAL,99215,CPT,,,942,RC,,Outpatient,,,270,701,Aetna Med ADV,Aetna Med ADV,119.41,,,,,,,Fee Schedule,119.41,119.41,
G0108 DIABETES SERVICE 30 MIN PROF CHARGE,13484119,LOCAL,G0108,CPT,,,942,RC,,Outpatient,,,105,128,Aetna Med ADV,Aetna Med ADV,52.15,,,,,,,Fee Schedule,52.15,95.93,
G0109 DSMT DIABETES GROUP 30 MIN ProFee,7936084,LOCAL,G0109,CPT,,,,,,Outpatient,,,30,18,Aetna Med ADV,Aetna Med ADV,14.97,,,,,,,Fee Schedule,14.97,67.18,
IMPLANT MEMORY GEL #350-6004BC,4803876,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,0.01,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
"Protein, Tot & Prot Electrop Interp QSTC",8852423,LOCAL,84165,CPT,,,301,RC,,Outpatient,,,3.92,12.89,Viva Med ADV,Viva Med ADV,2.8,,,,,,,Fee Schedule,2.796363636,17.73,
"Protein, Total QSTC",8852413,LOCAL,84165,CPT,,,301,RC,,Outpatient,,,3.92,12.89,Viva Med ADV,Viva Med ADV,2.8,,,,,,,Fee Schedule,2.796363636,17.73,
DRESSING TELFA ISLAND 4X10,11074306,LOCAL,,,L3908,HCPCS,270,RC,,Outpatient,,,4.29,86,Viva Med ADV,Viva Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
.RPR Titer QSTC,6231113,LOCAL,86593,CPT,,,302,RC,,Outpatient,,,5.9,5.28,Viva Med ADV,Viva Med ADV,4.4,,,,,,,Fee Schedule,4.4,15.29,
UA Microscopic,633864,LOCAL,81015,CPT,,,301,RC,,Outpatient,,,6,3.66,Viva Med ADV,Viva Med ADV,1.68,,,,,,,Fee Schedule,1.68192607,4.02,
Urinalysis Review Manual,8502419,LOCAL,81015,CPT,,,301,RC,,Outpatient,,,6,3.66,Viva Med ADV,Viva Med ADV,1.68,,,,,,,Fee Schedule,1.68192607,4.02,
Hematocrit QSTC,8852782,LOCAL,85014,CPT,,,301,RC,,Outpatient,,,7.21,2.84,Viva Med ADV,Viva Med ADV,12.62,,,,,,,Fee Schedule,8.21,12.62068493,
Hemoglobin A2 (Quant) QSTC,8852791,LOCAL,83020,CPT,,,301,RC,,Outpatient,,,7.21,15.44,Viva Med ADV,Viva Med ADV,12.87,,,,,,,Fee Schedule,12.87,17.73,
Hemoglobin QSTC,8852780,LOCAL,85018,CPT,,,301,RC,,Outpatient,,,7.21,2.84,Viva Med ADV,Viva Med ADV,10.94,,,,,,,Fee Schedule,8.21,10.94316176,
Red Blood Cell Count QSTC,8852779,LOCAL,85041,CPT,,,301,RC,,Outpatient,,,7.21,3.62,Viva Med ADV,Viva Med ADV,3.02,,,,,,,Fee Schedule,3.02,8.21,
87107 Fungal Isolate Identification QST,14813753,LOCAL,87107,CPT,,,300,RC,,Outpatient,,,7.5,12.38,Viva Med ADV,Viva Med ADV,10.32,,,,,,,Fee Schedule,10.32,20.05,
87143 Fungal Isolate Identification QST,14815667,LOCAL,87143,CPT,,,300,RC,,Outpatient,,,7.5,15.02,Viva Med ADV,Viva Med ADV,12.52,,,,,,,Fee Schedule,10.57,12.52,
87149 Fungal Isolate Identification QST,14813753,LOCAL,87149,CPT,,,300,RC,,Outpatient,,,7.5,24.06,Viva Med ADV,Viva Med ADV,20.05,,,,,,,Fee Schedule,10.32,20.05,
Glucose Fasting Urine,7974487,LOCAL,81003,CPT,,,307,RC,,Outpatient,,,7.88,2.7,Viva Med ADV,Viva Med ADV,3.8,,,,,,,Fee Schedule,3.795286195,4.02,
"Uric Acid, Synovial Fluid QSTC",9607980,LOCAL,84560,CPT,,,301,RC,,Outpatient,,,8.37,6.1,Viva Med ADV,Viva Med ADV,19.49,,,,,,,Fee Schedule,7.16,19.49,
Alkaline Phosphatase QSTC,8848272,LOCAL,84075,CPT,,,301,RC,,Outpatient,,,9.11,6.22,Viva Med ADV,Viva Med ADV,5.18,,,,,,,Fee Schedule,5.18,7.16,
Bone Isoenzymes QSTC,8848275,LOCAL,84080,CPT,,,301,RC,,Outpatient,,,9.11,17.74,Viva Med ADV,Viva Med ADV,14.78,,,,,,,Fee Schedule,14.78,17.73,
SLING ARM MEDIUM,11070727,LOCAL,,,L1830,HCPCS,270,RC,,Outpatient,,,9.3,158,Viva Med ADV,Viva Med ADV,77.23,,,,,,,Fee Schedule,77.23,77.23,
acetylcysteine 20% Inhalation Sol [CULL],11208888,LOCAL,J7608,CPT,,,,,,Outpatient,1,ML,10,,Viva Med ADV,Viva Med ADV,8.46,,,,,,,Fee Schedule,8.455,8.455,
albuterol 1.25 mg/3 mL (0.042%) Sol [CULL],11203025,LOCAL,J7613,CPT,,,,,,Outpatient,3,ML,10,,Viva Med ADV,Viva Med ADV,4.66,,,,,,,Fee Schedule,4.66,4.66,
albuterol 2.5 mg/3 mL (0.083%) inhalation solution 3 mL [CULL],11203024,LOCAL,J7613,CPT,,,,,,Outpatient,3,ML,10,,Viva Med ADV,Viva Med ADV,4.66,,,,,,,Fee Schedule,4.66,4.66,
albuterol 5 mg/mL (0.5%) inhalation solution [CULL],11203026,LOCAL,J7611,CPT,,,,,,Outpatient,1,ML,10,,Viva Med ADV,Viva Med ADV,0.26,,,,,,,Fee Schedule,0.262,0.262,
amiodarone 50 mg/mL intravenous solution 3 mL [CULL],11200004,LOCAL,J0282,CPT,,,,,,Outpatient,3,ML,10,,Viva Med ADV,Viva Med ADV,0.41,,,,,,,Fee Schedule,0.409,0.409,
azaTHIOprine 50 mg oral tablet [CULL],11200492,LOCAL,J7500,CPT,,,,,,Outpatient,1,EA,10,,Viva Med ADV,Viva Med ADV,0.06,,,,,,,Fee Schedule,0.057,0.057,
BUPivacaine 0.25% preservative-free Sol [CULL],11282035,LOCAL,J0665,CPT,,,,,,Outpatient,10,ML,10,,Viva Med ADV,Viva Med ADV,0.01,,,,,,,Fee Schedule,0.01,0.011,
BUPivacaine 0.75%-D8.25% preservative-free intrathecal solution 2 mL [CULL],11202136,LOCAL,J0665,CPT,,,,,,Outpatient,2,ML,10,,Viva Med ADV,Viva Med ADV,0.01,,,,,,,Fee Schedule,0.01,0.011,
cycloSPORINE modified 25 mg oral capsule [CULL],11210499,LOCAL,J7515,CPT,,,,,,Outpatient,1,EA,10,,Viva Med ADV,Viva Med ADV,0.53,,,,,,,Fee Schedule,0.526,0.526,
dexAMETHasone 10 mg/mL injectable solution 1 mL [CULL],11202292,LOCAL,J1100,CPT,,,,,,Outpatient,1,ML,10,,Viva Med ADV,Viva Med ADV,10.49,,,,,,,Fee Schedule,10.48743758,10.48743758,
ipratropium 500 mcg/2.5 mL inhalation solution 2.5 mL [CULL],11203105,LOCAL,J7644,CPT,,,,,,Outpatient,2.5,ML,10,,Viva Med ADV,Viva Med ADV,0.4,,,,,,,Fee Schedule,0.4,0.4,
ketorolac 60 mg/2 mL Sol [CULL],11202716,LOCAL,J1885,CPT,,,,,,Outpatient,2,ML,10,,Viva Med ADV,Viva Med ADV,0.27,,,,,,,Fee Schedule,0.27,0.27,
levalbuterol 0.31 mg/3 mL inhalation solution 3 mL [CULL],11203125,LOCAL,J7614,CPT,,,,,,Outpatient,3,ML,10,,Viva Med ADV,Viva Med ADV,0.08,,,,,,,Fee Schedule,0.083,0.083,
levalbuterol 0.63 mg/3 mL inhalation solution 3 mL [CULL],11203127,LOCAL,J7614,CPT,,,,,,Outpatient,3,ML,10,,Viva Med ADV,Viva Med ADV,0.08,,,,,,,Fee Schedule,0.083,0.083,
levalbuterol 1.25 mg/3 mL inhalation solution 3 mL [CULL],11203128,LOCAL,J7614,CPT,,,,,,Outpatient,3,ML,10,,Viva Med ADV,Viva Med ADV,0.08,,,,,,,Fee Schedule,0.083,0.083,
methylPREDNISolone 4 mg oral tablet [CULL],11230944,LOCAL,J7509,CPT,,,,,,Outpatient,1,EA,10,,Viva Med ADV,Viva Med ADV,0.14,,,,,,,Fee Schedule,0.139,0.139,
mitoMYcin 20 mg/40 mL Sol [CULL],11205507,LOCAL,J9280,CPT,,,,,,Outpatient,0.5,ML,10,,Viva Med ADV,Viva Med ADV,20.35,,,,,,,Fee Schedule,20.35,525.49,
ondansetron 2 mg/mL injectable solution 2 mL [CULL],11211057,LOCAL,J2405,CPT,,,,,,Outpatient,2,ML,10,,Viva Med ADV,Viva Med ADV,0.06,,,,,,,Fee Schedule,0.057806268,0.057806268,
phenytoin 50 mg/mL injectable solution 2 mL [CULL],11282560,LOCAL,J1165,CPT,,,,,,Outpatient,2,ML,10,,Viva Med ADV,Viva Med ADV,0.6,,,,,,,Fee Schedule,0.595,0.595,
phenytoin 50 mg/mL injectable solution 5 mL [CULL],11212135,LOCAL,J1165,CPT,,,,,,Outpatient,5,ML,10,,Viva Med ADV,Viva Med ADV,0.6,,,,,,,Fee Schedule,0.595,0.595,
prednisoLONE sodium phosphate 15 mg/5 mL Liq [CULL],11250339,LOCAL,J7510,CPT,,,,,,Outpatient,5,ML,10,,Viva Med ADV,Viva Med ADV,0.92,,,,,,,Fee Schedule,0.919,0.919,
"rabies immune globulin, human 150 intl units/mL intramuscular solution 2 mL [CULL]",11212251,LOCAL,90376,CPT,,,,,,Outpatient,0.007,ML,10,347,Viva Med ADV,Viva Med ADV,347.32,,,,,,,Fee Schedule,347.32,2110.36,
tacrolimus 0.5 mg oral capsule [CULL],11205999,LOCAL,J7507,CPT,,,,,,Outpatient,1,EA,10,,Viva Med ADV,Viva Med ADV,0.2,,,,,,,Fee Schedule,0.197,0.197,
tobramycin 40 mg/mL injectable solution 2 mL [CULL],11212375,LOCAL,J3260,CPT,,,,,,Outpatient,2,ML,10,,Viva Med ADV,Viva Med ADV,2.07,,,,,,,Fee Schedule,2.071,2.071,
BUPivacaine 0.25% preservative-free injectable solution 30 mL [CULL],11202111,LOCAL,J0665,CPT,,,,,,Outpatient,30,ML,10.24,,Viva Med ADV,Viva Med ADV,0.01,,,,,,,Fee Schedule,0.01,0.011,
"Protein, Total, Peritoneal Fluid QSTC",9039313,LOCAL,84157,CPT,,,,,,Outpatient,,,10.44,4.8,Viva Med ADV,Viva Med ADV,4,,,,,,,Fee Schedule,4,7.16,
Rheumatoid Factor QSTC,9039252,LOCAL,86431,CPT,,,,,,Outpatient,,,10.8,6.8,Viva Med ADV,Viva Med ADV,6.3,,,,,,,Fee Schedule,6.29875,15.29,
ketorolac 30 mg/mL injectable solution 1 mL [CULL],11202715,LOCAL,J1885,CPT,,,,,,Outpatient,1,ML,10.944,,Viva Med ADV,Viva Med ADV,0.27,,,,,,,Fee Schedule,0.27,0.27,
RPR (Dx) w/Refl Titer/Confrm Testing QST,8972905,LOCAL,86592,CPT,,,,,,Outpatient,,,11.16,5.12,Viva Med ADV,Viva Med ADV,19.99,,,,,,,Fee Schedule,15.29,19.99375,
RPR (Monitor) w/Refl Titer QSTC,8972905,LOCAL,86592,CPT,,,,,,Outpatient,,,11.16,5.12,Viva Med ADV,Viva Med ADV,19.99,,,,,,,Fee Schedule,15.29,19.99375,
cefuroxime 750 mg injection [CULL],11201445,LOCAL,J0697,CPT,,,,,,Outpatient,1,EA,11.22304,,Viva Med ADV,Viva Med ADV,2.05,,,,,,,Fee Schedule,2.054,2.054,
"Creatinine, Random Ur QSTC",9320766,LOCAL,82570,CPT,,,,,,Outpatient,,,11.25,6.22,Viva Med ADV,Viva Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
BUPivacaine 0.5% preservative-free injectable solution 10 mL [CULL],11282050,LOCAL,J0665,CPT,,,,,,Outpatient,10,ML,11.52,,Viva Med ADV,Viva Med ADV,0.01,,,,,,,Fee Schedule,0.01,0.011,
ciprofloxacin 200 mg/100 mL-D5% intravenous solution 100 mL [CULL],11201485,LOCAL,J0744,CPT,,,,,,Outpatient,100,ML,11.52,,Viva Med ADV,Viva Med ADV,2,,,,,,,Fee Schedule,1.997,1.997,
diphenhydrAMINE 50 mg/mL injectable solution 1 mL [CULL],11202342,LOCAL,J1200,CPT,,,,,,Outpatient,1,ML,11.5584,,Viva Med ADV,Viva Med ADV,0.14,,,,,,,Fee Schedule,0.143,0.143,
HYDROmorphone 2 mg/mL Sol [CULL],11202621,LOCAL,J1171,CPT,,,,,,Outpatient,1,ML,11.7504,,Viva Med ADV,Viva Med ADV,1.84,,,,,,,Fee Schedule,1.836603774,1.836603774,
Source QSTC,8983584,LOCAL,87209,CPT,,,,,,Outpatient,,,13.19,21.58,Viva Med ADV,Viva Med ADV,17.98,,,,,,,Fee Schedule,10.57,17.98,
ampicillin 500 mg injection [CULL],11201162,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,13.28,,Viva Med ADV,Viva Med ADV,0.59,,,,,,,Fee Schedule,0.591,0.591,
ampicillin 250 mg injection [CULL],11201150,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,13.3952,,Viva Med ADV,Viva Med ADV,0.59,,,,,,,Fee Schedule,0.591,0.591,
clindamycin 150 mg/mL injectable solution 4 mL [CULL],11202228,LOCAL,J0736,CPT,,,,,,Outpatient,4,ML,13.4784,,Viva Med ADV,Viva Med ADV,0.82,,,,,,,Fee Schedule,0.819,0.819,
"ANA IFA Scrn w/Rfx Titr & Patt, IFA QSTC",8764654,LOCAL,86038,CPT,,,,,,Outpatient,,,13.5,14.51,Viva Med ADV,Viva Med ADV,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
"ANA Scr,IFA w/R Tit/Ptn/MPX Ab Casc QSTC",8764642,LOCAL,86038,CPT,,,,,,Outpatient,,,13.5,14.51,Viva Med ADV,Viva Med ADV,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
"Bacterial Identification, Aerobic QST",13344175,LOCAL,87077,CPT,,,,,,Outpatient,,,13.5,9.7,Viva Med ADV,Viva Med ADV,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
T3 Uptake QSTC,9039244,LOCAL,84479,CPT,,,,,,Outpatient,,,13.5,7.76,Viva Med ADV,Viva Med ADV,6.47,,,,,,,Fee Schedule,6.47,18.43,
COLLAR CERVICAL SOFT MEDIUM,11071045,LOCAL,,,L0120,HCPCS,,,,Outpatient,,,13.75,44,Viva Med ADV,Viva Med ADV,34.57,,,,,,,Fee Schedule,34.57,34.57,
HYDROmorphone 1 mg/mL Sol,11202620,LOCAL,J1171,CPT,,,,,,Outpatient,1,ML,13.824,,Viva Med ADV,Viva Med ADV,1.84,,,,,,,Fee Schedule,1.836603774,1.836603774,
tacrolimus 1 mg oral capsule [CULL],11205998,LOCAL,J7507,CPT,,,,,,Outpatient,1,EA,14.2704,,Viva Med ADV,Viva Med ADV,0.2,,,,,,,Fee Schedule,0.197,0.197,
Measles Antibody (IgG) QSTC,8764682,LOCAL,86765,CPT,,,,,,Outpatient,,,14.63,15.46,Viva Med ADV,Viva Med ADV,12.88,,,,,,,Fee Schedule,12.88,15.29,
gentamicin 60 mg/50 mL-NaCl 0.9% intravenous solution 50 mL [CULL],11201825,LOCAL,J1580,CPT,,,,,,Outpatient,50,ML,14.69466667,,Viva Med ADV,Viva Med ADV,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
SLING ARM LARGE,11071011,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,14.8,158,Viva Med ADV,Viva Med ADV,77.23,,,,,,,Fee Schedule,77.23,77.23,
HYDROmorphone 10 mg/mL Sol [CULL],11202625,LOCAL,J1171,CPT,,,,,,Outpatient,1,ML,14.96064,,Viva Med ADV,Viva Med ADV,1.84,,,,,,,Fee Schedule,1.836603774,1.836603774,
"hCG, Total, QN Male Only QSTC",8853229,LOCAL,84702,CPT,,,,,,Outpatient,,,15,18.06,Viva Med ADV,Viva Med ADV,15.05,,,,,,,Fee Schedule,15.05,18.43,
"Herpes Simplex Virus 2 (IgG), with Reflex to HSV-2 Inhibition QST",14811888,LOCAL,86696,CPT,,,,,,Outpatient,,,15,23.22,Viva Med ADV,Viva Med ADV,19.35,,,,,,,Fee Schedule,15.29,19.35,
gentamicin 80 mg/50 mL-NaCl 0.9% intravenous solution 50 mL [CULL],11201824,LOCAL,J1580,CPT,,,,,,Outpatient,50,ML,15.62533333,,Viva Med ADV,Viva Med ADV,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
gentamicin 40 mg/mL injectable solution 2 mL [CULL],11282205,LOCAL,J1580,CPT,,,,,,Outpatient,2,ML,15.6288,,Viva Med ADV,Viva Med ADV,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
HYDROmorphone 0.5 mg/0.5 mL Sol [CULL],11202622,LOCAL,J1171,CPT,,,,,,Outpatient,0.5,ML,15.936,,Viva Med ADV,Viva Med ADV,1.84,,,,,,,Fee Schedule,1.836603774,1.836603774,
gentamicin 120 mg/100 mL-NaCl 0.9% intravenous solution 100 mL [CULL],11209100,LOCAL,J1580,CPT,,,,,,Outpatient,100,ML,15.98666667,,Viva Med ADV,Viva Med ADV,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
alpha 1-proteinase inhibitor human Sol 10 mg [CULL],11211124,LOCAL,J0256,CPT,,,,,,Outpatient,1,EA,16,,Viva Med ADV,Viva Med ADV,5.46,,,,,,,Fee Schedule,5.46,2110.36,
"Chloride, Random Urine without Creatinine QSTC",10011691,LOCAL,82436,CPT,,,,,,Outpatient,,,16.25,6.9,Viva Med ADV,Viva Med ADV,5.75,,,,,,,Fee Schedule,5.75,7.16,
"Potassium, U24 w/o Creatinine QSTC",13864422,LOCAL,84133,CPT,,,,,,Outpatient,,,16.25,5.68,Viva Med ADV,Viva Med ADV,19.32,,,,,,,Fee Schedule,7.16,19.32,
Sickle Cell Screen QSTC,10073685,LOCAL,85660,CPT,,,,,,Outpatient,,,16.25,6.61,Viva Med ADV,Viva Med ADV,5.51,,,,,,,Fee Schedule,5.51,8.21,
gentamicin 100 mg/100 mL-NaCl 0.9% intravenous solution 100 mL [CULL],11201827,LOCAL,J1580,CPT,,,,,,Outpatient,100,ML,16.41066667,,Viva Med ADV,Viva Med ADV,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
"Creatinine, Random Ur, Microalbumin QSTC",9041589,LOCAL,82570,CPT,,,,,,Outpatient,,,16.88,6.22,Viva Med ADV,Viva Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Ratio, Microalbumin Random Ur QSTC",9041592,LOCAL,82043,CPT,,,,,,Outpatient,,,16.88,6.94,Viva Med ADV,Viva Med ADV,20.16,,,,,,,Fee Schedule,4.02,20.15557971,
Protein Level 24 Hour Urine,633811,LOCAL,84156,CPT,,,,,,Outpatient,,,17,4.4,Viva Med ADV,Viva Med ADV,11.68,,,,,,,Fee Schedule,7.16,11.68,
Thrombin Clotting Time QSTC,8764547,LOCAL,85670,CPT,,,,,,Outpatient,,,17.1,6.92,Viva Med ADV,Viva Med ADV,5.77,,,,,,,Fee Schedule,5.42,5.77,
"Urea Nitrogen Ur, Rand QSTC",13864416,LOCAL,84540,CPT,,,,,,Outpatient,,,17.1,6.67,Viva Med ADV,Viva Med ADV,5.56,,,,,,,Fee Schedule,5.56,7.16,
nalbuphine 10 mg/mL Sol,J2300,CPT,,,,,,,,Outpatient,10,ML,17.12,,Viva Med ADV,Viva Med ADV,3.45,,,,,,,Fee Schedule,3.45,3.45,
cycloSPORINE modified 100 mg oral capsule [CULL],11210500,LOCAL,J7502,CPT,,,,,,Outpatient,1,EA,17.58826667,,Viva Med ADV,Viva Med ADV,1.81,,,,,,,Fee Schedule,1.81,1.81,
SPLINT WRIST FOREARM LEFT LG,11071054,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,Viva Med ADV,Viva Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM LT MED,11071053,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,Viva Med ADV,Viva Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM LT SM,11071052,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,Viva Med ADV,Viva Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM RT LG,11071050,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,Viva Med ADV,Viva Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM RT MED,11071049,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,Viva Med ADV,Viva Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM RT PED,11071047,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,Viva Med ADV,Viva Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM RT SM,11071048,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,Viva Med ADV,Viva Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
95852 RANGE OF MOTION-HAND 15 MIN CHARGE,9410221,LOCAL,95852,CPT,,,,,GP,Outpatient,,,17.86,12,Viva Med ADV,Viva Med ADV,4.74,,,,,,,Fee Schedule,4.74,4.74,
SPLINT WRIST FOREARM LEFT X L,11074363,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.88,86,Viva Med ADV,Viva Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT XLG WRIST FOREARM RIGHT,11074362,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.88,86,Viva Med ADV,Viva Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
Creatine Kinase Isoenzyme Interp. QSTC,8852390,LOCAL,82550,CPT,,,,,,Outpatient,,,18,7.81,Viva Med ADV,Viva Med ADV,23.74,,,,,,,Fee Schedule,7.16,23.7373913,
Creatine Kinase Isoenzyme w/ Tot CK QSTC,8764767,LOCAL,82552,CPT,,,,,,Outpatient,,,18,16.07,Viva Med ADV,Viva Med ADV,13.39,,,,,,,Fee Schedule,13.39,17.73,
Creatine Kinase Isoenzymes w/o Ttl QSTC,13864524,LOCAL,82552,CPT,,,,,,Outpatient,,,18,16.07,Viva Med ADV,Viva Med ADV,13.39,,,,,,,Fee Schedule,13.39,17.73,
"Creatine Kinase, Total QSTC",8852386,LOCAL,82552,CPT,,,,,,Outpatient,,,18,16.07,Viva Med ADV,Viva Med ADV,13.39,,,,,,,Fee Schedule,13.39,17.73,
Rubella Antibody (IgG) QSTC,8853250,LOCAL,86762,CPT,,,,,,Outpatient,,,18,17.27,Viva Med ADV,Viva Med ADV,14.39,,,,,,,Fee Schedule,14.39,15.29,
Urine Creatinine,7050475,LOCAL,82570,CPT,,,,,,Outpatient,,,18,6.22,Viva Med ADV,Viva Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
Urine Protein Level,7412757,LOCAL,84156,CPT,,,,,,Outpatient,,,18,4.4,Viva Med ADV,Viva Med ADV,11.68,,,,,,,Fee Schedule,7.16,11.68,
phytonadione 1 mg/0.5 mL injectable solution 0.5 mL [CULL],11212147,LOCAL,J3430,CPT,,,,,,Outpatient,0.5,ML,18.223104,,Viva Med ADV,Viva Med ADV,2.81,,,,,,,Fee Schedule,2.808,2.808,
SPLINT WRIST FOREARM LT PED,11070883,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,18.43,86,Viva Med ADV,Viva Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
fosphenytoin 100 mgPE/2 mL Sol [CULL],11205072,LOCAL,Q2009,CPT,,,,,,Outpatient,2,ML,18.432,,Viva Med ADV,Viva Med ADV,1.47,,,,,,,Fee Schedule,1.47,1.47,
methylPREDNISolone 40 mg Pow [CULL],11204478,LOCAL,J2919,CPT,,,,,,Outpatient,1,UN,18.432,,Viva Med ADV,Viva Med ADV,0.21,,,,,,,Fee Schedule,0.21,0.21,
Almond (F20) IgE QST,14586519,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Alternaria Alternata (M6) IgE QST,14586545,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Brazil Nut (F18) IgE QST,14586553,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cashew Nut (F202) IgE QST,14586555,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cat Dander (E1) IgE QST,14586539,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cladosporium Herbarum (M2) IgE QST,14586543,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cockroach (I6) IgE QST,14586549,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Codfish (F3) IgE QST,14586521,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cow's Milk (F2) IgE QST,14586529,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dermatophagoides Farinae (D2) IgE QST,14586537,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dermatophagoides Pteronyssinu D1 IgE QST,14586535,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dog Dander (E5) IgE QST,14586541,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Egg White (F1) IgE QST,14586527,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Hazelnut (F17) IgE QST,14586551,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Immunoglobulin E QST,14586516,LOCAL,82785,CPT,,,,,,Outpatient,,,18.5,19.75,Viva Med ADV,Viva Med ADV,203.96,,,,,,,Fee Schedule,17.73,203.9616667,
Macadamia Nut (RF345) IgE QST,14586525,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Mouse Urine Proteins (E72) IgE QST,14586547,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Peanut (F13) IgE QST,14586517,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Shrimp (F24) IgE QST,14586523,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Soybean (F14) IgE QST,14586533,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Walnut (F256) IgE QST,14586557,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Wheat (F4) IgE QST,14586531,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
droNABinol 2.5 mg Cap [CULL],11220183,LOCAL,Q0167,CPT,,,,,,Outpatient,1,EA,18.853344,,Viva Med ADV,Viva Med ADV,1.35,,,,,,,Fee Schedule,1.352,1.352,
"HPV mRNA E6/E7, POST-$HYST, VAGINAL W/REFL QST",14782711,LOCAL,87624,CPT,,,,,,Outpatient,,,18.9,42.11,Viva Med ADV,Viva Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
Lead Capillary QSTC,14116315,LOCAL,83655,CPT,,,,,,Outpatient,,,19.12,14.53,Viva Med ADV,Viva Med ADV,13.99,,,,,,,Fee Schedule,13.99076923,16.07,
"Lead, Blood QSTC",8764839,LOCAL,83655,CPT,,,,,,Outpatient,,,19.13,14.53,Viva Med ADV,Viva Med ADV,13.99,,,,,,,Fee Schedule,13.99076923,16.07,
"Lead, Blood QSTC",13864923,LOCAL,83655,CPT,,,,,,Outpatient,,,19.13,14.53,Viva Med ADV,Viva Med ADV,13.99,,,,,,,Fee Schedule,13.99076923,16.07,
fluconazole 100 mg/50 mL-NaCl 0.9% intravenous solution 50 mL [CULL],11291246,LOCAL,J1450,CPT,,,,,,Outpatient,50,ML,19.2,,Viva Med ADV,Viva Med ADV,4.48,,,,,,,Fee Schedule,4.48,4.48,
"Albumin, Peritoneal Fluid QSTC",8972935,LOCAL,82042,CPT,,,,,,Outpatient,,,19.4,9.34,Viva Med ADV,Viva Med ADV,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Albumin, Pleural Fluid QST",12130816,LOCAL,82042,CPT,,,,,,Outpatient,,,19.4,9.34,Viva Med ADV,Viva Med ADV,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Albumin, Pleural Fluid QSTC",12130706,LOCAL,82042,CPT,,,,,,Outpatient,,,19.4,9.34,Viva Med ADV,Viva Med ADV,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Glucose, Peritoneal Fluid QSTC",9039310,LOCAL,82945,CPT,,,,,,Outpatient,,,19.4,4.72,Viva Med ADV,Viva Med ADV,3.93,,,,,,,Fee Schedule,3.93,7.16,
Cardiolipin Ab (IgA)QSTC,9215429,LOCAL,86147,CPT,,,,,,Outpatient,,,19.58,30.54,Viva Med ADV,Viva Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Antibody IgG QSTC,10100354,LOCAL,86147,CPT,,,,,,Outpatient,,,19.58,30.54,Viva Med ADV,Viva Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Antibody IgM QSTC,10100355,LOCAL,86147,CPT,,,,,,Outpatient,,,19.58,30.54,Viva Med ADV,Viva Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
24hr Urine Creatinine QSTC,10005155,LOCAL,82570,CPT,,,,,,Outpatient,,,19.76,6.22,Viva Med ADV,Viva Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Creatinine, Random U QSTC",12290061,LOCAL,82570,CPT,,,,,,Outpatient,,,19.76,6.22,Viva Med ADV,Viva Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
Interp: QSTC,8851928,LOCAL,84166,CPT,,,,,,Outpatient,,,19.76,21.4,Viva Med ADV,Viva Med ADV,18.62,,,,,,,Fee Schedule,17.73,18.62,
Interp: QSTC,8851952,LOCAL,84166,CPT,,,,,,Outpatient,,,19.76,21.4,Viva Med ADV,Viva Med ADV,18.62,,,,,,,Fee Schedule,17.73,18.62,
"Protein, Total, Random Urine QSTC",8851945,LOCAL,84156,CPT,,,,,,Outpatient,,,19.76,4.4,Viva Med ADV,Viva Med ADV,11.68,,,,,,,Fee Schedule,7.16,11.68,
SHOE POST OP MALE LARGE,11070723,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,19.86,223,Viva Med ADV,Viva Med ADV,175.72,,,,,,,Fee Schedule,175.72,175.72,
SHOE POST OP MALE MD,11071019,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,19.86,12,Viva Med ADV,Viva Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
SHOE POST OP MALE SMALL,11070721,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,19.86,223,Viva Med ADV,Viva Med ADV,175.72,,,,,,,Fee Schedule,175.72,175.72,
methotrexate 2.5 mg oral tablet [CULL],11240138,LOCAL,J8610,CPT,,,,,,Outpatient,1,EA,19.9584,,Viva Med ADV,Viva Med ADV,0.15,,,,,,,Fee Schedule,0.151,0.151,
cefTAZidime 1 g injection [CULL],11201385,LOCAL,J0713,CPT,,,,,,Outpatient,1,EA,19.968,,Viva Med ADV,Viva Med ADV,1.47,,,,,,,Fee Schedule,1.468,1.468,
Carbon Dioxide Level,7903173,LOCAL,82374,CPT,,,,,,Outpatient,,,20,5.86,Viva Med ADV,Viva Med ADV,4.88,,,,,,,Fee Schedule,4.88,7.16,
Creatinine,3454470,LOCAL,82565,CPT,,,,,,Outpatient,,,20,6.14,Viva Med ADV,Viva Med ADV,10.06,,,,,,,Fee Schedule,7.16,10.061625,
COLLAR CERVICAL SOFT SMALL,11071044,LOCAL,,,L0120,HCPCS,,,,Outpatient,,,20.13,44,Viva Med ADV,Viva Med ADV,34.57,,,,,,,Fee Schedule,34.57,34.57,
Gastric Occult Blood,7974128,LOCAL,82271,CPT,,,,,,Outpatient,,,20.16,6.38,Viva Med ADV,Viva Med ADV,5.32,,,,,,,Fee Schedule,5.32,7.16,
Immunoglobulin A QSTC,8764567,LOCAL,82784,CPT,,,,,,Outpatient,,,20.25,11.16,Viva Med ADV,Viva Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
Immunoglobulin M QSTC,8853219,LOCAL,82784,CPT,,,,,,Outpatient,,,20.25,11.16,Viva Med ADV,Viva Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
"PSA, Free QSTC",8852652,LOCAL,84154,CPT,,,,,,Outpatient,,,20.25,22.07,Viva Med ADV,Viva Med ADV,19.14,,,,,,,Fee Schedule,17.73,19.14,
COLLAR CERVICAL SOFT LARGE,11071046,LOCAL,,,L0120,HCPCS,,,,Outpatient,,,20.63,44,Viva Med ADV,Viva Med ADV,34.57,,,,,,,Fee Schedule,34.57,34.57,
gentamicin 10 mg/mL injectable solution 2 mL [CULL],11201813,LOCAL,J1580,CPT,,,,,,Outpatient,2,ML,20.7744,,Viva Med ADV,Viva Med ADV,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
.Manual Differential (CULL),13467987,LOCAL,85007,CPT,,,,,,Outpatient,,,20.81,4.56,Viva Med ADV,Viva Med ADV,3.34,,,,,,,Fee Schedule,3.338698061,8.21,
.Manual Differential (CULL_AL),6237143,LOCAL,85007,CPT,,,,,,Outpatient,,,20.81,4.56,Viva Med ADV,Viva Med ADV,3.34,,,,,,,Fee Schedule,3.338698061,8.21,
cefuroxime 1.5 g injection [CULL],11201459,LOCAL,J0697,CPT,,,,,,Outpatient,1,EA,20.83712,,Viva Med ADV,Viva Med ADV,2.05,,,,,,,Fee Schedule,2.054,2.054,
"Albumin, CSF QSTC",13873322,LOCAL,82042,CPT,,,,,,Outpatient,,,20.95,9.34,Viva Med ADV,Viva Med ADV,7.78,,,,,,,Fee Schedule,7.16,7.78,
"IgG, CSF QSTC",13873321,LOCAL,82784,CPT,,,,,,Outpatient,,,20.95,11.16,Viva Med ADV,Viva Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
"Amylase, Pleural Fluid QSTC",9039309,LOCAL,82150,CPT,,,,,,Outpatient,,,20.97,7.78,Viva Med ADV,Viva Med ADV,1.24,,,,,,,Fee Schedule,1.237209302,7.16,
"Calcium, Random Ur QSTC",13864744,LOCAL,82310,CPT,,,,,,Outpatient,,,20.99,6.19,Viva Med ADV,Viva Med ADV,5.16,,,,,,,Fee Schedule,5.16,7.16,
"Creatinine, Random U QSTC",13864745,LOCAL,82570,CPT,,,,,,Outpatient,,,20.99,6.22,Viva Med ADV,Viva Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
Fructosamine QSTC,8853273,LOCAL,82985,CPT,,,,,,Outpatient,,,21.02,20.11,Viva Med ADV,Viva Med ADV,16.76,,,,,,,Fee Schedule,16.76,17.73,
butorphanol 1 mg/mL Sol [CULL],11202144,LOCAL,J0595,CPT,,,,,,Outpatient,1,ML,21.40416,,Viva Med ADV,Viva Med ADV,5.54,,,,,,,Fee Schedule,5.544,5.544,
Direct LDL QSTC,9039357,LOCAL,83721,CPT,,,,,,Outpatient,,,21.6,12.6,Viva Med ADV,Viva Med ADV,10.5,,,,,,,Fee Schedule,10.5,17.73,
Hemoglobin A1c QSTC,6213055,LOCAL,83036,CPT,,,,,,Outpatient,,,21.6,11.65,Viva Med ADV,Viva Med ADV,28.6,,,,,,,Fee Schedule,7.16,28.59604426,
Varicella-Zoster Virus Ab (IgG) QSTC,8853252,LOCAL,86787,CPT,,,,,,Outpatient,,,21.6,15.46,Viva Med ADV,Viva Med ADV,12.88,,,,,,,Fee Schedule,12.88,15.29,
Serum Osmolality QSTC,8972765,LOCAL,83930,CPT,,,,,,Outpatient,,,21.65,7.93,Viva Med ADV,Viva Med ADV,6.61,,,,,,,Fee Schedule,6.61,7.16,
76376 3D RENDER W/O POSTPR CHARGE,9284912,LOCAL,76376,CPT,,,,,,Outpatient,,,22,391.88,Viva Med ADV,Viva Med ADV,13.93,,,,,,,Fee Schedule,13.93,13.93,
POC Hgb,7160347,LOCAL,83036,CPT,,,,,,Outpatient,,,22,11.65,Viva Med ADV,Viva Med ADV,28.6,,,,,,,Fee Schedule,7.16,28.59604426,
Creatinine Level 24 Hour Urine,1634894,LOCAL,82570,CPT,,,,,,Outpatient,,,22.03,6.22,Viva Med ADV,Viva Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Albumin, 24 Hour Urine w/o Creat QSTC",13864523,LOCAL,82043,CPT,,,,,,Outpatient,,,22.5,6.94,Viva Med ADV,Viva Med ADV,20.16,,,,,,,Fee Schedule,4.02,20.15557971,
"Folate, RBC QSTS",13899938,LOCAL,82747,CPT,,,,,,Outpatient,,,22.5,21.18,Viva Med ADV,Viva Med ADV,17.65,,,,,,,Fee Schedule,17.65,46.74,
Hepatitis C Ab rfx HCV RNA Qnt PCR QSTC,8764583,LOCAL,86803,CPT,,,,,,Outpatient,,,22.5,17.12,Viva Med ADV,Viva Med ADV,32.1,,,,,,,Fee Schedule,15.29,32.10014925,
IMMOBILIZER  SHOULDER MEDIUM,11070739,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,22.5,12,Viva Med ADV,Viva Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
IMMOBILIZER SHOULDER XL,11070165,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,22.5,12,Viva Med ADV,Viva Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
"PSA, Total QSTC",8852651,LOCAL,84153,CPT,,,,,,Outpatient,,,22.5,22.07,Viva Med ADV,Viva Med ADV,104.84,,,,,,,Fee Schedule,17.73,104.8447059,
"T4, Free QSTC",9291013,LOCAL,84439,CPT,,,,,,Outpatient,,,22.5,10.82,Viva Med ADV,Viva Med ADV,28.58,,,,,,,Fee Schedule,18.43,28.58065455,
DRAIN ROUND JP 10FR----OR,11071535,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,22.55,12,Viva Med ADV,Viva Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
"Heterophile, Mono Screen QSTC",13864506,LOCAL,86308,CPT,,,,,,Outpatient,,,22.68,6.22,Viva Med ADV,Viva Med ADV,5.18,,,,,,,Fee Schedule,5.18,15.29,
"T3, Free QSTC",8972902,LOCAL,84481,CPT,,,,,,Outpatient,,,22.68,20.33,Viva Med ADV,Viva Med ADV,34.46,,,,,,,Fee Schedule,18.43,34.46424242,
IMMOBILIZER SHOULDER SMALL,11071014,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,22.72,12,Viva Med ADV,Viva Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
COLLECTION: Venous Draw,1779389,LOCAL,36415,CPT,,,,,,Outpatient,,,22.73,10.91,Viva Med ADV,Viva Med ADV,6.74,,,,,,,Fee Schedule,3.41,6.740753664,
IMMOBILIZER SHOULDER LARGE,11071760,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,22.77,12,Viva Med ADV,Viva Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
Urine Eosinophil Smear,8690390,LOCAL,85008,CPT,,,,,,Outpatient,,,22.85,4.12,Viva Med ADV,Viva Med ADV,3.43,,,,,,,Fee Schedule,3.43,8.21,
Urine Eosinophils,7974116,LOCAL,89051,CPT,,,,,,Outpatient,,,22.85,6.72,Viva Med ADV,Viva Med ADV,35.8,,,,,,,Fee Schedule,14.07,35.795,
Sodium Level Urine,4185817,LOCAL,84300,CPT,,,,,,Outpatient,,,23,6.07,Viva Med ADV,Viva Med ADV,9.74,,,,,,,Fee Schedule,7.16,9.74,
Almond (F20) IgE QST,13344505,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Almond (f20) IgE QSTC,8764712,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Beef (f27) IgE QSTC,8764717,LOCAL,86003,CPT,86003,HCPCS,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Brazil Nut (F18) IgE QST,13344495,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Brazil Nut (f18) IgE QSTC,8764711,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cashew Nut (F202) IgE QST,13344499,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cashew Nut (f202) IgE QSTC,8764689,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cat Dander (e1) IgE QSTC,6241002,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Catfish (f369) IgE QSTC,8764761,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Chicken Meat (f83) IgE QSTC,8761426,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Clam (f207) IgE QSTC,8764592,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cocoa (f93) IgE QSTC,8764728,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Coconut (f36) IgE QSTC,8764719,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cow'S Milk (F2) IgE w/Rflx to Panel QST,12886535,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cow'S Milk(F2) IgE W/Rfx Panel QSTC,14129187,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Crab (f23) IgE QSTC,6210507,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Crayfish (Rf320) IgE** QSTC,9039458,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
D. Pteronyssinus (d1) IgE QST,6241001,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dermatophagoides Farinae (d2) IgE QST,10217085,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dog Dander (e5) IgE QSTC,6241003,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Egg White (f1) IgE QSTC,8764699,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Egg White (F2) IgE w/Rflx to Panel QST,12886536,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Egg Yolk (f75) IgE QSTC,8764725,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Fire Ant (i70) IgE QSTC,8764698,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Gluten (f79) IgE QSTC,9039341,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Hazelnut (F17) IgE QST,13344503,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Hazelnut (f17) IgE QSTC,8764710,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Lobster (f80) IgE QSTC,6210505,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Macadamia Nut (RF345) IgE QST,13344491,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Milk Component Panel QST,10217179,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Oyster (f290) IgE QSTC,6210503,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Peanut (F13) IgE QST,13344507,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Peanut (f13) IgE QSTC,8764708,LOCAL,86003,CPT,86003,HCPCS,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
"Peanut,Tot w/rfx to Peanut Comp Pnl QSTC",8764811,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pecan Nut (F201) IgE QST,13344493,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pecan Nut (f201) IgE QSTC,8764727,LOCAL,86003,CPT,86003,HCPCS,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Perch Ocean IgE QSTC,8764760,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pistachio (F203) IgE QST,13344501,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pork (f26) IgE QSTC,8764716,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Scallop (f338) IgE QSTC,6210506,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Shrimp (f24) IgE QSTC,6241010,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Soybean (f14) IgE QSTC,8764709,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Strawberry (f44) IgE QSTC,8764722,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Tilapia IgE* QSTC,8972793,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Tomato (f25) IgE QSTC,8764715,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Walnut (F256) IgE QST,13344497,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Walnut (f256) IgE QSTC,8764747,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Wheat (f4) IgE QSTC,6241013,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
95851 ROM MEASUREMENT(EXCLUDE HANDS) CHARGE,9410226,LOCAL,95851,CPT,,,,,GP,Outpatient,,,23.49,15,Viva Med ADV,Viva Med ADV,6.41,,,,,,,Fee Schedule,6.41,6.41,
digoxin 250 mcg/mL (0.25 mg/mL) injectable solution 2 mL [CULL],11282125,LOCAL,J1160,CPT,,,,,,Outpatient,2,ML,23.92,,Viva Med ADV,Viva Med ADV,9.57,,,,,,,Fee Schedule,9.574,9.574,
sulfamethoxazole-trimethoprim 80 mg-16 mg/mL Sol [CULL],11211277,LOCAL,J2865,CPT,,,,,,Outpatient,5,ML,24.3328,,Viva Med ADV,Viva Med ADV,0.04,,,,,,,Fee Schedule,0.01,0.038,
Immunoglobulin G QSTC,8764569,LOCAL,82784,CPT,,,,,,Outpatient,,,24.75,11.16,Viva Med ADV,Viva Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
Sjogren's Antibody (SS-A) QSTC,8860711,LOCAL,86235,CPT,,,,,,Outpatient,,,24.75,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-A) QSTC,9039451,LOCAL,86235,CPT,,,,,,Outpatient,,,24.75,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-B) QSTC,8860712,LOCAL,86235,CPT,,,,,,Outpatient,,,24.75,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-B) QSTC,9039452,LOCAL,86235,CPT,,,,,,Outpatient,,,24.75,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
methylPREDNISolone 125 mg Pow [CULL],11247586,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,24.8064,,Viva Med ADV,Viva Med ADV,0.21,,,,,,,Fee Schedule,0.21,0.21,
STRAP CLAVACLE LARGE,11070713,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,24.97,12,Viva Med ADV,Viva Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
STRAP CLAVICLE MED 3IN,11098246,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,24.97,12,Viva Med ADV,Viva Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
Aerobic Bacterium ID/ Susceptibility QST,13344167,LOCAL,87077,CPT,,,,,,Outpatient,,,25,9.7,Viva Med ADV,Viva Med ADV,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
"Catecholamines, Fractionated, Plasma QSTC",11335672,LOCAL,82384,CPT,,,,,,Outpatient,,,25,30.3,Viva Med ADV,Viva Med ADV,25.25,,,,,,,Fee Schedule,18.43,25.25,
Tissue A Clinical Impression QST,10148697,LOCAL,88300,CPT,,,,,,Outpatient,,,25,,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,22.39,32.32,
Tissue A Comment QST,10148702,LOCAL,88302,CPT,,,,,,Outpatient,,,25,,Viva Med ADV,Viva Med ADV,35.88,,,,,,,Fee Schedule,32.32,35.88,
Tissue A Diagnosis QST,10148701,LOCAL,88304,CPT,,,,,,Outpatient,,,25,,Viva Med ADV,Viva Med ADV,48.85,,,,,,,Fee Schedule,32.32,48.85,
Tissue A Gross Description QST,10148699,LOCAL,88305,CPT,,,,,,Outpatient,,,25,,Viva Med ADV,Viva Med ADV,48.85,,,,,,,Fee Schedule,48.85,59.06,
Tissue A Micro Description QST,10148700,LOCAL,88307,CPT,,,,,,Outpatient,,,25,,Viva Med ADV,Viva Med ADV,328.88,,,,,,,Fee Schedule,59.06,328.88,
Tissue A Procedure QST,10148698,LOCAL,88309,CPT,,,,,,Outpatient,,,25,,Viva Med ADV,Viva Med ADV,746.86,,,,,,,Fee Schedule,59.06,746.86,
Childhood Allergy Profile QSTC,8972792,LOCAL,86003,CPT,,,,,,Outpatient,,,25.16,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Expanded Childhood Allergy Profile ADD ON,14019143,LOCAL,86003,CPT,,,,,,Outpatient,,,25.16,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
"Albumin, CSF QSTC",8861454,LOCAL,82042,CPT,,,,,,Outpatient,,,25.28,9.34,Viva Med ADV,Viva Med ADV,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Albumin, Serum QSTC",8861457,LOCAL,82040,CPT,,,,,,Outpatient,,,25.28,5.94,Viva Med ADV,Viva Med ADV,127.89,,,,,,,Fee Schedule,7.16,127.89,
Immunoglobulin G QSTC,8861456,LOCAL,82784,CPT,,,,,,Outpatient,,,25.28,11.16,Viva Med ADV,Viva Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
Maternal Serum AFP QST,8972825,LOCAL,82105,CPT,,,,,,Outpatient,,,25.88,20.12,Viva Med ADV,Viva Med ADV,26.22,,,,,,,Fee Schedule,17.73,26.22,
Maternal Serum AFP QSTC,8972825,LOCAL,82105,CPT,,,,,,Outpatient,,,25.88,20.12,Viva Med ADV,Viva Med ADV,26.22,,,,,,,Fee Schedule,17.73,26.22,
"G-6-PD, RBC QSTC",8764537,LOCAL,82955,CPT,,,,,,Outpatient,,,26.15,11.64,Viva Med ADV,Viva Med ADV,9.7,,,,,,,Fee Schedule,7.16,9.7,
ampicillin 1 g injection [CULL],11201129,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,26.256,,Viva Med ADV,Viva Med ADV,0.59,,,,,,,Fee Schedule,0.591,0.591,
DOBUTamine 12.5 mg/mL intravenous solution 20 mL [CULL],11201690,LOCAL,J1250,CPT,,,,,,Outpatient,20,ML,26.6144,,Viva Med ADV,Viva Med ADV,8.02,,,,,,,Fee Schedule,8.024,8.024,
Serotype 1 (1) QST,10243602,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 12 (12F) QST,10243608,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 14 (14) QST,10243609,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 17 (17F) QST,10242538,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 19 (19F) QST,10243610,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 2 (2) QST,10242514,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 20 (20) QST,10242544,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 22 (22F) QST,10242547,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 23 (23F) QST,10243611,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 26 (6B) QST,10243612,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 3 (3) QST,10243603,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 34 (10A) QST,10242556,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 4 (4) QST,10243604,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 43 (11A) QST,10242559,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 5 (5) QST,10243605,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 51 (7F) QST,10243613,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 54 (15B) QST,10242565,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 56 (18C) QST,10243614,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 57 (19A) QST,10242571,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 68 (9V) QST,10243615,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 70 (33F) QST,10242577,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 8 (8) QST,10243606,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 9 (9N) QST,10243607,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Viva Med ADV,Viva Med ADV,14.99,,,,,,,Fee Schedule,14.99,15.29,
ciprofloxacin 400 mg/200 mL-5% Sol,11201486,LOCAL,J0744,CPT,,,,,,Outpatient,200,ML,26.8416,,Viva Med ADV,Viva Med ADV,2,,,,,,,Fee Schedule,1.997,1.997,
Aldolase QSTC,8764531,LOCAL,82085,CPT,,,,,,Outpatient,,,26.87,11.65,Viva Med ADV,Viva Med ADV,18.2,,,,,,,Fee Schedule,7.16,18.195,
Glucose Fingerstick Clinic POC (RE),4192199,LOCAL,82962,CPT,,,,,,Outpatient,,,26.93,3.94,Viva Med ADV,Viva Med ADV,9.08,,,,,,,Fee Schedule,7.16,9.084767596,
".Smooth Muscle Ab, Titer QSTC",13864540,LOCAL,86256,CPT,,,,,,Outpatient,,,27,14.46,Viva Med ADV,Viva Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
DNA (ds) Antibody QSTC,8764566,LOCAL,86225,CPT,,,,,,Outpatient,,,27,16.49,Viva Med ADV,Viva Med ADV,14.72,,,,,,,Fee Schedule,14.71636364,15.29,
Hepatitis B Core Ab (IgM) QSTC,8764681,LOCAL,86705,CPT,,,,,,Outpatient,,,27,14.12,Viva Med ADV,Viva Med ADV,32.8,,,,,,,Fee Schedule,15.29,32.80285714,
Mumps Virus Antibody (IgG) QSTC,8764679,LOCAL,86735,CPT,,,,,,Outpatient,,,27,15.66,Viva Med ADV,Viva Med ADV,13.05,,,,,,,Fee Schedule,13.05,15.29,
Prolactin QSTC,8972761,LOCAL,84146,CPT,,,,,,Outpatient,,,27,23.26,Viva Med ADV,Viva Med ADV,19.38,,,,,,,Fee Schedule,18.43,19.38,
Smooth Muscle Ab w/refl Titer QSTC,13864539,LOCAL,83497,CPT,,,,,,Outpatient,,,27,15.48,Viva Med ADV,Viva Med ADV,12.9,,,,,,,Fee Schedule,12.9,19.405,
Smooth Muscle Ab w/rfx Titer QSTC,13864539,LOCAL,86015,CPT,,,,,,Outpatient,,,27,14.46,Viva Med ADV,Viva Med ADV,19.41,,,,,,,Fee Schedule,12.9,19.405,
"Treponema pall Ab, Particle Agg QSTC",8972906,LOCAL,86780,CPT,,,,,,Outpatient,,,27,15.89,Viva Med ADV,Viva Med ADV,13.24,,,,,,,Fee Schedule,13.24,15.29,
Protein Level Urine,4186691,LOCAL,84156,CPT,,,,,,Outpatient,,,27.74,4.4,Viva Med ADV,Viva Med ADV,11.68,,,,,,,Fee Schedule,7.16,11.68,
Lipid Panel w/ Rfx to Direct LDL QSTC,13864433,LOCAL,80061,CPT,,,,,,Outpatient,,,27.9,16.07,Viva Med ADV,Viva Med ADV,16.6,,,,,,,Fee Schedule,12.14,16.59934459,
cyanocobalamin 1000 mcg/mL injectable solution 1 mL [CULL],11202258,LOCAL,J3420,CPT,,,,,,Outpatient,1,ML,27.968,,Viva Med ADV,Viva Med ADV,3.17,,,,,,,Fee Schedule,3.167142857,3.167142857,
G0109 DM OP SMT GRP PER 30 MIN CHARGE,8709096,LOCAL,,,G0109,HCPCS,,,,Outpatient,,,27.99,18,Viva Med ADV,Viva Med ADV,15.04,,,,,,,Fee Schedule,15.04,67.18,
ID,8131550,LOCAL,87077,CPT,,,,,,Outpatient,,,28.15,9.7,Viva Med ADV,Viva Med ADV,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
ID Add On,13661571,LOCAL,87077,CPT,,,,,,Outpatient,,,28.15,9.7,Viva Med ADV,Viva Med ADV,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
Mitochondria M2 Ab (IgG) QSTC,8764575,LOCAL,86381,CPT,,,,,,Outpatient,,,28.26,30.54,Viva Med ADV,Viva Med ADV,26.61,,,,,,,Fee Schedule,15.29,26.605,
PC DOPP LOWER EXT ART/ABI,8200227,LOCAL,93922,CPT,,,,,,Outpatient,,,28.29,265,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,117.85,161.71,
clindamycin 300 mg/50 mL-NaCl 0.9% Sol [CULL],11290065,LOCAL,J0737,CPT,,,,,,Outpatient,50,ML,28.32,,Viva Med ADV,Viva Med ADV,2.35,,,,,,,Fee Schedule,0.819,2.346,
butorphanol 2 mg/mL Sol [CULL],11202147,LOCAL,J0595,CPT,,,,,,Outpatient,1,ML,28.7968,,Viva Med ADV,Viva Med ADV,5.54,,,,,,,Fee Schedule,5.544,5.544,
"Gastrin, Serum QSTC",8764526,LOCAL,82941,CPT,,,,,,Outpatient,,,28.8,21.16,Viva Med ADV,Viva Med ADV,17.63,,,,,,,Fee Schedule,17.63,18.43,
Hep B Core Ab (Total)w/Rfx to IgM QSTC,9039408,LOCAL,86704,CPT,,,,,,Outpatient,,,28.8,14.46,Viva Med ADV,Viva Med ADV,17.4,,,,,,,Fee Schedule,15.29,17.40428571,
Hepatitis A IgM QSTC,8764600,LOCAL,86709,CPT,,,,,,Outpatient,,,28.8,13.51,Viva Med ADV,Viva Med ADV,11.26,,,,,,,Fee Schedule,11.26,15.29,
"Hepatitis B Core Ab, Total QSTC",8764579,LOCAL,86704,CPT,,,,,,Outpatient,,,28.8,14.46,Viva Med ADV,Viva Med ADV,17.4,,,,,,,Fee Schedule,15.29,17.40428571,
Complement Component C3c QSTC,8972768,LOCAL,86160,CPT,,,,,,Outpatient,,,29.25,14.4,Viva Med ADV,Viva Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
Complement Component C4c QSTC,8972769,LOCAL,86160,CPT,,,,,,Outpatient,,,29.25,14.4,Viva Med ADV,Viva Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
Insulin QSTC,9039285,LOCAL,83525,CPT,,,,,,Outpatient,,,29.25,13.72,Viva Med ADV,Viva Med ADV,11.43,,,,,,,Fee Schedule,11.43,18.43,
Clozapine QSTC,8764629,LOCAL,80159,CPT,,,,,,Outpatient,,,29.7,24.18,Viva Med ADV,Viva Med ADV,20.15,,,,,,,Fee Schedule,15.38,20.15,
HSV 1 and 2 IgG Antibodies QSTC,8853241,LOCAL,86695,CPT,,,,,,Outpatient,,,29.97,15.83,Viva Med ADV,Viva Med ADV,13.19,,,,,,,Fee Schedule,13.19,15.29,
"HSV 1/2 IgG,Type Specific Ab QST",8389465,LOCAL,86695,CPT,,,,,,Outpatient,,,29.97,15.83,Viva Med ADV,Viva Med ADV,13.19,,,,,,,Fee Schedule,13.19,15.29,
97804 Medical Nutrit Group 30Min CHARGE,9323172,LOCAL,97804,CPT,,,,,,Outpatient,,,30,20,Viva Med ADV,Viva Med ADV,11.75,,,,,,,Fee Schedule,11.75,287.34,
Insulin Level Total,3454335,LOCAL,83525,CPT,,,,,,Outpatient,,,30,13.72,Viva Med ADV,Viva Med ADV,11.43,,,,,,,Fee Schedule,11.43,18.43,
budesonide 0.25 mg/2 mL inhalation suspension 2 mL [CULL],11205254,LOCAL,J7626,CPT,,,,,,Outpatient,2,ML,30.1056,,Viva Med ADV,Viva Med ADV,1.05,,,,,,,Fee Schedule,1.049,1.049,
cefTRIAXone 2 g injection ADDV [CULL],11282070,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,30.61632,,Viva Med ADV,Viva Med ADV,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
labetalol 5 mg/mL intravenous solution 20 mL [CULL],11201873,LOCAL,J1920,CPT,,,,,,Outpatient,20,ML,30.72,,Viva Med ADV,Viva Med ADV,5.46,,,,,,,Fee Schedule,5.464225352,5.464225352,
triamcinolone acetonide 40 mg/mL injectable suspension 1 mL [CULL],11212390,LOCAL,J3301,CPT,,,,,,Outpatient,1,ML,31.072,,Viva Med ADV,Viva Med ADV,3.03,,,,,,,Fee Schedule,3.025614035,3.025614035,
clindamycin 300 mg/50 mL-D5% intravenous solution 50 mL [CULL],11290065,LOCAL,J0736,CPT,,,,,,Outpatient,50,ML,31.48133333,,Viva Med ADV,Viva Med ADV,0.82,,,,,,,Fee Schedule,0.819,2.346,
".ANA, Titer and Pattern QSTC",8764643,LOCAL,86039,CPT,,,,,,Outpatient,,,31.5,13.39,Viva Med ADV,Viva Med ADV,21.22,,,,,,,Fee Schedule,15.29,21.22,
Cytomegalovirus Antibody (IgG) QSTC,13972135,LOCAL,86644,CPT,,,,,,Outpatient,,,31.5,17.27,Viva Med ADV,Viva Med ADV,14.39,,,,,,,Fee Schedule,14.39,15.29,
Cytomegalovirus Antibody (IgG) QSTC,8853227,LOCAL,86644,CPT,,,,,,Outpatient,,,31.5,17.27,Viva Med ADV,Viva Med ADV,14.39,,,,,,,Fee Schedule,14.39,15.29,
C-Reactive Protein,1628890,LOCAL,86140,CPT,,,,,,Outpatient,,,32,6.22,Viva Med ADV,Viva Med ADV,13.3,,,,,,,Fee Schedule,13.29690962,15.29,
Fecal WBC,4123047,LOCAL,87205,CPT,,,,,,Outpatient,,,32,5.12,Viva Med ADV,Viva Med ADV,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
Stool WBC,10294481,LOCAL,87205,CPT,,,,,,Outpatient,,,32,5.12,Viva Med ADV,Viva Med ADV,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
"Complement, Total (CH50) QSTC",8764582,LOCAL,86162,CPT,,,,,,Outpatient,,,32.4,24.38,Viva Med ADV,Viva Med ADV,20.32,,,,,,,Fee Schedule,15.29,20.32,
DHEA Sulfate QSTC,9696140,LOCAL,82627,CPT,,,,,,Outpatient,,,32.4,26.68,Viva Med ADV,Viva Med ADV,27.1,,,,,,,Fee Schedule,18.43,27.095,
Haptoglobin QSTC,8764542,LOCAL,83010,CPT,,,,,,Outpatient,,,32.4,15.1,Viva Med ADV,Viva Med ADV,12.58,,,,,,,Fee Schedule,12.58,17.73,
"Hepatitis A Ab, Total QSTC",8764599,LOCAL,86708,CPT,,,,,,Outpatient,,,32.4,14.87,Viva Med ADV,Viva Med ADV,12.39,,,,,,,Fee Schedule,12.39,15.29,
Jo-1 Antibody QSTC,8764688,LOCAL,86235,CPT,,,,,,Outpatient,,,32.4,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
"RNP Antibody, QSTC",10100359,LOCAL,86235,CPT,,,,,,Outpatient,,,32.4,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
"Sm Antibody, QSTC",10100362,LOCAL,86235,CPT,,,,,,Outpatient,,,32.4,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
"STRAP, CLAVICLE SMALL-3004-06",6010605,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,32.4,12,Viva Med ADV,Viva Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
"Albumin, CSF QSTC",13873031,LOCAL,82042,CPT,,,,,,Outpatient,,,32.46,9.34,Viva Med ADV,Viva Med ADV,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Albumin, Serum QSTC",13873034,LOCAL,82040,CPT,,,,,,Outpatient,,,32.46,5.94,Viva Med ADV,Viva Med ADV,127.89,,,,,,,Fee Schedule,7.16,127.89,
Immunoglobulin G QSTC,13873033,LOCAL,82784,CPT,,,,,,Outpatient,,,32.46,11.16,Viva Med ADV,Viva Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
"Oligoclonal Bands (IgG),CSF QSTC",13873028,LOCAL,83916,CPT,,,,,,Outpatient,,,32.46,32.87,Viva Med ADV,Viva Med ADV,27.39,,,,,,,Fee Schedule,17.73,27.39,
Immunoglobulin A QSTC,13904383,LOCAL,82784,CPT,,,,,,Outpatient,,,32.62,11.16,Viva Med ADV,Viva Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
tTG IgA Ab QSTC,13904382,LOCAL,86364,CPT,,,,,,Outpatient,,,32.63,13.84,Viva Med ADV,Viva Med ADV,61.9,,,,,,,Fee Schedule,15.29,61.9,
"Delta-Aminolevulinic Acid, Random Urine QSTC",12329984,LOCAL,82135,CPT,,,,,,Outpatient,,,32.81,19.74,Viva Med ADV,Viva Med ADV,16.45,,,,,,,Fee Schedule,16.45,17.73,
Bilirubin Cord Blood,10237211,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,Viva Med ADV,Viva Med ADV,5.02,,,,,,,Fee Schedule,5.02,7.16,
Bilirubin Neonatal (Bu/Bc),14541767,LOCAL,82248,CPT,,,,,,Outpatient,,,33.46,6.02,Viva Med ADV,Viva Med ADV,26.63,,,,,,,Fee Schedule,7.16,26.6275,
Bilirubin Neonatal 2,8883195,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,Viva Med ADV,Viva Med ADV,5.02,,,,,,,Fee Schedule,5.02,7.16,
Bilirubin Total,633672,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,Viva Med ADV,Viva Med ADV,5.02,,,,,,,Fee Schedule,5.02,7.16,
Bilirubin Total,7939102,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,Viva Med ADV,Viva Med ADV,5.02,,,,,,,Fee Schedule,5.02,7.16,
Bilirubin Total,8443661,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,Viva Med ADV,Viva Med ADV,5.02,,,,,,,Fee Schedule,5.02,7.16,
Cyclic Citrull Peptide (CCP) Ab IgG QSTC,8764613,LOCAL,86200,CPT,,,,,,Outpatient,,,33.75,15.54,Viva Med ADV,Viva Med ADV,7.49,,,,,,,Fee Schedule,7.491935484,15.29,
"Cholinesterase, Plasma QSTC",13873320,LOCAL,82482,CPT,,,,,,Outpatient,,,33.8,11.77,Viva Med ADV,Viva Med ADV,9.81,,,,,,,Fee Schedule,7.16,9.81,
"Cholinesterase, RBC QSTC",13873317,LOCAL,82480,CPT,,,,,,Outpatient,,,33.8,9.44,Viva Med ADV,Viva Med ADV,7.87,,,,,,,Fee Schedule,7.16,7.87,
STRAP CLAVICLE PED.,11071010,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,33.94,12,Viva Med ADV,Viva Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
"Calcium, 24 hour Urine QSTC",13864700,LOCAL,82340,CPT,,,,,,Outpatient,,,33.95,7.24,Viva Med ADV,Viva Med ADV,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
"Citric Acid, 24 Hour Urine QSTC",13864703,LOCAL,82507,CPT,,,,,,Outpatient,,,33.95,33.36,Viva Med ADV,Viva Med ADV,30.63,,,,,,,Fee Schedule,17.73,30.625,
"Creatinine, 24 Hour Urine QSTC",13864712,LOCAL,82570,CPT,,,,,,Outpatient,,,33.95,6.22,Viva Med ADV,Viva Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Magnesium, 24 Hour Urine QSTC",13864709,LOCAL,83735,CPT,,,,,,Outpatient,,,33.95,8.04,Viva Med ADV,Viva Med ADV,3.66,,,,,,,Fee Schedule,3.657824427,7.16,
"Oxalate, 24 Hour Urine QSTC",13864701,LOCAL,83945,CPT,,,,,,Outpatient,,,33.95,17.34,Viva Med ADV,Viva Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.085,
pH Urine QSTC,13864699,LOCAL,83986,CPT,,,,,,Outpatient,,,33.95,4.3,Viva Med ADV,Viva Med ADV,18.76,,,,,,,Fee Schedule,7.16,18.755,
"Phosphorus, 24 Hour Urine QSTC",13864707,LOCAL,84105,CPT,,,,,,Outpatient,,,33.95,6.94,Viva Med ADV,Viva Med ADV,19.84,,,,,,,Fee Schedule,7.16,19.835,
"Potassium, 24 Hour Urine QSTC",13864711,LOCAL,84133,CPT,,,,,,Outpatient,,,33.95,5.68,Viva Med ADV,Viva Med ADV,19.32,,,,,,,Fee Schedule,7.16,19.32,
"Sodium, 24 Hour Urine QSTC",13864704,LOCAL,84300,CPT,,,,,,Outpatient,,,33.95,6.07,Viva Med ADV,Viva Med ADV,9.74,,,,,,,Fee Schedule,7.16,9.74,
"Sulfate, 24 Hour Urine QSTC",13864705,LOCAL,84392,CPT,,,,,,Outpatient,,,33.95,6.59,Viva Med ADV,Viva Med ADV,19.7,,,,,,,Fee Schedule,4.02,19.695,
Uric Acid QSTC,13864716,LOCAL,84560,CPT,,,,,,Outpatient,,,33.95,6.1,Viva Med ADV,Viva Med ADV,19.49,,,,,,,Fee Schedule,7.16,19.49,
Ammonium Urine QSTC,8997190,LOCAL,82140,CPT,,,,,,Outpatient,,,34,17.48,Viva Med ADV,Viva Med ADV,22.63,,,,,,,Fee Schedule,17.73,22.62909091,
"Calcium, 24 hour Urine QSTC",8997182,LOCAL,82340,CPT,,,,,,Outpatient,,,34,7.24,Viva Med ADV,Viva Med ADV,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
"Citric Acid, 24 Hour Urine QSTC",8997185,LOCAL,82507,CPT,,,,,,Outpatient,,,34,33.36,Viva Med ADV,Viva Med ADV,30.63,,,,,,,Fee Schedule,17.73,30.625,
"Creatinine, 24 Hour Urine QSTC",8997192,LOCAL,82570,CPT,,,,,,Outpatient,,,34,6.22,Viva Med ADV,Viva Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Magnesium, 24 Hour Urine QSTC",8997189,LOCAL,83735,CPT,,,,,,Outpatient,,,34,8.04,Viva Med ADV,Viva Med ADV,3.66,,,,,,,Fee Schedule,3.657824427,7.16,
"Oxalate, 24 Hour Urine QSTC",8997183,LOCAL,83945,CPT,,,,,,Outpatient,,,34,17.34,Viva Med ADV,Viva Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.085,
pH Urine QSTC,8997180,LOCAL,83986,CPT,,,,,,Outpatient,,,34,4.3,Viva Med ADV,Viva Med ADV,18.76,,,,,,,Fee Schedule,7.16,18.755,
"Phosphorus, 24 Hour Urine QSTC",8997188,LOCAL,84105,CPT,,,,,,Outpatient,,,34,6.94,Viva Med ADV,Viva Med ADV,19.84,,,,,,,Fee Schedule,7.16,19.835,
"Potassium, 24 Hour Urine QSTC",8997191,LOCAL,84133,CPT,,,,,,Outpatient,,,34,5.68,Viva Med ADV,Viva Med ADV,19.32,,,,,,,Fee Schedule,7.16,19.32,
"Sodium, 24 Hour Urine QSTC",8997186,LOCAL,84300,CPT,,,,,,Outpatient,,,34,6.07,Viva Med ADV,Viva Med ADV,9.74,,,,,,,Fee Schedule,7.16,9.74,
"Sulfate, 24 Hour Urine QSTC",8997187,LOCAL,84392,CPT,,,,,,Outpatient,,,34,6.59,Viva Med ADV,Viva Med ADV,19.7,,,,,,,Fee Schedule,4.02,19.695,
"Uric Acid, 24 Hour Urine QSTC",8997184,LOCAL,84560,CPT,,,,,,Outpatient,,,34,6.1,Viva Med ADV,Viva Med ADV,19.49,,,,,,,Fee Schedule,7.16,19.49,
BINDER ABDOMINAL MALE,11070715,LOCAL,,,L0625,HCPCS,,,,Outpatient,,,34.21,86,Viva Med ADV,Viva Med ADV,42.8,,,,,,,Fee Schedule,42.8,42.8,
Lipase Level,633776,LOCAL,83690,CPT,,,,,,Outpatient,,,34.27,8.27,Viva Med ADV,Viva Med ADV,1.3,,,,,,,Fee Schedule,1.304132029,7.16,
fluconazole 200 mg/100 mL-NaCl 0.9% intravenous solution 100 mL [CULL],11220720,LOCAL,J1450,CPT,,,,,,Outpatient,100,ML,34.56,,Viva Med ADV,Viva Med ADV,4.48,,,,,,,Fee Schedule,4.48,4.48,
vancomycin 500 mg/100 mL intravenous solution 100 mL [CULL],11290008,LOCAL,J3375,CPT,,,,,,Outpatient,100,ML,34.56,,Viva Med ADV,Viva Med ADV,0.13,,,,,,,Fee Schedule,0.134,0.134,
Ceruloplasmin QSTC,8764535,LOCAL,82390,CPT,,,,,,Outpatient,,,34.88,12.89,Viva Med ADV,Viva Med ADV,10.74,,,,,,,Fee Schedule,10.74,17.73,
labetalol 5 mg/mL intravenous solution 4 mL [CULL],11201874,LOCAL,J1920,CPT,,,,,,Outpatient,4,ML,34.88,,Viva Med ADV,Viva Med ADV,5.46,,,,,,,Fee Schedule,5.464225352,5.464225352,
Amikacin Level,9034955,LOCAL,80150,CPT,,,,,,Outpatient,,,35,18.1,Viva Med ADV,Viva Med ADV,15.08,,,,,,,Fee Schedule,15.08,15.38,
"ANA Screen, IFA QSTC",14116751,LOCAL,86038,CPT,,,,,,Outpatient,,,35,14.51,Viva Med ADV,Viva Med ADV,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
Breath Alcohol,9687753,LOCAL,82075,CPT,,,,,,Outpatient,,,35,36,Viva Med ADV,Viva Med ADV,30,,,,,,,Fee Schedule,17.73,30,
"CCP, Antibody (IgG) QSTC",14116753,LOCAL,86200,CPT,,,,,,Outpatient,,,35,15.54,Viva Med ADV,Viva Med ADV,7.49,,,,,,,Fee Schedule,7.491935484,15.29,
"MCV, Antibody QSTC",14116754,LOCAL,83520,CPT,,,,,,Outpatient,,,35,20.72,Viva Med ADV,Viva Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rheumatoid Factor QSTC,14116752,LOCAL,86431,CPT,,,,,,Outpatient,,,35,6.8,Viva Med ADV,Viva Med ADV,6.3,,,,,,,Fee Schedule,6.29875,15.29,
T4 Total,633845,LOCAL,84436,CPT,,,,,,Outpatient,,,35.09,8.24,Viva Med ADV,Viva Med ADV,17.54,,,,,,,Fee Schedule,17.54230769,18.43,
Rheumatoid Factor Qualitative,7906954,LOCAL,86430,CPT,,,,,,Outpatient,,,35.1,7.37,Viva Med ADV,Viva Med ADV,20.56,,,,,,,Fee Schedule,15.29,20.56,
Protein Tot & Protein Electrophore QSTC,8764768,LOCAL,84155,CPT,,,,,,Outpatient,,,35.23,4.4,Viva Med ADV,Viva Med ADV,3.67,,,,,,,Fee Schedule,3.67,7.16,
Glucose 2 Hour Post Prandial,7973897,LOCAL,82947,CPT,,,,,,Outpatient,,,35.5,4.72,Viva Med ADV,Viva Med ADV,10.3,,,,,,,Fee Schedule,7.16,10.29541667,
Lithium Level,2046348,LOCAL,80178,CPT,,,,,,Outpatient,,,35.5,7.93,Viva Med ADV,Viva Med ADV,20.99,,,,,,,Fee Schedule,15.38,20.99,
Magnesium Level,633781,LOCAL,83735,CPT,,,,,,Outpatient,,,35.5,8.04,Viva Med ADV,Viva Med ADV,3.66,,,,,,,Fee Schedule,3.657824427,7.16,
BINDER ABDOMINAL FEMALE,11070714,LOCAL,,,L0625,HCPCS,,,,Outpatient,,,35.59,86,Viva Med ADV,Viva Med ADV,42.8,,,,,,,Fee Schedule,42.8,42.8,
Crystal Analysis QSTC,9658951,LOCAL,89060,CPT,,,,,,Outpatient,,,35.87,8.8,Viva Med ADV,Viva Med ADV,21.53,,,,,,,Fee Schedule,14.07,21.53,
Glucose 1 Hour,7973889,LOCAL,82951,CPT,,,,,,Outpatient,,,35.9,15.44,Viva Med ADV,Viva Med ADV,12.87,,,,,,,Fee Schedule,12.87,17.73,
Glucose 2 Hour,7973890,LOCAL,82952,CPT,,,,,,Outpatient,,,35.9,4.7,Viva Med ADV,Viva Med ADV,3.92,,,,,,,Fee Schedule,3.92,7.16,
Glucose Level,633594,LOCAL,82947,CPT,,,,,,Outpatient,,,35.9,4.72,Viva Med ADV,Viva Med ADV,10.3,,,,,,,Fee Schedule,7.16,10.29541667,
Thyroid Peroxidase Abs QSTC,8861417,LOCAL,86376,CPT,,,,,,Outpatient,,,35.91,17.46,Viva Med ADV,Viva Med ADV,25.09,,,,,,,Fee Schedule,15.29,25.085,
Thyroid Peroxidase Antibodies QSTC,8764563,LOCAL,86376,CPT,,,,,,Outpatient,,,35.91,17.46,Viva Med ADV,Viva Med ADV,25.09,,,,,,,Fee Schedule,15.29,25.085,
"Alpha-1-Antitrypsin, Qn QSTC",9039253,LOCAL,82103,CPT,,,,,,Outpatient,,,36,16.13,Viva Med ADV,Viva Med ADV,60.59,,,,,,,Fee Schedule,17.73,60.59,
"Alpha-Fetoprotein, Tumor Marker QSTC",8764596,LOCAL,82105,CPT,,,,,,Outpatient,,,36,20.12,Viva Med ADV,Viva Med ADV,26.22,,,,,,,Fee Schedule,17.73,26.22,
"B2 Microglobulin, Serum QSTC",8764794,LOCAL,82232,CPT,,,,,,Outpatient,,,36,19.42,Viva Med ADV,Viva Med ADV,16.18,,,,,,,Fee Schedule,16.18,18.43,
Bill Decalcification Procedure,8489589,LOCAL,88311,CPT,,,,,,Outpatient,,,36,,Viva Med ADV,Viva Med ADV,7.2,,,,,,,Fee Schedule,7.2,59.06,
CA 125 QSTC,8764680,LOCAL,86304,CPT,,,,,,Outpatient,,,36,24.97,Viva Med ADV,Viva Med ADV,20.81,,,,,,,Fee Schedule,15.29,20.81,
CA 19-9 QSTC,8764669,LOCAL,86301,CPT,,,,,,Outpatient,,,36,24.97,Viva Med ADV,Viva Med ADV,20.81,,,,,,,Fee Schedule,15.29,20.81,
CA 27.29 QSTC,8764762,LOCAL,86300,CPT,,,,,,Outpatient,,,36,24.97,Viva Med ADV,Viva Med ADV,43.34,,,,,,,Fee Schedule,15.29,43.34448276,
Copper QSTC,8764536,LOCAL,82525,CPT,,,,,,Outpatient,,,36,14.89,Viva Med ADV,Viva Med ADV,24.09,,,,,,,Fee Schedule,16.07,24.085,
"Fungal Identification, Molds QSTC",8873558,LOCAL,87107,CPT,,,,,,Outpatient,,,36,12.38,Viva Med ADV,Viva Med ADV,10.32,,,,,,,Fee Schedule,10.32,10.57,
"Gliadin(Deamidated) Ab,IgA QSTC",9039363,LOCAL,86258,CPT,,,,,,Outpatient,,,36,14.46,Viva Med ADV,Viva Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
"Gliadin(Deamidated) Ab,IgG QSTC",9039362,LOCAL,86258,CPT,,,,,,Outpatient,,,36,14.46,Viva Med ADV,Viva Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
Lamotrigine QSTC,8853218,LOCAL,80175,CPT,,,,,,Outpatient,,,36,15.9,Viva Med ADV,Viva Med ADV,13.25,,,,,,,Fee Schedule,13.25,15.38,
"Protein, Total, w/Creat, Random Ur QSTC",9291011,LOCAL,84156,CPT,,,,,,Outpatient,,,36,4.4,Viva Med ADV,Viva Med ADV,11.68,,,,,,,Fee Schedule,7.16,11.68,
"Testosterone, Total, MS QSTC",8848606,LOCAL,84402,CPT,,,,,,Outpatient,,,36,30.56,Viva Med ADV,Viva Med ADV,30.49,,,,,,,Fee Schedule,18.43,30.485,
SLING PED/INFANT 5'X9,6000156,LOCAL,,,A4565,HCPCS,,,,Outpatient,,,36.19,19,Viva Med ADV,Viva Med ADV,10.98,,,,,,,Fee Schedule,10.98,10.98,
"Copper, 24-Hour Urine QSTC",9390117,LOCAL,82525,CPT,,,,,,Outpatient,,,36.27,14.89,Viva Med ADV,Viva Med ADV,24.09,,,,,,,Fee Schedule,16.07,24.085,
MALDI ID,X87077,LOCAL,87077,CPT,,,,,,Outpatient,,,36.36,9.7,Viva Med ADV,Viva Med ADV,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
cefTAZidime 2 g injection [CULL],11201395,LOCAL,J0713,CPT,,,,,,Outpatient,1,EA,36.67968,,Viva Med ADV,Viva Med ADV,1.47,,,,,,,Fee Schedule,1.468,1.468,
"ANA Screen, IFA QST",9110748,LOCAL,86038,CPT,,,,,,Outpatient,,,37,14.51,Viva Med ADV,Viva Med ADV,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
Complement Component C3C QST,12876950,LOCAL,86160,CPT,,,,,,Outpatient,,,37,14.4,Viva Med ADV,Viva Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
Complement Component C4C QST,12876951,LOCAL,86160,CPT,,,,,,Outpatient,,,37,14.4,Viva Med ADV,Viva Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
DNA (DS) Antibody QST,9110747,LOCAL,86225,CPT,,,,,,Outpatient,,,37,16.49,Viva Med ADV,Viva Med ADV,14.72,,,,,,,Fee Schedule,14.71636364,15.29,
Microalbumin Level Urine,7974117,LOCAL,82043,CPT,,,,,,Outpatient,,,37,6.94,Viva Med ADV,Viva Med ADV,20.16,,,,,,,Fee Schedule,4.02,20.15557971,
Rheumatoid Factor QST,9110751,LOCAL,86431,CPT,,,,,,Outpatient,,,37,6.8,Viva Med ADV,Viva Med ADV,6.3,,,,,,,Fee Schedule,6.29875,15.29,
Ribosomal P Antibody QST,9110754,LOCAL,83516,CPT,,,,,,Outpatient,,,37,13.84,Viva Med ADV,Viva Med ADV,11.53,,,,,,,Fee Schedule,11.53,17.73,
SCL-70 Antibody QST,9110757,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-A) QST,9110760,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-B) QST,9110763,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sm Antibody QST,9110766,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
SM/RNP Antibody QST,9110769,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Thyroid Peroxidase Antibodies QST,9110772,LOCAL,86376,CPT,,,,,,Outpatient,,,37,17.46,Viva Med ADV,Viva Med ADV,25.09,,,,,,,Fee Schedule,15.29,25.085,
EBV EBNA Ab (IgG) Interp QSTC,8849012,LOCAL,86664,CPT,,,,,,Outpatient,,,37.13,18.35,Viva Med ADV,Viva Med ADV,15.29,,,,,,,Fee Schedule,15.29,15.29,
EBV VCA Ab (IgM) QSTC,8849009,LOCAL,86665,CPT,,,,,,Outpatient,,,37.13,21.77,Viva Med ADV,Viva Med ADV,18.14,,,,,,,Fee Schedule,15.29,18.14,
".B. henselae Ab(IgG),Titer QSTC",8764830,LOCAL,86611,CPT,,,,,,Outpatient,,,37.35,12.22,Viva Med ADV,Viva Med ADV,10.18,,,,,,,Fee Schedule,10.18,15.29,
".B. henselae Ab(IgM),Titer QSTC",8764831,LOCAL,86611,CPT,,,,,,Outpatient,,,37.35,12.22,Viva Med ADV,Viva Med ADV,10.18,,,,,,,Fee Schedule,10.18,15.29,
".B. quintana Ab(IgG),Titer QSTC",10128892,LOCAL,86611,CPT,,,,,,Outpatient,,,37.35,12.22,Viva Med ADV,Viva Med ADV,10.18,,,,,,,Fee Schedule,10.18,15.29,
IMMOBLIZER KNEE XX-LARGE,11070340,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,37.9,158,Viva Med ADV,Viva Med ADV,77.23,,,,,,,Fee Schedule,77.23,77.23,
methocarbamol 100 mg/mL injectable solution 10 mL [CULL],11201939,LOCAL,J2800,CPT,,,,,,Outpatient,10,ML,38.4,,Viva Med ADV,Viva Med ADV,4.54,,,,,,,Fee Schedule,4.535,4.535,
calcium gluconate 100 mg/mL injectable solution 10 mL [CULL],11201252,LOCAL,J0612,CPT,,,,,,Outpatient,10,ML,38.4768,,Viva Med ADV,Viva Med ADV,0.03,,,,,,,Fee Schedule,0.01,0.03,
SLING & SWATHE W/SLEEVE,11071056,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,38.89,12,Viva Med ADV,Viva Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
TBG QSTC,8853216,LOCAL,84442,CPT,,,,,,Outpatient,,,39.06,17.74,Viva Med ADV,Viva Med ADV,14.78,,,,,,,Fee Schedule,14.78,18.43,
"Culture, Fungus, Skin, Hair, Nails QSTC",8972785,LOCAL,87101,CPT,,,,,,Outpatient,,,39.11,9.25,Viva Med ADV,Viva Med ADV,7.71,,,,,,,Fee Schedule,7.71,10.57,
Prostate Specific Antigen Total,7939094,LOCAL,84153,CPT,,,,,,Outpatient,,,39.17,22.07,Viva Med ADV,Viva Med ADV,104.84,,,,,,,Fee Schedule,17.73,104.8447059,
Prealbumin,3454341,LOCAL,84134,CPT,,,,,,Outpatient,,,39.98,17.51,Viva Med ADV,Viva Med ADV,4.93,,,,,,,Fee Schedule,4.934545455,17.73,
20560 DRY NEEDLING 1 OR 2 MUSCLES WO INJECTION,9650048,LOCAL,20560,CPT,,,,,,Outpatient,,,40,26,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,22.39,863,
Beef (F27) IgE Class QSTC,14129407,LOCAL,86003,CPT,,,,,,Outpatient,,,40,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Glucose Body Fluid,1628896,LOCAL,82945,CPT,,,,,,Outpatient,,,40,4.72,Viva Med ADV,Viva Med ADV,3.93,,,,,,,Fee Schedule,3.93,7.16,
Lamb (F88) IgE Class QSTC,14129413,LOCAL,86003,CPT,,,,,,Outpatient,,,40,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pork (F26) IgE Class QSTC,14129419,LOCAL,86003,CPT,,,,,,Outpatient,,,40,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
RESULTS_QSTC,14755730,LOCAL,86008,CPT,,,,,,Outpatient,,,40,21.52,Viva Med ADV,Viva Med ADV,17.93,,,,,,,Fee Schedule,15.29,17.93,
"Pyruvic Acid (Pyruvate),B QSTC",13864526,LOCAL,84210,CPT,,,,,,Outpatient,,,40.1,17.38,Viva Med ADV,Viva Med ADV,14.48,,,,,,,Fee Schedule,14.48,17.73,
"VDRL, CSF QSTC",8764738,LOCAL,86592,CPT,,,,,,Outpatient,,,40.41,5.12,Viva Med ADV,Viva Med ADV,19.99,,,,,,,Fee Schedule,15.29,19.99375,
Angiotensin Converting Enzyme QSTC,8764564,LOCAL,82164,CPT,,,,,,Outpatient,,,40.5,17.52,Viva Med ADV,Viva Med ADV,27.41,,,,,,,Fee Schedule,17.73,27.405,
Intrinsic Factor Blocking Antibody QSTC,8764611,LOCAL,86340,CPT,,,,,,Outpatient,,,40.5,18.1,Viva Med ADV,Viva Med ADV,15.08,,,,,,,Fee Schedule,15.08,15.29,
Osmolality Serum,9414322,LOCAL,83930,CPT,,,,,,Outpatient,,,40.5,7.93,Viva Med ADV,Viva Med ADV,6.61,,,,,,,Fee Schedule,6.61,7.16,
97018 OT PARAFFIN BATH 1+ AREAS APPLIC CHARGE,9850020,LOCAL,97018,CPT,,,,,GO,Outpatient,,,40.9,27,Viva Med ADV,Viva Med ADV,5.41,,,,,,,Fee Schedule,5.41,47.26,
97018 OT PARAFFIN BATH CHARGE,9860020,LOCAL,97018,CPT,,,,,GO|CO,Outpatient,,,40.9,27,Viva Med ADV,Viva Med ADV,5.41,,,,,,,Fee Schedule,5.41,47.26,
OT Paraffin Bath Assistant Units,7895270,LOCAL,97018,CPT,,,,,CQ,Outpatient,,,40.9,27,Viva Med ADV,Viva Med ADV,5.41,,,,,,,Fee Schedule,5.41,47.26,
OT Paraffin Bath Units,1373447,LOCAL,97018,CPT,,,,,GO,Outpatient,,,40.9,27,Viva Med ADV,Viva Med ADV,5.41,,,,,,,Fee Schedule,5.41,47.26,
Paraffin Bath Charge,7895270,LOCAL,97018,CPT,,,,,GO,Outpatient,,,40.9,27,Viva Med ADV,Viva Med ADV,5.41,,,,,,,Fee Schedule,5.41,47.26,
Centromere B Antibody QSTC,8764633,LOCAL,86235,CPT,,,,,,Outpatient,,,40.91,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
COLLAR LG HARD C,11070731,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,41.14,223,Viva Med ADV,Viva Med ADV,175.72,,,,,,,Fee Schedule,175.72,175.72,
COLLAR MED.HARD,11071039,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,41.14,223,Viva Med ADV,Viva Med ADV,175.72,,,,,,,Fee Schedule,175.72,175.72,
COLLAR SM HARD C,11070729,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,41.14,223,Viva Med ADV,Viva Med ADV,175.72,,,,,,,Fee Schedule,175.72,175.72,
M. pneumoniae Ab (IgM) QSTC,8764773,LOCAL,86738,CPT,,,,,,Outpatient,,,41.49,15.89,Viva Med ADV,Viva Med ADV,13.24,,,,,,,Fee Schedule,13.24,15.29,
CULL Pre-MRI Device Screening,14536295,LOCAL,76014,CPT,,,,,,Outpatient,,,41.5,19.8,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,22.39,22.39,
MRI Safety Screening,14536295,LOCAL,76014,CPT,,,,,,Outpatient,,,41.5,19.8,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,22.39,22.39,
Zinc QSTC,8764557,LOCAL,84630,CPT,,,,,,Outpatient,,,41.58,13.67,Viva Med ADV,Viva Med ADV,26.38,,,,,,,Fee Schedule,16.07,26.375,
Gram Stain (General Lab),8726050,LOCAL,87205,CPT,,,,,,Outpatient,,,41.62,5.12,Viva Med ADV,Viva Med ADV,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
Gram Stain Intraoperative,13436049,LOCAL,87205,CPT,,,,,,Outpatient,,,41.62,5.12,Viva Med ADV,Viva Med ADV,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
Gram Stain Report,634217,LOCAL,87205,CPT,,,,,,Outpatient,,,41.62,5.12,Viva Med ADV,Viva Med ADV,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
"Bile Acids, Fractionated and Total QSTC",13864500,LOCAL,82542,CPT,,,,,,Outpatient,,,41.85,28.91,Viva Med ADV,Viva Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.09,
"Calcium, 24 hr Ur (w/o Creatinine) QSTC",9039238,LOCAL,82340,CPT,,,,,,Outpatient,,,41.99,7.24,Viva Med ADV,Viva Med ADV,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
Drug Panel (10),13954356,LOCAL,80306,CPT,,,,,,Outpatient,,,42.45,20.57,Viva Med ADV,Viva Med ADV,0.24,,,,,,,Fee Schedule,0.2416,17.73,
Bill Intraoperative Additonal,14048005,LOCAL,88332,CPT,,,,,,Outpatient,,,42.46,,Viva Med ADV,Viva Med ADV,21.23,,,,,,,Fee Schedule,21.23,53.82,
Toxoplasma Antibody (IgG) QSTC,8861628,LOCAL,86777,CPT,,,,,,Outpatient,,,42.48,17.27,Viva Med ADV,Viva Med ADV,14.39,,,,,,,Fee Schedule,14.39,15.29,
Toxoplasma Antibody (IgM) QSTC,8861629,LOCAL,86778,CPT,,,,,,Outpatient,,,42.48,17.29,Viva Med ADV,Viva Med ADV,14.41,,,,,,,Fee Schedule,14.41,15.29,
clindamycin 600 mg/50 mL-NaCl 0.9% Sol [CULL],11290024,LOCAL,J0737,CPT,,,,,,Outpatient,50,ML,42.72,,Viva Med ADV,Viva Med ADV,2.35,,,,,,,Fee Schedule,0.819,2.346,
"Cadmium, Blood, QSTC",13864925,LOCAL,82300,CPT,,,,,,Outpatient,,,42.75,28.37,Viva Med ADV,Viva Med ADV,29.91,,,,,,,Fee Schedule,16.07,29.91,
"Vitamin B1 (Thiamine), B QSTC",8972833,LOCAL,84425,CPT,,,,,,Outpatient,,,42.75,25.48,Viva Med ADV,Viva Med ADV,30.05,,,,,,,Fee Schedule,17.73,30.04654545,
"Calcium, Ionized QSTC",9039239,LOCAL,82330,CPT,,,,,,Outpatient,,,43.2,16.42,Viva Med ADV,Viva Med ADV,28.31,,,,,,,Fee Schedule,17.73,28.305,
"Cortisol, Free, U24 QSTC",8764823,LOCAL,82530,CPT,,,,,,Outpatient,,,43.2,20.05,Viva Med ADV,Viva Med ADV,29.79,,,,,,,Fee Schedule,17.73,29.79,
"Vanillylmandelic Acid, U24 QSTC",8764683,LOCAL,84585,CPT,,,,,,Outpatient,,,43.2,18.6,Viva Med ADV,Viva Med ADV,15.5,,,,,,,Fee Schedule,15.5,18.43,
"Aspergillus fumigatus, IgG Ab QSTC",13864492,LOCAL,86606,CPT,,,,,,Outpatient,,,43.25,18.06,Viva Med ADV,Viva Med ADV,15.05,,,,,,,Fee Schedule,15.05,15.29,
"Blastomyces Ab,Immunodiff QSTC",10100364,LOCAL,86612,CPT,,,,,,Outpatient,,,43.25,15.48,Viva Med ADV,Viva Med ADV,12.9,,,,,,,Fee Schedule,12.9,15.29,
Cryptococcal Antigen Latex QSTC,8972754,LOCAL,86403,CPT,,,,,,Outpatient,,,43.25,13.85,Viva Med ADV,Viva Med ADV,11.54,,,,,,,Fee Schedule,11.54,15.29,
"5HIAA, 24-Hour Urine QSTC",8764545,LOCAL,83497,CPT,,,,,,Outpatient,,,43.34,15.48,Viva Med ADV,Viva Med ADV,12.9,,,,,,,Fee Schedule,12.9,18.43,
betamethasone 12 mg/mL injectable suspension 2mL [CULL],11205515,LOCAL,J0702,CPT,,,,,,Outpatient,1,ML,43.4048,,Viva Med ADV,Viva Med ADV,22.48,,,,,,,Fee Schedule,22.47566502,22.47566502,
O2 Saturation Arterial,12487723,LOCAL,82810,CPT,,,,,,Outpatient,,,43.6,11.72,Viva Med ADV,Viva Med ADV,9.77,,,,,,,Fee Schedule,9.77,17.73,
O2 Saturation Venous,12487723,LOCAL,82810,CPT,,,,,,Outpatient,,,43.6,11.72,Viva Med ADV,Viva Med ADV,9.77,,,,,,,Fee Schedule,9.77,17.73,
"Creatinine Random Ur, QSTC",10127838,LOCAL,82570,CPT,,,,,,Outpatient,,,43.61,6.22,Viva Med ADV,Viva Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Metanephrine Ur, Total QSTC",10127837,LOCAL,83835,CPT,,,,,,Outpatient,,,43.61,20.33,Viva Med ADV,Viva Med ADV,98.31,,,,,,,Fee Schedule,18.43,98.305,
CA 15-3 QSTC,8764684,LOCAL,86300,CPT,,,,,,Outpatient,,,44.55,24.97,Viva Med ADV,Viva Med ADV,43.34,,,,,,,Fee Schedule,15.29,43.34448276,
"Electrolytes, Urine",12312936,LOCAL,84166,CPT,,,,,,Outpatient,,,44.88,21.4,Viva Med ADV,Viva Med ADV,18.62,,,,,,,Fee Schedule,17.73,18.62,
Occult Blood Stool Screen,7909957,LOCAL,82272,CPT,,,,,,Outpatient,,,44.88,5.08,Viva Med ADV,Viva Med ADV,4.46,,,,,,,Fee Schedule,4.457272727,7.16,
"Carbamazepine, Total QSTC",9039320,LOCAL,80156,CPT,,,,,,Outpatient,,,44.95,17.48,Viva Med ADV,Viva Med ADV,16.45,,,,,,,Fee Schedule,15.38,16.45277778,
Gastric Parietal Cell AB QSTC,8764524,LOCAL,83516,CPT,,,,,,Outpatient,,,44.96,13.84,Viva Med ADV,Viva Med ADV,11.53,,,,,,,Fee Schedule,11.53,17.73,
"ACTH, Plasma QSTC",8764544,LOCAL,82024,CPT,,,,,,Outpatient,,,45,46.34,Viva Med ADV,Viva Med ADV,38.62,,,,,,,Fee Schedule,18.43,38.62,
Beta2-Glycoprotein IgA QSTC,10100357,LOCAL,86146,CPT,,,,,,Outpatient,,,45,30.54,Viva Med ADV,Viva Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
Immunoglobulin G Subclass 4 QSTC,10100372,LOCAL,82787,CPT,,,,,,Outpatient,,,45,9.62,Viva Med ADV,Viva Med ADV,8.02,,,,,,,Fee Schedule,7.16,8.02,
Testosterone Free & Total MS QSTC,8764632,LOCAL,84403,CPT,,,,,,Outpatient,,,45,30.97,Viva Med ADV,Viva Med ADV,52.38,,,,,,,Fee Schedule,18.43,52.3775,
Tissue Transglutaminase IgA Ab QSTC,8764753,LOCAL,86364,CPT,,,,,,Outpatient,,,45,13.84,Viva Med ADV,Viva Med ADV,61.9,,,,,,,Fee Schedule,15.29,61.9,
acetaminophen 10 mg/mL intravenous solution 100 mL [CULL],11200037,LOCAL,J0134,CPT,,,,,,Outpatient,100,ML,46.08,,Viva Med ADV,Viva Med ADV,3.16,,,,,,,Fee Schedule,3.159596774,3.159596774,
Scl-70 Antibody QSTC,8853206,LOCAL,86235,CPT,,,,,,Outpatient,,,46.17,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Egg Component Panel QSTC,9039428,LOCAL,86008,CPT,,,,,,Outpatient,,,46.26,21.52,Viva Med ADV,Viva Med ADV,17.93,,,,,,,Fee Schedule,15.29,17.93,
Total Iron Binding Capacity,7909796,LOCAL,83550,CPT,,,,,,Outpatient,,,47,10.49,Viva Med ADV,Viva Med ADV,8.74,,,,,,,Fee Schedule,8.74,17.73,
amikacin 250 mg/mL injectable solution 2 mL [CULL],11201051,LOCAL,J0278,CPT,,,,,,Outpatient,2,ML,47.0592,,Viva Med ADV,Viva Med ADV,0.62,,,,,,,Fee Schedule,0.621,0.621,
cefTRIAXone 250 mg injection [CULL],11202192,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,47.4112,,Viva Med ADV,Viva Med ADV,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
clindamycin 600 mg/50 mL-D5% intravenous solution 50 mL [CULL],11290024,LOCAL,J0736,CPT,,,,,,Outpatient,50,ML,47.484,,Viva Med ADV,Viva Med ADV,0.82,,,,,,,Fee Schedule,0.819,2.346,
Yeast Culture,7909554,LOCAL,87101,CPT,,,,,,Outpatient,,,47.7,9.25,Viva Med ADV,Viva Med ADV,7.71,,,,,,,Fee Schedule,7.71,10.57,
T3 Total,633833,LOCAL,84480,CPT,,,,,,Outpatient,,,48,17.02,Viva Med ADV,Viva Med ADV,33.01,,,,,,,Fee Schedule,18.43,33.01411765,
97035 OT ULTRASOUND,9850026,LOCAL,97035,CPT,,,,,GO,Outpatient,,,48.35,31,Viva Med ADV,Viva Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
97035 OT Ultrasound Assistant Units,9860026,LOCAL,97035,CPT,,,,,GO|CO,Outpatient,,,48.35,31,Viva Med ADV,Viva Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
97035 PT ULTRASOUND,9640026,LOCAL,97035,CPT,,,,,GP,Outpatient,,,48.35,31,Viva Med ADV,Viva Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
97035 PT Ultrasound Assistant Units,9650026,LOCAL,97035,CPT,,,,,GP|CQ,Outpatient,,,48.35,31,Viva Med ADV,Viva Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
97035 ULTRASOUND EA 15 MIN CHARGE,9410126,LOCAL,97035,CPT,,,,,GP,Outpatient,,,48.35,31,Viva Med ADV,Viva Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
OT Ultrasound Assistant Units,1366376,LOCAL,97035,CPT,,,,,CQ,Outpatient,,,48.35,31,Viva Med ADV,Viva Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
OT Ultrasound Charges,1366376,LOCAL,97035,CPT,,,,,GO,Outpatient,,,48.35,31,Viva Med ADV,Viva Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
OT Ultrasound Units,1373448,LOCAL,97035,CPT,,,,,GO,Outpatient,,,48.35,31,Viva Med ADV,Viva Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
PT Ultrasound Assistant Units,9390428,LOCAL,97035,CPT,,,,,CQ,Outpatient,,,48.35,31,Viva Med ADV,Viva Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
Ultrasound Charges,1366376,LOCAL,97035,CPT,,,,,GO,Outpatient,,,48.35,31,Viva Med ADV,Viva Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
Ultrasound Charges,7895933,LOCAL,97035,CPT,,,,,GP,Outpatient,,,48.35,31,Viva Med ADV,Viva Med ADV,13.34,,,,,,,Fee Schedule,13.34,47.26,
Phenobarbital QSTC,8972760,LOCAL,80184,CPT,,,,,,Outpatient,,,48.65,18.36,Viva Med ADV,Viva Med ADV,15.3,,,,,,,Fee Schedule,15.3,15.38,
"penicillin G potassium 5,000,000 units injection [CULL]",11211091,LOCAL,J2540,CPT,,,,,,Outpatient,1,EA,48.84864,,Viva Med ADV,Viva Med ADV,0.78,,,,,,,Fee Schedule,0.78,0.78,
Semen Analysis Post Vasectomy,3454457,LOCAL,89320,CPT,,,,,,Outpatient,,,48.96,14.77,Viva Med ADV,Viva Med ADV,12.31,,,,,,,Fee Schedule,12.31,14.07,
"HIV Ag/Ab, 4th Gen w reflexes QSTC",8764806,LOCAL,87389,CPT,,,,,,Outpatient,,,49.5,28.9,Viva Med ADV,Viva Med ADV,36.55,,,,,,,Fee Schedule,10.57,36.55,
"Phenytoin, Free QSTC",8764686,LOCAL,80186,CPT,,,,,,Outpatient,,,49.5,16.51,Viva Med ADV,Viva Med ADV,31.5,,,,,,,Fee Schedule,15.38,31.495,
"T3, Reverse, LCMSMS QSTC",8764804,LOCAL,84482,CPT,,,,,,Outpatient,,,49.5,18.91,Viva Med ADV,Viva Med ADV,32.48,,,,,,,Fee Schedule,18.43,32.475,
"82140 Ammonium, 24 HR, U",14789403,LOCAL,82140,CPT,,,,,,Outpatient,,,49.65,17.48,Viva Med ADV,Viva Med ADV,22.63,,,,,,,Fee Schedule,17.73,22.62909091,
"82340 Calcium, 24 HR, U",14797185,LOCAL,82340,CPT,,,,,,Outpatient,,,49.65,7.24,Viva Med ADV,Viva Med ADV,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
"82436 Chloride, 24 HR, U",14797182,LOCAL,82436,CPT,,,,,,Outpatient,,,49.65,6.9,Viva Med ADV,Viva Med ADV,5.75,,,,,,,Fee Schedule,5.75,7.16,
"82507 Citrate Excretion, 24 HR, U",14787436,LOCAL,82507,CPT,,,,,,Outpatient,,,49.65,33.36,Viva Med ADV,Viva Med ADV,30.63,,,,,,,Fee Schedule,17.73,30.625,
"82570 Creatinine, 24 HR, U",14798767,LOCAL,82570,CPT,,,,,,Outpatient,,,49.65,6.22,Viva Med ADV,Viva Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"83735 Magnesium, 24 HR, U",14789401,LOCAL,83735,CPT,,,,,,Outpatient,,,49.65,8.04,Viva Med ADV,Viva Med ADV,3.66,,,,,,,Fee Schedule,3.657824427,7.16,
"83945 Oxalate, 24 HR, U",14797186,LOCAL,83945,CPT,,,,,,Outpatient,,,49.65,17.34,Viva Med ADV,Viva Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.085,
"84105 Phosphorus, 24 HR, U",14787442,LOCAL,84105,CPT,,,,,,Outpatient,,,49.65,6.94,Viva Med ADV,Viva Med ADV,19.84,,,,,,,Fee Schedule,7.16,19.835,
"84133 Potassium, 24 HR, U",14797183,LOCAL,84133,CPT,,,,,,Outpatient,,,49.65,5.68,Viva Med ADV,Viva Med ADV,19.32,,,,,,,Fee Schedule,7.16,19.32,
"84300 Sodium, 24 HR, U",14797184,LOCAL,84300,CPT,,,,,,Outpatient,,,49.65,6.07,Viva Med ADV,Viva Med ADV,9.74,,,,,,,Fee Schedule,7.16,9.74,
"84540 Urea Nitrogen, 24 HR, U",14789404,LOCAL,84540,CPT,,,,,,Outpatient,,,49.65,6.67,Viva Med ADV,Viva Med ADV,5.56,,,,,,,Fee Schedule,5.56,7.16,
"84560 Uric Acid, 24 HR, U",14787441,LOCAL,84560,CPT,,,,,,Outpatient,,,49.65,6.1,Viva Med ADV,Viva Med ADV,19.49,,,,,,,Fee Schedule,7.16,19.49,
BUPivacaine 0.5% preservative-free injectable solution 30 mL [CULL],11282051,LOCAL,J0665,CPT,,,,,,Outpatient,30,ML,49.68576,,Viva Med ADV,Viva Med ADV,0.01,,,,,,,Fee Schedule,0.01,0.011,
deferoxamine 500 mg injection [CULL],11214520,LOCAL,J0895,CPT,,,,,,Outpatient,1,EA,49.728,,Viva Med ADV,Viva Med ADV,8.47,,,,,,,Fee Schedule,8.468,8.468,
C-Peptide,12252873,LOCAL,84681,CPT,,,,,,Outpatient,,,50,24.97,Viva Med ADV,Viva Med ADV,33.24,,,,,,,Fee Schedule,17.73,33.24444444,
D-Dimer,3454398,LOCAL,85380,CPT,,,,,,Outpatient,,,50,12.22,Viva Med ADV,Viva Med ADV,5.76,,,,,,,Fee Schedule,5.76079096,8.21,
G0447 BEHAVIORAL COUNSIL OBESITY 15 MIN CHARGE,8635988,LOCAL,,,G0447,HCPCS,,,,Outpatient,,,50,33,Viva Med ADV,Viva Med ADV,84.57,,,,,,,Fee Schedule,84.57,177.17,
Hepatitis B S Ab,1628908,LOCAL,86706,CPT,,,,,,Outpatient,,,50,12.89,Viva Med ADV,Viva Med ADV,17.79,,,,,,,Fee Schedule,15.29,17.794,
Hepatitis B Surface Antibody w/ Interp,9299896,LOCAL,86706,CPT,,,,,,Outpatient,,,50,12.89,Viva Med ADV,Viva Med ADV,17.79,,,,,,,Fee Schedule,15.29,17.794,
Lactate Dehydrogenase Body Fluid,3454444,LOCAL,83615,CPT,,,,,,Outpatient,,,50,7.25,Viva Med ADV,Viva Med ADV,21.68,,,,,,,Fee Schedule,7.16,21.675,
"Cytomegalovirus Antibodies (IgG,IgM) QSTC",8972893,LOCAL,86645,CPT,,,,,,Outpatient,,,50.4,20.22,Viva Med ADV,Viva Med ADV,16.85,,,,,,,Fee Schedule,15.29,16.85,
Cytomegalovirus Antibody (IgM) QSTC,8764581,LOCAL,86645,CPT,,,,,,Outpatient,,,50.4,20.22,Viva Med ADV,Viva Med ADV,16.85,,,,,,,Fee Schedule,15.29,16.85,
Micronutrient Vitamin E QSTC,14116320,LOCAL,84446,CPT,,,,,,Outpatient,,,50.4,17.02,Viva Med ADV,Viva Med ADV,14.18,,,,,,,Fee Schedule,14.18,17.73,
Vitamin A (Retinol) QSTC,8764529,LOCAL,84590,CPT,,,,,,Outpatient,,,50.4,13.93,Viva Med ADV,Viva Med ADV,30.89,,,,,,,Fee Schedule,17.73,30.89,
Ethosuximide QSTC,8764552,LOCAL,80168,CPT,,,,,,Outpatient,,,50.54,19.61,Viva Med ADV,Viva Med ADV,16.34,,,,,,,Fee Schedule,15.38,16.34,
77061 MG Diagnostic Tomo Charge: AddOn Left,13960722,LOCAL,G0279,CPT,,,,,LT,Outpatient,,,50.92,,Viva Med ADV,Viva Med ADV,11.11,,,,,,,Fee Schedule,11.11,74,
77061 MG Diagnostic Tomo Charge: AddOn Right,13960723,LOCAL,G0279,CPT,,,,,RT,Outpatient,,,50.92,,Viva Med ADV,Viva Med ADV,11.11,,,,,,,Fee Schedule,11.11,74,
77061 MG Diagnostic Tomo Charge: AddOn Right,13969683,LOCAL,G0279,CPT,,,,,RT,Outpatient,,,50.92,,Viva Med ADV,Viva Med ADV,11.11,,,,,,,Fee Schedule,11.11,74,
77063 MG Tomo Charge: AddOn Left,13621442,LOCAL,77063,CPT,,,,,LT,Outpatient,,,50.92,54.45,Viva Med ADV,Viva Med ADV,20.75,,,,,,,Fee Schedule,20.75,74,
77063 MG Tomo Charge: AddOn Right,13621441,LOCAL,77063,CPT,,,,,RT,Outpatient,,,50.92,54.45,Viva Med ADV,Viva Med ADV,20.75,,,,,,,Fee Schedule,20.75,74,
PC DOPP ART BIL REST,8200579,LOCAL,93923,CPT,,,,,,Outpatient,,,51.06,401,Viva Med ADV,Viva Med ADV,143.05,,,,,,,Fee Schedule,143.05,244.97,
acyclovir 50 mg/mL intravenous solution 10 mL [CULL],11201009,LOCAL,J0133,CPT,,,,,,Outpatient,10,ML,51.2,,Viva Med ADV,Viva Med ADV,0.12,,,,,,,Fee Schedule,0.119,0.119,
Chloride Level,633621,LOCAL,82435,CPT,,,,,,Outpatient,,,51.41,5.52,Viva Med ADV,Viva Med ADV,4.6,,,,,,,Fee Schedule,4.6,7.16,
KOH POCT,10913182,LOCAL,87220,CPT,,,,,,Outpatient,,,51.41,5.12,Viva Med ADV,Viva Med ADV,4.27,,,,,,,Fee Schedule,4.27,10.57,
E-Stim for Wound Other Charge,7895924,LOCAL,G0283,CPT,G0283,HCPCS,,,GP,Outpatient,,,51.51,33,Viva Med ADV,Viva Med ADV,11.75,,,,,,,Fee Schedule,11.75,47.26,
G0283 INTERFERENCE CHARGES,9640019,LOCAL,,,G0283,HCPCS,,,GP,Outpatient,,,51.51,33,Viva Med ADV,Viva Med ADV,11.81,,,,,,,Fee Schedule,11.81,47.26,
G0283 PT Elect Stim Unattended Assistant Units Charge,9650019,LOCAL,,,G0283,HCPCS,,,GP,Outpatient,,,51.51,33,Viva Med ADV,Viva Med ADV,11.81,,,,,,,Fee Schedule,11.81,47.26,
G0283 OT ELEC STIM MEDICARE CHARGE,9860018,LOCAL,,,G0283,HCPCS,,,GO|CO,Outpatient,,,51.52,33,Viva Med ADV,Viva Med ADV,11.81,,,,,,,Fee Schedule,11.81,47.26,
G0283 OT ESTIM UNATTENDED CHARGE,9850018,LOCAL,,,G0283,HCPCS,,,GO,Outpatient,,,51.52,33,Viva Med ADV,Viva Med ADV,11.81,,,,,,,Fee Schedule,11.81,47.26,
OT Unattended E-Stim Assistant Units,7895266,LOCAL,,,G0283,HCPCS,,,CQ,Outpatient,,,51.52,33,Viva Med ADV,Viva Med ADV,11.81,,,,,,,Fee Schedule,11.81,47.26,
OTElectrical Stim (Unattended) - Non-Wound,1373552,LOCAL,,,G0283,HCPCS,,,GO,Outpatient,,,51.52,33,Viva Med ADV,Viva Med ADV,11.81,,,,,,,Fee Schedule,11.81,47.26,
UA w Micro if Ind,1148022,LOCAL,81003,CPT,,,,,,Outpatient,,,51.6,2.7,Viva Med ADV,Viva Med ADV,3.8,,,,,,,Fee Schedule,3.795286195,4.02,
UA w Micro if Ind & Cult if Ind,8088555,LOCAL,81003,CPT,,,,,,Outpatient,,,51.6,2.7,Viva Med ADV,Viva Med ADV,3.8,,,,,,,Fee Schedule,3.795286195,4.02,
Urinalysis Macroscopic,633863,LOCAL,81003,CPT,,,,,,Outpatient,,,51.6,2.7,Viva Med ADV,Viva Med ADV,3.8,,,,,,,Fee Schedule,3.795286195,4.02,
"T4, Free, Direct Dialysis QSTC",13864535,LOCAL,84439,CPT,,,,,,Outpatient,,,51.98,10.82,Viva Med ADV,Viva Med ADV,28.58,,,,,,,Fee Schedule,18.43,28.58065455,
"Immunofixation, Serum QSTC",8764779,LOCAL,86334,CPT,,,,,,Outpatient,,,52.7,26.81,Viva Med ADV,Viva Med ADV,37.3,,,,,,,Fee Schedule,15.29,37.3,
77061 MG Diagnostic Tomo Charge: AddOn Left,13960724,LOCAL,G0279,CPT,,,,,LT,Outpatient,,,52.92,,Viva Med ADV,Viva Med ADV,11.11,,,,,,,Fee Schedule,11.11,74,
"CtrachomatisRNA, TMA, Urog QSTC",8996973,LOCAL,87491,CPT,,,,,QW,Outpatient,,,53.48,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"NgonorrhoeaeRNA, TMA, Urog QSTC",8996974,LOCAL,87591,CPT,,,,,QW,Outpatient,,,53.48,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Chlamydia Trachomatis RNA, TMA QST",8395007,LOCAL,87491,CPT,,,,,,Outpatient,,,53.5,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",8395010,LOCAL,87591,CPT,,,,,,Outpatient,,,53.5,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"N. Gonorrhoeae RNA, TMA, Urogenital QSTC",13864518,LOCAL,87591,CPT,,,,,QW,Outpatient,,,53.51,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Homocysteine QSTC,8764574,LOCAL,83090,CPT,,,,,,Outpatient,,,53.55,21.5,Viva Med ADV,Viva Med ADV,17.92,,,,,,,Fee Schedule,17.92,18.43,
"Mycobact Culture, w Fluorochrome Sm QSTC",9039257,LOCAL,87116,CPT,,,,,,Outpatient,,,53.55,12.96,Viva Med ADV,Viva Med ADV,25.66,,,,,,,Fee Schedule,10.57,25.656,
"Mycobacteria, Cult, w Fluoro Smear QST",9039257,LOCAL,87116,CPT,,,,,,Outpatient,,,53.55,12.96,Viva Med ADV,Viva Med ADV,25.66,,,,,,,Fee Schedule,10.57,25.656,
ampicillin 2 g injection [CULL],11201144,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,53.6096,,Viva Med ADV,Viva Med ADV,0.59,,,,,,,Fee Schedule,0.591,0.591,
DOBUTamine 2 mg/mL-D5% intravenous solution 250 mL [CULL],11201692,LOCAL,J1250,CPT,,,,,,Outpatient,250,ML,53.68,,Viva Med ADV,Viva Med ADV,8.02,,,,,,,Fee Schedule,8.024,8.024,
acetylcysteine 20% inhalation solution 4 mL [CULL],11205094,LOCAL,J7608,CPT,,,,,,Outpatient,4,ML,53.7984,,Viva Med ADV,Viva Med ADV,8.46,,,,,,,Fee Schedule,8.455,8.455,
"Angiotensin Converting Enzyme (ACE), CSF QSTC",10170069,LOCAL,82164,CPT,,,,,,Outpatient,,,54,17.52,Viva Med ADV,Viva Med ADV,27.41,,,,,,,Fee Schedule,17.73,27.405,
"Endomysial Ab Screen IgA, Rfx Titer QSTC",8764677,LOCAL,86231,CPT,,,,,,Outpatient,,,54,14.51,Viva Med ADV,Viva Med ADV,106.94,,,,,,,Fee Schedule,15.29,106.935,
Hexagonal Phase Confirm. QSTC,9039456,LOCAL,85598,CPT,,,,,,Outpatient,,,54,21.58,Viva Med ADV,Viva Med ADV,17.98,,,,,,,Fee Schedule,5.42,17.98,
hs-CRP QSTC,8853237,LOCAL,86141,CPT,,,,,,Outpatient,,,54,15.54,Viva Med ADV,Viva Med ADV,12.95,,,,,,,Fee Schedule,12.95,15.29,
Lipoprotein (a) QSTC,8853258,LOCAL,83695,CPT,,,,,,Outpatient,,,54,17.18,Viva Med ADV,Viva Med ADV,14.32,,,,,,,Fee Schedule,14.32,17.73,
"Oligoclonal Bands (IgG), CSF QSTC",8764540,LOCAL,83916,CPT,,,,,,Outpatient,,,54,32.87,Viva Med ADV,Viva Med ADV,27.39,,,,,,,Fee Schedule,17.73,27.39,
"Plasma Renin Activity, LC/MS/MS QSTC",8764647,LOCAL,84244,CPT,,,,,,Outpatient,,,54,26.39,Viva Med ADV,Viva Med ADV,37.78,,,,,,,Fee Schedule,18.43,37.78,
"Vitamin D, 1,25-Dihydroxy QSTC",8764639,LOCAL,82652,CPT,,,,,,Outpatient,,,54,46.2,Viva Med ADV,Viva Med ADV,38.5,,,,,,,Fee Schedule,38.5,46.74,
Apolipoprotein Evaluation QSTC,13864521,LOCAL,82172,CPT,,,,,,Outpatient,,,54.36,25.31,Viva Med ADV,Viva Med ADV,37.52,,,,,,,Fee Schedule,17.73,37.515,
nitroglycerin 5 mg/mL intravenous solution 10 mL [CULL],11211028,LOCAL,J2305,CPT,,,,,,Outpatient,10,ML,54.7968,,Viva Med ADV,Viva Med ADV,1.52,,,,,,,Fee Schedule,1.523,1.523,
"C1 Esterase Inhibitor, Protein QSTC",8764554,LOCAL,86160,CPT,,,,,,Outpatient,,,54.9,14.4,Viva Med ADV,Viva Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
droNABinol 5 mg Cap [CULL],11200011,LOCAL,Q0167,CPT,,,,,,Outpatient,1,EA,54.9824,,Viva Med ADV,Viva Med ADV,1.35,,,,,,,Fee Schedule,1.352,1.352,
Hepatitis B Surface Antigen,633752,LOCAL,87340,CPT,,,,,,Outpatient,,,55,12.4,Viva Med ADV,Viva Med ADV,22.2,,,,,,,Fee Schedule,10.57,22.20058824,
Hepatitis B Surface Antigen w/ Interp,9517997,LOCAL,87340,CPT,,,,,,Outpatient,,,55,12.4,Viva Med ADV,Viva Med ADV,22.2,,,,,,,Fee Schedule,10.57,22.20058824,
HIV 1/2 Antibody Screen (exposure only),9609059,LOCAL,86701,CPT,,,,,,Outpatient,,,55,10.67,Viva Med ADV,Viva Med ADV,8.89,,,,,,,Fee Schedule,8.89,15.29,
IMMOBILIZER KNEE LARGE,11071020,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,55,158,Viva Med ADV,Viva Med ADV,77.23,,,,,,,Fee Schedule,77.23,77.23,
IMMOBILIZER KNEE XL 79-80028,11070735,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,55,158,Viva Med ADV,Viva Med ADV,77.23,,,,,,,Fee Schedule,77.23,77.23,
Potassium POCT,9616981,LOCAL,84132,CPT,,,,,,Outpatient,,,55,5.71,Viva Med ADV,Viva Med ADV,8.7,,,,,,,Fee Schedule,7.16,8.697880184,
IMMOBILIZER KNEE MEDIUM,11071084,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,55.06,158,Viva Med ADV,Viva Med ADV,77.23,,,,,,,Fee Schedule,77.23,77.23,
IMMOBILIZER KNEE SMALL,11071082,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,55.06,158,Viva Med ADV,Viva Med ADV,77.23,,,,,,,Fee Schedule,77.23,77.23,
Additional Testing PTT-LA QSTC,9004754,LOCAL,85730,CPT,,,,,,Outpatient,,,55.1,7.21,Viva Med ADV,Viva Med ADV,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
dRVVT Mix Interpretation: QSTC,9004757,LOCAL,85613,CPT,,,,,,Outpatient,,,55.1,11.5,Viva Med ADV,Viva Med ADV,9.58,,,,,,,Fee Schedule,5.42,9.58,
Valproic Acid Level,3170351,LOCAL,80164,CPT,,,,,,Outpatient,,,55.49,16.25,Viva Med ADV,Viva Med ADV,34.38,,,,,,,Fee Schedule,15.38,34.38,
.RMSF IgG Titer QSTC,8764766,LOCAL,86757,CPT,,,,,,Outpatient,,,56.25,23.22,Viva Med ADV,Viva Med ADV,19.35,,,,,,,Fee Schedule,15.29,19.35,
.RMSF IgM Titer QSTC,8764765,LOCAL,86757,CPT,,,,,,Outpatient,,,56.25,23.22,Viva Med ADV,Viva Med ADV,19.35,,,,,,,Fee Schedule,15.29,19.35,
HIV 1 Antibody QSTC,8852095,LOCAL,86701,CPT,,,,,,Outpatient,,,56.25,10.67,Viva Med ADV,Viva Med ADV,8.89,,,,,,,Fee Schedule,8.89,15.29,
HIV 2 Antibody QSTC,8852096,LOCAL,86702,CPT,,,,,,Outpatient,,,56.25,16.22,Viva Med ADV,Viva Med ADV,13.52,,,,,,,Fee Schedule,13.52,15.29,
"Aldosterone, LC/MS QSTC",8853271,LOCAL,82088,CPT,,,,,,Outpatient,,,56.93,48.9,Viva Med ADV,Viva Med ADV,48.44,,,,,,,Fee Schedule,18.43,48.435,
Calcium Level Total,1628887,LOCAL,82310,CPT,,,,,,Outpatient,,,57.12,6.19,Viva Med ADV,Viva Med ADV,5.16,,,,,,,Fee Schedule,5.16,7.16,
EPINEPHrine 1 mg/mL injectable solution 1 mL [CULL],11202413,LOCAL,J0169,CPT,,,,,,Outpatient,1,ML,57.4464,,Viva Med ADV,Viva Med ADV,1.38,,,,,,,Fee Schedule,1.383,1.383,
Bill UA With Microscopic,14634624,LOCAL,81001,CPT,,,,,,Outpatient,,,57.6,3.8,Viva Med ADV,Viva Med ADV,6.91,,,,,,,Fee Schedule,4.02,6.910081301,
PC DOPP ART BIL EXERCISE,8200578,LOCAL,93924,CPT,,,,,,Outpatient,,,57.94,302,Viva Med ADV,Viva Med ADV,143.05,,,,,,,Fee Schedule,143.05,161.71,
Reticulocyte Count,7909814,LOCAL,85044,CPT,,,,,,Outpatient,,,57.94,5.17,Viva Med ADV,Viva Med ADV,16.96,,,,,,,Fee Schedule,8.21,16.95545455,
Reticulocyte Count with Immature Reticulocyte Fraction,3454466,LOCAL,85044,CPT,,,,,,Outpatient,,,57.94,5.17,Viva Med ADV,Viva Med ADV,16.96,,,,,,,Fee Schedule,8.21,16.95545455,
clindamycin 900 mg/50 mL-D5% intravenous solution 50 mL [CULL],11212348,LOCAL,J0736,CPT,,,,,,Outpatient,50,ML,57.99733333,,Viva Med ADV,Viva Med ADV,0.82,,,,,,,Fee Schedule,0.819,0.819,
milrinone 200 mcg/mL-D5% intravenous solution 100 mL [CULL],11290134,LOCAL,J2260,CPT,,,,,,Outpatient,100,ML,58.368,,Viva Med ADV,Viva Med ADV,1.35,,,,,,,Fee Schedule,1.351,1.351,
"Vitamin B6, Plasma QSTC",8853234,LOCAL,84207,CPT,,,,,,Outpatient,,,58.5,33.72,Viva Med ADV,Viva Med ADV,40.33,,,,,,,Fee Schedule,17.73,40.33125,
Total Iron Binding Capacity,7050172,LOCAL,84466,CPT,,,,,,Outpatient,,,58.75,15.31,Viva Med ADV,Viva Med ADV,29.64,,,,,,,Fee Schedule,17.73,29.64248366,
Total Iron Binding Capacity,10543521,LOCAL,84466,CPT,,,,,,Outpatient,,,58.75,15.31,Viva Med ADV,Viva Med ADV,29.64,,,,,,,Fee Schedule,17.73,29.64248366,
"Varicella-Zoster Virus Abs(IgG,IgM) QSTC",8853253,LOCAL,86787,CPT,,,,,,Outpatient,,,59.4,15.46,Viva Med ADV,Viva Med ADV,12.88,,,,,,,Fee Schedule,12.88,15.29,
protamine 10 mg/mL injectable solution 5 mL [CULL],11211135,LOCAL,J2720,CPT,,,,,,Outpatient,5,ML,59.4432,,Viva Med ADV,Viva Med ADV,1.57,,,,,,,Fee Schedule,1.571,1.571,
Immunoglobulin E QSTC,8764571,LOCAL,82785,CPT,,,,,,Outpatient,,,59.49,19.75,Viva Med ADV,Viva Med ADV,203.96,,,,,,,Fee Schedule,17.73,203.9616667,
IMMOBILIZER SHOULDER XXXLARGE,4803390,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,59.62,12,Viva Med ADV,Viva Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
orphenadrine 30 mg/mL injectable solution 2 mL [CULL],11212051,LOCAL,J2360,CPT,,,,,,Outpatient,2,ML,59.904,,Viva Med ADV,Viva Med ADV,1.76,,,,,,,Fee Schedule,1.756666667,1.756666667,
Cortisol,3352314,LOCAL,82533,CPT,,,,,,Outpatient,,,60,19.56,Viva Med ADV,Viva Med ADV,15.2,,,,,,,Fee Schedule,15.196,18.43,
Cortisol 60 Min,8373789,LOCAL,82533,CPT,,,,,,Outpatient,,,60,19.56,Viva Med ADV,Viva Med ADV,15.2,,,,,,,Fee Schedule,15.196,18.43,
Free T4 Level,3170324,LOCAL,84439,CPT,,,,,,Outpatient,,,60,10.82,Viva Med ADV,Viva Med ADV,28.58,,,,,,,Fee Schedule,18.43,28.58065455,
Hepatitis A Antibody IgM,1628904,LOCAL,86709,CPT,,,,,,Outpatient,,,60,13.51,Viva Med ADV,Viva Med ADV,11.26,,,,,,,Fee Schedule,11.26,15.29,
HIV 1/2 Antibody and P24 Screen,633757,LOCAL,87389,CPT,,,,,,Outpatient,,,60,28.9,Viva Med ADV,Viva Med ADV,36.55,,,,,,,Fee Schedule,10.57,36.55,
HIV 1/2 Antibody and P24 Screen,633757,LOCAL,G0475,CPT,,,,,,Outpatient,,,60,28.9,Viva Med ADV,Viva Med ADV,20.9,,,,,,,Fee Schedule,10.57,36.55,
Protein Body Fluid,1634879,LOCAL,84157,CPT,,,,,,Outpatient,,,60.38,4.8,Viva Med ADV,Viva Med ADV,4,,,,,,,Fee Schedule,4,7.16,
IMMOBILIZER SHOULDER XXLARGE 9008-05,4803139,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,60.39,12,Viva Med ADV,Viva Med ADV,67.31,,,,,,,Fee Schedule,67.31,67.31,
Aspergillus fumigatus QSTC,9966204,LOCAL,86331,CPT,,,,,,Outpatient,,,60.8,14.38,Viva Med ADV,Viva Med ADV,11.98,,,,,,,Fee Schedule,11.98,15.29,
S. viridis QSTC,9966214,LOCAL,86609,CPT,,,,,,Outpatient,,,60.8,15.46,Viva Med ADV,Viva Med ADV,12.88,,,,,,,Fee Schedule,12.88,15.29,
T. candidus QSTC,9966205,LOCAL,86606,CPT,,,,,,Outpatient,,,60.8,18.06,Viva Med ADV,Viva Med ADV,15.05,,,,,,,Fee Schedule,15.05,15.29,
adenosine 3 mg/mL intravenous solution 2 mL [CULL],11201015,LOCAL,J0153,CPT,,,,,,Outpatient,2,ML,61.056,,Viva Med ADV,Viva Med ADV,0.53,,,,,,,Fee Schedule,0.529,0.529,
"Mercury, Blood QSTC",13864924,LOCAL,83825,CPT,,,,,,Outpatient,,,61.2,19.51,Viva Med ADV,Viva Med ADV,35.86,,,,,,,Fee Schedule,16.07,35.86038462,
Sex Hormone Binding Glob QSTC,8764670,LOCAL,84270,CPT,,,,,,Outpatient,,,61.2,26.08,Viva Med ADV,Viva Med ADV,21.73,,,,,,,Fee Schedule,17.73,21.73,
Stone Analysis w/ Image QSTC,9777240,LOCAL,82365,CPT,,,,,,Outpatient,,,61.2,15.48,Viva Med ADV,Viva Med ADV,24.62,,,,,,,Fee Schedule,17.73,24.61666667,
97012 APPLICATION OF TRACTION/MECH CHARGE,8133034,LOCAL,97012,CPT,,,,,GP,Outpatient,,,61.28,40,Viva Med ADV,Viva Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
97012 MECH TRACTION THERAPY Assistant Charge,9860050,LOCAL,97012,CPT,,,,,GO|CO,Outpatient,,,61.28,40,Viva Med ADV,Viva Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
97012 Mechanical Traction PT,9850050,LOCAL,97012,CPT,,,,,GO,Outpatient,,,61.28,40,Viva Med ADV,Viva Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
97012 TRACTION - MECHANICAL,9640018,LOCAL,97012,CPT,,,,,GP,Outpatient,,,61.28,40,Viva Med ADV,Viva Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
Mechanical Traction Charge -> Yes,13786833,LOCAL,97012,CPT,,,,,GP,Outpatient,,,61.28,40,Viva Med ADV,Viva Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
Mechanical Traction Provided,8510678,LOCAL,97012,CPT,,,,,GP,Outpatient,,,61.28,40,Viva Med ADV,Viva Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
OT Mechanical Trac Therapy Asist Units,7897758,LOCAL,97012,CPT,,,,,CQ,Outpatient,,,61.28,40,Viva Med ADV,Viva Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
OT Mechanical Traction Therapy Units,7897758,LOCAL,97012,CPT,,,,,GO,Outpatient,,,61.28,40,Viva Med ADV,Viva Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
PT Mechanical Traction Assistant Units,9390392,LOCAL,97012,CPT,,,,,CQ,Outpatient,,,61.28,40,Viva Med ADV,Viva Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
PT TRACTION MECHANICAL,9650018,LOCAL,97012,CPT,,,,,GP|CQ,Outpatient,,,61.28,40,Viva Med ADV,Viva Med ADV,13.47,,,,,,,Fee Schedule,13.47,47.26,
"Ethylene Glycol, Blood QSTC",8764539,LOCAL,82693,CPT,,,,,,Outpatient,,,61.34,17.88,Viva Med ADV,Viva Med ADV,14.9,,,,,,,Fee Schedule,14.9,16.07,
vancomycin 1 g/200 mL intravenous solution 200 mL [CULL],11291267,LOCAL,J3372,CPT,,,,,,Outpatient,200,ML,61.44,,Viva Med ADV,Viva Med ADV,5.49,,,,,,,Fee Schedule,5.487407407,5.487407407,
HIV 1/2 Antibody Screen,7939338,LOCAL,86703,CPT,,,,,,Outpatient,,,61.7,16.45,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.57,
"Alprazolam (Xanax), Serum QSTC",8972830,LOCAL,80299,CPT,,,,,,Outpatient,,,62.06,22.37,Viva Med ADV,Viva Med ADV,18.64,,,,,,,Fee Schedule,15.38,18.64,
Glucose 3 Hour,7973891,LOCAL,82952,CPT,,,,,,Outpatient,,,62.17,4.7,Viva Med ADV,Viva Med ADV,3.92,,,,,,,Fee Schedule,3.92,7.16,
Glucose 4 Hour,7973892,LOCAL,82952,CPT,,,,,,Outpatient,,,62.17,4.7,Viva Med ADV,Viva Med ADV,3.92,,,,,,,Fee Schedule,3.92,7.16,
Glucose 5 Hour,7973894,LOCAL,82952,CPT,,,,,,Outpatient,,,62.17,4.7,Viva Med ADV,Viva Med ADV,3.92,,,,,,,Fee Schedule,3.92,7.16,
"Cyclosporine Trough,LCMSMS QSTC",8764656,LOCAL,80158,CPT,,,,,,Outpatient,,,62.37,21.66,Viva Med ADV,Viva Med ADV,18.05,,,,,,,Fee Schedule,15.38,18.05,
"Ova&Parasite,Conc&Perm Smear Result QSTC",8873966,LOCAL,87177,CPT,,,,,,Outpatient,,,62.37,10.68,Viva Med ADV,Viva Med ADV,8.9,,,,,,,Fee Schedule,8.9,10.57,
97150  Group Therapeutic Procedure,9640074,LOCAL,97150,CPT,,,,,GP,Outpatient,,,62.69,41,Viva Med ADV,Viva Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
97150 OT Group Therapy Charge,9850058,LOCAL,97150,CPT,,,,,GO,Outpatient,,,62.69,41,Viva Med ADV,Viva Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
97150 OT Group Therapy Modifier Charge,9860058,LOCAL,97150,CPT,,,,,GO|CO,Outpatient,,,62.69,41,Viva Med ADV,Viva Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
97150 PT Group Therapy Assistant Units,9650074,LOCAL,97150,CPT,,,,,GP|CQ,Outpatient,,,62.69,41,Viva Med ADV,Viva Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
Group Therapy Charge,7895938,LOCAL,97150,CPT,,,,,GP,Outpatient,,,62.69,41,Viva Med ADV,Viva Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
Group Therapy Provided,7895280,LOCAL,97150,CPT,,,,,GO,Outpatient,,,62.69,41,Viva Med ADV,Viva Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
OT Group Therapy Assistant Units,7895280,LOCAL,97150,CPT,,,,,CQ,Outpatient,,,62.69,41,Viva Med ADV,Viva Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
OT Group Therapy Assistant Units,7897695,LOCAL,97150,CPT,,,,,CQ,Outpatient,,,62.69,41,Viva Med ADV,Viva Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
OT Group Therapy Rehab Units,7897695,LOCAL,97150,CPT,,,,,GO,Outpatient,,,62.69,41,Viva Med ADV,Viva Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
PT Group Therapy Assistant Units,9390418,LOCAL,97150,CPT,,,,,CQ,Outpatient,,,62.69,41,Viva Med ADV,Viva Med ADV,16.89,,,,,,,Fee Schedule,16.89,56.44,
"Giardia Antigen, EIA, Stool QSTC",8972764,LOCAL,87329,CPT,,,,,,Outpatient,,,63,14.38,Viva Med ADV,Viva Med ADV,11.98,,,,,,,Fee Schedule,10.57,11.98,
Methylmalonic Acid QSTC,8853212,LOCAL,83921,CPT,,,,,,Outpatient,,,63,25.45,Viva Med ADV,Viva Med ADV,21.21,,,,,,,Fee Schedule,17.73,21.21,
Nortriptyline QSTC,8853203,LOCAL,80299,CPT,,,,,,Outpatient,,,63.45,22.37,Viva Med ADV,Viva Med ADV,18.64,,,,,,,Fee Schedule,15.38,18.64,
97034 CONTRAST BATH THERAPY,9860025,LOCAL,97034,CPT,,,,,GO|CO,Outpatient,,,63.72,41,Viva Med ADV,Viva Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
97034 CONTRAST BATHS EACH 15 MIN CHARGE,9640025,LOCAL,97034,CPT,,,,,GP,Outpatient,,,63.72,41,Viva Med ADV,Viva Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
97034 OT CONTRAST BATH 15 MIN APPL CHARGE,9850025,LOCAL,97034,CPT,,,,,GO,Outpatient,,,63.72,41,Viva Med ADV,Viva Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
97034 PT CONTRAST BATH 15 MIN ASST,9650025,LOCAL,97034,CPT,,,,,GP|CQ,Outpatient,,,63.72,41,Viva Med ADV,Viva Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
OT Contrast Bath Assistant Units,7895283,LOCAL,97034,CPT,,,,,CQ,Outpatient,,,63.72,41,Viva Med ADV,Viva Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
OT Contrast Bath Assistant Units,1373567,LOCAL,97034,CPT,,,,,CQ,Outpatient,,,63.72,41,Viva Med ADV,Viva Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
OT Contrast Bath Charges,7895283,LOCAL,97034,CPT,,,,,GO,Outpatient,,,63.72,41,Viva Med ADV,Viva Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
OT Contrast Bath Units,1373567,LOCAL,97034,CPT,,,,,GO,Outpatient,,,63.72,41,Viva Med ADV,Viva Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
PT Attended E-Stim Assistant Units,9390422,LOCAL,97034,CPT,,,,,CQ,Outpatient,,,63.72,41,Viva Med ADV,Viva Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
PT Contrast Bath Charges,7895979,LOCAL,97034,CPT,,,,,GP,Outpatient,,,63.72,41,Viva Med ADV,Viva Med ADV,13.05,,,,,,,Fee Schedule,13.05,47.26,
BRACE ANKLE LG,9400076,LOCAL,,,L1902,HCPCS,,,,Outpatient,,,64.13,,Viva Med ADV,Viva Med ADV,94.39,,,,,,,Fee Schedule,94.39,94.39,
Medium Ankle Brace,9400086,LOCAL,,,L1902,HCPCS,,,,Outpatient,,,64.13,,Viva Med ADV,Viva Med ADV,94.39,,,,,,,Fee Schedule,94.39,94.39,
"ANA Screen, IFA QSTC",14127792,LOCAL,86038,CPT,,,,,,Outpatient,,,64.31,14.51,Viva Med ADV,Viva Med ADV,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
Beta2-Glycoprotein I (IgA) QSTC,14127808,LOCAL,86146,CPT,,,,,,Outpatient,,,64.31,30.54,Viva Med ADV,Viva Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
Beta2-Glycoprotein I (IgG) QSTC,14127809,LOCAL,86146,CPT,,,,,,Outpatient,,,64.31,30.54,Viva Med ADV,Viva Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
Beta2-Glycoprotein I (IgM) QSTC,14127810,LOCAL,86146,CPT,,,,,,Outpatient,,,64.31,30.54,Viva Med ADV,Viva Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Ab (IgA) QSTC,14127805,LOCAL,86147,CPT,,,,,,Outpatient,,,64.31,30.54,Viva Med ADV,Viva Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Ab (IgG) QSTC,14127806,LOCAL,86147,CPT,,,,,,Outpatient,,,64.31,30.54,Viva Med ADV,Viva Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Ab (IgM) QSTC,14127807,LOCAL,86147,CPT,,,,,,Outpatient,,,64.31,30.54,Viva Med ADV,Viva Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
"CCP, Antibody (IgG) QSTC",14127817,LOCAL,86200,CPT,,,,,,Outpatient,,,64.31,15.54,Viva Med ADV,Viva Med ADV,7.49,,,,,,,Fee Schedule,7.491935484,15.29,
Centromere B Antibody QSTC,14127802,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Chromatin (Nucleosomal) Ab QSTC,14127794,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Complement Component C3c QSTC,14127803,LOCAL,86160,CPT,,,,,,Outpatient,,,64.31,14.4,Viva Med ADV,Viva Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
Complement Component C4c QSTC,14127804,LOCAL,86160,CPT,,,,,,Outpatient,,,64.31,14.4,Viva Med ADV,Viva Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
"DNA Ab (DS) Crithidia, IFA QSTC",14127793,LOCAL,86255,CPT,,,,,,Outpatient,,,64.31,14.46,Viva Med ADV,Viva Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
Jo-1 Antibody QSTC,14127801,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
"MCV, Antibody QSTC",14127818,LOCAL,83520,CPT,,,,,,Outpatient,,,64.31,20.72,Viva Med ADV,Viva Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rheumatoid Factor (IgA) QSTC,14127812,LOCAL,83520,CPT,,,,,,Outpatient,,,64.31,20.72,Viva Med ADV,Viva Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rheumatoid Factor (IgG) QSTC,14127814,LOCAL,83520,CPT,,,,,,Outpatient,,,64.31,20.72,Viva Med ADV,Viva Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rheumatoid Factor (IgM) QSTC,14127816,LOCAL,83520,CPT,,,,,,Outpatient,,,64.31,20.72,Viva Med ADV,Viva Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
RNP Antibody QSTC,14127797,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Scl-70 Antibody QSTC,14127800,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-A) QSTC,14127798,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-B) QSTC,14127799,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sm Antibody QSTC,14127795,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sm/RNP Antibody QSTC,14127796,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Thyroid Peroxidase Abs QSTC,14127819,LOCAL,86376,CPT,,,,,,Outpatient,,,64.31,17.46,Viva Med ADV,Viva Med ADV,25.09,,,,,,,Fee Schedule,15.29,25.085,
Calcitonin QSTC,8764739,LOCAL,82308,CPT,,,,,,Outpatient,,,64.8,32.15,Viva Med ADV,Viva Med ADV,26.79,,,,,,,Fee Schedule,18.43,26.79,
"DHEA, Unconjugated QSTC",8853248,LOCAL,82626,CPT,,,,,,Outpatient,,,64.8,30.32,Viva Med ADV,Viva Med ADV,25.27,,,,,,,Fee Schedule,17.73,25.27,
"Sjogren's Antibodies (SS-A, SS-B) QSTC",8853207,LOCAL,86235,CPT,,,,,,Outpatient,,,64.85,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Bill Special Stains Group II,8489591,LOCAL,88313,CPT,,,,,,Outpatient,,,64.93,,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,32.32,117.85,
17-Hydroxyprogesterone QSTC,8853287,LOCAL,83498,CPT,,,,,,Outpatient,,,64.94,32.6,Viva Med ADV,Viva Med ADV,27.17,,,,,,,Fee Schedule,18.43,27.17,
Carcinoembryonic Antigen,633697,LOCAL,82378,CPT,,,,,,Outpatient,,,65,22.75,Viva Med ADV,Viva Med ADV,36.03,,,,,,,Fee Schedule,17.73,36.03017241,
Hepatitis B Core Antibody IgM,1628907,LOCAL,86705,CPT,,,,,,Outpatient,,,65,14.12,Viva Med ADV,Viva Med ADV,32.8,,,,,,,Fee Schedule,15.29,32.80285714,
Celiac Disease Comp w/Gliadin Ab IgG QSTC,13864455,LOCAL,82784,CPT,,,,,,Outpatient,,,65.25,11.16,Viva Med ADV,Viva Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
Hep B Surface Ag w/Rflx to Confirm. QSTC,9039254,LOCAL,87340,CPT,,,,,,Outpatient,,,65.25,12.4,Viva Med ADV,Viva Med ADV,22.2,,,,,,,Fee Schedule,10.57,22.20058824,
Immunoglobulin Panel QSTC,8764543,LOCAL,82784,CPT,,,,,,Outpatient,,,65.25,11.16,Viva Med ADV,Viva Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
Body Fluid Cell Count w/ Diff,6213822,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,Viva Med ADV,Viva Med ADV,35.8,,,,,,,Fee Schedule,14.07,35.795,
Body Fluid Cell Count with Differential If Indicated,8127214,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,Viva Med ADV,Viva Med ADV,35.8,,,,,,,Fee Schedule,14.07,35.795,
Body Fluid Differential,4240538,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,Viva Med ADV,Viva Med ADV,35.8,,,,,,,Fee Schedule,14.07,35.795,
CSF Cell Count with Differential If Indicated,3454318,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,Viva Med ADV,Viva Med ADV,35.8,,,,,,,Fee Schedule,14.07,35.795,
CSF Differential,3454393,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,Viva Med ADV,Viva Med ADV,35.8,,,,,,,Fee Schedule,14.07,35.795,
Digoxin Level,1628891,LOCAL,80162,CPT,,,,,,Outpatient,,,66.1,15.94,Viva Med ADV,Viva Med ADV,26.44,,,,,,,Fee Schedule,15.38,26.44,
Potassium Level,633616,LOCAL,84132,CPT,,,,,,Outpatient,,,66.1,5.71,Viva Med ADV,Viva Med ADV,8.7,,,,,,,Fee Schedule,7.16,8.697880184,
24hr Urine Creatinine QSTC,10600648,LOCAL,82570,CPT,,,,,,Outpatient,,,66.76,6.22,Viva Med ADV,Viva Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Aldosterone, 24-Hour Urine QSTC",8995528,LOCAL,82088,CPT,,,,,,Outpatient,,,66.76,48.9,Viva Med ADV,Viva Med ADV,48.44,,,,,,,Fee Schedule,18.43,48.435,
"Aspergillus Ab, Immunodiffusion QSTC",13864516,LOCAL,86606,CPT,,,,,,Outpatient,,,66.87,18.06,Viva Med ADV,Viva Med ADV,15.05,,,,,,,Fee Schedule,15.05,15.29,
T3 Free,3170323,LOCAL,84481,CPT,,,,,,Outpatient,,,67,20.33,Viva Med ADV,Viva Med ADV,34.46,,,,,,,Fee Schedule,18.43,34.46424242,
ANCA Screen w Reflex to ANCA Titer QSTC,8764789,LOCAL,86036,CPT,,,,,,Outpatient,,,67.5,14.46,Viva Med ADV,Viva Med ADV,39.66,,,,,,,Fee Schedule,15.29,39.655,
Androstenedione QSTC,8764648,LOCAL,82157,CPT,,,,,,Outpatient,,,67.5,35.14,Viva Med ADV,Viva Med ADV,29.28,,,,,,,Fee Schedule,18.43,29.28,
Antithrombin III Activity QSTC,8764597,LOCAL,85300,CPT,,,,,,Outpatient,,,67.5,14.22,Viva Med ADV,Viva Med ADV,11.85,,,,,,,Fee Schedule,5.42,11.85,
Influenza A,7909953,LOCAL,87804,CPT,,,,,,Outpatient,,,67.5,19.86,Viva Med ADV,Viva Med ADV,6.42,,,,,,,Fee Schedule,6.419753086,10.57,
Influenza B,7909954,LOCAL,87804,CPT,,,,,,Outpatient,,,67.5,19.86,Viva Med ADV,Viva Med ADV,6.42,,,,,,,Fee Schedule,6.419753086,10.57,
"Protein C, Activity QSTC",8764685,LOCAL,85303,CPT,,,,,,Outpatient,,,67.5,16.61,Viva Med ADV,Viva Med ADV,13.84,,,,,,,Fee Schedule,5.42,13.84,
"Protein S Antigen, Free QSTC",9777259,LOCAL,85306,CPT,,,,,,Outpatient,,,67.5,18.38,Viva Med ADV,Viva Med ADV,15.32,,,,,,,Fee Schedule,5.42,15.32,
"Protein S, Activity QSTC",8764774,LOCAL,85306,CPT,,,,,,Outpatient,,,67.5,18.38,Viva Med ADV,Viva Med ADV,15.32,,,,,,,Fee Schedule,5.42,15.32,
Shiga Toxin 1 and 2,7939191,LOCAL,87427,CPT,,,,,,Outpatient,,,67.5,14.38,Viva Med ADV,Viva Med ADV,29.72,,,,,,,Fee Schedule,10.57,29.71875,
Shiga Toxin 1 and 2,8875416,LOCAL,87427,CPT,,,,,,Outpatient,,,67.5,14.38,Viva Med ADV,Viva Med ADV,29.72,,,,,,,Fee Schedule,10.57,29.71875,
Tissue Transglutaminase IgG Ab QSTC,8764825,LOCAL,86364,CPT,,,,,,Outpatient,,,67.5,13.84,Viva Med ADV,Viva Med ADV,61.9,,,,,,,Fee Schedule,15.29,61.9,
Vitamin B12 QSTC,9291002,LOCAL,82607,CPT,,,,,,Outpatient,,,67.5,18.1,Viva Med ADV,Viva Med ADV,82.43,,,,,,,Fee Schedule,18.43,82.43266533,
Glucose CSF,1628897,LOCAL,82945,CPT,,,,,,Outpatient,,,67.73,4.72,Viva Med ADV,Viva Med ADV,3.93,,,,,,,Fee Schedule,3.93,7.16,
Protein CSF,1634881,LOCAL,84157,CPT,,,,,,Outpatient,,,67.73,4.8,Viva Med ADV,Viva Med ADV,4,,,,,,,Fee Schedule,4,7.16,
Erythropoietin (EPO) QSTC,8764551,LOCAL,82668,CPT,,,,,,Outpatient,,,68.4,22.55,Viva Med ADV,Viva Med ADV,43.41,,,,,,,Fee Schedule,17.73,43.41,
RT Vapotherm Subsequent CHARGE,8143879,LOCAL,94003,CPT,,,,,,Outpatient,,,68.49,613,Viva Med ADV,Viva Med ADV,604.42,,,,,,,Fee Schedule,604.42,941,
Hematocrit,633742,LOCAL,85014,CPT,,,,,,Outpatient,,,68.54,2.84,Viva Med ADV,Viva Med ADV,12.62,,,,,,,Fee Schedule,8.21,12.62068493,
Hematocrit,1635636,LOCAL,85014,CPT,,,,,,Outpatient,,,68.54,2.84,Viva Med ADV,Viva Med ADV,12.62,,,,,,,Fee Schedule,8.21,12.62068493,
Hemoglobin,633741,LOCAL,85018,CPT,,,,,,Outpatient,,,68.54,2.84,Viva Med ADV,Viva Med ADV,10.94,,,,,,,Fee Schedule,8.21,10.94316176,
Hemoglobin,1635635,LOCAL,85018,CPT,,,,,,Outpatient,,,68.54,2.84,Viva Med ADV,Viva Med ADV,10.94,,,,,,,Fee Schedule,8.21,10.94316176,
C1 Esterase Inhibitor QST,13870084,LOCAL,86160,CPT,,,,,,Outpatient,,,68.85,14.4,Viva Med ADV,Viva Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
"C1 Esterase Inhibitor, Functional QSTC",8853251,LOCAL,86161,CPT,,,,,,Outpatient,,,68.85,14.4,Viva Med ADV,Viva Med ADV,12,,,,,,,Fee Schedule,12,15.29,
Antibody Screen Gel 2,8196056,LOCAL,86850,CPT,,,,,,Outpatient,,,68.88,11.72,Viva Med ADV,Viva Med ADV,48.85,,,,,,,Fee Schedule,6.29,48.85,
Antibody Screen Tube.,8417431,LOCAL,86850,CPT,,,,,,Outpatient,,,68.88,11.72,Viva Med ADV,Viva Med ADV,48.85,,,,,,,Fee Schedule,6.29,48.85,
BB RH (D) TYPE XX,6432042,LOCAL,86901,CPT,,,,,,Outpatient,,,68.88,3.59,Viva Med ADV,Viva Med ADV,35.88,,,,,,,Fee Schedule,6.29,35.88,
Acid Fast Stain Report,634214,LOCAL,87206,CPT,,,,,,Outpatient,,,69.36,6.47,Viva Med ADV,Viva Med ADV,34.45,,,,,,,Fee Schedule,10.57,34.45384615,
Milk Component Panel QSTC,8912186,LOCAL,86008,CPT,,,,,,Outpatient,,,69.39,21.52,Viva Med ADV,Viva Med ADV,17.93,,,,,,,Fee Schedule,15.29,17.93,
REF TRXN Pathologist Interp,13479165,LOCAL,86078,CPT,,,,,,Outpatient,,,69.8,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.88,156.67,
BB REF RH(D) TYPING TRANSFUSION RXN,6433001,LOCAL,86901,CPT,,,,,,Outpatient,,,69.86,3.59,Viva Med ADV,Viva Med ADV,35.88,,,,,,,Fee Schedule,6.29,35.88,
BB REF XMATCH (IAT) TRANSFUSION RXN,6433004,LOCAL,86922,CPT,,,,,,Outpatient,,,69.86,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
REF ABO/Rh (TRXN),13479164,LOCAL,86900,CPT,,,,,,Outpatient,,,69.86,3.59,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,6.29,117.85,
REF Antibody Screen (TRXN),13479162,LOCAL,86850,CPT,,,,,,Outpatient,,,69.86,11.72,Viva Med ADV,Viva Med ADV,48.85,,,,,,,Fee Schedule,6.29,48.85,
REF Crossmatch (TRXN),13481255,LOCAL,86920,CPT,,,,,,Outpatient,,,69.86,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
REF DAT (TRXN),13479163,LOCAL,86880,CPT,,,,,,Outpatient,,,69.86,6.47,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,6.29,54.31,
Clostridium difficile Quik Chek Complete,10574492,LOCAL,87324,CPT,,,,,,Outpatient,,,70,14.38,Viva Med ADV,Viva Med ADV,20.44,,,,,,,Fee Schedule,10.57,20.4375,
Hemoglobin (POCT),4192190,LOCAL,85018,CPT,,,,,,Outpatient,,,70,2.84,Viva Med ADV,Viva Med ADV,10.94,,,,,,,Fee Schedule,8.21,10.94316176,
Hepatitis C Ab,1628911,LOCAL,86803,CPT,,,,,,Outpatient,,,70,17.12,Viva Med ADV,Viva Med ADV,32.1,,,,,,,Fee Schedule,15.29,32.10014925,
RT Education/Instruction CHARGE,90840011,LOCAL,94664,CPT,,,,,,Outpatient,,,70.15,46,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
"RT Evaluation, Respiratory CHARGE",90840013,LOCAL,94664,CPT,,,,,,Outpatient,,,70.15,46,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
tacrolimus 5 mg oral capsule [CULL],11205997,LOCAL,J7507,CPT,,,,,,Outpatient,1,EA,71.352,,Viva Med ADV,Viva Med ADV,0.2,,,,,,,Fee Schedule,0.197,0.197,
"Gliadin (Deamidated) Ab (IgG, IgA) QSTC",8764748,LOCAL,86258,CPT,,,,,,Outpatient,,,72,14.46,Viva Med ADV,Viva Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
HFO (L3929),10393294,LOCAL,,,L3929,HCPCS,,,,Outpatient,,,72,,Viva Med ADV,Viva Med ADV,94.67,,,,,,,Fee Schedule,94.67,94.67,
Hemoglobin A1c,1383763,LOCAL,83036,CPT,,,,,,Outpatient,,,72.22,11.65,Viva Med ADV,Viva Med ADV,28.6,,,,,,,Fee Schedule,7.16,28.59604426,
"Arsenic, Blood QSTC",13864922,LOCAL,82175,CPT,,,,,,Outpatient,,,72.27,22.76,Viva Med ADV,Viva Med ADV,42.26,,,,,,,Fee Schedule,16.07,42.25673077,
97032 ELECTRIC STIM,8478060,LOCAL,97032,CPT,,,,,GN,Outpatient,,,72.32,47,Viva Med ADV,Viva Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 ELECTRIC STIM OT,9630084,LOCAL,97032,CPT,,,,,GN,Outpatient,,,72.32,47,Viva Med ADV,Viva Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 OT E STIM CON - EA 15MIN CHARGE,9856105,LOCAL,97032,CPT,,,,,GO,Outpatient,,,72.32,47,Viva Med ADV,Viva Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 OT Elec Stim Attended Assistant Units,9866105,LOCAL,97032,CPT,,,,,GO|CO,Outpatient,,,72.32,47,Viva Med ADV,Viva Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 PT E STIM CON - EA 15MIN CHARGE,9640023,LOCAL,97032,CPT,,,,,GP,Outpatient,,,72.32,47,Viva Med ADV,Viva Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 PT Elect Stim Attended Assistant Units,9650023,LOCAL,97032,CPT,,,,,GP|CQ,Outpatient,,,72.32,47,Viva Med ADV,Viva Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
Attended E-Stim Charges,1366373,LOCAL,97032,CPT,,,,,GO,Outpatient,,,72.32,47,Viva Med ADV,Viva Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
Attended E-Stim Charges,7895926,LOCAL,97032,CPT,,,,,GP,Outpatient,,,72.32,47,Viva Med ADV,Viva Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
OT Attended E-Stim Assistant Units,1366373,LOCAL,97032,CPT,,,,,CQ,Outpatient,,,72.32,47,Viva Med ADV,Viva Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
OT Attended E-Stim Assistant Units,1373442,LOCAL,97032,CPT,,,,,CQ,Outpatient,,,72.32,47,Viva Med ADV,Viva Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
OT Attended E-Stim Charges,1366373,LOCAL,97032,CPT,,,,,GO,Outpatient,,,72.32,47,Viva Med ADV,Viva Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
OT Attended E-Stim Units,1373442,LOCAL,97032,CPT,,,,,GO,Outpatient,,,72.32,47,Viva Med ADV,Viva Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
PT Attended E-Stim Assistant Units,9396343,LOCAL,97032,CPT,,,,,CQ,Outpatient,,,72.32,47,Viva Med ADV,Viva Med ADV,13.8,,,,,,,Fee Schedule,13.8,47.26,
Newborn Hearing Test Type -> Auditory brainstem response,8982858,LOCAL,92700,CPT,,,,,,Outpatient,,,72.72,47,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,22.39,162.41,
"IGF-1, LC/MS QSTC",8764636,LOCAL,84305,CPT,,,,,,Outpatient,,,72.9,25.51,Viva Med ADV,Viva Med ADV,46.87,,,,,,,Fee Schedule,18.43,46.87,
"Chlamydia Trachomatis RNA, TMA QST",10578255,LOCAL,87491,CPT,,,,,,Outpatient,,,73.16,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",10578245,LOCAL,87591,CPT,,,,,,Outpatient,,,73.16,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Thinprep Review Cytotechnologist: QST,10590230,LOCAL,88175,CPT,,,,,,Outpatient,,,73.16,31.93,Viva Med ADV,Viva Med ADV,26.61,,,,,,,Fee Schedule,25.25,26.61,
pyridoxine 100 mg/mL injectable solution 1 mL [CULL],11212249,LOCAL,J3415,CPT,,,,,,Outpatient,1,ML,73.1904,,Viva Med ADV,Viva Med ADV,15.56,,,,,,,Fee Schedule,15.555,15.555,
97803 RE-ASSESSMENT & INTERVENTION CHARGE,8821410,LOCAL,97803,CPT,,,,,,Outpatient,,,73.41,48,Viva Med ADV,Viva Med ADV,21.06,,,,,,,Fee Schedule,21.06,287.34,
Amylase Level,631567,LOCAL,82150,CPT,,,,,,Outpatient,,,73.44,7.78,Viva Med ADV,Viva Med ADV,1.24,,,,,,,Fee Schedule,1.237209302,7.16,
Prothrombin Time,7904947,LOCAL,85610,CPT,,,,,,Outpatient,,,73.44,5.15,Viva Med ADV,Viva Med ADV,2.36,,,,,,,Fee Schedule,2.355196507,5.42,
Prothrombin Time and INR,633793,LOCAL,85610,CPT,,,,,,Outpatient,,,73.44,5.15,Viva Med ADV,Viva Med ADV,2.36,,,,,,,Fee Schedule,2.355196507,5.42,
Vancomycin Level,1634895,LOCAL,80202,CPT,,,,,,Outpatient,,,73.44,16.25,Viva Med ADV,Viva Med ADV,29.02,,,,,,,Fee Schedule,15.38,29.0215,
Vancomycin Level Peak,1634896,LOCAL,80202,CPT,,,,,,Outpatient,,,73.44,16.25,Viva Med ADV,Viva Med ADV,29.02,,,,,,,Fee Schedule,15.38,29.0215,
Vancomycin Level Trough,1634897,LOCAL,80202,CPT,,,,,,Outpatient,,,73.44,16.25,Viva Med ADV,Viva Med ADV,29.02,,,,,,,Fee Schedule,15.38,29.0215,
97016 OT VASOPNEUMATIC DEVICE CHARGE,9850019,LOCAL,97016,CPT,,,,,GO,Outpatient,,,73.6,48,Viva Med ADV,Viva Med ADV,11.17,,,,,,,Fee Schedule,11.17,47.26,
97016 PT JOBST COMPRESSION CHARGE,9640020,LOCAL,97016,CPT,,,,,GP,Outpatient,,,73.6,48,Viva Med ADV,Viva Med ADV,11.17,,,,,,,Fee Schedule,11.17,47.26,
97016 PT VASOPNEUMATIC DEVICE CHARGE,9650020,LOCAL,97016,CPT,,,,,GP|CQ,Outpatient,,,73.6,48,Viva Med ADV,Viva Med ADV,11.17,,,,,,,Fee Schedule,11.17,47.26,
OT Vasopneumatic Device Charge,7895255,LOCAL,97016,CPT,,,,,GO,Outpatient,,,73.6,48,Viva Med ADV,Viva Med ADV,11.17,,,,,,,Fee Schedule,11.17,47.26,
OT Vasopneumatic Devices Assistant Units,7895255,LOCAL,97016,CPT,,,,,CQ,Outpatient,,,73.6,48,Viva Med ADV,Viva Med ADV,11.17,,,,,,,Fee Schedule,11.17,47.26,
OT Vasopneumatic Devices Units,1373553,LOCAL,97016,CPT,,,,,GO,Outpatient,,,73.6,48,Viva Med ADV,Viva Med ADV,11.17,,,,,,,Fee Schedule,11.17,47.26,
PT Vasopneumatic Devices Assistant Units,9390396,LOCAL,97016,CPT,,,,,CQ,Outpatient,,,73.6,48,Viva Med ADV,Viva Med ADV,11.17,,,,,,,Fee Schedule,11.17,47.26,
Vasopneumatic Device Charge,7895963,LOCAL,97016,CPT,,,,,GP,Outpatient,,,73.6,48,Viva Med ADV,Viva Med ADV,11.17,,,,,,,Fee Schedule,11.17,47.26,
Beta hCG Quantitative,633665,LOCAL,84702,CPT,,,,,,Outpatient,,,75,18.06,Viva Med ADV,Viva Med ADV,15.05,,,,,,,Fee Schedule,15.05,18.43,
Flu A -Sofia,8267167,LOCAL,87804,CPT,,,,,,Outpatient,,,75,19.86,Viva Med ADV,Viva Med ADV,6.42,,,,,,,Fee Schedule,6.419753086,10.57,
Flu B -Sofia,8267168,LOCAL,87804,CPT,,,,,,Outpatient,,,75,19.86,Viva Med ADV,Viva Med ADV,6.42,,,,,,,Fee Schedule,6.419753086,10.57,
pH Venous,3454453,LOCAL,82800,CPT,,,,,,Outpatient,,,75,13.2,Viva Med ADV,Viva Med ADV,11,,,,,,,Fee Schedule,11,17.73,
"Protein, Total, 24 Hr Ur QSTC",8851917,LOCAL,84156,CPT,,,,,,Outpatient,,,75,4.4,Viva Med ADV,Viva Med ADV,11.68,,,,,,,Fee Schedule,7.16,11.68,
SARS-CoV-2 (COVID-19) IgG Ab,9706404,LOCAL,86769,CPT,,,,,,Outpatient,,,75,50.56,Viva Med ADV,Viva Med ADV,42.13,,,,,,,Fee Schedule,15.29,42.13,
Total hCG Quantitative,9299894,LOCAL,84702,CPT,,,,,,Outpatient,,,75,18.06,Viva Med ADV,Viva Med ADV,15.05,,,,,,,Fee Schedule,15.05,18.43,
pH Pleural Fluid,9631697,LOCAL,83986,CPT,,,,,,Outpatient,,,75.14,4.3,Viva Med ADV,Viva Med ADV,18.76,,,,,,,Fee Schedule,7.16,18.755,
terbutaline 1 mg/mL injectable solution 1 mL [CULL],11212324,LOCAL,J3105,CPT,,,,,,Outpatient,1,ML,75.648,,Viva Med ADV,Viva Med ADV,2.47,,,,,,,Fee Schedule,2.473,2.473,
Estradiol Lvl,3170319,LOCAL,82670,CPT,,,,,,Outpatient,,,75.89,33.53,Viva Med ADV,Viva Med ADV,51.64,,,,,,,Fee Schedule,18.43,51.64,
"Metanephrines, Fraction, LCMSMS,U24 QSTC",8764626,LOCAL,83835,CPT,,,,,,Outpatient,,,75.96,20.33,Viva Med ADV,Viva Med ADV,98.31,,,,,,,Fee Schedule,18.43,98.305,
"Mycobacteria Stain, Acid Fast, Fluorochrome QST",12126168,LOCAL,87206,CPT,,,,,,Outpatient,,,76,6.47,Viva Med ADV,Viva Med ADV,34.45,,,,,,,Fee Schedule,10.57,34.45384615,
C1 Esterase Inhibitor Protein QST,13870086,LOCAL,86160,CPT,,,,,,Outpatient,,,76.5,14.4,Viva Med ADV,Viva Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
Complement Component C4C QST,13870085,LOCAL,86161,CPT,,,,,,Outpatient,,,76.5,14.4,Viva Med ADV,Viva Med ADV,12,,,,,,,Fee Schedule,12,15.29,
"Serotonin, Serum QSTC",8853235,LOCAL,84260,CPT,,,,,,Outpatient,,,76.5,37.18,Viva Med ADV,Viva Med ADV,30.98,,,,,,,Fee Schedule,18.43,30.98,
.Thyroglobulin QSTC,13864485,LOCAL,84432,CPT,,,,,,Outpatient,,,76.73,19.27,Viva Med ADV,Viva Med ADV,46.24,,,,,,,Fee Schedule,18.43,46.235,
dexAMETHasone 4 mg/mL Sol [CULL],11202297,LOCAL,J1100,CPT,,,,,,Outpatient,1,ML,76.9408,,Viva Med ADV,Viva Med ADV,10.49,,,,,,,Fee Schedule,10.48743758,10.48743758,
CT PCR,12526323,LOCAL,87491,CPT,,,,,,Outpatient,,,76.95,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
NG PCR,12526324,LOCAL,87591,CPT,,,,,,Outpatient,,,76.95,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Alkaline Phosphatase,1620878,LOCAL,84075,CPT,,,,,,Outpatient,,,77.11,6.22,Viva Med ADV,Viva Med ADV,5.18,,,,,,,Fee Schedule,5.18,7.16,
G0008 MC ADMIN INFLUENZA VIRUS VACCINE CHARGE,7923017,LOCAL,,,G0008,HCPCS,,,,Outpatient,,,77.13,50,Viva Med ADV,Viva Med ADV,42.18,,,,,,,Fee Schedule,42.18,56.18,
G0009 VACCINE ADMINISTRATION PNEUMONIA,12214659,LOCAL,,,G0009,HCPCS,,,,Outpatient,,,77.13,50,Viva Med ADV,Viva Med ADV,42.18,,,,,,,Fee Schedule,42.18,56.18,
64461 THORACIC PARAVERTEBRAL BLOCK,5661020,LOCAL,64461,CPT,,,,,,Outpatient,,,77.31,50,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
"Cryoglobulin (% Cryocrit), Serum QSTC",8764756,LOCAL,82595,CPT,,,,,,Outpatient,,,78.75,7.76,Viva Med ADV,Viva Med ADV,6.47,,,,,,,Fee Schedule,6.47,7.16,
Group B Strep Culture,7842541,LOCAL,87070,CPT,,,,,,Outpatient,,,79.56,10.34,Viva Med ADV,Viva Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Partial Thromboplastin Time,633794,LOCAL,85730,CPT,,,,,,Outpatient,,,79.56,7.21,Viva Med ADV,Viva Med ADV,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
Partial Thromboplastin Time,7904949,LOCAL,85730,CPT,,,,,,Outpatient,,,79.56,7.21,Viva Med ADV,Viva Med ADV,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
Strep Confirmation,8019111,LOCAL,87081,CPT,,,,,,Outpatient,,,79.56,7.96,Viva Med ADV,Viva Med ADV,37.18,,,,,,,Fee Schedule,10.57,37.17627685,
99152 MOD SED SAME PHYS/QHP 5/>YRS,8653149,LOCAL,99152,CPT,,,,,,Outpatient,,,79.64,52,Viva Med ADV,Viva Med ADV,10.38,,,,,,,Fee Schedule,10.38,34.95,
fluconazole 400 mg/200 mL-NaCl 0.9% intravenous solution 200 mL [CULL],11220722,LOCAL,J1450,CPT,,,,,,Outpatient,200,ML,79.9168,,Viva Med ADV,Viva Med ADV,4.48,,,,,,,Fee Schedule,4.48,4.48,
20561 DRY NEEDLING 3+ MUSCLES WO INJECTION,9650049,LOCAL,20561,CPT,,,,,,Outpatient,,,80,52,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,22.39,863,
GC Culture,633895,LOCAL,87081,CPT,,,,,,Outpatient,,,80.78,7.96,Viva Med ADV,Viva Med ADV,37.18,,,,,,,Fee Schedule,10.57,37.17627685,
Lactate Dehydrogenase,633770,LOCAL,83615,CPT,,,,,,Outpatient,,,80.78,7.25,Viva Med ADV,Viva Med ADV,21.68,,,,,,,Fee Schedule,7.16,21.675,
MRSA Screen Culture,8244872,LOCAL,87081,CPT,,,,,,Outpatient,,,80.78,7.96,Viva Med ADV,Viva Med ADV,37.18,,,,,,,Fee Schedule,10.57,37.17627685,
Protein Total,633818,LOCAL,84155,CPT,,,,,,Outpatient,,,80.78,4.4,Viva Med ADV,Viva Med ADV,3.67,,,,,,,Fee Schedule,3.67,7.16,
"Bill Only ABID Panel, Selected Cell",8629507,LOCAL,86885,CPT,,,,,,Outpatient,,,81,6.86,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,6.29,156.67,
"Chromium, Serum QSTC",9701437,LOCAL,82495,CPT,,,,,,Outpatient,,,81,24.34,Viva Med ADV,Viva Med ADV,20.28,,,,,,,Fee Schedule,16.07,20.28,
Levetiracetam QSTC,8764628,LOCAL,80177,CPT,,,,,,Outpatient,,,81,15.9,Viva Med ADV,Viva Med ADV,9.4,,,,,,,Fee Schedule,9.399,15.38,
"Chlamydia Trachomatis RNA, TMA QST",10585658,LOCAL,87491,CPT,,,,,,Outpatient,,,82,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
HPV mRNA E6/E7 QST,10585657,LOCAL,87624,CPT,,,,,,Outpatient,,,82,42.11,Viva Med ADV,Viva Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
"Neisseria Gonorrhoeae RNA, TMA QST",10585659,LOCAL,87591,CPT,,,,,,Outpatient,,,82,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Thinprep Review Cytotechnologist: QST,10585654,LOCAL,88175,CPT,,,,,,Outpatient,,,82,31.93,Viva Med ADV,Viva Med ADV,26.61,,,,,,,Fee Schedule,25.25,26.61,
Testosterone Level Total,3170320,LOCAL,84403,CPT,,,,,,Outpatient,,,82.01,30.97,Viva Med ADV,Viva Med ADV,52.38,,,,,,,Fee Schedule,18.43,52.3775,
methadone 10 mg/mL Injectable Sol 20 mL UD [CULL],11240064,LOCAL,J1230,CPT,,,,,,Outpatient,1,ML,82.07808,,Viva Med ADV,Viva Med ADV,17.7,,,,,,,Fee Schedule,17.7,17.7,
Malaria/Babesia/Other Blood Parasites QSTC,10707969,LOCAL,87207,CPT,,,,,,Outpatient,,,82.35,7.19,Viva Med ADV,Viva Med ADV,5.99,,,,,,,Fee Schedule,5.99,10.57,
H. Pylori CLO,9517164,LOCAL,86677,CPT,,,,,,Outpatient,,,83.23,20.22,Viva Med ADV,Viva Med ADV,16.85,,,,,,,Fee Schedule,15.29,16.85,
Phosphorus Level,633803,LOCAL,84100,CPT,,,,,,Outpatient,,,83.23,5.69,Viva Med ADV,Viva Med ADV,26.45,,,,,,,Fee Schedule,7.16,26.45123596,
"Estrogen, Total, Serum QSTC",8764701,LOCAL,82672,CPT,,,,,,Outpatient,,,83.25,26.04,Viva Med ADV,Viva Med ADV,21.7,,,,,,,Fee Schedule,18.43,21.7,
PHENobarbital 65 mg/mL Sol [CULL],11211087,LOCAL,J2560,CPT,,,,,,Outpatient,1,ML,83.7888,,Viva Med ADV,Viva Med ADV,29.08,,,,,,,Fee Schedule,29.077,29.077,
97129 ST COG/ATTEN/MEM/PROD CHARGE,9600117,LOCAL,97129,CPT,,,,,GN,Outpatient,,,84.77,114,Viva Med ADV,Viva Med ADV,18.94,,,,,,,Fee Schedule,18.94,56.44,
97130 ST Cognitive skills development each additional 15 minutes,9600118,LOCAL,97130,CPT,,,,,GN,Outpatient,,,84.77,114,Viva Med ADV,Viva Med ADV,18.08,,,,,,,Fee Schedule,18.08,56.44,
"SLP Cog Ther Intervent, Addl 15Min Units",9399379,LOCAL,97130,CPT,,,,,GN,Outpatient,,,84.77,114,Viva Med ADV,Viva Med ADV,18.08,,,,,,,Fee Schedule,18.08,56.44,
"SLP Cog Ther Intervent,First 15Min Units",9399375,LOCAL,97129,CPT,,,,,GN,Outpatient,,,84.77,114,Viva Med ADV,Viva Med ADV,18.94,,,,,,,Fee Schedule,18.94,56.44,
97802 MEDICAL NUTRITIONAL THERAPY CHARGE,13475610,LOCAL,97802,CPT,,,,,,Outpatient,,,84.82,55,Viva Med ADV,Viva Med ADV,25.2,,,,,,,Fee Schedule,25.2,287.34,
Minimum Inhibitory Concentration,294946,LOCAL,87186,CPT,,,,,,Outpatient,,,85,10.38,Viva Med ADV,Viva Med ADV,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
"HPV mRNA E6/E7, POST-$HYSTERECTOMY, VAGINAL QST",14782713,LOCAL,87624,CPT,,,,,,Outpatient,,,85.05,42.11,Viva Med ADV,Viva Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
BB REF LAB RH (D) TYPING,6413256,LOCAL,86901,CPT,,,,,,Outpatient,,,85.5,3.59,Viva Med ADV,Viva Med ADV,35.88,,,,,,,Fee Schedule,6.29,35.88,
"Ehrlichia chaffeensis Ab (IgG,IgM) QSTC",8853255,LOCAL,86666,CPT,,,,,,Outpatient,,,85.5,12.22,Viva Med ADV,Viva Med ADV,10.18,,,,,,,Fee Schedule,10.18,15.29,
REF ABO/Rh,7939266,LOCAL,86900,CPT,,,,,,Outpatient,,,85.5,3.59,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,6.29,117.85,
Uric Acid,633858,LOCAL,84550,CPT,,,,,,Outpatient,,,85.68,5.42,Viva Med ADV,Viva Med ADV,35.18,,,,,,,Fee Schedule,7.16,35.17852564,
cefTRIAXone 500 mg injection [CULL],11202193,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,85.9328,,Viva Med ADV,Viva Med ADV,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
chloroprocaine 3% preservative-free Sol [CULL],11202203,LOCAL,J2401,CPT,,,,,,Outpatient,20,ML,85.9392,,Viva Med ADV,Viva Med ADV,0.04,,,,,,,Fee Schedule,0.01,0.038,
Chol/HDL C QSTC,14129541,LOCAL,80061,CPT,,,,,,Outpatient,,,86,16.07,Viva Med ADV,Viva Med ADV,16.6,,,,,,,Fee Schedule,12.14,16.59934459,
HDL P QSTC,14129559,LOCAL,83704,CPT,,,,,,Outpatient,,,86,41.03,Viva Med ADV,Viva Med ADV,34.19,,,,,,,Fee Schedule,34.19,46.74,
HPV mRNA E6/E7 QST,9773934,LOCAL,87624,CPT,,,,,,Outpatient,,,86,42.11,Viva Med ADV,Viva Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
HPV mRNA E6/E7 QST,9773934,LOCAL,87624,CPT,,,,,,Outpatient,,,86,42.11,Viva Med ADV,Viva Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
HPV mRNA E6/E7 QSTC,9773934,LOCAL,87624,CPT,,,,,,Outpatient,,,86,42.11,Viva Med ADV,Viva Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
DOBUTamine 1 mg/mL-D5% Sol [CULL],11201073,LOCAL,J1250,CPT,,,,,,Outpatient,250,ML,86.208,,Viva Med ADV,Viva Med ADV,8.02,,,,,,,Fee Schedule,8.024,8.024,
Estrone QSTC,8853208,LOCAL,82679,CPT,,,,,,Outpatient,,,86.4,29.94,Viva Med ADV,Viva Med ADV,24.95,,,,,,,Fee Schedule,18.43,24.95,
fosphenytoin 500 mgPE/10 mL injectable solution 10 mL [CULL],11205071,LOCAL,Q2009,CPT,,,,,,Outpatient,10,ML,86.4,,Viva Med ADV,Viva Med ADV,1.47,,,,,,,Fee Schedule,1.47,1.47,
methacholine varying strength inhalation solution [CULL],11290186,LOCAL,J7674,CPT,,,,,,Outpatient,3,ML,86.4,,Viva Med ADV,Viva Med ADV,1.9,,,,,,,Fee Schedule,1.898,1.898,
Cyanide QSTC,13864508,LOCAL,82600,CPT,,,,,,Outpatient,,,86.45,23.28,Viva Med ADV,Viva Med ADV,19.4,,,,,,,Fee Schedule,16.07,19.4,
nitroglycerin 200 mcg/mL-D5% intravenous solution 250 mL [CULL],11211024,LOCAL,J2305,CPT,,,,,,Outpatient,250,ML,86.54666667,,Viva Med ADV,Viva Med ADV,1.52,,,,,,,Fee Schedule,1.523,1.523,
Electrolyte Panel,633610,LOCAL,80051,CPT,,,,,,Outpatient,,,86.9,8.41,Viva Med ADV,Viva Med ADV,7.01,,,,,,,Fee Schedule,7.01,12.14,
Sodium Level,633611,LOCAL,84295,CPT,,,,,,Outpatient,,,86.9,5.77,Viva Med ADV,Viva Med ADV,18.32,,,,,,,Fee Schedule,7.16,18.324,
76377 Requiring image post processing on an independent workstation,10740136,LOCAL,76377,CPT,,,,,,Outpatient,,,87,,Viva Med ADV,Viva Med ADV,36.62,,,,,,,Fee Schedule,36.62,36.62,
acetylcysteine 20% inhalation solution 30 mL [CULL],11203022,LOCAL,J7608,CPT,,,,,,Outpatient,30,ML,87.62688,,Viva Med ADV,Viva Med ADV,8.46,,,,,,,Fee Schedule,8.455,8.455,
Measles Antibody (IgM) QSTC,8853259,LOCAL,86765,CPT,,,,,,Outpatient,,,87.8,15.46,Viva Med ADV,Viva Med ADV,12.88,,,,,,,Fee Schedule,12.88,15.29,
Maize/Corn (F8) IgE QSTC,14116318,LOCAL,86001,CPT,,,,,,Outpatient,,,87.93,9.38,Viva Med ADV,Viva Med ADV,7.82,,,,,,,Fee Schedule,7.82,15.29,
97022 FLUIDOTHERAPY CHARGES,9646093,LOCAL,97022,CPT,,,,,GP,Outpatient,,,88.1,57,Viva Med ADV,Viva Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
97022 OT WHIRLPOOL - ASEPTIC,9856111,LOCAL,97022,CPT,,,,,GO,Outpatient,,,88.1,57,Viva Med ADV,Viva Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
97022 OT WHIRLPOOL 1+ AREAS APPL CHARGE,9866111,LOCAL,97022,CPT,,,,,GO|CO,Outpatient,,,88.1,57,Viva Med ADV,Viva Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
97022 PT SMALL WHIRLPOOL CHARGE,9656093,LOCAL,97022,CPT,,,,,GP|CQ,Outpatient,,,88.1,57,Viva Med ADV,Viva Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
97022 WHIRLPOOL CHARGE,9410091,LOCAL,97022,CPT,,,,,GP,Outpatient,,,88.1,57,Viva Med ADV,Viva Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
OT Whirlpool Therapy Assitant Units,9401114,LOCAL,97022,CPT,,,,,CQ,Outpatient,,,88.1,57,Viva Med ADV,Viva Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
OT Whirlpool Units,9401114,LOCAL,97022,CPT,,,,,GO,Outpatient,,,88.1,57,Viva Med ADV,Viva Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
"OT Whirlpool, Fluidotherapy Assistant Units",1373554,LOCAL,97022,CPT,,,,,CQ,Outpatient,,,88.1,57,Viva Med ADV,Viva Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
"OT Whirlpool, Fluidotherapy Units",1373554,LOCAL,97022,CPT,,,,,GO,Outpatient,,,88.1,57,Viva Med ADV,Viva Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
Whirlpool Full Body Charge,7895951,LOCAL,97022,CPT,,,,,GP,Outpatient,,,88.1,57,Viva Med ADV,Viva Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
"Whirlpool, 1+ Areas 97022",9640021,LOCAL,97022,CPT,,,,,,Outpatient,,,88.1,57,Viva Med ADV,Viva Med ADV,14.34,,,,,,,Fee Schedule,14.34,47.26,
"Factor XI Activity, Clotting QSTC",10358416,LOCAL,85270,CPT,,,,,,Outpatient,,,88.2,21.48,Viva Med ADV,Viva Med ADV,17.9,,,,,,,Fee Schedule,5.42,17.9,
99151 MOD SED SAME PHYS/QHP <5 YRS,8653147,LOCAL,99151,CPT,,,,,,Outpatient,,,88.82,58,Viva Med ADV,Viva Med ADV,20.19,,,,,,,Fee Schedule,20.19,34.95,
Selenium QSTC,8972757,LOCAL,84255,CPT,,,,,,Outpatient,,,89.6,30.64,Viva Med ADV,Viva Med ADV,57.31,,,,,,,Fee Schedule,17.73,57.31,
Theophylline Level,1634886,LOCAL,80198,CPT,,,,,,Outpatient,,,89.76,16.97,Viva Med ADV,Viva Med ADV,14.14,,,,,,,Fee Schedule,14.14,15.38,
97552 OT Caregiver Training Group,13649812,LOCAL,97552,CPT,,,,,,Outpatient,,,90,,Viva Med ADV,Viva Med ADV,9.04,,,,,,,Fee Schedule,9.04,67.18,
97552 Speech Caregiver Training Group,13767339,LOCAL,97552,CPT,,,,,,Outpatient,,,90,,Viva Med ADV,Viva Med ADV,9.04,,,,,,,Fee Schedule,9.04,67.18,
"Beta-2-Glycoprotein I Antibodies (IgG, IgM) QSTC",10094523,LOCAL,86146,CPT,,,,,,Outpatient,,,90,30.54,Viva Med ADV,Viva Med ADV,25.45,,,,,,,Fee Schedule,15.29,25.45,
Bill Only ABO,7936964,LOCAL,86900,CPT,,,,,,Outpatient,,,90,3.59,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,6.29,117.85,
Bill Only Rh,7936965,LOCAL,86901,CPT,,,,,,Outpatient,,,90,3.59,Viva Med ADV,Viva Med ADV,35.88,,,,,,,Fee Schedule,6.29,35.88,
B-Type Natriuretic Peptide,1383771,LOCAL,83880,CPT,,,,,,Outpatient,,,90,47.11,Viva Med ADV,Viva Med ADV,13.36,,,,,,,Fee Schedule,13.36379562,46.74,
"GROUP CAREGIVER TRAINING IN STRATEGIES & TECHNIQUES, FACE TO FACE, INITIAL 30 MIN 97552",13788179,LOCAL,97552,CPT,,,,,,Outpatient,,,90,,Viva Med ADV,Viva Med ADV,9.04,,,,,,,Fee Schedule,9.04,67.18,
"Helicobacter pylori Ag, EIA, Stool QSTC",8873559,LOCAL,87338,CPT,,,,,,Outpatient,,,90,17.26,Viva Med ADV,Viva Med ADV,14.38,,,,,,,Fee Schedule,10.57,14.38,
Heparin Induced Plt Ab QSTC,8995550,LOCAL,86022,CPT,,,,,,Outpatient,,,90,22.04,Viva Med ADV,Viva Med ADV,18.37,,,,,,,Fee Schedule,15.29,18.37,
"HPV Genotypes 16,18/45 QST",9773953,LOCAL,87625,CPT,,,,,,Outpatient,,,90,48.66,Viva Med ADV,Viva Med ADV,64.87,,,,,,,Fee Schedule,40.19,64.87,
"HPV GENOTYPES 16,18/45,$POST-HYST, VAGINAL QST",14782712,LOCAL,87625,CPT,,,,,,Outpatient,,,90,48.66,Viva Med ADV,Viva Med ADV,64.87,,,,,,,Fee Schedule,40.19,64.87,
N-Terminal Pro B-Type Natriuretic Peptide,1503769,LOCAL,83880,CPT,,,,,,Outpatient,,,90,47.11,Viva Med ADV,Viva Med ADV,13.36,,,,,,,Fee Schedule,13.36379562,46.74,
OT Group Caregiver Training Units,13624357,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,90,,Viva Med ADV,Viva Med ADV,20.25,,,,,,,Fee Schedule,20.25,67.18,
SLP Group Caregiver Training Time,14466882,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,90,,Viva Med ADV,Viva Med ADV,20.25,,,,,,,Fee Schedule,20.25,67.18,
"Tacrolimus, Highly Sens, LC/MS/MS QSTC",8764783,LOCAL,80197,CPT,,,,,,Outpatient,,,90,16.48,Viva Med ADV,Viva Med ADV,51.73,,,,,,,Fee Schedule,15.38,51.73,
Topiramate QSTC,8764585,LOCAL,80201,CPT,,,,,,Outpatient,,,90,14.3,Viva Med ADV,Viva Med ADV,11.92,,,,,,,Fee Schedule,11.92,15.38,
Vitamin D 25 Hydroxy Level,4240407,LOCAL,82306,CPT,,,,,,Outpatient,,,90,35.52,Viva Med ADV,Viva Med ADV,45.2,,,,,,,Fee Schedule,17.73,45.19775253,
NEUROPSYCHOLOGICAL TEST ADMINISTRATION,13472049,LOCAL,96146,CPT,,,,,,Outpatient,,,91.31,59,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,22.39,846.56,
Creatinine Urine,1930782,LOCAL,82570,CPT,,,,,,Outpatient,,,91.8,6.22,Viva Med ADV,Viva Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
Fibrinogen Level,633728,LOCAL,85384,CPT,,,,,,Outpatient,,,92.21,11.66,Viva Med ADV,Viva Med ADV,9.72,,,,,,,Fee Schedule,5.42,9.72,
Rapid Plasma Reagin,633820,LOCAL,86592,CPT,,,,,,Outpatient,,,92.21,5.12,Viva Med ADV,Viva Med ADV,19.99,,,,,,,Fee Schedule,15.29,19.99375,
Rapid Plasma Reagin Qualitative,7948395,LOCAL,86592,CPT,,,,,,Outpatient,,,92.21,5.12,Viva Med ADV,Viva Med ADV,19.99,,,,,,,Fee Schedule,15.29,19.99375,
Rapid Plasma Reagin Qualitative w/ Reflex,8166073,LOCAL,86592,CPT,,,,,,Outpatient,,,92.21,5.12,Viva Med ADV,Viva Med ADV,19.99,,,,,,,Fee Schedule,15.29,19.99375,
Blood Type ABO/Rh Typing,634326,LOCAL,86900,CPT,,,,,,Outpatient,,,92.71,3.59,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,6.29,117.85,
Cord ABORh,8019069,LOCAL,86900,CPT,,,,,,Outpatient,,,92.71,3.59,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,6.29,117.85,
Neonatal ABORh,8070665,LOCAL,86900,CPT,,,,,,Outpatient,,,92.71,3.59,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,6.29,117.85,
Fetal Screen,634335,LOCAL,85461,CPT,,,,,,Outpatient,,,93.02,11.23,Viva Med ADV,Viva Med ADV,9.36,,,,,,,Fee Schedule,8.21,9.36,
methylPREDNISolone sodium succinate 500 mg injection [CULL],11201954,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,93.2352,,Viva Med ADV,Viva Med ADV,0.21,,,,,,,Fee Schedule,0.21,0.21,
99175 IPECAC EMESIS W/OBSERVATION TechFee,8057714,LOCAL,99175,CPT,,,,,,Outpatient,,,93.74,61,Viva Med ADV,Viva Med ADV,39.94,,,,,,,Fee Schedule,39.94,983.02,
RT Vapotherm Initial CHARGE,8144190,LOCAL,94002,CPT,,,,,,Outpatient,,,94.68,663,Viva Med ADV,Viva Med ADV,604.42,,,,,,,Fee Schedule,604.42,941,
"Coccidioides Antibody, CF & ID, S QSTC",8764815,LOCAL,86635,CPT,,,,,,Outpatient,,,95.18,13.76,Viva Med ADV,Viva Med ADV,11.47,,,,,,,Fee Schedule,11.47,15.29,
"Chlamydia Trachomatis RNA, TMA QST",9774353,LOCAL,87491,CPT,,,,,,Outpatient,,,96,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
DAPTOmycin 350 mg intravenous injection [CULL],11210540,LOCAL,J0878,CPT,,,,,,Outpatient,1,EA,96,480,Viva Med ADV,Viva Med ADV,0.03,,,,,,,Fee Schedule,0.01,122.4,
"Neisseria Gonorrhoeae RNA, TMA QST",9774354,LOCAL,87591,CPT,,,,,,Outpatient,,,96,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Trichomonas Vaginalis RNA, Ql, TMA QST",9774358,LOCAL,87661,CPT,,,,,,Outpatient,,,96,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Creat Clear,633609,LOCAL,82575,CPT,,,,,,Outpatient,,,96.29,11.35,Viva Med ADV,Viva Med ADV,52.79,,,,,,,Fee Schedule,7.16,52.785,
Creat Clear (No U24),8477916,LOCAL,82575,CPT,,,,,,Outpatient,,,96.29,11.35,Viva Med ADV,Viva Med ADV,52.79,,,,,,,Fee Schedule,7.16,52.785,
doxycycline 100 mg injection [CULL],11201705,LOCAL,J1271,CPT,,,,,,Outpatient,1,EA,96.64,,Viva Med ADV,Viva Med ADV,0.1,,,,,,,Fee Schedule,0.102,0.102,
Aspartate aminotransferase,633633,LOCAL,84450,CPT,,,,,,Outpatient,,,96.7,6.22,Viva Med ADV,Viva Med ADV,50.89,,,,,,,Fee Schedule,7.16,50.89,
Blood Urea Nitrogen,633605,LOCAL,84520,CPT,,,,,,Outpatient,,,96.7,4.74,Viva Med ADV,Viva Med ADV,26.82,,,,,,,Fee Schedule,7.16,26.82133333,
Mononucleosis Screen,633785,LOCAL,86308,CPT,,,,,,Outpatient,,,96.7,6.22,Viva Med ADV,Viva Med ADV,5.18,,,,,,,Fee Schedule,5.18,15.29,
Monospot POCT,9038464,LOCAL,86308,CPT,,,,,,Outpatient,,,96.7,6.22,Viva Med ADV,Viva Med ADV,5.18,,,,,,,Fee Schedule,5.18,15.29,
Gentamicin Level,3454415,LOCAL,80170,CPT,,,,,,Outpatient,,,97.1,19.66,Viva Med ADV,Viva Med ADV,16.38,,,,,,,Fee Schedule,15.38,16.38,
Gentamicin Level Peak,633736,LOCAL,80170,CPT,,,,,,Outpatient,,,97.1,19.66,Viva Med ADV,Viva Med ADV,16.38,,,,,,,Fee Schedule,15.38,16.38,
Gentamicin Level Trough,633737,LOCAL,80170,CPT,,,,,,Outpatient,,,97.1,19.66,Viva Med ADV,Viva Med ADV,16.38,,,,,,,Fee Schedule,15.38,16.38,
Gamma Glutamyl Transferase,1628895,LOCAL,82977,CPT,,,,,,Outpatient,,,97.92,8.64,Viva Med ADV,Viva Med ADV,52.49,,,,,,,Fee Schedule,7.16,52.49,
Renal Function Panel,1634883,LOCAL,80069,CPT,,,,,,Outpatient,,,97.92,10.42,Viva Med ADV,Viva Med ADV,37.66,,,,,,,Fee Schedule,12.14,37.65984615,
CULL NM Therapy I131 Cap Per MCI,13644969,LOCAL,,,A9517,HCPCS,,,,Outpatient,,,98.48,64,Viva Med ADV,Viva Med ADV,23.13,,,,,,,Fee Schedule,23.13,662.39,
96423 CHEMO ARTRL INF EA ADDL HR CHARGE,9404493,LOCAL,96423,CPT,,,,,,Outpatient,,,98.94,64,Viva Med ADV,Viva Med ADV,42.18,,,,,,,Fee Schedule,42.18,749.76,
90913 - Bfb training ea addl 15 min.,9442436,LOCAL,90913,CPT,,,,,,Outpatient,,,99,64,Viva Med ADV,Viva Med ADV,20.19,,,,,,,Fee Schedule,20.19,233.61,
Caregiver Agreement on Discipline,7355021,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,99,,Viva Med ADV,Viva Med ADV,20.25,,,,,,,Fee Schedule,20.25,67.18,
Caregiver Agreement on Discipline,7355021,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,99,,Viva Med ADV,Viva Med ADV,20.25,,,,,,,Fee Schedule,20.25,67.18,
Cholesterol Total,633705,LOCAL,82465,CPT,,,,,,Outpatient,,,99.14,5.22,Viva Med ADV,Viva Med ADV,4.35,,,,,,,Fee Schedule,4.35,7.16,
Progesterone Level,3454459,LOCAL,84144,CPT,,,,,,Outpatient,,,99.14,25.03,Viva Med ADV,Viva Med ADV,59.8,,,,,,,Fee Schedule,18.43,59.795,
Triglyceride,633852,LOCAL,84478,CPT,,,,,,Outpatient,,,99.14,6.89,Viva Med ADV,Viva Med ADV,52.39,,,,,,,Fee Schedule,7.16,52.385,
"Histoplasma Antibody Panel, CF and ID, Serum QSTC",10185600,LOCAL,86698,CPT,,,,,,Outpatient,,,99.5,16.55,Viva Med ADV,Viva Med ADV,13.79,,,,,,,Fee Schedule,13.79,15.29,
"64420 INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVE, SINGLE ProFee",13959631,LOCAL,64420,CPT,,,,,,Outpatient,,,100,693,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
E3581 Thawed Cryo AHF,7267123,LOCAL,,,P9012,HCPCS,,,,Outpatient,,,100,65,Viva Med ADV,Viva Med ADV,63.57,,,,,,,Fee Schedule,63.57,217.45,
HPV mRNA E6/E7 QST,9775619,LOCAL,87624,CPT,,,,,,Outpatient,,,100,42.11,Viva Med ADV,Viva Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
HPV mRNA E6/E7 QST,10585636,LOCAL,87624,CPT,,,,,,Outpatient,,,100,42.11,Viva Med ADV,Viva Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
POC Chem8+ Panel,8920330,LOCAL,80048,CPT,,,,,,Outpatient,,,100,10.15,Viva Med ADV,Viva Med ADV,37.17,,,,,,,Fee Schedule,12.14,37.17170492,
Thinprep Review Cytotechnologist: QST,9775616,LOCAL,88175,CPT,,,,,,Outpatient,,,100,31.93,Viva Med ADV,Viva Med ADV,26.61,,,,,,,Fee Schedule,25.25,26.61,
Thinprep Review Cytotechnologist: QST,10585633,LOCAL,88175,CPT,,,,,,Outpatient,,,100,31.93,Viva Med ADV,Viva Med ADV,26.61,,,,,,,Fee Schedule,25.25,26.61,
97116  SB Pt Gait Train 15 mn,9640030,LOCAL,97116,CPT,,,,,GP,Outpatient,,,100.04,65,Viva Med ADV,Viva Med ADV,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
97116 GAIT TRAINING CHARGE,9410151,LOCAL,97116,CPT,,,,,GP,Outpatient,,,100.04,65,Viva Med ADV,Viva Med ADV,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
97116 PT Gait Training Assistant Units,9650030,LOCAL,97116,CPT,,,,,GP|CQ,Outpatient,,,100.04,65,Viva Med ADV,Viva Med ADV,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
Gait Training Charges,7895941,LOCAL,97116,CPT,,,,,GP,Outpatient,,,100.04,65,Viva Med ADV,Viva Med ADV,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
PT Gait Training Assistant Units,9390436,LOCAL,97116,CPT,,,,,CQ,Outpatient,,,100.04,65,Viva Med ADV,Viva Med ADV,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
Activated PTT,7938959,LOCAL,85730,CPT,,,,,,Outpatient,,,101.52,7.21,Viva Med ADV,Viva Med ADV,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
Bilirubin Direct,4240528,LOCAL,82248,CPT,,,,,,Outpatient,,,101.59,6.02,Viva Med ADV,Viva Med ADV,26.63,,,,,,,Fee Schedule,7.16,26.6275,
Bilirubin Direct,7939101,LOCAL,82248,CPT,,,,,,Outpatient,,,101.59,6.02,Viva Med ADV,Viva Med ADV,26.63,,,,,,,Fee Schedule,7.16,26.6275,
Bilirubin Direct,8443662,LOCAL,82248,CPT,,,,,,Outpatient,,,101.59,6.02,Viva Med ADV,Viva Med ADV,26.63,,,,,,,Fee Schedule,7.16,26.6275,
iSTAT Creatinine POCT,11673045,LOCAL,82565,CPT,,,,,,Outpatient,,,101.59,6.14,Viva Med ADV,Viva Med ADV,10.06,,,,,,,Fee Schedule,7.16,10.061625,
Lipid Pnl,633777,LOCAL,80061,CPT,,,,,,Outpatient,,,101.59,16.07,Viva Med ADV,Viva Med ADV,16.6,,,,,,,Fee Schedule,12.14,16.59934459,
77062 MG Diagnostic Tomo Charge: AddOn Bilateral,13969682,LOCAL,G0279,CPT,,,,,,Outpatient,,,101.84,,Viva Med ADV,Viva Med ADV,11.11,,,,,,,Fee Schedule,11.11,74,
77063 MG Tomo Charge: AddOn Bilateral,13621440,LOCAL,77063,CPT,,,,,,Outpatient,,,101.84,54.45,Viva Med ADV,Viva Med ADV,20.75,,,,,,,Fee Schedule,20.75,74,
CULL Mammo Tomo Add On,7867705,LOCAL,77063,CPT,,,,,,Outpatient,,,101.84,54.45,Viva Med ADV,Viva Med ADV,20.75,,,,,,,Fee Schedule,20.75,74,
hepatitis B pediatric vaccine 10 mcg/0.5 mL intramuscular suspension 0.5 mL [CULL],11202559,LOCAL,90744,CPT,,,,,,Outpatient,0.5,ML,102.17472,,Viva Med ADV,Viva Med ADV,33.2,,,,,,,Fee Schedule,33.204,39.58,
Immunoglobulin G Subclass 1 QSTC,8851875,LOCAL,82787,CPT,,,,,,Outpatient,,,102.38,9.62,Viva Med ADV,Viva Med ADV,8.02,,,,,,,Fee Schedule,7.16,8.02,
"Immunoglobulin G, Serum QSTC",8851879,LOCAL,82784,CPT,,,,,,Outpatient,,,102.38,11.16,Viva Med ADV,Viva Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
"HVA, 24h Urine w/o Creat QSTC",13864511,LOCAL,83150,CPT,,,,,,Outpatient,,,102.56,26.89,Viva Med ADV,Viva Med ADV,22.41,,,,,,,Fee Schedule,18.43,22.41,
CYSTOGRAM INJ,8210035,LOCAL,51600,CPT,,,,,,Outpatient,,,103,246,Viva Med ADV,Viva Med ADV,35.39,,,,,,,Fee Schedule,35.39,863,
Therapeutic Phlebotomy,8118276,LOCAL,99195,CPT,,,,,,Outpatient,,,103.04,67,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,85.79,117.85,
Strep A Xpress (GeneXpert),8642789,LOCAL,87651,CPT,,,,,,Outpatient,,,103.5,42.11,Viva Med ADV,Viva Med ADV,3.7,,,,,,,Fee Schedule,3.7,40.19,
Cerebrospinal Fluid Culture,4122737,LOCAL,87070,CPT,,,,,,Outpatient,,,103.63,10.34,Viva Med ADV,Viva Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
pamidronate 3 mg/mL intravenous solution 10 mL [CULL],11211072,LOCAL,J2430,CPT,,,,,,Outpatient,10,ML,103.68,,Viva Med ADV,Viva Med ADV,11.29,,,,,,,Fee Schedule,11.29,11.29,
Coronavirus SARS Ag (Sofia),9803641,LOCAL,87426,CPT,,,,,,Outpatient,,,104,42.4,Viva Med ADV,Viva Med ADV,56.41,,,,,,,Fee Schedule,10.57,56.40806897,
COVID-19 Ag,11561110,LOCAL,87426,CPT,,,,,,Outpatient,,,104,42.4,Viva Med ADV,Viva Med ADV,56.41,,,,,,,Fee Schedule,10.57,56.40806897,
Urine Drug Screen,3454403,LOCAL,80306,CPT,,,,,,Outpatient,,,104,20.57,Viva Med ADV,Viva Med ADV,0.24,,,,,,,Fee Schedule,0.2416,17.73,
97533 PT SENSORY INTEGRATIVE TECH 15MIN,9866109,LOCAL,97533,CPT,,,,,GO|CO,Outpatient,,,104.14,68,Viva Med ADV,Viva Med ADV,55.09,,,,,,,Fee Schedule,55.09,56.44,
97533 SENSORY INTEGATIVE TECHNIQUES EACH 15 MINS,9856109,LOCAL,97533,CPT,,,,,GO,Outpatient,,,104.14,68,Viva Med ADV,Viva Med ADV,55.09,,,,,,,Fee Schedule,55.09,56.44,
OT Sensory Integrative Tech Assistant Units,7895276,LOCAL,97533,CPT,,,,,CQ,Outpatient,,,104.14,68,Viva Med ADV,Viva Med ADV,55.09,,,,,,,Fee Schedule,55.09,56.44,
OT Sensory Integrative Techniques Units,1373568,LOCAL,97533,CPT,,,,,GO,Outpatient,,,104.14,68,Viva Med ADV,Viva Med ADV,55.09,,,,,,,Fee Schedule,55.09,56.44,
Sensory Stimulation Charge,7895276,LOCAL,97533,CPT,,,,,GO,Outpatient,,,104.14,68,Viva Med ADV,Viva Med ADV,55.09,,,,,,,Fee Schedule,55.09,56.44,
L3908 Clavicle Brace,9800048,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,104.31,86,Viva Med ADV,Viva Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
L3908 Wrist/forearm Brace,9800047,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,104.31,86,Viva Med ADV,Viva Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
"Chlamydia Trachomatis RNA, TMA QST",14435138,LOCAL,87491,CPT,,,,,,Outpatient,,,105,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
HPV mRNA E6/E7 QST,14435137,LOCAL,87624,CPT,,,,,,Outpatient,,,105,42.11,Viva Med ADV,Viva Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
"Neisseria Gonorrhoeae RNA, TMA QST",14435139,LOCAL,87591,CPT,,,,,,Outpatient,,,105,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Thinprep Review Cytotechnologist: QST,14435134,LOCAL,88175,CPT,,,,,,Outpatient,,,105,31.93,Viva Med ADV,Viva Med ADV,26.61,,,,,,,Fee Schedule,25.25,26.61,
Iron Level,633765,LOCAL,83540,CPT,,,,,,Outpatient,,,105.26,7.76,Viva Med ADV,Viva Med ADV,48.88,,,,,,,Fee Schedule,7.16,48.87820628,
Iron Level,7050169,LOCAL,83540,CPT,,,,,,Outpatient,,,105.26,7.76,Viva Med ADV,Viva Med ADV,48.88,,,,,,,Fee Schedule,7.16,48.87820628,
Iron Level,10543519,LOCAL,83540,CPT,,,,,,Outpatient,,,105.26,7.76,Viva Med ADV,Viva Med ADV,48.88,,,,,,,Fee Schedule,7.16,48.87820628,
"Vitamin B2 (Riboflavin), P QSTC",8972877,LOCAL,84252,CPT,,,,,,Outpatient,,,106.2,24.29,Viva Med ADV,Viva Med ADV,20.24,,,,,,,Fee Schedule,17.73,20.24,
L3908 Daytimer Wrist Support,9800046,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,106.38,86,Viva Med ADV,Viva Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
97537 COMMUNITY/WORK REINTEGRATION,9650036,LOCAL,97537,CPT,,,,,GP|CQ,Outpatient,,,107.75,70,Viva Med ADV,Viva Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
97537 Community/work reintegration training; each 15 minutes,9860034,LOCAL,97537,CPT,,,,,GO|CO,Outpatient,,,107.75,70,Viva Med ADV,Viva Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
97537 OT COMM WORK INTEGRATION CHARGE,9850034,LOCAL,97537,CPT,,,,,GO,Outpatient,,,107.75,70,Viva Med ADV,Viva Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
97537 PT ERGONOMIC TRAINING,9640036,LOCAL,97537,CPT,,,,,GP,Outpatient,,,107.75,70,Viva Med ADV,Viva Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
Community/Work Reintegration Charges,1366455,LOCAL,97537,CPT,,,,,GO,Outpatient,,,107.75,70,Viva Med ADV,Viva Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
"OT Community, Work Reintegration Assistant Units",1366455,LOCAL,97537,CPT,,,,,CQ,Outpatient,,,107.75,70,Viva Med ADV,Viva Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
"OT Community, Work Reintegration Assistant Units",1373453,LOCAL,97537,CPT,,,,,CQ,Outpatient,,,107.75,70,Viva Med ADV,Viva Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
"OT Community, Work Reintegration Units",1373453,LOCAL,97537,CPT,,,,,GO,Outpatient,,,107.75,70,Viva Med ADV,Viva Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
OT Community/Work Reintegration Charges,1366455,LOCAL,97537,CPT,,,,,GO,Outpatient,,,107.75,70,Viva Med ADV,Viva Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
"PT Community,Work Reintegration Assistant Units",9390450,LOCAL,97537,CPT,,,,,CQ,Outpatient,,,107.75,70,Viva Med ADV,Viva Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
PT Community/Work Reintegration Charge,7895991,LOCAL,97537,CPT,,,,,GP,Outpatient,,,107.75,70,Viva Med ADV,Viva Med ADV,29.96,,,,,,,Fee Schedule,29.96,56.44,
AChR Bind Ab w/rfx MuSK Ab QSTC,13864498,LOCAL,86041,CPT,,,,,,Outpatient,,,108,22.08,Viva Med ADV,Viva Med ADV,18.4,,,,,,,Fee Schedule,15.29,18.4,
Alpha-1-Antitrypsin QN QSTC,13873077,LOCAL,82103,CPT,,,,,,Outpatient,,,108,16.13,Viva Med ADV,Viva Med ADV,60.59,,,,,,,Fee Schedule,17.73,60.59,
Carnitine QSTC,8764784,LOCAL,82379,CPT,,,,,,Outpatient,,,108,20.24,Viva Med ADV,Viva Med ADV,16.87,,,,,,,Fee Schedule,16.87,17.73,
EKG Charges - RT -> Routine ECG 12 lead/15 lead tracing only,5367589,LOCAL,93041,CPT,,,,,,Outpatient,,,108.53,71,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,38.53,54.31,
97542  SB PT Wheelchair Mgt,9640037,LOCAL,97542,CPT,,,,,GP,Outpatient,,,108.91,71,Viva Med ADV,Viva Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
97542 OT WHEELCHAIR MANAGE/TRAIN 15MIN,9820201,LOCAL,97542,CPT,,,,,GO,Outpatient,,,108.91,71,Viva Med ADV,Viva Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
97542 PT WC SEATING EVAL CHARGE,9650037,LOCAL,97542,CPT,,,,,GP|CQ,Outpatient,,,108.91,71,Viva Med ADV,Viva Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
"97542 Wheelchair management (eg, assessment, fitting, training), each 15 minutes",9860201,LOCAL,97542,CPT,,,,,GO|CO,Outpatient,,,108.91,71,Viva Med ADV,Viva Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
97542 WHEELCHAIR MANAGEMENT CHARGE,9410201,LOCAL,97542,CPT,,,,,GP,Outpatient,,,108.91,71,Viva Med ADV,Viva Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
OT Wheelchair Management Assistant Units,7895273,LOCAL,97542,CPT,,,,,CQ,Outpatient,,,108.91,71,Viva Med ADV,Viva Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
OT Wheelchair Management Units,1373570,LOCAL,97542,CPT,,,,,GO,Outpatient,,,108.91,71,Viva Med ADV,Viva Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
PT Wheelchair Management Assistant Units,9390452,LOCAL,97542,CPT,,,,,CQ,Outpatient,,,108.91,71,Viva Med ADV,Viva Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
Wheelchair Charge,7895273,LOCAL,97542,CPT,,,,,GO,Outpatient,,,108.91,71,Viva Med ADV,Viva Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
Wheelchair Management Charges,7895931,LOCAL,97542,CPT,,,,,GP,Outpatient,,,108.91,71,Viva Med ADV,Viva Med ADV,29.37,,,,,,,Fee Schedule,29.37,56.44,
97551 OT Caregiver Training Ea Add'l 15 Mins,13647370,LOCAL,97551,CPT,,,,,,Outpatient,,,110,,Viva Med ADV,Viva Med ADV,20.67,,,,,,,Fee Schedule,20.67,95.93,
97551 PT Caregiver Training Ea Add'l 15 Mins,13645598,LOCAL,97551,CPT,,,,,,Outpatient,,,110,,Viva Med ADV,Viva Med ADV,20.67,,,,,,,Fee Schedule,20.67,95.93,
97551 ST Caregiver Training Ea  Addl 15 min,14017194,LOCAL,97551,CPT,,,,,,Outpatient,,,110,,Viva Med ADV,Viva Med ADV,20.67,,,,,,,Fee Schedule,20.67,95.93,
Facility Eval and Management Level 1 99211,10633491,LOCAL,99211,CPT,,,,,,Outpatient,,,110,226,Viva Med ADV,Viva Med ADV,7.37,,,,,,,Fee Schedule,7.37,7.37,
Medical Day Dressing Change,10633491,LOCAL,99211,CPT,,,,,,Outpatient,,,110,226,Viva Med ADV,Viva Med ADV,7.37,,,,,,,Fee Schedule,7.37,7.37,
"OT Caregiver Training, Addl 15 Min Asst",13623455,LOCAL,,,G0542,HCPCS,,,,Outpatient,,,110,,Viva Med ADV,Viva Med ADV,25.18,,,,,,,Fee Schedule,25.18,95.93,
"OT Caregiver Training, First 30 Min Asst",13623453,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,110,,Viva Med ADV,Viva Med ADV,50.79,,,,,,,Fee Schedule,50.79,95.93,
"SLP Caregiver Training, Addl 15 Min Time",14466886,LOCAL,,,G0542,HCPCS,,,,Outpatient,,,110,,Viva Med ADV,Viva Med ADV,25.18,,,,,,,Fee Schedule,25.18,95.93,
% CD19 (B Cells) QSTC,9416397,LOCAL,86355,CPT,,,,,,Outpatient,,,110.25,45.28,Viva Med ADV,Viva Med ADV,37.73,,,,,,,Fee Schedule,15.29,37.73,
%CD 16+CD56 (NK Cells) QSTC,9416395,LOCAL,86357,CPT,,,,,,Outpatient,,,110.25,45.28,Viva Med ADV,Viva Med ADV,37.73,,,,,,,Fee Schedule,15.29,37.73,
%CD3 Mature T Cells QSTC,9416288,LOCAL,86359,CPT,,,,,,Outpatient,,,110.25,45.28,Viva Med ADV,Viva Med ADV,37.73,,,,,,,Fee Schedule,15.29,37.73,
CD4/CD8 Ratio QSTC,8852258,LOCAL,86360,CPT,,,,,,Outpatient,,,110.25,56.38,Viva Med ADV,Viva Med ADV,46.98,,,,,,,Fee Schedule,44.29,46.98,
"Parvovirus B19 Antibodies(IgG, IgM) QSTC",8764577,LOCAL,86747,CPT,,,,,,Outpatient,,,110.25,18.04,Viva Med ADV,Viva Med ADV,15.03,,,,,,,Fee Schedule,15.03,15.29,
chlorproMAZINE 25 mg/mL injectable solution 1 mL [CULL],11202221,LOCAL,J3230,CPT,,,,,,Outpatient,1,ML,110.9376,,Viva Med ADV,Viva Med ADV,23.77,,,,,,,Fee Schedule,23.767,23.767,
CBC w/ Manual Differential,633682,LOCAL,85027,CPT,,,,,,Outpatient,,,111.38,7.76,Viva Med ADV,Viva Med ADV,27.03,,,,,,,Fee Schedule,8.21,27.02937879,
CBC without Differential,3798345,LOCAL,85027,CPT,,,,,,Outpatient,,,111.38,7.76,Viva Med ADV,Viva Med ADV,27.03,,,,,,,Fee Schedule,8.21,27.02937879,
gentamicin 40 mg/mL injectable solution 20 mL [CULL],11205229,LOCAL,J1580,CPT,,,,,,Outpatient,20,ML,112.2048,,Viva Med ADV,Viva Med ADV,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
DNase-B Antibody QSTC,8764548,LOCAL,86215,CPT,,,,,,Outpatient,,,112.5,15.9,Viva Med ADV,Viva Med ADV,13.25,,,,,,,Fee Schedule,13.25,15.29,
"Tissue Transglutaminase Ab(IgG,IgA) QSTC",8972930,LOCAL,86364,CPT,,,,,,Outpatient,,,112.5,13.84,Viva Med ADV,Viva Med ADV,61.9,,,,,,,Fee Schedule,15.29,61.9,
Cord DAT Gel,8416626,LOCAL,86880,CPT,,,,,,Outpatient,,,112.65,6.47,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,6.29,54.31,
DAT IgG Gel,7906396,LOCAL,86880,CPT,,,,,,Outpatient,,,112.65,6.47,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,6.29,54.31,
Neonatal DAT Gel,13460490,LOCAL,86880,CPT,,,,,,Outpatient,,,112.65,6.47,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,6.29,54.31,
LA Ven - Sepsis 2Hr,8485386,LOCAL,83605,CPT,,,,,,Outpatient,,,113.42,13.88,Viva Med ADV,Viva Med ADV,0.9,,,,,,,Fee Schedule,0.901879518,17.73,
Lactic Acid (Venous),3454442,LOCAL,83605,CPT,,,,,,Outpatient,,,113.42,13.88,Viva Med ADV,Viva Med ADV,0.9,,,,,,,Fee Schedule,0.901879518,17.73,
Lactic Acid (Venous) - Sepsis,8058058,LOCAL,83605,CPT,,,,,,Outpatient,,,113.42,13.88,Viva Med ADV,Viva Med ADV,0.9,,,,,,,Fee Schedule,0.901879518,17.73,
Unstable Hemoglobin QSTC,13864449,LOCAL,83068,CPT,,,,,,Outpatient,,,113.63,11.36,Viva Med ADV,Viva Med ADV,9.47,,,,,,,Fee Schedule,7.16,9.47,
97124 MASSAGE CHARGE,9640031,LOCAL,97124,CPT,,,,,GP,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
97124 OT MASSAGE CHARGE,9850029,LOCAL,97124,CPT,,,,,GO,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
97124 OT-MASSAGE EA 15 MIN,9860029,LOCAL,97124,CPT,,,,,GO|CO,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
97124 PT Massage Assistant Units,9650031,LOCAL,97124,CPT,,,,,GP|CQ,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
97140  Manual Therapy 15 min,9850047,LOCAL,97140,CPT,,,,,GO,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,65.85,,,,,,,Fee Schedule,56.44,65.845,
97140 MAN THER EA 15 MIN CHARGES,9640047,LOCAL,97140,CPT,,,,,GP,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,65.85,,,,,,,Fee Schedule,56.44,65.845,
97140 OT Manual Therapy Assistant Units,9860047,LOCAL,97140,CPT,,,,,GO|CO,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,65.85,,,,,,,Fee Schedule,56.44,65.845,
97140 PT Manual Therapy Assistant Units,9650047,LOCAL,97140,CPT,,,,,GP|CQ,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,65.85,,,,,,,Fee Schedule,56.44,65.845,
Manual Therapy Charge Units,7895928,LOCAL,97140,CPT,,,,,GP,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,65.85,,,,,,,Fee Schedule,56.44,65.845,
Manual Traction Charge,7895279,LOCAL,97140,CPT,,,,,GO,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,65.85,,,,,,,Fee Schedule,56.44,65.845,
Massage Charge Units,1041799,LOCAL,97124,CPT,,,,,GO,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
Massage Charge Units,7895954,LOCAL,97124,CPT,,,,,GP,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
OT Manual Therapy Assistant Units,1373444,LOCAL,97140,CPT,,,,,CQ,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,65.85,,,,,,,Fee Schedule,56.44,65.845,
OT Manual Therapy Units,1373444,LOCAL,97140,CPT,,,,,GO,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,65.85,,,,,,,Fee Schedule,56.44,65.845,
OT Massage Assistant Units,1041799,LOCAL,97124,CPT,,,,,CQ,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
OT Massage Charge Units,1041799,LOCAL,97124,CPT,,,,,GO,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
OT Massage Rehab Assist Units,7897698,LOCAL,97124,CPT,,,,,CQ,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
OT Massage Rehab Units,7897698,LOCAL,97124,CPT,,,,,GO,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
PT Manual Therapy Assistant Units,9390440,LOCAL,97140,CPT,,,,,CQ,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,65.85,,,,,,,Fee Schedule,56.44,65.845,
PT Massage Assistant Units,9390438,LOCAL,97124,CPT,,,,,CQ,Outpatient,,,114.56,74,Viva Med ADV,Viva Med ADV,27.37,,,,,,,Fee Schedule,27.37,47.26,
methylergonovine 0.2 mg/mL injectable solution 1 mL [CULL],11202918,LOCAL,J2210,CPT,,,,,,Outpatient,1,ML,114.8928,,Viva Med ADV,Viva Med ADV,21.36,,,,,,,Fee Schedule,21.363,21.363,
Thinprep TIS Pap QST,9773891,LOCAL,88175,CPT,,,,,,Outpatient,,,115,31.93,Viva Med ADV,Viva Med ADV,26.61,,,,,,,Fee Schedule,25.25,26.61,
Thinprep TIS Pap Rfx HPV mRNA E6/E7 QST,9773936,LOCAL,88175,CPT,,,,,,Outpatient,,,115,31.93,Viva Med ADV,Viva Med ADV,26.61,,,,,,,Fee Schedule,25.25,26.61,
97033 IONTOPHORESIS CHARGE,9410271,LOCAL,97033,CPT,,,,,GP,Outpatient,,,115.06,75,Viva Med ADV,Viva Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
97033 IONTOPHORESIS EA 15 MIN CHARGES,9640077,LOCAL,97033,CPT,,,,,GP,Outpatient,,,115.06,75,Viva Med ADV,Viva Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
97033 OT IONTOPHORESIS,9850073,LOCAL,97033,CPT,,,,,GO,Outpatient,,,115.06,75,Viva Med ADV,Viva Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
97033 OT IONTOPHORESIS 15 MIN APPL CHARGE,9860073,LOCAL,97033,CPT,,,,,GO|CO,Outpatient,,,115.06,75,Viva Med ADV,Viva Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
97033 PT IONTOPHORESIS,9650077,LOCAL,97033,CPT,,,,,GP|CQ,Outpatient,,,115.06,75,Viva Med ADV,Viva Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
Iontophoresis Charges,1366374,LOCAL,97033,CPT,,,,,GO,Outpatient,,,115.06,75,Viva Med ADV,Viva Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
Iontophoresis Charges,7895927,LOCAL,97033,CPT,,,,,GP,Outpatient,,,115.06,75,Viva Med ADV,Viva Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
OT Iontophoresis Assistant Units,1366374,LOCAL,97033,CPT,,,,,CQ,Outpatient,,,115.06,75,Viva Med ADV,Viva Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
OT Iontophoresis Assistant Units,1373443,LOCAL,97033,CPT,,,,,CQ,Outpatient,,,115.06,75,Viva Med ADV,Viva Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
OT Iontophoresis Charges,1366374,LOCAL,97033,CPT,,,,,GO,Outpatient,,,115.06,75,Viva Med ADV,Viva Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
OT Iontophoresis Units,1373443,LOCAL,97033,CPT,,,,,GO,Outpatient,,,115.06,75,Viva Med ADV,Viva Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
PT Iontophoresis Assistant Units,9390424,LOCAL,97033,CPT,,,,,CQ,Outpatient,,,115.06,75,Viva Med ADV,Viva Med ADV,17.64,,,,,,,Fee Schedule,17.64,47.26,
Allergy Panel13 Stinging Insect Grp QSTC,9063178,LOCAL,86003,CPT,,,,,,Outpatient,,,115.65,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Honey Bee (I1) IgE QST,12866524,LOCAL,86003,CPT,,,,,,Outpatient,,,115.65,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Peanut Component Panel QSTC,8764809,LOCAL,86008,CPT,,,,,,Outpatient,,,115.65,21.52,Viva Med ADV,Viva Med ADV,17.93,,,,,,,Fee Schedule,15.29,17.93,
RT CHARGE Chest Physiotherapy -> PEP Therapy Initial,8699752,LOCAL,94668,CPT,,,,,,Outpatient,,,115.89,75,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,76.09,117.85,
"Chlamydia Trachomatis RNA, TMA QST",12762527,LOCAL,87491,CPT,,,,,,Outpatient,,,117,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Mycoplasma Genitalium, rRNA QST",12762530,LOCAL,87563,CPT,,,,,,Outpatient,,,117,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",12762531,LOCAL,87591,CPT,,,,,,Outpatient,,,117,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Trichomonas Vaginalis RNA QST,12762534,LOCAL,87661,CPT,,,,,,Outpatient,,,117,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Ferritin,1628893,LOCAL,82728,CPT,,,,,,Outpatient,,,117.5,16.36,Viva Med ADV,Viva Med ADV,50.83,,,,,,,Fee Schedule,17.73,50.82956044,
97750 - Physical performance test or measurement,9640058,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,Viva Med ADV,Viva Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 FCE-FUNCTIONAL CAPACITY EVAL 1 CHARGE,9640050,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,Viva Med ADV,Viva Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 OT PERF TEST MEAS 15 MIN CHARGE,9850061,LOCAL,97750,CPT,,,,,GO,Outpatient,,,118.17,77,Viva Med ADV,Viva Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 OT Strapping Shoulder Assistant Units,9860061,LOCAL,97750,CPT,,,,,GO|CO,Outpatient,,,118.17,77,Viva Med ADV,Viva Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 PRE WORK SCREEN CHARGE,9650058,LOCAL,97750,CPT,,,,,GP|CQ,Outpatient,,,118.17,77,Viva Med ADV,Viva Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 PT ISOKINETIC TEST 15 MIN,9640053,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,Viva Med ADV,Viva Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 PT ISOKINETIC TEST 15 MIN ASST,9650053,LOCAL,97750,CPT,,,,,GP|CQ,Outpatient,,,118.17,77,Viva Med ADV,Viva Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 PT PHYSICAL PERFORMANCE TEST CHARGE,9650050,LOCAL,97750,CPT,,,,,GP|CQ,Outpatient,,,118.17,77,Viva Med ADV,Viva Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
97761 (PROSTHETIC TRAINING CAWC),9650033,LOCAL,97761,CPT,,,,,GP|CQ,Outpatient,,,118.17,77,Viva Med ADV,Viva Med ADV,37.35,,,,,,,Fee Schedule,37.35,56.44,
97761 PROSTHETIC TRAINING 15 MINS,9640033,LOCAL,97761,CPT,,,,,GP,Outpatient,,,118.17,77,Viva Med ADV,Viva Med ADV,37.35,,,,,,,Fee Schedule,37.35,56.44,
97761 PT PROSTHETIC TRAINING CHARGE,9410181,LOCAL,97761,CPT,,,,,GP,Outpatient,,,118.17,77,Viva Med ADV,Viva Med ADV,37.35,,,,,,,Fee Schedule,37.35,56.44,
Functional Capacity Eval Charge,7895967,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,Viva Med ADV,Viva Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
OT Physical Performance Test Assistant Units,7895284,LOCAL,97750,CPT,,,,,CQ,Outpatient,,,118.17,77,Viva Med ADV,Viva Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
OT Physical Performance Test Charges,7895284,LOCAL,97750,CPT,,,,,GO,Outpatient,,,118.17,77,Viva Med ADV,Viva Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
OT Physical Performance Test Units,7897702,LOCAL,97750,CPT,,,,,GO,Outpatient,,,118.17,77,Viva Med ADV,Viva Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
Prosthetic Training Charges,7895930,LOCAL,97761,CPT,,,,,GP,Outpatient,,,118.17,77,Viva Med ADV,Viva Med ADV,37.35,,,,,,,Fee Schedule,37.35,56.44,
PT Physical Performance Assistant Test,9390432,LOCAL,97750,CPT,,,,,CQ,Outpatient,,,118.17,77,Viva Med ADV,Viva Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
PT Physical Performance Test Charges,7895980,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,Viva Med ADV,Viva Med ADV,31.29,,,,,,,Fee Schedule,31.29,56.44,
"PT Prosthetic Management, Train Assistant Units",9390460,LOCAL,97761,CPT,,,,,CQ,Outpatient,,,118.17,77,Viva Med ADV,Viva Med ADV,37.35,,,,,,,Fee Schedule,37.35,56.44,
"29125 Application of short arm splint (forearm to hand); static, right",8584933,LOCAL,29125,CPT,,,,,,Outpatient,,,120,129,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,63.51,863,
"Chlamydia Trachomatis RNA, TMA QST",14747186,LOCAL,87491,CPT,,,,,,Outpatient,,,120,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Cortisol Baseline,7974014,LOCAL,80400,CPT,,,,,,Outpatient,,,120,39.14,Viva Med ADV,Viva Med ADV,75.99,,,,,,,Fee Schedule,18.43,75.985,
Cyt Clinical Info QST,14754292,LOCAL,88104,CPT,,,,,,Outpatient,,,120,,Viva Med ADV,Viva Med ADV,35.88,,,,,,,Fee Schedule,14.07,35.88,
Cyt Pathologist QST,14754294,LOCAL,88172,CPT,,,,,,Outpatient,,,120,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,58.01,156.67,
Cyt Report Notes QST,14754295,LOCAL,88173,CPT,,,,,,Outpatient,,,120,,Viva Med ADV,Viva Med ADV,48.85,,,,,,,Fee Schedule,48.85,53.82,
Cyt Report Type QST,14754291,LOCAL,88121,CPT,,,,,,Outpatient,,,120,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,58.01,156.67,
Cyt Screener QST,14754293,LOCAL,87207,CPT,,,,,,Outpatient,,,120,7.19,Viva Med ADV,Viva Med ADV,5.99,,,,,,,Fee Schedule,5.99,10.57,
"Mycoplasma Genitalium, rRNA QST",14747189,LOCAL,87563,CPT,,,,,,Outpatient,,,120,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",14747187,LOCAL,87591,CPT,,,,,,Outpatient,,,120,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Tissue 1A Source QST,14754297,LOCAL,88108,CPT,,,,,,Outpatient,,,120,,Viva Med ADV,Viva Med ADV,35.88,,,,,,,Fee Schedule,14.07,35.88,
Tissue 1B Source QST,14754303,LOCAL,88108,CPT,,,,,,Outpatient,,,120,,Viva Med ADV,Viva Med ADV,35.88,,,,,,,Fee Schedule,14.07,35.88,
Tissue 1C Source QST,14754321,LOCAL,88108,CPT,,,,,,Outpatient,,,120,,Viva Med ADV,Viva Med ADV,35.88,,,,,,,Fee Schedule,14.07,35.88,
Tissue A Clinical Impression QST,14754296,LOCAL,88160,CPT,,,,,,Outpatient,,,120,,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue A Comment QST,14754301,LOCAL,88161,CPT,,,,,,Outpatient,,,120,,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue A Diagnosis QST,14754300,LOCAL,88162,CPT,,,,,,Outpatient,,,120,,Viva Med ADV,Viva Med ADV,48.85,,,,,,,Fee Schedule,48.85,58.01,
Tissue A Gross Description QST,14754299,LOCAL,88305,CPT,,,,,,Outpatient,,,120,,Viva Med ADV,Viva Med ADV,48.85,,,,,,,Fee Schedule,48.85,59.06,
Tissue B Comment QST,14754307,LOCAL,88161,CPT,,,,,,Outpatient,,,120,,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue B Diagnosis QST,14754306,LOCAL,88162,CPT,,,,,,Outpatient,,,120,,Viva Med ADV,Viva Med ADV,48.85,,,,,,,Fee Schedule,48.85,58.01,
Tissue B Gross Description QST,14754305,LOCAL,88305,CPT,,,,,,Outpatient,,,120,,Viva Med ADV,Viva Med ADV,48.85,,,,,,,Fee Schedule,48.85,59.06,
Tissue C Clinical Impression QST,14754320,LOCAL,88160,CPT,,,,,,Outpatient,,,120,,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue C Comment QST,14754325,LOCAL,88161,CPT,,,,,,Outpatient,,,120,,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue C Diagnosis QST,14754324,LOCAL,88162,CPT,,,,,,Outpatient,,,120,,Viva Med ADV,Viva Med ADV,48.85,,,,,,,Fee Schedule,48.85,58.01,
Tissue C Gross Description QST,14754323,LOCAL,88305,CPT,,,,,,Outpatient,,,120,,Viva Med ADV,Viva Med ADV,48.85,,,,,,,Fee Schedule,48.85,59.06,
Trichomonas Vaginalis RNA QST,14747188,LOCAL,87661,CPT,,,,,,Outpatient,,,120,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
naloxone 1 mg/mL injectable solution 2 mL [CULL],11202975,LOCAL,J2312,CPT,,,,,,Outpatient,2,ML,120.384,,Viva Med ADV,Viva Med ADV,0.07,,,,,,,Fee Schedule,0.065,0.065,
T. candidus QSTC,9010450,LOCAL,86606,CPT,,,,,,Outpatient,,,120.75,18.06,Viva Med ADV,Viva Med ADV,15.05,,,,,,,Fee Schedule,15.05,15.29,
T. vulgaris QSTC,9010456,LOCAL,86609,CPT,,,,,,Outpatient,,,120.75,15.46,Viva Med ADV,Viva Med ADV,12.88,,,,,,,Fee Schedule,12.88,15.29,
Trichoderma viride IgG QSTC,9010474,LOCAL,86001,CPT,,,,,,Outpatient,,,120.75,9.38,Viva Med ADV,Viva Med ADV,7.82,,,,,,,Fee Schedule,7.82,15.29,
L3925 Fo pip dip jnt/sprng pre ots,9856100,LOCAL,,,L3925,HCPCS,,,,Outpatient,,,121.05,79,Viva Med ADV,Viva Med ADV,59.39,,,,,,,Fee Schedule,59.39,59.39,
"Fecal Lipids, Total QSTC",8972795,LOCAL,82710,CPT,,,,,,Outpatient,,,121.19,20.16,Viva Med ADV,Viva Med ADV,16.8,,,,,,,Fee Schedule,16.8,17.73,
Oxcarbazepine Metabolite QSTC,8764758,LOCAL,80183,CPT,,,,,,Outpatient,,,121.5,15.9,Viva Med ADV,Viva Med ADV,13.25,,,,,,,Fee Schedule,13.25,15.38,
Lactated Ringers Injection 1000 mL [CULL],11281275,LOCAL,J7120,CPT,,,,,,Outpatient,1000,ML,121.6,,Viva Med ADV,Viva Med ADV,0.54,,,,,,,Fee Schedule,0.543820225,0.543820225,
97110  SB OT Thera Exer,9850027,LOCAL,97110,CPT,,,,,GO,Outpatient,,,122.28,79,Viva Med ADV,Viva Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110  SB PT Thera Exer,9650027,LOCAL,97110,CPT,,,,,GP|CQ,Outpatient,,,122.28,79,Viva Med ADV,Viva Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 EXERCISE 1/MORE AREAS CHARGE,9410136,LOCAL,97110,CPT,,,,,GP,Outpatient,,,122.28,79,Viva Med ADV,Viva Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 OT Therapeutic Exercise Assistant Units,9860027,LOCAL,97110,CPT,,,,,GO|CO,Outpatient,,,122.28,79,Viva Med ADV,Viva Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 PT THERAPEUTIC EXERCISE,9640054,LOCAL,97110,CPT,,,,,GP,Outpatient,,,122.28,79,Viva Med ADV,Viva Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 PT Therapeutic Exercise Assistant Units,9650054,LOCAL,97110,CPT,,,,,GP|CQ,Outpatient,,,122.28,79,Viva Med ADV,Viva Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 THERAPEUTIC EXER 15 MIN CHARGES,9640027,LOCAL,97110,CPT,,,,,GP,Outpatient,,,122.28,79,Viva Med ADV,Viva Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
OT Therapeutic Exercise Assistant Units,750901,LOCAL,97110,CPT,,,,,CQ,Outpatient,,,122.28,79,Viva Med ADV,Viva Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
OT Therapeutic Exercise Charges,750901,LOCAL,97110,CPT,,,,,GO,Outpatient,,,122.28,79,Viva Med ADV,Viva Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
OT Therapeutic Exercise Rehab Units,7897696,LOCAL,97110,CPT,,,,,GO,Outpatient,,,122.28,79,Viva Med ADV,Viva Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
PT Therapeutic Exercise Assistant Units,9390430,LOCAL,97110,CPT,,,,,CQ,Outpatient,,,122.28,79,Viva Med ADV,Viva Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
Therapeutic Exercise Charges,750901,LOCAL,97110,CPT,,,,,GO,Outpatient,,,122.28,79,Viva Med ADV,Viva Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
Therapeutic Exercise Charges,7895934,LOCAL,97110,CPT,,,,,GP,Outpatient,,,122.28,79,Viva Med ADV,Viva Med ADV,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
Creatine Kinase,633712,LOCAL,82550,CPT,,,,,,Outpatient,,,122.4,7.81,Viva Med ADV,Viva Med ADV,23.74,,,,,,,Fee Schedule,7.16,23.7373913,
Genital Culture,633894,LOCAL,87070,CPT,,,,,,Outpatient,,,122.4,10.34,Viva Med ADV,Viva Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Respiratory Culture,4123062,LOCAL,87070,CPT,,,,,,Outpatient,,,122.4,10.34,Viva Med ADV,Viva Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Sputum Culture,7909553,LOCAL,87070,CPT,,,,,,Outpatient,,,122.4,10.34,Viva Med ADV,Viva Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Blood Culture,4122800,LOCAL,87040,CPT,,,,,,Outpatient,,,123.22,12.38,Viva Med ADV,Viva Med ADV,19.45,,,,,,,Fee Schedule,10.57,19.45393258,
Blood Unit Culture,7967813,LOCAL,87040,CPT,,,,,,Outpatient,,,123.22,12.38,Viva Med ADV,Viva Med ADV,19.45,,,,,,,Fee Schedule,10.57,19.45393258,
Folate Level,1628894,LOCAL,82746,CPT,,,,,,Outpatient,,,123.62,17.64,Viva Med ADV,Viva Med ADV,48.81,,,,,,,Fee Schedule,17.73,48.81056075,
Troponin-I,1634892,LOCAL,84484,CPT,,,,,,Outpatient,,,124.52,14.96,Viva Med ADV,Viva Med ADV,0.89,,,,,,,Fee Schedule,0.887987013,17.73,
influenza vaccine (Flucelvax PF) vaccine 2025-2026 [CULL],11292050,LOCAL,90661,CPT,,,,,,Outpatient,0.5,ML,124.60032,,Viva Med ADV,Viva Med ADV,52.02,,,,,,,Fee Schedule,39.58,52.0225,
methylPREDNISolone 1 g Pow,11201957,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,124.8,,Viva Med ADV,Viva Med ADV,0.21,,,,,,,Fee Schedule,0.21,0.21,
29584 PT APPLICATION OF MULTI-LAYER COMPRESSION SYSTEM,9109668,LOCAL,29584,CPT,,,,,GP,Outpatient,,,125,81,Viva Med ADV,Viva Med ADV,144.26,,,,,,,Fee Schedule,63.51,863,
PT MultiLayer Compress Below Knee Charge,7896004,LOCAL,29584,CPT,,,,,GP,Outpatient,,,125,81,Viva Med ADV,Viva Med ADV,144.26,,,,,,,Fee Schedule,63.51,863,
XR TMJ Open and Closed Left,9514710,LOCAL,70328,CPT,,,,,LT,Outpatient,,,125,66.83,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR TMJ Open and Closed Right,9514712,LOCAL,70328,CPT,,,,,RT,Outpatient,,,125,66.83,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
Liver Kidney Microsomal LKM1 Ab IgG QSTC,8764790,LOCAL,86376,CPT,,,,,,Outpatient,,,125.19,17.46,Viva Med ADV,Viva Med ADV,25.09,,,,,,,Fee Schedule,15.29,25.085,
Medium Cam Walking Boot,9400074,LOCAL,,,L4387,HCPCS,,,,Outpatient,,,125.35,67,Viva Med ADV,Viva Med ADV,195.89,,,,,,,Fee Schedule,195.89,195.89,
PTH-Related Protein (PTH-RP) QSTC,8764743,LOCAL,83519,CPT,,,,,,Outpatient,,,126,22.08,Viva Med ADV,Viva Med ADV,72.02,,,,,,,Fee Schedule,17.73,72.02,
REF DAT IgG,7939268,LOCAL,86880,CPT,,,,,,Outpatient,,,126,6.47,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,6.29,54.31,
Computer Crossmatch Interp -> Computer XM OK,8142426,LOCAL,86923,CPT,,,,,,Outpatient,,,126.02,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
Serological Immediate Spin -> Compatible,8014366,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
Serological Immediate Spin -> Corrected,10125801,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
Serological Immediate Spin -> Incompatible,9527535,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Gel Interp -> Compatible,8013754,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Gel Interp -> Incompatible,8013753,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Gel Interp -> Least Incompatible,8013752,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Tube Interp -> Compatible,8014220,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Tube Interp -> Incompatible,8014219,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Tube Interp -> Least Incompatible,8014218,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
Alanine aminotransferase,633632,LOCAL,84460,CPT,,,,,,Outpatient,,,126.07,6.36,Viva Med ADV,Viva Med ADV,5.3,,,,,,,Fee Schedule,5.3,7.16,
Erythrocyte Sedimentation Rate (ESR),7909828,LOCAL,85652,CPT,,,,,,Outpatient,,,126.07,3.24,Viva Med ADV,Viva Med ADV,43.68,,,,,,,Fee Schedule,8.21,43.67975976,
97112 BAL ACT EA 15 MIN CHARGES,9640028,LOCAL,97112,CPT,,,,,GP,Outpatient,,,127.2,83,Viva Med ADV,Viva Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
97112 NEUROMUSCULAR RE-EDUCATION CHARGE,9410141,LOCAL,97112,CPT,,,,,GP,Outpatient,,,127.2,83,Viva Med ADV,Viva Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
97112 OT NEURO MUSCULAR RE ED EA 15 MIN,9850028,LOCAL,97112,CPT,,,,,GO,Outpatient,,,127.2,83,Viva Med ADV,Viva Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
97112 OT Neuromusc Re-education Assistant Units,9860028,LOCAL,97112,CPT,,,,,GO|CO,Outpatient,,,127.2,83,Viva Med ADV,Viva Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
97112 PT Neuromuscular Re-Ed Assistant Units,9650028,LOCAL,97112,CPT,,,,,GP|CQ,Outpatient,,,127.2,83,Viva Med ADV,Viva Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
Neuromuscular Reeducation Charges,750905,LOCAL,97112,CPT,,,,,GO,Outpatient,,,127.2,83,Viva Med ADV,Viva Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
Neuromuscular Reeducation Charges,7895932,LOCAL,97112,CPT,,,,,GP,Outpatient,,,127.2,83,Viva Med ADV,Viva Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
OT Neuromuscular Reeducation Assistant Units,750905,LOCAL,97112,CPT,,,,,CQ,Outpatient,,,127.2,83,Viva Med ADV,Viva Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
OT Neuromuscular Reeducation Charges,750905,LOCAL,97112,CPT,,,,,GO,Outpatient,,,127.2,83,Viva Med ADV,Viva Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
OT Neuromuscular Reeducation Rehab Units,7897697,LOCAL,97112,CPT,,,,,GO,Outpatient,,,127.2,83,Viva Med ADV,Viva Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
PT Neuromuscular Reeducation Assistant Units,9390444,LOCAL,97112,CPT,,,,,CQ,Outpatient,,,127.2,83,Viva Med ADV,Viva Med ADV,30.63,,,,,,,Fee Schedule,30.63,56.44,
Culture Fungus Smear not Hr Skn Bld QST,10217136,LOCAL,87102,CPT,,,,,,Outpatient,,,127.3,10.09,Viva Med ADV,Viva Med ADV,53.14,,,,,,,Fee Schedule,10.57,53.14428571,
Alcohol Level,1503765,LOCAL,,,G0480,HCPCS,,,,Outpatient,,,129.74,84,Viva Med ADV,Viva Med ADV,114.43,,,,,,,Fee Schedule,46.74,114.43,
CBC w/ Differential,633683,LOCAL,85025,CPT,,,,,,Outpatient,,,129.74,9.32,Viva Med ADV,Viva Med ADV,31.46,,,,,,,Fee Schedule,8.21,31.45666667,
Na Citrate Platelet Count,9472554,LOCAL,85049,CPT,,,,,,Outpatient,,,129.74,5.38,Viva Med ADV,Viva Med ADV,33.54,,,,,,,Fee Schedule,8.21,33.535,
Platelet Count,2182297,LOCAL,85049,CPT,,,,,,Outpatient,,,129.74,5.38,Viva Med ADV,Viva Med ADV,33.54,,,,,,,Fee Schedule,8.21,33.535,
Platelet Count Manual,7974157,LOCAL,85049,CPT,,,,,,Outpatient,,,129.74,5.38,Viva Med ADV,Viva Med ADV,33.54,,,,,,,Fee Schedule,8.21,33.535,
iron dextran 50 mg/mL injectable solution 2 mL [CULL],11205256,LOCAL,J1750,CPT,,,,,,Outpatient,2,ML,129.85728,,Viva Med ADV,Viva Med ADV,18.11,,,,,,,Fee Schedule,18.11,122.4,
70030 X-RAY EYE FOR FOREIGN BODY,8658473,LOCAL,70030,CPT,,,,,,Outpatient,,,130,72.6,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Foreign Body Localization Eye,8658473,LOCAL,70030,CPT,,,,,,Outpatient,,,130,72.6,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
TSI(Thyroid Stimulating Immunoglob) QSTC,8764795,LOCAL,84445,CPT,,,,,,Outpatient,,,130.05,61.03,Viva Med ADV,Viva Med ADV,89.95,,,,,,,Fee Schedule,47.35,89.95,
Glucose Fasting GTT,8238854,LOCAL,82951,CPT,,,,,,Outpatient,,,130.97,15.44,Viva Med ADV,Viva Med ADV,12.87,,,,,,,Fee Schedule,12.87,17.73,
Small Cam Walking Boot,9400073,LOCAL,,,L4387,HCPCS,,,,Outpatient,,,131.56,67,Viva Med ADV,Viva Med ADV,195.89,,,,,,,Fee Schedule,195.89,195.89,
L3908 Comfort cool thumb/wrist CMC orthosis,9800210,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,131.58,86,Viva Med ADV,Viva Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
L3908 OT WRIST HAND ORTHOSIS,9800211,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,131.58,86,Viva Med ADV,Viva Med ADV,67.37,,,,,,,Fee Schedule,67.37,67.37,
Large Cam Walking Boot,9400070,LOCAL,,,L4387,HCPCS,,,,Outpatient,,,131.67,67,Viva Med ADV,Viva Med ADV,195.89,,,,,,,Fee Schedule,195.89,195.89,
97535  SB PT Act of Liv 15 m,9640035,LOCAL,97535,CPT,,,,,GP,Outpatient,,,132.09,86,Viva Med ADV,Viva Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97535 OT HOME MAKING ACTIVITY CHARGE,9820191,LOCAL,97535,CPT,,,,,GO,Outpatient,,,132.09,86,Viva Med ADV,Viva Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97535 OT SELF CARE/HOME MGMT/ADL 15 MIN,9860191,LOCAL,97535,CPT,,,,,GO|CO,Outpatient,,,132.09,86,Viva Med ADV,Viva Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97535 PT ADL Training/Self Care Assistant Units,9650035,LOCAL,97535,CPT,,,,,GP|CQ,Outpatient,,,132.09,86,Viva Med ADV,Viva Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97535 SELF CARE/HOME MGMT-ADL'S CHARGE,9410191,LOCAL,97535,CPT,,,,,GP,Outpatient,,,132.09,86,Viva Med ADV,Viva Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
ADL Training Charge,7895959,LOCAL,97535,CPT,,,,,GP,Outpatient,,,132.09,86,Viva Med ADV,Viva Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
ADL Training Charges,1366372,LOCAL,97535,CPT,,,,,GO,Outpatient,,,132.09,86,Viva Med ADV,Viva Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
OT ADL Training Charges,1366372,LOCAL,97535,CPT,,,,,GO,Outpatient,,,132.09,86,Viva Med ADV,Viva Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
"OT Self Care, Home Management Units",1373569,LOCAL,97535,CPT,,,,,GO,Outpatient,,,132.09,86,Viva Med ADV,Viva Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
"OT Self Care, Home Mgmt Assistant Units",1373569,LOCAL,97535,CPT,,,,,CQ,Outpatient,,,132.09,86,Viva Med ADV,Viva Med ADV,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97530  SB OT Thera Act 15,9850032,LOCAL,97530,CPT,,,,,GO,Outpatient,,,133.15,87,Viva Med ADV,Viva Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
97530 ACTIVITIES EACH 15 MIN CHARGE,9410270,LOCAL,97530,CPT,,,,,GP,Outpatient,,,133.15,87,Viva Med ADV,Viva Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
97530 OT Therapeutic Activities Assistant Units,9860032,LOCAL,97530,CPT,,,,,GO|CO,Outpatient,,,133.15,87,Viva Med ADV,Viva Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
97530 PT MAT\BED ACTIVITIES CHARGE,9640034,LOCAL,97530,CPT,,,,,GP,Outpatient,,,133.15,87,Viva Med ADV,Viva Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
97530 PT Theraputic Activities Assistant Units,9650034,LOCAL,97530,CPT,,,,,GP|CQ,Outpatient,,,133.15,87,Viva Med ADV,Viva Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
OT Therapeutic Activities Assistant Units,750903,LOCAL,97530,CPT,,,,,CQ,Outpatient,,,133.15,87,Viva Med ADV,Viva Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
OT Therapeutic Activities Charges,750903,LOCAL,97530,CPT,,,,,GO,Outpatient,,,133.15,87,Viva Med ADV,Viva Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
OT Therapeutic Activities Rehab Units,7897699,LOCAL,97530,CPT,,,,,GO,Outpatient,,,133.15,87,Viva Med ADV,Viva Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
PT Therapeutic Activity Assistant Units,9390442,LOCAL,97530,CPT,,,,,CQ,Outpatient,,,133.15,87,Viva Med ADV,Viva Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
Therapeutic Activities Charge,7895929,LOCAL,97530,CPT,,,,,GP,Outpatient,,,133.15,87,Viva Med ADV,Viva Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
Therapeutic Activities Charges,750903,LOCAL,97530,CPT,,,,,GO,Outpatient,,,133.15,87,Viva Med ADV,Viva Med ADV,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
amiodarone 150 mg/100 mL-D5% intravenous solution 100 mL [CULL],11200044,LOCAL,J0283,CPT,,,,,,Outpatient,100,ML,133.2106667,,Viva Med ADV,Viva Med ADV,2.53,,,,,,,Fee Schedule,2.529,2.529,
BB CROSSMATCH (AHG),6413027,LOCAL,86922,CPT,,,,,,Outpatient,,,133.82,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
BB CROSSMATCH (XMG INSTRUMENT),6413070,LOCAL,86922,CPT,,,,,,Outpatient,,,133.82,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
Urine Culture,4126493,LOCAL,87086,CPT,,,,,,Outpatient,,,134.64,9.68,Viva Med ADV,Viva Med ADV,31.43,,,,,,,Fee Schedule,10.57,31.43235995,
.dRVVT 1:1 Mix QSTC,6230328,LOCAL,85613,CPT,,,,,,Outpatient,,,135,11.5,Viva Med ADV,Viva Med ADV,9.58,,,,,,,Fee Schedule,5.42,9.58,
Glomerular Basement Memb. Ab (IgG) QSTC,8853257,LOCAL,83520,CPT,,,,,,Outpatient,,,135,20.72,Viva Med ADV,Viva Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Glutamic Acid Decarboxylase-65 Ab QSTC,8764746,LOCAL,86341,CPT,,,,,,Outpatient,,,135,28.28,Viva Med ADV,Viva Med ADV,23.57,,,,,,,Fee Schedule,15.29,23.57,
Quad Screen QSTC,8972927,LOCAL,81511,CPT,,,,,,Outpatient,,,135,184.2,Viva Med ADV,Viva Med ADV,153.5,,,,,,,Fee Schedule,153.5,173.68,
Ribosomal P Antibody QSTC,8853260,LOCAL,83516,CPT,,,,,,Outpatient,,,135,13.84,Viva Med ADV,Viva Med ADV,11.53,,,,,,,Fee Schedule,11.53,17.73,
"Rickettsia RMSF IgG,IgM w rfx Titer QSTC",8764764,LOCAL,86757,CPT,,,,,,Outpatient,,,135,23.22,Viva Med ADV,Viva Med ADV,19.35,,,,,,,Fee Schedule,15.29,19.35,
Tryptase QSTC,8764744,LOCAL,83520,CPT,,,,,,Outpatient,,,135,20.72,Viva Med ADV,Viva Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
96523 Port Flush,14892040,LOCAL,96523,CPT,,,,,59,Outpatient,,,136,153,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,54.31,64.56,
OLANZapine 10 mg VL [CULL],11240752,LOCAL,J2358,CPT,,,,,,Outpatient,1,EA,136.096,,Viva Med ADV,Viva Med ADV,2.92,,,,,,,Fee Schedule,2.92,2.92,
.Endomysial Ab Titer QSTC,8853243,LOCAL,86231,CPT,,,,,,Outpatient,,,136.17,14.51,Viva Med ADV,Viva Med ADV,106.94,,,,,,,Fee Schedule,15.29,106.935,
Endomysial (IgG) Antibody Screen and Titer QSTC,10146198,LOCAL,86231,CPT,,,,,,Outpatient,,,136.17,14.51,Viva Med ADV,Viva Med ADV,106.94,,,,,,,Fee Schedule,15.29,106.935,
L3808 OT SPLINT - DORSAL HAND SPLINT CHARGE,9856068,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,137.3,89,Viva Med ADV,Viva Med ADV,375.59,,,,,,,Fee Schedule,375.59,375.59,
"L3808 WHFO, RIGID W/O JOINTS CHARGE",9856097,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,137.3,89,Viva Med ADV,Viva Med ADV,375.59,,,,,,,Fee Schedule,375.59,375.59,
"96361- Hydration, each additional hour",1928298,LOCAL,96361,CPT,,,,,,Outpatient,,,137.66,89,Viva Med ADV,Viva Med ADV,42.18,,,,,,,Fee Schedule,42.18,749.76,
96361 IV INFUSION HYDRATION ADDL HR Charge,8049102,LOCAL,96361,CPT,,,,,,Outpatient,,,137.66,89,Viva Med ADV,Viva Med ADV,42.18,,,,,,,Fee Schedule,42.18,749.76,
90472 PO IMMUNIZATION ADM EA ADDTL VAC CHARGE,9279753,LOCAL,90472,CPT,,,,,,Outpatient,,,137.77,90,Viva Med ADV,Viva Med ADV,14.55,,,,,,,Fee Schedule,14.55,56.18,
Phenytoin Lvl Total,7973985,LOCAL,80185,CPT,,,,,,Outpatient,,,138,15.9,Viva Med ADV,Viva Med ADV,75.5,,,,,,,Fee Schedule,15.38,75.495,
aztreonam 1 g injection [CULL],11201222,LOCAL,J0457,CPT,,,,,,Outpatient,1,EA,138.5472,,Viva Med ADV,Viva Med ADV,2.23,,,,,,,Fee Schedule,2.233,2.233,
"Allergy Panel 19, Seafood QSTC",13864480,LOCAL,86003,CPT,,,,,,Outpatient,,,138.78,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Crystal Examination Body Fluid,3454316,LOCAL,89060,CPT,,,,,,Outpatient,,,139,8.8,Viva Med ADV,Viva Med ADV,21.53,,,,,,,Fee Schedule,14.07,21.53,
Bill Cyto Path Cell Enhance Tech,8489561,LOCAL,88112,CPT,,,,,,Outpatient,,,139.94,,Viva Med ADV,Viva Med ADV,48.85,,,,,,,Fee Schedule,42.2,48.85,
Bill FNA Eval Interp & Rpt,8489566,LOCAL,88173,CPT,,,,,,Outpatient,,,139.94,,Viva Med ADV,Viva Med ADV,48.85,,,,,,,Fee Schedule,48.85,53.82,
Bill IHC Antibody Additional,14048006,LOCAL,88341,CPT,,,,,,Outpatient,,,139.94,,Viva Med ADV,Viva Med ADV,59.04,,,,,,,Fee Schedule,59.04,59.06,
Bill Tissue Exam Level 3,14047998,LOCAL,88304,CPT,,,,,,Outpatient,,,139.94,,Viva Med ADV,Viva Med ADV,48.85,,,,,,,Fee Schedule,32.32,48.85,
Bill Tissue Exam Level 4,14036169,LOCAL,88305,CPT,,,,,,Outpatient,,,139.94,,Viva Med ADV,Viva Med ADV,48.85,,,,,,,Fee Schedule,48.85,59.06,
70250 X-RAY EXAM OF SKULL,8658523,LOCAL,70250,CPT,,,,,,Outpatient,,,140,286.28,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
hepatitis A pediatric vaccine 25 units/0.5 mL intramuscular suspension 0.5 mL [CULL],11202555,LOCAL,90632,CPT,,,,,,Outpatient,0.5,ML,140.288,,Viva Med ADV,Viva Med ADV,73.54,,,,,,,Fee Schedule,39.58,73.542,
medroxyPROGESTERone 150 mg/mL intramuscular suspension 1 mL [CULL],11204480,LOCAL,J1050,CPT,,,,,,Outpatient,1,ML,140.704,,Viva Med ADV,Viva Med ADV,50.14,,,,,,,Fee Schedule,50.14,50.14,
"West Nile Ab IgG, CSF QSTC",13872975,LOCAL,86789,CPT,,,,,,Outpatient,,,141.3,17.27,Viva Med ADV,Viva Med ADV,14.39,,,,,,,Fee Schedule,14.39,15.29,
"West Nile Ab IgG, Serum QSTC",9010233,LOCAL,86789,CPT,,,,,,Outpatient,,,141.3,17.27,Viva Med ADV,Viva Med ADV,14.39,,,,,,,Fee Schedule,14.39,15.29,
"West Nile Ab IgM, CSF QSTC",13872978,LOCAL,86788,CPT,,,,,,Outpatient,,,141.3,20.22,Viva Med ADV,Viva Med ADV,16.85,,,,,,,Fee Schedule,15.29,16.85,
"West Nile Ab IgM, Serum QSTC",9010236,LOCAL,86788,CPT,,,,,,Outpatient,,,141.3,20.22,Viva Med ADV,Viva Med ADV,16.85,,,,,,,Fee Schedule,15.29,16.85,
"Chlamydia Trachomatis RNA, TMA QST",14718353,LOCAL,87491,CPT,,,,,,Outpatient,,,142,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
HPV MRNA E6/E7 QSTA,14718356,LOCAL,87624,CPT,,,,,,Outpatient,,,142,42.11,Viva Med ADV,Viva Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
Thinprep Review Cytotechnologist: QST,14718368,LOCAL,88175,CPT,,,,,,Outpatient,,,142,31.93,Viva Med ADV,Viva Med ADV,26.61,,,,,,,Fee Schedule,25.25,26.61,
"Trichomonas vaginalis, Ql TMA, Pap QST",14718355,LOCAL,87661,CPT,,,,,,Outpatient,,,142,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Cardio IQ(R) Lipoprotein Fraction, Ion Mobility QSTC",9039426,LOCAL,83704,CPT,,,,,,Outpatient,,,142.38,41.03,Viva Med ADV,Viva Med ADV,34.19,,,,,,,Fee Schedule,34.19,46.74,
Parathyroid Hormone Intact,3455483,LOCAL,83970,CPT,,,,,,Outpatient,,,143,49.54,Viva Med ADV,Viva Med ADV,92.84,,,,,,,Fee Schedule,47.35,92.84111111,
"Factor VIII Activity, Clotting QSTC",9039263,LOCAL,85240,CPT,,,,,,Outpatient,,,144,21.48,Viva Med ADV,Viva Med ADV,17.9,,,,,,,Fee Schedule,5.42,17.9,
"Sirolimus, LC/MS/MS QSTC",8764819,LOCAL,80195,CPT,,,,,,Outpatient,,,144,16.48,Viva Med ADV,Viva Med ADV,13.73,,,,,,,Fee Schedule,13.73,15.38,
97760 ORTHOTICS FIT/TRAIN EA 15MN CHARGE,9410176,LOCAL,97760,CPT,,,,,GP,Outpatient,,,144.44,94,Viva Med ADV,Viva Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
97760 ORTHOTICS FITTING & TRAINING CHARGE,9850030,LOCAL,97760,CPT,,,,,GO,Outpatient,,,144.44,94,Viva Med ADV,Viva Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
97760 OT Orthotic Mgmt/Train Initial Charge Assistant Units,9860030,LOCAL,97760,CPT,,,,,GO|CO,Outpatient,,,144.44,94,Viva Med ADV,Viva Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
97760 PO ORTHOTIC EVALUATION CHARGE,9640032,LOCAL,97760,CPT,,,,,GP,Outpatient,,,144.44,94,Viva Med ADV,Viva Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
97760 PO ORTHOTIC FOLLOW UP CHARGE,9650032,LOCAL,97760,CPT,,,,,GP|CQ,Outpatient,,,144.44,94,Viva Med ADV,Viva Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
Orthotic Mgmt and Training Charges,7895275,LOCAL,97760,CPT,,,,,GO,Outpatient,,,144.44,94,Viva Med ADV,Viva Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
Orthotic Mgmt and Training Charges,7895953,LOCAL,97760,CPT,,,,,GP,Outpatient,,,144.44,94,Viva Med ADV,Viva Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
"OT Orthotic Management, Train Assistant Units",1373573,LOCAL,97760,CPT,,,,,CQ,Outpatient,,,144.44,94,Viva Med ADV,Viva Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
"OT Orthotic Management, Train Units",1373573,LOCAL,97760,CPT,,,,,GO,Outpatient,,,144.44,94,Viva Med ADV,Viva Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
"PT Orthotic Management, Train Assistant Units",9390458,LOCAL,97760,CPT,,,,,CQ,Outpatient,,,144.44,94,Viva Med ADV,Viva Med ADV,42.32,,,,,,,Fee Schedule,42.32,56.44,
Urinary Catheter Type:; -> Straight/Intermittent,4610954,LOCAL,51701,CPT,,,,,,Outpatient,,,144.74,94,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,105.27,863,
EVENT MONITOR RECORDING ONLY,8200120,LOCAL,93270,CPT,,,,,,Outpatient,,,145.04,94,Viva Med ADV,Viva Med ADV,34.09,,,,,,,Fee Schedule,34.09,99.86,
desmopressin 4 mcg/mL injectable solution 1 mL [CULL],11201582,LOCAL,J2597,CPT,,,,,,Outpatient,1,ML,145.92,,Viva Med ADV,Viva Med ADV,3.52,,,,,,,Fee Schedule,3.52,233.26,
% CD3 (Mature T Cells) QSTC,13873423,LOCAL,86359,CPT,,,,,,Outpatient,,,146.25,45.28,Viva Med ADV,Viva Med ADV,37.73,,,,,,,Fee Schedule,15.29,37.73,
CD4/CD8 Ratio QSTC,13873439,LOCAL,86360,CPT,,,,,,Outpatient,,,146.25,56.38,Viva Med ADV,Viva Med ADV,46.98,,,,,,,Fee Schedule,44.29,46.98,
Beta hCG Qualitative,633663,LOCAL,84703,CPT,,,,,,Outpatient,,,146.88,9.02,Viva Med ADV,Viva Med ADV,7.52,,,,,,,Fee Schedule,7.16,7.52,
Serum Pregnancy Qual POCT,10461706,LOCAL,84703,CPT,,,,,,Outpatient,,,146.88,9.02,Viva Med ADV,Viva Med ADV,7.52,,,,,,,Fee Schedule,7.16,7.52,
Serum Pregnancy Test Qualitative,7909775,LOCAL,84703,CPT,,,,,,Outpatient,,,146.88,9.02,Viva Med ADV,Viva Med ADV,7.52,,,,,,,Fee Schedule,7.16,7.52,
Serum Pregnancy Test Qualitative w/ Reflex,9384303,LOCAL,84703,CPT,,,,,,Outpatient,,,146.88,9.02,Viva Med ADV,Viva Med ADV,7.52,,,,,,,Fee Schedule,7.16,7.52,
Urine Pregnancy POCT,8373784,LOCAL,81025,CPT,,,,,,Outpatient,,,146.88,10.33,Viva Med ADV,Viva Med ADV,13.38,,,,,,,Fee Schedule,4.02,13.375,
Urine Pregnancy Test Qualitative,7909798,LOCAL,81025,CPT,,,,,,Outpatient,,,146.88,10.33,Viva Med ADV,Viva Med ADV,13.38,,,,,,,Fee Schedule,4.02,13.375,
cefTRIAXone 1 g injection [CULL],11201426,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,147.0368,,Viva Med ADV,Viva Med ADV,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
"IgA, Serum QSTC",13873298,LOCAL,82787,CPT,,,,,,Outpatient,,,147.38,9.62,Viva Med ADV,Viva Med ADV,8.02,,,,,,,Fee Schedule,7.16,8.02,
IgA1 QSTC,13873292,LOCAL,82784,CPT,,,,,,Outpatient,,,147.38,11.16,Viva Med ADV,Viva Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
Tobramycin Level,1634888,LOCAL,80200,CPT,,,,,,Outpatient,,,148.1,19.36,Viva Med ADV,Viva Med ADV,16.13,,,,,,,Fee Schedule,15.38,16.13,
Blood Gas Arterial RT,8172944,LOCAL,36600,CPT,,,,,,Outpatient,,,148.2,96,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,85.79,863,
Blood Gas Draw Type -> Arterial (Puncture),5230102,LOCAL,36600,CPT,,,,,,Outpatient,,,148.2,96,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,85.79,863,
RT Arterial Puncture CHARGE,8143881,LOCAL,36600,CPT,,,,,,Outpatient,,,148.2,96,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,85.79,863,
"RT CHARGE PFT -> Maximum breathing capacity, Maximal voluntary ventilation (M",5267133,LOCAL,94200,CPT,,,,,,Outpatient,,,148.2,96,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,54.31,76.09,
XR TMJ Open and Closed Bilateral,1170502,LOCAL,70330,CPT,,,,,,Outpatient,,,150,80.85,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
Diphtheria Antitoxoid QSTC,14129477,LOCAL,86648,CPT,,,,,,Outpatient,,,151,18.25,Viva Med ADV,Viva Med ADV,15.21,,,,,,,Fee Schedule,15.21,15.29,
Tetanus Antitoxoid QSTC,14129478,LOCAL,86774,CPT,,,,,,Outpatient,,,151,17.76,Viva Med ADV,Viva Med ADV,14.8,,,,,,,Fee Schedule,14.8,15.29,
Hepatic Function Panel,633744,LOCAL,80076,CPT,,,,,,Outpatient,,,151.78,9.8,Viva Med ADV,Viva Med ADV,58.59,,,,,,,Fee Schedule,12.14,58.58814815,
Hepatic Panel,633744,LOCAL,80076,CPT,,,,,,Outpatient,,,151.78,9.8,Viva Med ADV,Viva Med ADV,58.59,,,,,,,Fee Schedule,12.14,58.58814815,
Dihydrotestosterone QSTC,8853275,LOCAL,82642,CPT,,,,,,Outpatient,,,151.88,35.14,Viva Med ADV,Viva Med ADV,29.28,,,,,,,Fee Schedule,18.43,29.28,
36430 BLOOD TRANSFUSION CHARGE,9284603,LOCAL,36430,CPT,,,,,,Outpatient,,,151.98,99,Viva Med ADV,Viva Med ADV,399.7,,,,,,,Fee Schedule,399.7,863,
BLOOD ADMINISTRATION Charge,5240125,LOCAL,36430,CPT,,,,,,Outpatient,,,151.98,99,Viva Med ADV,Viva Med ADV,399.7,,,,,,,Fee Schedule,399.7,863,
92608 ST EX FOR SPEECH DEVICE RX EACH 30 MIN ADDL TIM,9636007,LOCAL,92608,CPT,,,,,GN,Outpatient,,,152.72,99,Viva Med ADV,Viva Med ADV,44.72,,,,,,,Fee Schedule,44.72,337.75,
SLP Speech AAC Eval Addl Half Hour Units,1373854,LOCAL,92608,CPT,,,,,GN,Outpatient,,,152.72,99,Viva Med ADV,Viva Med ADV,44.72,,,,,,,Fee Schedule,44.72,337.75,
Speech Generating Device Eval Additional 30 Min,1373854,LOCAL,92608,CPT,,,,,GN,Outpatient,,,152.72,99,Viva Med ADV,Viva Med ADV,44.72,,,,,,,Fee Schedule,44.72,337.75,
Bill Only REF Splitting,13514968,LOCAL,86985,CPT,,,,,,Outpatient,,,153,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.88,156.67,
"Quantiferon(R)-TB Gold Plus, 1 Tube QST",9384402,LOCAL,86480,CPT,,,,,,Outpatient,,,153,74.38,Viva Med ADV,Viva Med ADV,65.24,,,,,,,Fee Schedule,44.29,65.24390244,
"Quantiferon(R)-TB Gold Plus, 1 Tube QSTC",8983765,LOCAL,86480,CPT,,,,,,Outpatient,,,153,74.38,Viva Med ADV,Viva Med ADV,65.24,,,,,,,Fee Schedule,44.29,65.24390244,
97113 AQUATIC THERAPY 15 MINS,9650029,LOCAL,97113,CPT,,,,,GP|CQ,Outpatient,,,153.55,100,Viva Med ADV,Viva Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
97113 AQUATIC THERAPY 15 MINS OT,9860051,LOCAL,97113,CPT,,,,,GO|CO,Outpatient,,,153.55,100,Viva Med ADV,Viva Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
97113 Occupational Therapy Aquatic charge,9850051,LOCAL,97113,CPT,,,,,GO,Outpatient,,,153.55,100,Viva Med ADV,Viva Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
97113 OT AQUATIC THERAPY CHARGE,9640029,LOCAL,97113,CPT,,,,,GP,Outpatient,,,153.55,100,Viva Med ADV,Viva Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
Aquatic Charge,7895272,LOCAL,97113,CPT,,,,,GO,Outpatient,,,153.55,100,Viva Med ADV,Viva Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
Aquatic Therapy Charges,7895958,LOCAL,97113,CPT,,,,,GP,Outpatient,,,153.55,100,Viva Med ADV,Viva Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
OT Aquatic Exercise Assistant Units,7895272,LOCAL,97113,CPT,,,,,CQ,Outpatient,,,153.55,100,Viva Med ADV,Viva Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
OT Aquatic Exercise Assistant Units,7898597,LOCAL,97113,CPT,,,,,CQ,Outpatient,,,153.55,100,Viva Med ADV,Viva Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
OT Aquatic Exercise Units,7897709,LOCAL,97113,CPT,,,,,GO,Outpatient,,,153.55,100,Viva Med ADV,Viva Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
OT Aquatic Exercise Units,7898597,LOCAL,97113,CPT,,,,,GO,Outpatient,,,153.55,100,Viva Med ADV,Viva Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
PT Aquatic Assistant Units,9390434,LOCAL,97113,CPT,,,,,CQ,Outpatient,,,153.55,100,Viva Med ADV,Viva Med ADV,34.34,,,,,,,Fee Schedule,34.34,56.44,
G0237 PULM REHAB EA 15 MIN,10470027,LOCAL,,,G0237,HCPCS,,,59,Outpatient,,,154.78,101,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,22.39,51.98,
G0239 PULMONARY EXERCISE,10470025,LOCAL,,,G0239,HCPCS,,,,Outpatient,,,154.78,101,Viva Med ADV,Viva Med ADV,35.88,,,,,,,Fee Schedule,35.88,51.98,
Calcium Oxalate QSTC,8997193,LOCAL,82340,CPT,,,,,,Outpatient,,,155,7.24,Viva Med ADV,Viva Med ADV,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
Sodium Urate QSTC,8997195,LOCAL,84300,CPT,,,,,,Outpatient,,,155,6.07,Viva Med ADV,Viva Med ADV,9.74,,,,,,,Fee Schedule,7.16,9.74,
Uric Acid QSTC,8997197,LOCAL,84560,CPT,,,,,,Outpatient,,,155,6.1,Viva Med ADV,Viva Med ADV,19.49,,,,,,,Fee Schedule,7.16,19.49,
"LD, Pericardial Fluid QSTC",13864442,LOCAL,83615,CPT,,,,,,Outpatient,,,155.39,7.25,Viva Med ADV,Viva Med ADV,21.68,,,,,,,Fee Schedule,7.16,21.675,
"16000 Initial treatment, first degree burn, when no more than local treatment required",9400038,LOCAL,16000,CPT,,,,,,Outpatient,,,155.91,101,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
Diphtheria Antitoxoid QST,13824476,LOCAL,86648,CPT,,,,,,Outpatient,,,156,18.25,Viva Med ADV,Viva Med ADV,15.21,,,,,,,Fee Schedule,15.21,15.29,
Tetanus Antitoxoid QST,13824477,LOCAL,86774,CPT,,,,,,Outpatient,,,156,17.76,Viva Med ADV,Viva Med ADV,14.8,,,,,,,Fee Schedule,14.8,15.29,
Transferrin,633851,LOCAL,84466,CPT,,,,,,Outpatient,,,156.67,15.31,Viva Med ADV,Viva Med ADV,29.64,,,,,,,Fee Schedule,17.73,29.64248366,
CANDIDA GLABRATA QST,12439000,LOCAL,87481,CPT,,,,,,Outpatient,,,157,42.11,Viva Med ADV,Viva Med ADV,478.17,,,,,,,Fee Schedule,40.19,478.165,
CANDIDA SPECIES QST,12438999,LOCAL,87481,CPT,,,,,,Outpatient,,,157,42.11,Viva Med ADV,Viva Med ADV,478.17,,,,,,,Fee Schedule,40.19,478.165,
"Chlamydia Trachomatis RNA, TMA QST",12439002,LOCAL,87591,CPT,,,,,,Outpatient,,,157,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",12439003,LOCAL,87491,CPT,,,,,,Outpatient,,,157,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
SURESWAB(R) ADV BV QST,12438998,LOCAL,81513,CPT,,,,,,Outpatient,,,157,171.16,Viva Med ADV,Viva Med ADV,142.63,,,,,,,Fee Schedule,63.34,142.63,
"TRICHOMONAS VAGINALIS (TV), TMA QST",12439001,LOCAL,87661,CPT,,,,,,Outpatient,,,157,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
CANDIDA GLABRATA QST,12433969,LOCAL,87481,CPT,,,,,,Outpatient,,,157.5,42.11,Viva Med ADV,Viva Med ADV,478.17,,,,,,,Fee Schedule,40.19,478.165,
CANDIDA SPECIES QST,12433968,LOCAL,87481,CPT,,,,,,Outpatient,,,157.5,42.11,Viva Med ADV,Viva Med ADV,478.17,,,,,,,Fee Schedule,40.19,478.165,
"CRYPTOSPORIDIUM ANTIGEN, EIA QSTC",12500635,LOCAL,87328,CPT,,,,,,Outpatient,,,157.5,16.58,Viva Med ADV,Viva Med ADV,13.82,,,,,,,Fee Schedule,10.57,13.82,
"Kappa/LambdaLt Chains,Freew/Ratio,S QSTC",8853285,LOCAL,83521,CPT,,,,,,Outpatient,,,157.5,20.72,Viva Med ADV,Viva Med ADV,87.22,,,,,,,Fee Schedule,17.73,87.215,
XR Bone Age Studies,1170014,LOCAL,77072,CPT,,,,,,Outpatient,,,157.72,84.98,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
BB REF ABO DISCREP (RH),6432002,LOCAL,86901,CPT,,,,,,Outpatient,,,159.75,3.59,Viva Med ADV,Viva Med ADV,35.88,,,,,,,Fee Schedule,6.29,35.88,
REF ABO/Rh Discrep,13484121,LOCAL,86900,CPT,,,,,,Outpatient,,,159.75,3.59,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,6.29,117.85,
"Ammonia, Plasma",7974187,LOCAL,82140,CPT,,,,,,Outpatient,,,160.34,17.48,Viva Med ADV,Viva Med ADV,22.63,,,,,,,Fee Schedule,17.73,22.62909091,
97164 CIS Prgm PT Re-Evaluation 20 min,9650016,LOCAL,97164,CPT,,,,,GP|CQ,Outpatient,,,160.46,104,Viva Med ADV,Viva Med ADV,62.94,,,,,,,Fee Schedule,62.94,349.89,
97164 RE-EVALUATION CHARGE,9410061,LOCAL,97164,CPT,,,,,GP,Outpatient,,,160.46,104,Viva Med ADV,Viva Med ADV,62.94,,,,,,,Fee Schedule,62.94,349.89,
97164 RE-EVALUATION PT CHARGES,9640016,LOCAL,97164,CPT,,,,,GP,Outpatient,,,160.46,104,Viva Med ADV,Viva Med ADV,62.94,,,,,,,Fee Schedule,62.94,349.89,
PT ReEval Time,7896016,LOCAL,97164,CPT,,,,,GP,Outpatient,,,160.46,104,Viva Med ADV,Viva Med ADV,62.94,,,,,,,Fee Schedule,62.94,349.89,
Tobramycin Level Peak,1634889,LOCAL,80200,CPT,,,,,,Outpatient,,,163.2,19.36,Viva Med ADV,Viva Med ADV,16.13,,,,,,,Fee Schedule,15.38,16.13,
Tobramycin Level Trough,1634890,LOCAL,80200,CPT,,,,,,Outpatient,,,163.2,19.36,Viva Med ADV,Viva Med ADV,16.13,,,,,,,Fee Schedule,15.38,16.13,
11719 TRIM NAIL(S) ANY NUMBER WC CHARGE,8726774,LOCAL,11719,CPT,,,,,,Outpatient,,,163.39,106,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,54.31,863,
.C-ANCA Titer QSTC,8764786,LOCAL,86037,CPT,,,,,,Outpatient,,,163.67,14.46,Viva Med ADV,Viva Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
.P-ANCA Titer QSTC,6225794,LOCAL,86037,CPT,,,,,,Outpatient,,,163.67,14.46,Viva Med ADV,Viva Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
"Methicillin Resistant Staphylococcus aureus,PCR QSTC",9630594,LOCAL,87641,CPT,,,,,,Outpatient,,,164.16,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
phytonadione 10 mg/mL injectable solution 1 mL [CULL],11212150,LOCAL,J3430,CPT,,,,,,Outpatient,1,ML,164.224,,Viva Med ADV,Viva Med ADV,2.81,,,,,,,Fee Schedule,2.808,2.808,
Bill Manual Tumor IM Histochem,14049347,LOCAL,88360,CPT,,,,,,Outpatient,,,164.92,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,59.06,156.67,
Bill SB Consult 1st TB w FS SGL SP,14048002,LOCAL,88331,CPT,,,,,,Outpatient,,,164.92,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,53.82,156.67,
Bill IHC Initial Antibody,14049345,LOCAL,88342,CPT,,,,,,Outpatient,,,164.98,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,59.06,156.67,
29105 - Long Arm Splint,9322359,LOCAL,29105,CPT,,,,,,Outpatient,,,165,158,Viva Med ADV,Viva Med ADV,144.26,,,,,,,Fee Schedule,63.51,863,
Toxocara Ab (IgG) QSTC,13864452,LOCAL,86682,CPT,,,,,,Outpatient,,,165.38,15.61,Viva Med ADV,Viva Med ADV,13.01,,,,,,,Fee Schedule,13.01,15.29,
Tissue Culture,633906,LOCAL,87070,CPT,,,,,,Outpatient,,,166.46,10.34,Viva Med ADV,Viva Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
acetaZOLAMIDE 500 mg intravenous injection [CULL],11200001,LOCAL,J1120,CPT,,,,,,Outpatient,1,EA,168.8,,Viva Med ADV,Viva Med ADV,25.59,,,,,,,Fee Schedule,25.594,25.594,
97763 OT Orthotic Mgmt/Train Establish Charge,9650038,LOCAL,97763,CPT,,,,,GP|CQ,Outpatient,,,168.9,110,Viva Med ADV,Viva Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
97763 OT Orthotic Mgmt/Train Established Assistant Units,9820206,LOCAL,97763,CPT,,,,,GO,Outpatient,,,168.9,110,Viva Med ADV,Viva Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
97763 OT Orthotic/Prosthetic Mgmt/Training - each 15 min,9860206,LOCAL,97763,CPT,,,,,GO|CO,Outpatient,,,168.9,110,Viva Med ADV,Viva Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
97763 PT ORTHO/PROST MNG/TRAIN EA 15,9410206,LOCAL,97763,CPT,,,,,GP,Outpatient,,,168.9,110,Viva Med ADV,Viva Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
97763 PT Orthotic Mgmt/Train Establish Charge,9640038,LOCAL,97763,CPT,,,,,GP,Outpatient,,,168.9,110,Viva Med ADV,Viva Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
OT Orthotic Mgmt/Train Est. Assit Units,7965332,LOCAL,97763,CPT,,,,,CQ,Outpatient,,,168.9,110,Viva Med ADV,Viva Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
OT Orthotic Mgmt/Train Establish Charge,7965332,LOCAL,97763,CPT,,,,,GO,Outpatient,,,168.9,110,Viva Med ADV,Viva Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
OT Orthotic Mgmt/Train Establish Rehab Units,7964942,LOCAL,97763,CPT,,,,,GO,Outpatient,,,168.9,110,Viva Med ADV,Viva Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
PT Orthotic Mgmt/Train Establish Charge,7965252,LOCAL,97763,CPT,,,,,GP,Outpatient,,,168.9,110,Viva Med ADV,Viva Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
"PT Orthotic/Prosthetic Manage,Train Assistant Units",9390462,LOCAL,97763,CPT,,,,,CQ,Outpatient,,,168.9,110,Viva Med ADV,Viva Med ADV,45.74,,,,,,,Fee Schedule,45.74,56.44,
Total Glutathione QST,14799054,LOCAL,82978,CPT,,,,,,Outpatient,,,169,18.54,Viva Med ADV,Viva Med ADV,15.45,,,,,,,Fee Schedule,15.45,17.73,
epoetin alfa-epbx 4000 units/mL preservative-free injectable solution 1 mL [CULL],11202396,LOCAL,Q5106,CPT,,,,,,Outpatient,1,ML,169.4208,,Viva Med ADV,Viva Med ADV,7.85,,,,,,,Fee Schedule,7.85,525.49,
CT Heart Calcium Scoring,2424782,LOCAL,75571,CPT,,,,,,Outpatient,,,170,90.75,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,170.53,
"Cortisol, LC/MS, Saliva QSTC",8853249,LOCAL,82530,CPT,,,,,,Outpatient,,,171,20.05,Viva Med ADV,Viva Med ADV,29.79,,,,,,,Fee Schedule,17.73,29.79,
Factor V (Leiden) Mutation Analysis QSTC,8764652,LOCAL,81241,CPT,,,,,,Outpatient,,,171,88.04,Viva Med ADV,Viva Med ADV,73.37,,,,,,,Fee Schedule,63.34,73.37,
"Lyme Disease Ab (IgM), Blot QSTC",8849718,LOCAL,86617,CPT,,,,,,Outpatient,,,171,18.59,Viva Med ADV,Viva Med ADV,15.49,,,,,,,Fee Schedule,15.29,15.49,
"Lyme Disease Ab(IgG),Blot QSTC",8849707,LOCAL,86617,CPT,,,,,,Outpatient,,,171,18.59,Viva Med ADV,Viva Med ADV,15.49,,,,,,,Fee Schedule,15.29,15.49,
Prothrombin Gene Analysis QSTC,8764653,LOCAL,81240,CPT,,,,,,Outpatient,,,171,78.83,Viva Med ADV,Viva Med ADV,65.69,,,,,,,Fee Schedule,63.34,65.69,
Cholesterol HDL,3170344,LOCAL,83718,CPT,,,,,,Outpatient,,,172,9.83,Viva Med ADV,Viva Med ADV,8.19,,,,,,,Fee Schedule,7.16,8.19,
Glucagon QSTC,13864528,LOCAL,82943,CPT,,,,,,Outpatient,,,173.7,17.15,Viva Med ADV,Viva Med ADV,14.29,,,,,,,Fee Schedule,14.29,18.43,
fondaparinux 2.5 mg/0.5 mL subcutaneous solution 0.5 mL [CULL],11260583,LOCAL,J1652,CPT,,,,,,Outpatient,0.5,ML,174.8864,,Viva Med ADV,Viva Med ADV,0.88,,,,,,,Fee Schedule,0.877,0.877,
CULL MG Wire Loc Needle,13721990,LOCAL,10035,CPT,A4648,HCPCS,,,,Outpatient,,,174.99,114,Viva Med ADV,Viva Med ADV,643.26,,,,,,,Fee Schedule,643.26,1291,
90912 - Bfb training 1st 15 min.,9442435,LOCAL,90912,CPT,,,,,,Outpatient,,,175,114,Viva Med ADV,Viva Med ADV,35.97,,,,,,,Fee Schedule,35.97,233.61,
97129 Cognition Ther Intervent First 15 min,9850048,LOCAL,97129,CPT,,,,,GO,Outpatient,,,175,114,Viva Med ADV,Viva Med ADV,18.94,,,,,,,Fee Schedule,18.94,56.44,
97129 Cognition Ther Intervent First 15 min Assistant Units,9860048,LOCAL,97129,CPT,,,,,GO|CO,Outpatient,,,175,114,Viva Med ADV,Viva Med ADV,18.94,,,,,,,Fee Schedule,18.94,56.44,
97130 Cognition Ther Intervent Addlt 15 min,9850049,LOCAL,97130,CPT,,,,,GO,Outpatient,,,175,114,Viva Med ADV,Viva Med ADV,18.08,,,,,,,Fee Schedule,18.08,56.44,
97130 Cognition Ther Intervent Addlt 15 min Assistant Units,9860049,LOCAL,97130,CPT,,,,,GO|CO,Outpatient,,,175,114,Viva Med ADV,Viva Med ADV,18.08,,,,,,,Fee Schedule,18.08,56.44,
"OT Cog Ther Intervent, Addl 15 Min Asst",9401146,LOCAL,97130,CPT,,,,,CQ,Outpatient,,,175,114,Viva Med ADV,Viva Med ADV,18.08,,,,,,,Fee Schedule,18.08,56.44,
"OT Cog Ther Intervent, Addl 15 Min Units",9401146,LOCAL,97130,CPT,,,,,GO,Outpatient,,,175,114,Viva Med ADV,Viva Med ADV,18.08,,,,,,,Fee Schedule,18.08,56.44,
"OT Cog Ther Intervent, First 15 Min Asst",9401140,LOCAL,97129,CPT,,,,,CQ,Outpatient,,,175,114,Viva Med ADV,Viva Med ADV,18.94,,,,,,,Fee Schedule,18.94,56.44,
"OT Cog Ther Intervent,First 15 Min Units",9401140,LOCAL,97129,CPT,,,,,GO,Outpatient,,,175,114,Viva Med ADV,Viva Med ADV,18.94,,,,,,,Fee Schedule,18.94,56.44,
Bill Only Pheno Non-Rh EA/Ag,13517193,LOCAL,86905,CPT,,,,,,Outpatient,,,175.5,4.6,Viva Med ADV,Viva Med ADV,328.88,,,,,,,Fee Schedule,6.29,328.88,
Bill Only REF Thawing,13514966,LOCAL,86927,CPT,,,,,,Outpatient,,,175.5,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.88,156.67,
Ref Hgb S,9527497,LOCAL,85660,CPT,,,,,,Outpatient,,,175.5,6.61,Viva Med ADV,Viva Med ADV,5.51,,,,,,,Fee Schedule,5.51,8.21,
Basic Metabolic Panel,633628,LOCAL,80048,CPT,,,,,,Outpatient,,,176.26,10.15,Viva Med ADV,Viva Med ADV,37.17,,,,,,,Fee Schedule,12.14,37.17170492,
gemcitabine 1 g injection [CULL],11292094,LOCAL,J9201,CPT,,,,,,Outpatient,1,EA,176.384,,Viva Med ADV,Viva Med ADV,3.59,,,,,,,Fee Schedule,3.59,3.59,
RT CHARGE PFT -> Diffusion (DLCO),5267130,LOCAL,94729,CPT,,,,,,Outpatient,,,176.44,115,Viva Med ADV,Viva Med ADV,47.24,,,,,,,Fee Schedule,47.24,76.09,
E0773 Thawed FFP CPD,7267127,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Viva Med ADV,Viva Med ADV,84.29,,,,,,,Fee Schedule,84.29,217.45,
E1237 Thawed Aph FFP ACDA,7267133,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Viva Med ADV,Viva Med ADV,84.29,,,,,,,Fee Schedule,84.29,217.45,
E2701 Thawed Plasma CPD <24h,7267161,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Viva Med ADV,Viva Med ADV,84.29,,,,,,,Fee Schedule,84.29,217.45,
E2737 Thawed Plasma CP2D <24h,7267171,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Viva Med ADV,Viva Med ADV,84.29,,,,,,,Fee Schedule,84.29,217.45,
E4713 Thawed Aph FFP ACDA 1,7267173,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Viva Med ADV,Viva Med ADV,84.29,,,,,,,Fee Schedule,84.29,217.45,
E4717 Thawed Aph FFP ACDA 2,7267174,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Viva Med ADV,Viva Med ADV,84.29,,,,,,,Fee Schedule,84.29,217.45,
E4721 Thawed Aph FFP ACDA 3,7267175,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Viva Med ADV,Viva Med ADV,84.29,,,,,,,Fee Schedule,84.29,217.45,
amiodarone 360 mg/200 mL-D5% intravenous solution 200 mL [CULL],11200046,LOCAL,J0283,CPT,,,,,,Outpatient,200,ML,177.1776,,Viva Med ADV,Viva Med ADV,2.53,,,,,,,Fee Schedule,2.529,2.529,
protamine 10 mg/mL injectable solution 25 mL [CULL],11211130,LOCAL,J2720,CPT,,,,,,Outpatient,25,ML,178.208,,Viva Med ADV,Viva Med ADV,1.57,,,,,,,Fee Schedule,1.571,1.571,
Anti-Mullerian Hormone (AMH) Female QSTC,8972886,LOCAL,82166,CPT,,,,,,Outpatient,,,180,46.34,Viva Med ADV,Viva Med ADV,38.62,,,,,,,Fee Schedule,17.73,38.62,
"Chlamydia Trachomatis RNA, TMA QST",14718336,LOCAL,87491,CPT,,,,,,Outpatient,,,180,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Chromogranin A, LC/MS/MS QSTC",10319690,LOCAL,86316,CPT,,,,,,Outpatient,,,180,24.97,Viva Med ADV,Viva Med ADV,100.2,,,,,,,Fee Schedule,15.29,100.2,
"Estriol, Serum QSTC",9039351,LOCAL,82677,CPT,,,,,,Outpatient,,,180,29.02,Viva Med ADV,Viva Med ADV,24.18,,,,,,,Fee Schedule,18.43,24.18,
H. pylori Urea Breath Test QSTC,8764622,LOCAL,83013,CPT,,,,,,Outpatient,,,180,80.83,Viva Med ADV,Viva Med ADV,123.01,,,,,,,Fee Schedule,46.74,123.01,
"Metanephrines, Fract Free LCMSMS, P QSTC",8764672,LOCAL,83835,CPT,,,,,,Outpatient,,,180,20.33,Viva Med ADV,Viva Med ADV,98.31,,,,,,,Fee Schedule,18.43,98.305,
Mycophenolic Acid QSTC,9039269,LOCAL,80180,CPT,,,,,,Outpatient,,,180,21.66,Viva Med ADV,Viva Med ADV,98.85,,,,,,,Fee Schedule,15.38,98.845,
"Neisseria Gonorrhoeae RNA, TMA QST",14718337,LOCAL,87591,CPT,,,,,,Outpatient,,,180,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Thinprep Review Cytotechnologist: QST,14718350,LOCAL,88175,CPT,,,,,,Outpatient,,,180,31.93,Viva Med ADV,Viva Med ADV,26.61,,,,,,,Fee Schedule,25.25,26.61,
"Trichomonas vaginalis, Ql TMA, Pap QST",14718338,LOCAL,87661,CPT,,,,,,Outpatient,,,180,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Galactose-Alpha-1,3-Galactose IgE QSTC",8764840,LOCAL,86008,CPT,,,,,,Outpatient,,,180.09,21.52,Viva Med ADV,Viva Med ADV,17.93,,,,,,,Fee Schedule,15.29,17.93,
HOLTER MONITOR  24H,8200090,LOCAL,93225,CPT,,,,,,Outpatient,,,182,198,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,99.86,117.85,
DRAIN TRU-CLOSE 500CC (BUY BY EACH-10/CS,6800045,LOCAL,,,A7048,HCPCS,,,,Outpatient,,,183.26,88,Viva Med ADV,Viva Med ADV,60.63,,,,,,,Fee Schedule,60.63,60.63,
FLUORO CENTRAL LINE PLACEMENT,8201221,LOCAL,77001,CPT,,,,,,Outpatient,,,184.82,177.38,Viva Med ADV,Viva Med ADV,70.92,,,,,,,Fee Schedule,70.92,262.79,
Vitamin B12 Level,633871,LOCAL,82607,CPT,,,,,,Outpatient,,,184.82,18.1,Viva Med ADV,Viva Med ADV,82.43,,,,,,,Fee Schedule,18.43,82.43266533,
XR Port Placement,10460170,LOCAL,77001,CPT,,,,,,Outpatient,,,184.82,177.38,Viva Med ADV,Viva Med ADV,70.92,,,,,,,Fee Schedule,70.92,262.79,
RT CHARGE Chest Physiotherapy -> PEP Therapy Subsequent,8699751,LOCAL,94667,CPT,,,,,,Outpatient,,,184.89,120,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,76.09,117.85,
RT CHARGE Mechanical Oscillation -> Yes,10417130,LOCAL,94667,CPT,,,,,,Outpatient,,,184.89,120,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,76.09,117.85,
"Streptococcus pneumoniae Ag, Ur QSTC",13864418,LOCAL,87899,CPT,,,,,,Outpatient,,,185.22,19.28,Viva Med ADV,Viva Med ADV,16.07,,,,,,,Fee Schedule,10.57,16.07,
"FVIII Act, Clotting QSTC",13873492,LOCAL,85240,CPT,,,,,,Outpatient,,,186.96,21.48,Viva Med ADV,Viva Med ADV,17.9,,,,,,,Fee Schedule,5.42,17.9,
"PTT, Activated QSTC",13873491,LOCAL,85730,CPT,,,,,,Outpatient,,,186.96,7.21,Viva Med ADV,Viva Med ADV,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
Ristocetin Cofactor QSTC,13873494,LOCAL,85245,CPT,,,,,,Outpatient,,,186.96,27.53,Viva Med ADV,Viva Med ADV,22.94,,,,,,,Fee Schedule,5.42,22.94,
von Willebrand Factor Ag QSTC,13873493,LOCAL,85246,CPT,,,,,,Outpatient,,,186.96,27.53,Viva Med ADV,Viva Med ADV,22.94,,,,,,,Fee Schedule,5.42,22.94,
"vWf Ag, Multimeric QSTC",13873495,LOCAL,85247,CPT,,,,,,Outpatient,,,186.96,27.53,Viva Med ADV,Viva Med ADV,22.94,,,,,,,Fee Schedule,5.42,22.94,
benztropine 1 mg/mL injectable solution 2 mL [CULL],11202065,LOCAL,J0515,CPT,,,,,,Outpatient,2,ML,188,,Viva Med ADV,Viva Med ADV,13.82,,,,,,,Fee Schedule,13.815,13.815,
.T. pallidum Ab QSTC,13864522,LOCAL,86780,CPT,,,,,,Outpatient,,,189,15.89,Viva Med ADV,Viva Med ADV,13.24,,,,,,,Fee Schedule,13.24,15.29,
Syphilis Antibody Cascading Reflex QSTC,8972904,LOCAL,86780,CPT,,,,,,Outpatient,,,189,15.89,Viva Med ADV,Viva Med ADV,13.24,,,,,,,Fee Schedule,13.24,15.29,
L3923 HFO W/O JOINTS PRE CST CHARGE,9646078,LOCAL,,,L3923,HCPCS,,,,Outpatient,,,191.03,124,Viva Med ADV,Viva Med ADV,97.81,,,,,,,Fee Schedule,97.81,97.81,
"MAG-SGPG Ab IgM, EIA QSTC",13864465,LOCAL,83520,CPT,,,,,,Outpatient,,,191.75,20.72,Viva Med ADV,Viva Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
amphotericin B 50 mg Pow [CULL],J0285,CPT,,,,,,,,Outpatient,50,ML,192,,Viva Med ADV,Viva Med ADV,43.29,,,,,,,Fee Schedule,43.29,43.29,
"96366 IV INFUSION, MEDICATIONS, ADDITIONAL",7904532,LOCAL,96366,CPT,,,,,,Outpatient,,,193,125,Viva Med ADV,Viva Med ADV,42.18,,,,,,,Fee Schedule,42.18,749.76,
"96366- IV tx, each additional hour",1928300,LOCAL,96366,CPT,,,,,,Outpatient,,,193,125,Viva Med ADV,Viva Med ADV,42.18,,,,,,,Fee Schedule,42.18,749.76,
"96367 IV INFUSION, SEQUENTIAL, NEW OR DIFF",7904533,LOCAL,96367,CPT,,,,,,Outpatient,,,193,125,Viva Med ADV,Viva Med ADV,65.07,,,,,,,Fee Schedule,65.07,442.94,
"96367- IV tx, sequential infusion",1928301,LOCAL,96367,CPT,,,,,,Outpatient,,,193,125,Viva Med ADV,Viva Med ADV,65.07,,,,,,,Fee Schedule,65.07,442.94,
"96374- IV Injection, single/initial",1928305,LOCAL,96374,CPT,,,,,59,Outpatient,,,193,125,Viva Med ADV,Viva Med ADV,192.63,,,,,,,Fee Schedule,64.56,192.63,
96374 IV PUSH MEDS INIT INJ 15 MIN OR LESS,7904536,LOCAL,96374,CPT,,,,,59,Outpatient,,,193,125,Viva Med ADV,Viva Med ADV,192.63,,,,,,,Fee Schedule,64.56,192.63,
"96375- IV Injection, add new drug",1928306,LOCAL,96375,CPT,,,,,59,Outpatient,,,193,125,Viva Med ADV,Viva Med ADV,42.18,,,,,,,Fee Schedule,42.18,64.56,
"96375 IV PUSH INJECTION ADD, NEW OR DIFF",7904537,LOCAL,96375,CPT,,,,,59,Outpatient,,,193,125,Viva Med ADV,Viva Med ADV,42.18,,,,,,,Fee Schedule,42.18,64.56,
INJ IV PUSH THER/PROPH SUBSTANCE INTIAL,8210021,LOCAL,96374,CPT,,,,,59,Outpatient,,,193,125,Viva Med ADV,Viva Med ADV,192.63,,,,,,,Fee Schedule,64.56,192.63,
"Beryllium, Serum/Plasma QSTC",10704808,LOCAL,83018,CPT,,,,,,Outpatient,,,194.5,26.35,Viva Med ADV,Viva Med ADV,21.96,,,,,,,Fee Schedule,16.07,21.96,
9581626 EEG AWAKE/DROWSY PRO FEE CHARGES,8795941,LOCAL,95816,CPT,,,,,26,Outpatient,,,195,533,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,284.7,466.96,
95819 EEG AWAKE AND ASLEEP PRO-FEE CHARGE,13508139,LOCAL,95819,CPT,,,,,26,Outpatient,,,195,599,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,284.7,466.96,
95822 EEG COMA or SLEEP ONLY PRO,10049176,LOCAL,95822,CPT,,,,,26,Outpatient,,,195,499,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,284.7,466.96,
Vitamin B3 QSTC,8972908,LOCAL,84591,CPT,,,,,,Outpatient,,,195.75,20.47,Viva Med ADV,Viva Med ADV,17.06,,,,,,,Fee Schedule,17.06,17.73,
Thyroid Stimulating Hormone,633844,LOCAL,84443,CPT,,,,,,Outpatient,,,195.84,20.16,Viva Med ADV,Viva Med ADV,87.64,,,,,,,Fee Schedule,18.43,87.63697303,
TSH with Reflex to FT4,7948309,LOCAL,84439,CPT,,,,,,Outpatient,,,195.84,10.82,Viva Med ADV,Viva Med ADV,28.58,,,,,,,Fee Schedule,18.43,28.58065455,
"Mumps Virus Ab IgG, IgM, Diagnostic QSTC",13864479,LOCAL,86735,CPT,,,,,,Outpatient,,,196.07,15.66,Viva Med ADV,Viva Med ADV,13.05,,,,,,,Fee Schedule,13.05,15.29,
Deoxycorticosterone QSTC,13864487,LOCAL,82633,CPT,,,,,,Outpatient,,,196.2,37.18,Viva Med ADV,Viva Med ADV,30.98,,,,,,,Fee Schedule,18.43,30.98,
Q Fever Ab IgG IgM w/rfx Titers QSTC,13864460,LOCAL,86638,CPT,,,,,,Outpatient,,,196.56,14.54,Viva Med ADV,Viva Med ADV,12.12,,,,,,,Fee Schedule,12.12,15.29,
G0108 Diabetes Management Treatment 30 Minutes CHARGE,10255367,LOCAL,,,G0108,HCPCS,,,,Outpatient,,,196.8,128,Viva Med ADV,Viva Med ADV,52.41,,,,,,,Fee Schedule,52.41,95.93,
94799 Pulm Function Screen Charge,10440012,LOCAL,94799,CPT,,,,,,Outpatient,,,198.38,129,Viva Med ADV,Viva Med ADV,143.05,,,,,,,Fee Schedule,76.09,143.05,
97168 CIS Prgm OT Re-Evaluation 30 min,9850016,LOCAL,97168,CPT,,,,,GO,Outpatient,,,200.91,131,Viva Med ADV,Viva Med ADV,63.82,,,,,,,Fee Schedule,63.82,269.95,
97168 RE-EVALUATION CHARGE,9860016,LOCAL,97168,CPT,,,,,GO|CO,Outpatient,,,200.91,131,Viva Med ADV,Viva Med ADV,63.82,,,,,,,Fee Schedule,63.82,269.95,
OT ReEval Units,7895298,LOCAL,97168,CPT,,,,,GO,Outpatient,,,200.91,131,Viva Med ADV,Viva Med ADV,63.82,,,,,,,Fee Schedule,63.82,269.95,
OT ReEvaluation Units,7897819,LOCAL,97168,CPT,,,,,GO,Outpatient,,,200.91,131,Viva Med ADV,Viva Med ADV,63.82,,,,,,,Fee Schedule,63.82,269.95,
Gabapentin QSTC,8764562,LOCAL,80171,CPT,,,,,,Outpatient,,,202.5,26,Viva Med ADV,Viva Med ADV,111.87,,,,,,,Fee Schedule,15.38,111.87,
TRAb (TSH Receptor Binding Ab) QSTC,8764674,LOCAL,83520,CPT,,,,,,Outpatient,,,202.5,20.72,Viva Med ADV,Viva Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
"Coccidioides Ab, CF w/ ID, CSF QSTC",13864531,LOCAL,86635,CPT,,,,,,Outpatient,,,203.04,13.76,Viva Med ADV,Viva Med ADV,11.47,,,,,,,Fee Schedule,11.47,15.29,
Body Fluid Culture,4122803,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Viva Med ADV,Viva Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Ear Culture,633890,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Viva Med ADV,Viva Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Eye Culture,633892,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Viva Med ADV,Viva Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Medical Device Culture,633898,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Viva Med ADV,Viva Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Nasal Culture,633900,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Viva Med ADV,Viva Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
"Porphyrins, Fract, Quant, Random Ur QSTC",13864457,LOCAL,84120,CPT,,,,,,Outpatient,,,203.18,17.65,Viva Med ADV,Viva Med ADV,14.71,,,,,,,Fee Schedule,14.71,17.73,
Stool Culture,633904,LOCAL,87045,CPT,,,,,,Outpatient,,,203.18,11.33,Viva Med ADV,Viva Med ADV,79.67,,,,,,,Fee Schedule,10.57,79.665,
Throat Culture,633905,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Viva Med ADV,Viva Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Wound Culture,633908,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Viva Med ADV,Viva Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Wound Culture Deep,8395521,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Viva Med ADV,Viva Med ADV,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
micafungin 100 mg intravenous injection [CULL],11220353,LOCAL,J2248,CPT,,,,,,Outpatient,1,EA,203.7888,,Viva Med ADV,Viva Med ADV,0.25,,,,,,,Fee Schedule,0.249,122.4,
Vitamin K QSTC,8972880,LOCAL,84597,CPT,,,,,,Outpatient,,,203.9,16.46,Viva Med ADV,Viva Med ADV,13.72,,,,,,,Fee Schedule,13.72,17.73,
PSA Diagnostic,1634882,LOCAL,84153,CPT,,,,,,Outpatient,,,206.86,22.07,Viva Med ADV,Viva Med ADV,104.84,,,,,,,Fee Schedule,17.73,104.8447059,
PSA Screening,4123035,LOCAL,,,G0103,HCPCS,,,,Outpatient,,,206.86,134,Viva Med ADV,Viva Med ADV,19.31,,,,,,,Fee Schedule,15.29,19.31,
Chromatin (Nucleosomal) Antibody QSTC,10148609,LOCAL,86235,CPT,,,,,,Outpatient,,,206.91,21.52,Viva Med ADV,Viva Med ADV,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
94640 UDN SPECIAL MED 2 CHARGE,13515633,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
94640 UDN SPECIAL MED CHARGE,13522003,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE Aerosol Therapy -> Subsequent,5397112,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE EZPAP -> Initial,9429159,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE EZPAP -> Subsequent,9429160,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE MDI -> Initial,12111660,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE MDI -> Subsequent,12111659,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE Suction -> BBG/Nasopharyngeal,6690655,LOCAL,31720,CPT,,,,,,Outpatient,,,208.54,136,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,863,
RT Continuous Neb Subsequent CHARGE,8144096,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT IPV Subsequent CHARGE,8144062,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> Cough,13657418,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> ET tube,13657417,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> Medication aerosol,8846461,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> Nasal aspirate,13650046,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> Nasal wash,13650044,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
L3912 HFO FLEXION,9856101,LOCAL,,,L3912,HCPCS,,,,Outpatient,,,211.05,137,Viva Med ADV,Viva Med ADV,108.07,,,,,,,Fee Schedule,108.07,108.07,
"penicillin G potassium 20,000,000 units injection [CULL]",11211080,LOCAL,J2540,CPT,,,,,,Outpatient,1,EA,211.2,,Viva Med ADV,Viva Med ADV,0.78,,,,,,,Fee Schedule,0.78,0.78,
REF Antibody Screen,7939320,LOCAL,86850,CPT,,,,,,Outpatient,,,211.5,11.72,Viva Med ADV,Viva Med ADV,48.85,,,,,,,Fee Schedule,6.29,48.85,
US Unlisted Procedure,8733482,LOCAL,76999,CPT,,,,,,Outpatient,,,212.54,113.85,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,161.71,
%CDT QSTC,13864781,LOCAL,82373,CPT,,,,,,Outpatient,,,213.75,21.67,Viva Med ADV,Viva Med ADV,18.06,,,,,,,Fee Schedule,17.73,18.06,
Transferrin - QSTC,13864778,LOCAL,84466,CPT,,,,,,Outpatient,,,213.75,15.31,Viva Med ADV,Viva Med ADV,29.64,,,,,,,Fee Schedule,17.73,29.64248366,
hyaluronidase 150 units/mL injectable solution 1 mL [CULL],11282257,LOCAL,J3470,CPT,,,,,,Outpatient,1,ML,214.272,,Viva Med ADV,Viva Med ADV,31.81,,,,,,,Fee Schedule,31.807,122.4,
"96372 INJECTIONS (IM, SC) OP",7904535,LOCAL,96372,CPT,,,,,59,Outpatient,,,214.42,139,Viva Med ADV,Viva Med ADV,65.07,,,,,,,Fee Schedule,64.56,65.07,
96372- Subq/IM Injection,1928303,LOCAL,96372,CPT,,,,,59,Outpatient,,,214.42,139,Viva Med ADV,Viva Med ADV,65.07,,,,,,,Fee Schedule,64.56,65.07,
RT CHARGE PFT -> Lung Volume,9004829,LOCAL,94727,CPT,,,,,,Outpatient,,,215.73,140,Viva Med ADV,Viva Med ADV,143.05,,,,,,,Fee Schedule,76.09,143.05,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,90471,CPT,G0010,HCPCS,,,,Outpatient,,,216.15,140,Viva Med ADV,Viva Med ADV,42.18,,,,,,,Fee Schedule,42.18,65.07,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,G0010,CPT,,,,,,Outpatient,,,216.15,,Viva Med ADV,Viva Med ADV,42.18,,,,,,,Fee Schedule,42.18,65.07,
CATH LAB US INTRAOPERATIVE,8200550,LOCAL,76998,CPT,,,,,,Outpatient,,,216.65,116.33,Viva Med ADV,Viva Med ADV,36.73,,,,,,,Fee Schedule,36.73,165.47,
Bladder Scan,649589,LOCAL,51798,CPT,,,,,,Outpatient,,,216.87,59,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,54.31,863,
DOPP LOWER EXT ARTERIAL/ABI,8200450,LOCAL,93922,CPT,,,,,,Outpatient,,,218,265,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,117.85,161.71,
69209 REM IMPACT CERUMEN REQ IRRIGAT CHARGE,8020086,LOCAL,69209,CPT,,,,,,Outpatient,,,219.69,143,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,54.31,863,
97550 CAREGIVER TRAINING 1ST 30 MIN,14015178,LOCAL,97550,CPT,,,,,,Outpatient,,,220,,Viva Med ADV,Viva Med ADV,38.85,,,,,,,Fee Schedule,38.85,95.93,
97550 OT Caregiver Training Init 30 Mins,13649811,LOCAL,97550,CPT,,,,,,Outpatient,,,220,,Viva Med ADV,Viva Med ADV,38.85,,,,,,,Fee Schedule,38.85,95.93,
97550 ST Caregiver Training 1st 30 min,14013233,LOCAL,97550,CPT,,,,,,Outpatient,,,220,,Viva Med ADV,Viva Med ADV,38.85,,,,,,,Fee Schedule,38.85,95.93,
"SLP Caregiver Training, First 30 Min Time",14466884,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,220,,Viva Med ADV,Viva Med ADV,50.79,,,,,,,Fee Schedule,50.79,95.93,
Bill Only ABSC,7936968,LOCAL,86850,CPT,,,,,,Outpatient,,,220.5,11.72,Viva Med ADV,Viva Med ADV,48.85,,,,,,,Fee Schedule,6.29,48.85,
"Platelet Antibody Screen, Serum QSTC",10736090,LOCAL,86022,CPT,,,,,,Outpatient,,,220.5,22.04,Viva Med ADV,Viva Med ADV,18.37,,,,,,,Fee Schedule,15.29,18.37,
92524 BEHAVIORAL AND QUALITATIVE ANALYSIS OF VOICE AND RESONANCE,9630059,LOCAL,92524,CPT,,,,,GN,Outpatient,,,222.2,144,Viva Med ADV,Viva Med ADV,103.27,,,,,,,Fee Schedule,103.27,337.75,
Behav/Qual Analysis of Voice and Resonance Charge,7897211,LOCAL,92524,CPT,,,,,GN,Outpatient,,,222.2,144,Viva Med ADV,Viva Med ADV,103.27,,,,,,,Fee Schedule,103.27,337.75,
SLP Analysis of Voice & Resonance Units,7897212,LOCAL,92524,CPT,,,,,GN,Outpatient,,,222.2,144,Viva Med ADV,Viva Med ADV,103.27,,,,,,,Fee Schedule,103.27,337.75,
92597 EVAL FOR USE AND/OR FITTING OF VOICE PROSTHETIC TO SUPPLEMENT ORAL SPEECH,9630068,LOCAL,92597,CPT,,,,,GN,Outpatient,,,223.9,146,Viva Med ADV,Viva Med ADV,67.18,,,,,,,Fee Schedule,67.18,337.75,
Eval for Use/Fitting of Voice Prosthetic Dvc Chg,1373846,LOCAL,92597,CPT,,,,,GN,Outpatient,,,223.9,146,Viva Med ADV,Viva Med ADV,67.18,,,,,,,Fee Schedule,67.18,337.75,
"SLP Use,Fit Speech Prosthetic Eval Units",1373846,LOCAL,92597,CPT,,,,,GN,Outpatient,,,223.9,146,Viva Med ADV,Viva Med ADV,67.18,,,,,,,Fee Schedule,67.18,337.75,
64418- Suprascapular nerve block,10452404,LOCAL,64418,CPT,,,,,,Outpatient,,,225,693,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
75809 SHUNTOGRAM PREV PLCMNT INDWELLING NONVASC SHUNT,13650394,LOCAL,75809,CPT,,,,,,Outpatient,,,225,87.45,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,176.48,
"Hantavirus Antibody IgG,IgM QSTC",13864534,LOCAL,86790,CPT,,,,,,Outpatient,,,225,15.46,Viva Med ADV,Viva Med ADV,12.88,,,,,,,Fee Schedule,12.88,15.29,
"Histoplasma Quantitative Antigen, EIA QSTC",9752803,LOCAL,87385,CPT,,,,,,Outpatient,,,225,15.9,Viva Med ADV,Viva Med ADV,13.25,,,,,,,Fee Schedule,10.57,13.25,
"Potassium w/o Creatinine, Random Ur QSTC",9039260,LOCAL,84133,CPT,,,,,,Outpatient,,,225,5.68,Viva Med ADV,Viva Med ADV,19.32,,,,,,,Fee Schedule,7.16,19.32,
Soluble Transferrin Receptor QSTC,9777250,LOCAL,84238,CPT,,,,,,Outpatient,,,225,43.88,Viva Med ADV,Viva Med ADV,36.57,,,,,,,Fee Schedule,36.57,46.74,
XR Shunt Series,13650394,LOCAL,75809,CPT,,,,,,Outpatient,,,225,87.45,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,176.48,
Dengue Fever Ab (IgG) QSTC,13873177,LOCAL,86790,CPT,,,,,,Outpatient,,,228,15.46,Viva Med ADV,Viva Med ADV,12.88,,,,,,,Fee Schedule,12.88,15.29,
Dengue Fever Ab (IgM) QSTC,13873183,LOCAL,86790,CPT,,,,,,Outpatient,,,228,15.46,Viva Med ADV,Viva Med ADV,12.88,,,,,,,Fee Schedule,12.88,15.29,
"Mycoplasma pneumoniae Ab (IgG, IgM) QSTC",8972832,LOCAL,86738,CPT,,,,,,Outpatient,,,228.83,15.89,Viva Med ADV,Viva Med ADV,13.24,,,,,,,Fee Schedule,13.24,15.29,
REF DAT Polyspecific,7939270,LOCAL,86880,CPT,,,,,,Outpatient,,,229.5,6.47,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,6.29,54.31,
voriconazole 200 mg intravenous injection [CULL],11211371,LOCAL,J3465,CPT,,,,,,Outpatient,1,EA,230.4,,Viva Med ADV,Viva Med ADV,0.75,,,,,,,Fee Schedule,0.751,0.751,
92610  Bedside Swallowing Eval,9630082,LOCAL,92610,CPT,,,,,GN,Outpatient,,,231.76,151,Viva Med ADV,Viva Med ADV,55.89,,,,,,,Fee Schedule,55.89,337.75,
Eval of Oral and Pharyngeal Swallowing Fx Chg  nd Pharyngeal Swallowing Fx Chg,7896918,LOCAL,92610,CPT,,,,,GN,Outpatient,,,231.76,151,Viva Med ADV,Viva Med ADV,55.89,,,,,,,Fee Schedule,55.89,337.75,
Eval of Oral and Pharyngeal Swallowing Fx Chg  nd Pharyngeal Swallowing Fx Chg -> Yes,7896918,LOCAL,92610,CPT,,,,,GN,Outpatient,,,231.76,151,Viva Med ADV,Viva Med ADV,55.89,,,,,,,Fee Schedule,55.89,337.75,
SLP Pharyngeal Swallow Eval Units,1373843,LOCAL,92610,CPT,,,,,GN,Outpatient,,,231.76,151,Viva Med ADV,Viva Med ADV,55.89,,,,,,,Fee Schedule,55.89,337.75,
"Caregiver / patient demonstrates understanding of substance abuse, triggers, treatment",4517330,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,235,,Viva Med ADV,Viva Med ADV,50.79,,,,,,,Fee Schedule,50.79,95.93,
"Caregiver / patient demonstrates understanding of substance abuse, triggers, treatment",4517330,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,235,,Viva Med ADV,Viva Med ADV,50.79,,,,,,,Fee Schedule,50.79,95.93,
PT CAREGIVER TRAINING INT 30 MIN,4517330,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,235,,Viva Med ADV,Viva Med ADV,50.79,,,,,,,Fee Schedule,50.79,95.93,
96523 FLUSH VAD CHARGE,8213318,LOCAL,96523,CPT,,,,,,Outpatient,,,235.66,153,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,54.31,64.56,
Follicle Stimulating Hormone Level,3170314,LOCAL,83001,CPT,,,,,,Outpatient,,,238.68,22.3,Viva Med ADV,Viva Med ADV,98.8,,,,,,,Fee Schedule,18.43,98.80384615,
Antibody ID,634330,LOCAL,86870,CPT,,,,,,Outpatient,,,238.76,,Viva Med ADV,Viva Med ADV,328.88,,,,,,,Fee Schedule,38.27,328.88,
BB THAW FFP,6413062,LOCAL,86931,CPT,,,,,,Outpatient,,,238.76,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.88,156.67,
Bill IHC Multiplex Antibody,14048007,LOCAL,88344,CPT,,,,,,Outpatient,,,238.76,,Viva Med ADV,Viva Med ADV,328.88,,,,,,,Fee Schedule,59.06,328.88,
"Bill Only Antigen Type, Patient",8872565,LOCAL,86905,CPT,,,,,,Outpatient,,,238.76,4.6,Viva Med ADV,Viva Med ADV,328.88,,,,,,,Fee Schedule,6.29,328.88,
"Bill Only Antigen Type, Product",8872566,LOCAL,86902,CPT,,,,,,Outpatient,,,238.76,7.62,Viva Med ADV,Viva Med ADV,328.88,,,,,,,Fee Schedule,6.29,328.88,
Bill Tissue Exam Level 5,14049344,LOCAL,88307,CPT,,,,,,Outpatient,,,238.76,,Viva Med ADV,Viva Med ADV,328.88,,,,,,,Fee Schedule,59.06,328.88,
11732 AVULSION OF EACH ADDITIONAL NAIL PLATE,13029593,LOCAL,11732,CPT,,,,,,Outpatient,,,239.9,156,Viva Med ADV,Viva Med ADV,14.39,,,,,,,Fee Schedule,14.39,863,
93463 Pharmacologic Agent Administration,8230065,LOCAL,93463,CPT,,,,,,Outpatient,,,240,156,Viva Med ADV,Viva Med ADV,79.18,,,,,,,Fee Schedule,64.56,863,
36591 COLLECT BLOOD FROM IMPL VEN DEVICE CHARGE,10451346,LOCAL,36591,CPT,,,,,,Outpatient,,,241.46,157,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,85.79,863,
Central Line Activity. -> Blood drawn,12856467,LOCAL,36592,CPT,,,,,,Outpatient,,,241.46,157,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,85.79,863,
Anaerobic Culture,4122782,LOCAL,87075,CPT,,,,,,Outpatient,,,242.35,11.36,Viva Med ADV,Viva Med ADV,50.33,,,,,,,Fee Schedule,10.57,50.328,
Bill Only ABID Panel,7936969,LOCAL,86870,CPT,,,,,,Outpatient,,,243,,Viva Med ADV,Viva Med ADV,328.88,,,,,,,Fee Schedule,38.27,328.88,
US OB Greater Than 14 Weeks,1169850,LOCAL,76805,CPT,,,,,,Outpatient,,,243,130.35,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,148.61,
US OB Greater Than 14 Weeks,1169851,LOCAL,76805,CPT,,,,,,Outpatient,,,243,130.35,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,148.61,
FLUOROSCOPY <1 HOUR,8210790,LOCAL,76000,CPT,,,,,,Outpatient,,,246.02,380.33,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,176.48,220.99,
.Hep C Viral RNA Quant RealTime PCR QSTC,8764584,LOCAL,87522,CPT,,,,,,Outpatient,,,247.5,51.41,Viva Med ADV,Viva Med ADV,144.75,,,,,,,Fee Schedule,40.19,144.745,
HCV RNA Quan Progress to Genotyping QSTC,9039270,LOCAL,87522,CPT,,,,,,Outpatient,,,247.5,51.41,Viva Med ADV,Viva Med ADV,144.75,,,,,,,Fee Schedule,40.19,144.745,
"Hepatitis C, RNA, Quantitative, PCR QSTC",8764755,LOCAL,87522,CPT,,,,,,Outpatient,,,247.5,51.41,Viva Med ADV,Viva Med ADV,144.75,,,,,,,Fee Schedule,40.19,144.745,
"HSV Type 1&2 DNA, Qual RT PCR QSTC",8873562,LOCAL,87529,CPT,,,,,,Outpatient,,,247.5,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Pancreatic Elastase-1 QSTC,8764835,LOCAL,82653,CPT,,,,,,Outpatient,,,247.5,27.56,Viva Med ADV,Viva Med ADV,22.97,,,,,,,Fee Schedule,17.73,22.97,
REF PLT Screening,13475613,LOCAL,86022,CPT,,,,,,Outpatient,,,247.5,22.04,Viva Med ADV,Viva Med ADV,18.37,,,,,,,Fee Schedule,15.29,18.37,
RT CHARGE Aerosol Therapy -> Initial,12502774,LOCAL,94640,CPT,,,,,,Outpatient,,,247.86,136,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT Continuous Neb Initial CHARGE,8144200,LOCAL,94640,CPT,,,,,,Outpatient,,,247.86,136,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT IPV Initial CHARGE,8144187,LOCAL,94640,CPT,,,,,,Outpatient,,,247.86,136,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,76.09,185.95,
96415 CHEMO IV INFUSION EA ADDL HR INF CHARGE,9665726,LOCAL,96415,CPT,,,,,,Outpatient,,,248.22,161,Viva Med ADV,Viva Med ADV,65.07,,,,,,,Fee Schedule,65.07,749.76,
aztreonam 2 g injection [CULL],11201229,LOCAL,J0457,CPT,,,,,,Outpatient,1,EA,249.6,,Viva Med ADV,Viva Med ADV,2.23,,,,,,,Fee Schedule,2.233,2.233,
"Clobazam and Metabolite, Serum/Plasma QSTC",8764736,LOCAL,80299,CPT,,,,,,Outpatient,,,249.75,22.37,Viva Med ADV,Viva Med ADV,18.64,,,,,,,Fee Schedule,15.38,18.64,
95977 - device analysis and complex programming,14685299,LOCAL,95977,CPT,,,,,,Outpatient,,,250,92,Viva Med ADV,Viva Med ADV,83.92,,,,,,,Fee Schedule,83.92,214.22,
Hep Acute Pnl,633756,LOCAL,80074,CPT,,,,,,Outpatient,,,250,57.16,Viva Med ADV,Viva Med ADV,59.34,,,,,,,Fee Schedule,12.14,59.336,
Hep Acute Pnl Post Exposure,9517262,LOCAL,80074,CPT,,,,,,Outpatient,,,250,57.16,Viva Med ADV,Viva Med ADV,59.34,,,,,,,Fee Schedule,12.14,59.336,
COLLAR HARD PED 8 -11,6000015,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,250.75,223,Viva Med ADV,Viva Med ADV,175.72,,,,,,,Fee Schedule,175.72,175.72,
Albumin Level,1620877,LOCAL,82040,CPT,,,,,,Outpatient,,,250.92,5.94,Viva Med ADV,Viva Med ADV,127.89,,,,,,,Fee Schedule,7.16,127.89,
Luteinizing Hormone,4240834,LOCAL,83002,CPT,,,,,,Outpatient,,,250.92,22.22,Viva Med ADV,Viva Med ADV,18.52,,,,,,,Fee Schedule,18.43,18.52,
Rufinamide QSTC,13864436,LOCAL,80210,CPT,,,,,,Outpatient,,,251.6,32.53,Viva Med ADV,Viva Med ADV,27.11,,,,,,,Fee Schedule,15.38,27.11,
XR Hand 2 Views Left,1170215,LOCAL,73120,CPT,,,,,LT,Outpatient,,,253.04,135.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Hand 2 Views Right,1170217,LOCAL,73120,CPT,,,,,RT,Outpatient,,,253.04,135.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Lower Extremity Infant 2 Views Bilat,8455866,LOCAL,73592,CPT,,,,,,Outpatient,,,253.13,136.13,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Lower Extremity Infant 2 Views Left,8455869,LOCAL,73592,CPT,,,,,LT,Outpatient,,,253.13,136.13,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Lower Extremity Infant 2 Views Right,8455872,LOCAL,73592,CPT,,,,,RT,Outpatient,,,253.13,136.13,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
hepatitis B adult vaccine 20 mcg/mL intramuscular suspension 1 mL [CULL],11202558,LOCAL,90746,CPT,,,,,,Outpatient,1,ML,253.80864,,Viva Med ADV,Viva Med ADV,75.15,,,,,,,Fee Schedule,39.58,75.145,
XR Chest 1 View,8132832,LOCAL,71045,CPT,,,,,,Outpatient,,,253.82,136.13,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Elbow 1 View Left,13554981,LOCAL,73070,CPT,,,,,52|LT,Outpatient,,,254.32,136.13,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Elbow 1 View Right,13554984,LOCAL,73070,CPT,,,,,52|RT,Outpatient,,,254.32,136.13,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
69210 REM IMPACT CERUMEN REQ INSTRU CHARGE,8020194,LOCAL,69210,CPT,,,,,,Outpatient,,,255.9,166,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,54.31,863,
Bill Only Computer Search EA/Ag,13517192,LOCAL,86902,CPT,,,,,,Outpatient,,,256.5,7.62,Viva Med ADV,Viva Med ADV,328.88,,,,,,,Fee Schedule,6.29,328.88,
Bill Only Fresh Unit (<5 Days Old),13517198,LOCAL,86999,CPT,,,,,,Outpatient,,,256.5,,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,6.29,22.39,
US Pelvic Ltd,8206967,LOCAL,76857,CPT,,,,,,Outpatient,,,257.05,137.78,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
RT CHARGE PFT -> Spirometry,5274349,LOCAL,94010,CPT,,,,,,Outpatient,,,258.58,168,Viva Med ADV,Viva Med ADV,143.05,,,,,,,Fee Schedule,76.09,143.05,
97161  SB PT Eval Low Comp,9640014,LOCAL,97161,CPT,,,,,GP,Outpatient,,,262.16,170,Viva Med ADV,Viva Med ADV,46.04,,,,,,,Fee Schedule,46.04162662,349.89,
97161 EVAL - LOW COMPLEXITY CHARGE,9410054,LOCAL,97161,CPT,,,,,GP,Outpatient,,,262.16,170,Viva Med ADV,Viva Med ADV,46.04,,,,,,,Fee Schedule,46.04162662,349.89,
97161 PHYSICAL THERAPY EVALUATION CHARGE,9650014,LOCAL,97161,CPT,,,,,GP|CQ,Outpatient,,,262.16,170,Viva Med ADV,Viva Med ADV,46.04,,,,,,,Fee Schedule,46.04162662,349.89,
PT Low Complex Units,7896010,LOCAL,97161,CPT,,,,,GP,Outpatient,,,262.16,170,Viva Med ADV,Viva Med ADV,46.04,,,,,,,Fee Schedule,46.04162662,349.89,
"Lactoferrin, QL, Stool QSTC",9039266,LOCAL,83630,CPT,,,,,,Outpatient,,,263.25,23.64,Viva Med ADV,Viva Med ADV,19.7,,,,,,,Fee Schedule,17.73,19.7,
"92521 EVALUATION OF SPEECH FLUENCY (STUTTERING, CLUTTERING)",9630056,LOCAL,92521,CPT,,,,,GN,Outpatient,,,263.99,172,Viva Med ADV,Viva Med ADV,125.86,,,,,,,Fee Schedule,125.86,337.75,
SLP Speech Fluency Eval Units,7897205,LOCAL,92521,CPT,,,,,GN,Outpatient,,,263.99,172,Viva Med ADV,Viva Med ADV,125.86,,,,,,,Fee Schedule,125.86,337.75,
Speech Fluency Eval Charge,7897205,LOCAL,92521,CPT,,,,,GN,Outpatient,,,263.99,172,Viva Med ADV,Viva Med ADV,125.86,,,,,,,Fee Schedule,125.86,337.75,
methylPREDNISolone 1 g preservative-free Pow,11287452,LOCAL,J2919,CPT,,,,,,Outpatient,1,UN,264.6528,,Viva Med ADV,Viva Med ADV,0.21,,,,,,,Fee Schedule,0.21,5685.74,
92526  Treatment of Swallow,9630083,LOCAL,92526,CPT,,,,,GN,Outpatient,,,265.2,172,Viva Med ADV,Viva Med ADV,85.25,,,,,,,Fee Schedule,56.44,85.2525,
dihydroergotamine 1 mg/mL injectable solution 1 mL [CULL],11202330,LOCAL,J1110,CPT,,,,,,Outpatient,1,ML,265.2,,Viva Med ADV,Viva Med ADV,57.08,,,,,,,Fee Schedule,57.082,57.082,
SLP Swallow Dysfunction Oral Feed Units,1373842,LOCAL,92526,CPT,,,,,GN,Outpatient,,,265.2,172,Viva Med ADV,Viva Med ADV,85.25,,,,,,,Fee Schedule,56.44,85.2525,
Treatment of Swallowing Dysfunction Charge,7896917,LOCAL,92526,CPT,,,,,GN,Outpatient,,,265.2,172,Viva Med ADV,Viva Med ADV,85.25,,,,,,,Fee Schedule,56.44,85.2525,
Treatment of Swallowing Dysfunction Charge -> Yes,7896917,LOCAL,92526,CPT,,,,,GN,Outpatient,,,265.2,172,Viva Med ADV,Viva Med ADV,85.25,,,,,,,Fee Schedule,56.44,85.2525,
RNA Polymerase III Antibody QSTC,10067478,LOCAL,83516,CPT,,,,,,Outpatient,,,265.5,13.84,Viva Med ADV,Viva Med ADV,11.53,,,,,,,Fee Schedule,11.53,17.73,
XR Sinuses Paranasal < 3 Views,1170432,LOCAL,70210,CPT,,,,,,Outpatient,,,266.27,142.73,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Pelvis 1 or 2 Views,1170351,LOCAL,72170,CPT,,,,,,Outpatient,,,266.62,142.73,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
Zonisamide QSTC,8764609,LOCAL,80203,CPT,,,,,,Outpatient,,,267.53,15.9,Viva Med ADV,Viva Med ADV,13.25,,,,,,,Fee Schedule,13.25,15.38,
"Iodine, U24 QSTC",13864440,LOCAL,82542,CPT,,,,,,Outpatient,,,267.8,28.91,Viva Med ADV,Viva Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.09,
.Atypical P-ANCA Titer QSTC,8764788,LOCAL,86037,CPT,,,,,,Outpatient,,,270,14.46,Viva Med ADV,Viva Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
"Acylcarnitine, Plasma QSTC",9215425,LOCAL,82017,CPT,,,,,,Outpatient,,,270,20.24,Viva Med ADV,Viva Med ADV,16.87,,,,,,,Fee Schedule,16.87,17.73,
C. difficile Toxin B Qual PCR QSTC,13864437,LOCAL,87493,CPT,,,,,,Outpatient,,,270,44.72,Viva Med ADV,Viva Med ADV,37.27,,,,,,,Fee Schedule,37.27,40.19,
"Cytomegalovirus DNA, QN, Real-T PCR QSTC",8764608,LOCAL,87497,CPT,,,,,,Outpatient,,,270,51.41,Viva Med ADV,Viva Med ADV,42.84,,,,,,,Fee Schedule,40.19,42.84,
"Kappa/Lambda Lght Chn, Free w Rat U QSTC",9039383,LOCAL,83883,CPT,,,,,,Outpatient,,,270,16.32,Viva Med ADV,Viva Med ADV,13.6,,,,,,,Fee Schedule,13.6,15.29,
"Kappa/Lambda Light Chains, Tot Ur QSTC",9039383,LOCAL,83883,CPT,,,,,,Outpatient,,,270,16.32,Viva Med ADV,Viva Med ADV,13.6,,,,,,,Fee Schedule,13.6,15.29,
"Mycoplasma Genitalium,R-T PCR QST",9773947,LOCAL,87624,CPT,,,,,,Outpatient,,,270,42.11,Viva Med ADV,Viva Med ADV,67.2,,,,,,,Fee Schedule,40.19,67.195,
Reference Lab Crossmatch -> Compatible,8185614,LOCAL,86920,CPT,,,,,,Outpatient,,,270,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
Reference Lab Crossmatch -> Incompatible,8185613,LOCAL,86920,CPT,,,,,,Outpatient,,,270,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
Reference Lab Crossmatch -> Least Incompatible,8185612,LOCAL,86920,CPT,,,,,,Outpatient,,,270,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
von Willebrand Factor Ag QSTC,8764731,LOCAL,85246,CPT,,,,,,Outpatient,,,270,27.53,Viva Med ADV,Viva Med ADV,22.94,,,,,,,Fee Schedule,5.42,22.94,
99281 Emergency Department Visit. Level 1,2644297,LOCAL,99281,CPT,,,,,25,Outpatient,,,272.36,177,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,80.5,
XR Finger(s) 1 View Left,13554987,LOCAL,73140,CPT,,,,,52|LT,Outpatient,,,272.62,146.03,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Finger(s) 1 View Right,13554990,LOCAL,73140,CPT,,,,,52|RT,Outpatient,,,272.62,146.03,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
Electrocardiogram 12 Lead.,9696149,LOCAL,93005,CPT,,,,,,Outpatient,,,273.98,178,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,38.53,54.31,
93242 Holter 3 to 7 Days Recording,90820010,LOCAL,93242,CPT,,,,,,Outpatient,,,275,179,Viva Med ADV,Viva Med ADV,35.88,,,,,,,Fee Schedule,35.88,99.86,
Prolactin Level,3170316,LOCAL,84146,CPT,,,,,,Outpatient,,,275.4,23.26,Viva Med ADV,Viva Med ADV,19.38,,,,,,,Fee Schedule,18.43,19.38,
XR Elbow 2 Views Left,1170121,LOCAL,73070,CPT,,,,,LT,Outpatient,,,275.53,136.13,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Elbow 2 Views Right,1170123,LOCAL,73070,CPT,,,,,RT,Outpatient,,,275.53,136.13,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
.TR Interpretation,1173781,LOCAL,86078,CPT,,,,,,Outpatient,,,277.85,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.88,156.67,
BB REF LAB PHYSICIAN INTERP,6413086,LOCAL,86077,CPT,,,,,,Outpatient,,,279,,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,22.39,38.88,
Bill Only Crossmatch IS,8419033,LOCAL,86920,CPT,,,,,,Outpatient,,,279,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
hepatitis B immune globulin intramuscular solution 0.5 mL [CULL],11202561,LOCAL,J1571,CPT,,,,,,Outpatient,0.5,ML,280.064,,Viva Med ADV,Viva Med ADV,66.64,,,,,,,Fee Schedule,66.64,771.25,
XR Spine 1 View Specify Level,8058789,LOCAL,72020,CPT,,,,,,Outpatient,,,281.44,150.98,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Knee 1 View Standing AP Bilateral,1170291,LOCAL,73565,CPT,,,,,,Outpatient,,,283.03,151.8,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
Iodine QSTC,13864439,LOCAL,82542,CPT,,,,,,Outpatient,,,283.32,28.91,Viva Med ADV,Viva Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.09,
XR Neck Soft Tissue,1170331,LOCAL,70360,CPT,,,,,,Outpatient,,,284.4,152.63,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
97162  SB PT Eval Mod Comp,9640015,LOCAL,97162,CPT,,,,,GP,Outpatient,,,287.16,187,Viva Med ADV,Viva Med ADV,42.69,,,,,,,Fee Schedule,42.68861429,349.89,
97162 EVAL - MODERATE COMPLEXITY CHARGE,9410055,LOCAL,97162,CPT,,,,,GP,Outpatient,,,287.16,187,Viva Med ADV,Viva Med ADV,42.69,,,,,,,Fee Schedule,42.68861429,349.89,
97162 PT EVAL MOD COMPLEX CHARGES,9650015,LOCAL,97162,CPT,,,,,GP|CQ,Outpatient,,,287.16,187,Viva Med ADV,Viva Med ADV,42.69,,,,,,,Fee Schedule,42.68861429,349.89,
PT Moderate Complex Units,7896012,LOCAL,97162,CPT,,,,,GP,Outpatient,,,287.16,187,Viva Med ADV,Viva Med ADV,42.69,,,,,,,Fee Schedule,42.68861429,349.89,
Soluble Liver Antigen (SLA) Autoantibody QSTC,10148492,LOCAL,83520,CPT,,,,,,Outpatient,,,288,20.72,Viva Med ADV,Viva Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
XR Shoulder 1 View Left,1170409,LOCAL,73020,CPT,,,,,LT,Outpatient,,,289.86,155.1,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Shoulder 1 View Right,1170411,LOCAL,73020,CPT,,,,,RT,Outpatient,,,289.86,155.1,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR AC Joints Bilateral,1169922,LOCAL,73050,CPT,,,,,,Outpatient,,,289.94,155.1,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Calcaneus Limited Left,13554972,LOCAL,73650,CPT,,,,,52|LT,Outpatient,,,290.55,174.9,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Calcaneus Limited Right,13554975,LOCAL,73650,CPT,,,,,52|RT,Outpatient,,,290.55,174.9,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
BD Bone Density DEXA Vert Fracture Assmt,8206345,LOCAL,77086,CPT,,,,,,Outpatient,,,291.16,155.93,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,116.02,
XR Foreign Body Localization Child 1 Vw,1170207,LOCAL,76010,CPT,,,,,,Outpatient,,,291.16,155.93,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
cefTRIAXone 2 g injection [CULL],11202189,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,292.1824,,Viva Med ADV,Viva Med ADV,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
"Cytomegalovirus DNA, QL R-T PCR QSTC",9777223,LOCAL,87496,CPT,,,,,,Outpatient,,,292.5,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Factor IX Activity,Clotting [352X]  QSTC",12534660,LOCAL,85250,CPT,,,,,,Outpatient,,,292.5,22.85,Viva Med ADV,Viva Med ADV,19.04,,,,,,,Fee Schedule,5.42,19.04,
"HIV-1 RNA, QN, Real-Time PCR QSTC",8764763,LOCAL,87536,CPT,,,,,,Outpatient,,,292.5,102.12,Viva Med ADV,Viva Med ADV,85.1,,,,,,,Fee Schedule,85.1,158.39,
XR Chest Decubitus,1170049,LOCAL,71046,CPT,,,,,,Outpatient,,,292.6,212.85,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
"Factor VIII Inhibitor, EIA QSTC",13873092,LOCAL,85335,CPT,,,,,,Outpatient,,,294.75,15.44,Viva Med ADV,Viva Med ADV,12.87,,,,,,,Fee Schedule,5.42,12.87,
"FVIII Act, Clotting QSTC",13873093,LOCAL,85240,CPT,,,,,,Outpatient,,,294.75,21.48,Viva Med ADV,Viva Med ADV,17.9,,,,,,,Fee Schedule,5.42,17.9,
XR Upper Extremity Infant 2 Views Left,8455878,LOCAL,73092,CPT,,,,,LT,Outpatient,,,296.99,159.23,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Upper Extremity Infant 2 Views Right,8455881,LOCAL,73092,CPT,,,,,RT,Outpatient,,,296.99,159.23,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
Ref Rh Phenotyping,9527485,LOCAL,86906,CPT,,,,,,Outpatient,,,297,9.3,Viva Med ADV,Viva Med ADV,35.88,,,,,,,Fee Schedule,6.29,35.88,
92611 ST VIDEOFLUOR SWALLOW CHARGE,9630067,LOCAL,92611,CPT,,,,,GN,Outpatient,,,297.49,193,Viva Med ADV,Viva Med ADV,189.99,,,,,,,Fee Schedule,176.48,189.9866667,
Fluoroscopic Evaluation of Swallow Function Charge,7896919,LOCAL,92611,CPT,,,,,GN,Outpatient,,,297.49,193,Viva Med ADV,Viva Med ADV,189.99,,,,,,,Fee Schedule,176.48,189.9866667,
SLP Fluoroscopic Evaluation Units,1373839,LOCAL,92611,CPT,,,,,GN,Outpatient,,,297.49,193,Viva Med ADV,Viva Med ADV,189.99,,,,,,,Fee Schedule,176.48,189.9866667,
97165 EVAL -  LOW COMPLEXITY CHARGE,9850014,LOCAL,97165,CPT,,,,,GO,Outpatient,,,297.74,194,Viva Med ADV,Viva Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
97165 OT Evaluation Low Complexity 30 min,9860014,LOCAL,97165,CPT,,,,,GO|CO,Outpatient,,,297.74,194,Viva Med ADV,Viva Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Evaluation Low Complexity Units,7897807,LOCAL,97165,CPT,,,,,GO,Outpatient,,,297.74,194,Viva Med ADV,Viva Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Low Complex Units,7895291,LOCAL,97165,CPT,,,,,GO,Outpatient,,,297.74,194,Viva Med ADV,Viva Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
"Aspergillus Antigen, EIA, Serum QSTC",9777227,LOCAL,87305,CPT,,,,,,Outpatient,,,298,14.38,Viva Med ADV,Viva Med ADV,11.98,,,,,,,Fee Schedule,10.57,11.98,
29581 PT Lower Extremity Application of Strapping,9640079,LOCAL,29581,CPT,,,,,GP,Outpatient,,,300,195,Viva Med ADV,Viva Med ADV,144.26,,,,,,,Fee Schedule,144.26,863,
PT Lymphedema Wrap below Knee Charge,7895901,LOCAL,29581,CPT,,,,,GP,Outpatient,,,300,195,Viva Med ADV,Viva Med ADV,144.26,,,,,,,Fee Schedule,144.26,863,
Lacosamide QSTC,8764635,LOCAL,80235,CPT,,,,,,Outpatient,,,301.5,32.53,Viva Med ADV,Viva Med ADV,27.11,,,,,,,Fee Schedule,15.38,27.11,
tetanus/diphth/pertussis (Tdap) adult/adol 5 units-2 units-15.5 mcg/0.5 mL intramuscular suspension 0.5 mL [CULL],11202346,LOCAL,90714,CPT,,,,,,Outpatient,0.5,ML,301.632,,Viva Med ADV,Viva Med ADV,14.45,,,,,,,Fee Schedule,14.45070423,39.58,
XR Toe(s) 2 PLUS Views Right,1170522,LOCAL,73660,CPT,,,,,RT,Outpatient,,,301.78,161.7,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Toe(s) 2+ Views Left,1170520,LOCAL,73660,CPT,,,,,LT,Outpatient,,,301.78,161.7,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
influenza vaccine (Fluzone HD) vaccine 2025-2026 [CULL],11292055,LOCAL,90662,CPT,,,,,,Outpatient,0.5,ML,303.5392,,Viva Med ADV,Viva Med ADV,86.13,,,,,,,Fee Schedule,39.58,86.13,
Large Humeral Fracture Brace,9400080,LOCAL,,,L3982,HCPCS,,,,Outpatient,,,303.88,,Viva Med ADV,Viva Med ADV,429.48,,,,,,,Fee Schedule,429.48,429.48,
Medium Humeral Fracture Brace,9400079,LOCAL,,,L3982,HCPCS,,,,Outpatient,,,303.88,,Viva Med ADV,Viva Med ADV,429.48,,,,,,,Fee Schedule,429.48,429.48,
CV Holter Monitor Recording up to 48 Hrs,8230053,LOCAL,93225,CPT,,,,,,Outpatient,,,304,198,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,99.86,117.85,
Holter Monitor 48 Hr,8230053,LOCAL,93225,CPT,,,,,,Outpatient,,,304,198,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,99.86,117.85,
Bill Only Rh Phenotyping,7936966,LOCAL,86906,CPT,,,,,,Outpatient,,,306,9.3,Viva Med ADV,Viva Med ADV,35.88,,,,,,,Fee Schedule,6.29,35.88,
COV19/Flu/RSV (GeneXpert Plus),10791321,LOCAL,87637,CPT,,,,,,Outpatient,,,306,171.16,Viva Med ADV,Viva Med ADV,69.48,,,,,,,Fee Schedule,40.19,69.4761107,
US OB Less Than 14 Weeks,8206952,LOCAL,76801,CPT,,,,,,Outpatient,,,307,165,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,148.61,
Chlamydia/Chlamydophila Ab 2 IgM QSTC,13864537,LOCAL,86632,CPT,,,,,,Outpatient,,,307.13,15.22,Viva Med ADV,Viva Med ADV,12.68,,,,,,,Fee Schedule,12.68,15.29,
EPINEPHrine 8 mg/250 mL-NaCl 0.9% Sol [CULL],11200040,LOCAL,J0165,CPT,,,,,,Outpatient,250,ML,307.2,,Viva Med ADV,Viva Med ADV,0.43,,,,,,,Fee Schedule,0.433,0.433,
Comprehensive Metabolic Panel,633709,LOCAL,80053,CPT,,,,,,Outpatient,,,307.22,12.67,Viva Med ADV,Viva Med ADV,82.76,,,,,,,Fee Schedule,12.14,82.75523053,
XR Ankle 1 View Left,13554963,LOCAL,73600,CPT,,,,,52|LT,Outpatient,,,307.85,165,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ankle 1 View Right,13554966,LOCAL,73600,CPT,,,,,52|RT,Outpatient,,,307.85,165,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Foot 2 Views Left,1170185,LOCAL,73620,CPT,,,,,LT,Outpatient,,,309.19,165.83,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Foot 2 Views Right,1170187,LOCAL,73620,CPT,,,,,RT,Outpatient,,,309.19,165.83,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
"Bill Only ABID Panel, Enzyme (Ab)",13517190,LOCAL,86870,CPT,,,,,,Outpatient,,,310.5,,Viva Med ADV,Viva Med ADV,328.88,,,,,,,Fee Schedule,38.27,328.88,
"Bill Only ABID Panel, Enzyme (Ezym)",13517194,LOCAL,86971,CPT,,,,,,Outpatient,,,310.5,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.88,156.67,
Insulin Autoantibody QSTC,8764818,LOCAL,86337,CPT,,,,,,Outpatient,,,310.5,25.69,Viva Med ADV,Viva Med ADV,21.41,,,,,,,Fee Schedule,15.29,21.41,
XR Finger(s) 2 Plus Views Left,1170151,LOCAL,73140,CPT,,,,,LT,Outpatient,,,311.14,146.03,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Finger(s) 2 Plus Views Right,1170153,LOCAL,73140,CPT,,,,,RT,Outpatient,,,311.14,146.03,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
97163  SB PT Eval High Comp,9640017,LOCAL,97163,CPT,,,,,GP,Outpatient,,,312.16,203,Viva Med ADV,Viva Med ADV,92.25,,,,,,,Fee Schedule,92.25,349.89,
97163 EVAL - HIGH COMPLEXITY CHARGE,9410062,LOCAL,97163,CPT,,,,,GP,Outpatient,,,312.16,203,Viva Med ADV,Viva Med ADV,92.25,,,,,,,Fee Schedule,92.25,349.89,
97163 IND EDUCATION EVAL CHARGE,9650017,LOCAL,97163,CPT,,,,,GP|CQ,Outpatient,,,312.16,203,Viva Med ADV,Viva Med ADV,92.25,,,,,,,Fee Schedule,92.25,349.89,
PT High Complex Units,7896014,LOCAL,97163,CPT,,,,,GP,Outpatient,,,312.16,203,Viva Med ADV,Viva Med ADV,92.25,,,,,,,Fee Schedule,92.25,349.89,
Factor II Activity QSTC,8972859,LOCAL,85210,CPT,,,,,,Outpatient,,,312.8,15.58,Viva Med ADV,Viva Med ADV,12.98,,,,,,,Fee Schedule,5.42,12.98,
MG Mammo Implant Screening Lt w/ Tomo.,8146654,LOCAL,77067,CPT,,,,,LT,Outpatient,,,313.11,363,Viva Med ADV,Viva Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Implant Screening Rt w/ Tomo.,8146657,LOCAL,77067,CPT,,,,,RT,Outpatient,,,313.11,363,Viva Med ADV,Viva Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Screening Left w/ Tomo.,8146660,LOCAL,77067,CPT,,,,,LT,Outpatient,,,313.11,363,Viva Med ADV,Viva Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Screening Right w/ Tomo.,8146663,LOCAL,77067,CPT,,,,,RT,Outpatient,,,313.11,363,Viva Med ADV,Viva Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
92609 ST USE OF SPEECH DEVICE SERVICES,9636008,LOCAL,92609,CPT,,,,,GN,Outpatient,,,314.48,204,Viva Med ADV,Viva Med ADV,95.88,,,,,,,Fee Schedule,56.44,95.88,
SLP Speech-Gen Dev Prog and Mod,7896913,LOCAL,92609,CPT,,,,,GN,Outpatient,,,314.48,204,Viva Med ADV,Viva Med ADV,95.88,,,,,,,Fee Schedule,56.44,95.88,
SLP Speech-Gen Dev Prog and Mod Time,1373849,LOCAL,92609,CPT,,,,,GN,Outpatient,,,314.48,204,Viva Med ADV,Viva Med ADV,95.88,,,,,,,Fee Schedule,56.44,95.88,
SLP Tx Generating Device Units,1373849,LOCAL,92609,CPT,,,,,GN,Outpatient,,,314.48,204,Viva Med ADV,Viva Med ADV,95.88,,,,,,,Fee Schedule,56.44,95.88,
"Factor V Activity, Clotting QSTC",9777239,LOCAL,85220,CPT,,,,,,Outpatient,,,315,21.18,Viva Med ADV,Viva Med ADV,17.65,,,,,,,Fee Schedule,5.42,17.65,
Hepatitis B Virus DNA Qnt RT PCR QSTC,8764549,LOCAL,87517,CPT,,,,,,Outpatient,,,315,51.41,Viva Med ADV,Viva Med ADV,178.5,,,,,,,Fee Schedule,40.19,178.495,
Inhibin A QSTC,8972775,LOCAL,86336,CPT,,,,,,Outpatient,,,315,18.71,Viva Med ADV,Viva Med ADV,15.59,,,,,,,Fee Schedule,15.29,15.59,
"Viral Respiratory, Rapid Culture with Reflex QST",12126195,LOCAL,87140,CPT,,,,,,Outpatient,,,315,6.68,Viva Med ADV,Viva Med ADV,5.57,,,,,,,Fee Schedule,5.57,10.57,
"Porphyrins, Total QSTC",13864419,LOCAL,82542,CPT,,,,,,Outpatient,,,315.9,28.91,Viva Med ADV,Viva Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.09,
"73040 Radiologic examination, shoulder, arthrography: AddOn",14917589,LOCAL,73040,CPT,,,,,,Outpatient,,,316.12,777.98,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Forearm 1 View Left,13554993,LOCAL,73090,CPT,,,,,52|LT,Outpatient,,,318.62,170.78,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Forearm 1 View Right,13554996,LOCAL,73090,CPT,,,,,52|RT,Outpatient,,,318.62,170.78,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ankle 2 Views Left,1169936,LOCAL,73600,CPT,,,,,LT,Outpatient,,,318.65,165,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ankle 2 Views Right,1169938,LOCAL,73600,CPT,,,,,RT,Outpatient,,,318.65,165,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
tobramycin 1.2 g injection [CULL],11211303,LOCAL,J3260,CPT,,,,,,Outpatient,1,EA,320,,Viva Med ADV,Viva Med ADV,2.07,,,,,,,Fee Schedule,2.071,2.071,
Complement Component C1q QSTC,8972752,LOCAL,86160,CPT,,,,,,Outpatient,,,322.65,14.4,Viva Med ADV,Viva Med ADV,36.91,,,,,,,Fee Schedule,15.29,36.909,
97166  SB OT Eval Mod Comp,9860015,LOCAL,97166,CPT,,,,,GO|CO,Outpatient,,,322.74,210,Viva Med ADV,Viva Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
97166 EVAL -  MODERATE COMPLEXITY CHARGE,9850015,LOCAL,97166,CPT,,,,,GO,Outpatient,,,322.74,210,Viva Med ADV,Viva Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Evaluation Moderate Complexity Units,7897808,LOCAL,97166,CPT,,,,,GO,Outpatient,,,322.74,210,Viva Med ADV,Viva Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Moderate Complex Units,7895293,LOCAL,97166,CPT,,,,,GO,Outpatient,,,322.74,210,Viva Med ADV,Viva Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
XR Calcaneus Left,1170032,LOCAL,73650,CPT,,,,,LT,Outpatient,,,325.42,174.9,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Calcaneus Right,1170034,LOCAL,73650,CPT,,,,,RT,Outpatient,,,325.42,174.9,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
94618 PULM STRESS TEST - 6 MIN WALK CHARGE,10470023,LOCAL,94618,CPT,,,,,59,Outpatient,,,326.86,212,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,76.09,117.85,
94618 PULMONARY STRESS TEST CHARGE,10470022,LOCAL,94618,CPT,,,,,,Outpatient,,,326.86,212,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,76.09,117.85,
XR Hips 2 Views w/AP Pelvis Bilat,7520609,LOCAL,73521,CPT,,,,,,Outpatient,,,327.27,175.73,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
"Neutrophil Funct, Oxidative Burst QSTC",13864519,LOCAL,82657,CPT,,,,,,Outpatient,,,327.6,26.6,Viva Med ADV,Viva Med ADV,22.17,,,,,,,Fee Schedule,17.73,22.17,
XR Clavicle Limited Left,13554978,LOCAL,73000,CPT,,,,,52|LT,Outpatient,,,330.84,198.83,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Clavicle Limited Right,13575896,LOCAL,73000,CPT,,,,,52|RT,Outpatient,,,330.84,198.83,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR CV Line Injection,10153535,LOCAL,77001,CPT,,,,,,Outpatient,,,330.88,177.38,Viva Med ADV,Viva Med ADV,70.92,,,,,,,Fee Schedule,70.92,262.79,
XR Portogram,8602535,LOCAL,36598,CPT,,,,,,Outpatient,,,330.88,587,Viva Med ADV,Viva Med ADV,192.63,,,,,,,Fee Schedule,192.63,863,
"Neuron Specific Enolase, CSF QSTC",13864472,LOCAL,86316,CPT,,,,,,Outpatient,,,335.25,24.97,Viva Med ADV,Viva Med ADV,100.2,,,,,,,Fee Schedule,15.29,100.2,
XR Sternum 2+ Views,1170496,LOCAL,71120,CPT,,,,,,Outpatient,,,335.51,179.85,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
"Borrelia species DNA, QL RT PCR QSTC",13864432,LOCAL,87801,CPT,,,,,,Outpatient,,,337.5,84.24,Viva Med ADV,Viva Med ADV,70.2,,,,,,,Fee Schedule,40.19,70.2,
"Calprotectin, Stool QSTC",8764641,LOCAL,83993,CPT,,,,,,Outpatient,,,337.5,23.56,Viva Med ADV,Viva Med ADV,19.63,,,,,,,Fee Schedule,17.73,19.63,
"Factor VII Activity, Clotting QSTC",12530023,LOCAL,85230,CPT,,,,,,Outpatient,,,337.5,21.48,Viva Med ADV,Viva Med ADV,17.9,,,,,,,Fee Schedule,5.42,17.9,
"Rheumatoid Factor (IgA, IgG, IgM) QSTC",9743436,LOCAL,83520,CPT,,,,,,Outpatient,,,337.5,20.72,Viva Med ADV,Viva Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
SURESWAB(R) ADV BV QST,12432150,LOCAL,81513,CPT,,,,,,Outpatient,,,338,171.16,Viva Med ADV,Viva Med ADV,142.63,,,,,,,Fee Schedule,63.34,142.63,
"Estrogens, Fractionated, LC/MS QSTC",8972883,LOCAL,82671,CPT,,,,,,Outpatient,,,340.29,38.76,Viva Med ADV,Viva Med ADV,185.98,,,,,,,Fee Schedule,18.43,185.975,
"86617-Lyme Disease Abs (IgG, IgM) IBL CSF QSTC",14825580,LOCAL,86617,CPT,,,,,,Outpatient,,,342,18.59,Viva Med ADV,Viva Med ADV,15.49,,,,,,,Fee Schedule,15.29,15.49,
"BK Virus DNA, Quant, RT PCR QSTC",8853280,LOCAL,87799,CPT,,,,,,Outpatient,,,342,51.41,Viva Med ADV,Viva Med ADV,42.84,,,,,,,Fee Schedule,40.19,42.84,
"Lyme Disease Ab Rfx Blot IgG, IgM QSTC",8764732,LOCAL,86618,CPT,,,,,,Outpatient,,,342,20.44,Viva Med ADV,Viva Med ADV,17.03,,,,,,,Fee Schedule,15.29,17.03,
"Lyme Disease Abs (IgG, IgM) IBL CSF QSTC",14114578,LOCAL,86617,CPT,,,,,,Outpatient,,,342,18.59,Viva Med ADV,Viva Med ADV,15.49,,,,,,,Fee Schedule,15.29,15.49,
"Lyme Disease Antibodies (IgG, IgM), Immunoblot, CSF QST",6232109,LOCAL,86617,CPT,,,,,,Outpatient,,,342,18.59,Viva Med ADV,Viva Med ADV,15.49,,,,,,,Fee Schedule,15.29,15.49,
sodium thiosulfate 25% intravenous solution 50 mL [CULL],11260081,LOCAL,J0208,CPT,,,,,,Outpatient,50,ML,342.4,,Viva Med ADV,Viva Med ADV,95.11,,,,,,,Fee Schedule,95.11,7537.07,
Chlamydia/Chlamydophila Ab 1 IgG QSTC,13864536,LOCAL,86631,CPT,,,,,,Outpatient,,,342.9,14.18,Viva Med ADV,Viva Med ADV,11.82,,,,,,,Fee Schedule,11.82,15.29,
"TRICHOMONAS VAGINALIS (TV), TMA QST",12432301,LOCAL,87661,CPT,,,,,,Outpatient,,,343.11,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
CANDIDA GLABRATA QST,12432300,LOCAL,87481,CPT,,,,,,Outpatient,,,343.13,42.11,Viva Med ADV,Viva Med ADV,478.17,,,,,,,Fee Schedule,40.19,478.165,
CANDIDA SPECIES QST,12432293,LOCAL,87481,CPT,,,,,,Outpatient,,,343.13,42.11,Viva Med ADV,Viva Med ADV,478.17,,,,,,,Fee Schedule,40.19,478.165,
CANDIDA SPECIES QST,12432299,LOCAL,87481,CPT,,,,,,Outpatient,,,343.13,42.11,Viva Med ADV,Viva Med ADV,478.17,,,,,,,Fee Schedule,40.19,478.165,
SURESWAB(R) ADV BV QST,12432298,LOCAL,81513,CPT,,,,,,Outpatient,,,343.13,171.16,Viva Med ADV,Viva Med ADV,142.63,,,,,,,Fee Schedule,63.34,142.63,
"EBV DNA, QN PCR QSTC",8764620,LOCAL,87799,CPT,,,,,,Outpatient,,,344.25,51.41,Viva Med ADV,Viva Med ADV,42.84,,,,,,,Fee Schedule,40.19,42.84,
XR Wrist 2 Views Left,1170606,LOCAL,73100,CPT,,,,,LT,Outpatient,,,344.56,184.8,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Wrist 2 Views Right,1170608,LOCAL,73100,CPT,,,,,RT,Outpatient,,,344.56,184.8,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
REF LAB IAT CROSSMATCH,13797753,LOCAL,86922,CPT,,,,,,Outpatient,,,347,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
XR Forearm 2 Views Left,1170197,LOCAL,73090,CPT,,,,,LT,Outpatient,,,347.3,170.78,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Forearm 2 Views Right,1170199,LOCAL,73090,CPT,,,,,RT,Outpatient,,,347.3,170.78,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
97167 EVAL -  HIGH COMPLEXITY CHARGE,9850017,LOCAL,97167,CPT,,,,,GO,Outpatient,,,347.74,226,Viva Med ADV,Viva Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
97167 IND EDUCATION EVAL CHARGE,9860017,LOCAL,97167,CPT,,,,,GO|CO,Outpatient,,,347.74,226,Viva Med ADV,Viva Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Evaluation High Complexity Units,7897809,LOCAL,97167,CPT,,,,,GO,Outpatient,,,347.74,226,Viva Med ADV,Viva Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT High Complex Units,7895295,LOCAL,97167,CPT,,,,,GO,Outpatient,,,347.74,226,Viva Med ADV,Viva Med ADV,94.3,,,,,,,Fee Schedule,94.3,269.95,
99211 LEVEL I VISIT CHARGE,9319019,LOCAL,99211,CPT,,,,,,Outpatient,,,348.41,226,Viva Med ADV,Viva Med ADV,7.37,,,,,,,Fee Schedule,7.37,7.37,
99211 Office Visit Established Pt. Level 1,10168485,LOCAL,99211,CPT,,,,,,Outpatient,,,348.41,226,Viva Med ADV,Viva Med ADV,7.37,,,,,,,Fee Schedule,7.37,7.37,
XR Scapula Left,1170401,LOCAL,73010,CPT,,,,,LT,Outpatient,,,348.57,187.28,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Scapula Right,1170403,LOCAL,73010,CPT,,,,,RT,Outpatient,,,348.57,187.28,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
Mycobacterium Slow Grower MIC QST,13864520,LOCAL,87186,CPT,,,,,,Outpatient,,,348.75,10.38,Viva Med ADV,Viva Med ADV,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
Mycobacterium Slow Grower MIC QSTC,13864520,LOCAL,87186,CPT,,,,,,Outpatient,,,348.75,10.38,Viva Med ADV,Viva Med ADV,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
CPAP Charge -> Subsequent,8365858,LOCAL,94660,CPT,,,,,,Outpatient,,,348.84,279,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,181.37,185.95,
17110 CRYOSURGERY REMOVAL OF LESIONS CHARGE,9038957,LOCAL,17110,CPT,,,,,,Outpatient,,,350,228,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
94625 PHY/QHP OP PULM RHB W/O MNTR,10470028,LOCAL,94625,CPT,,,,,,Outpatient,,,350,407,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,51.98,54.31,
11730 AVULSION OF NAIL PLATE SINGLE,8715870,LOCAL,11730,CPT,,,,,,Outpatient,,,350.01,228,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,95.93,863,
94618 PULMONARY STRESS TEST 6 MINUTE WALK,10440014,LOCAL,94618,CPT,,,,,,Outpatient,,,351.07,212,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,76.09,117.85,
linezolid 2 mg/mL-D5% intravenous solution 300 mL [CULL],11201931,LOCAL,J2020,CPT,,,,,,Outpatient,300,ML,352,,Viva Med ADV,Viva Med ADV,2.74,,,,,,,Fee Schedule,2.742,2.742,
RT CHARGE PFT -> Bedside Spirometry,8860673,LOCAL,94060,CPT,,,,,,Outpatient,,,353.43,230,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,149.57,284.7,
RT CHARGE PFT -> Spirometry before & after,5267139,LOCAL,94060,CPT,,,,,,Outpatient,,,353.43,230,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,149.57,284.7,
Alpha Subunit QSTC,9849271,LOCAL,83520,CPT,,,,,,Outpatient,,,354.33,20.72,Viva Med ADV,Viva Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
XR Spine Thoracic 2 Views,1170484,LOCAL,72070,CPT,,,,,,Outpatient,,,358.33,192.23,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
micafungin 50 mg intravenous injection [CULL],11220352,LOCAL,J2248,CPT,,,,,,Outpatient,1,EA,359.232,,Viva Med ADV,Viva Med ADV,0.25,,,,,,,Fee Schedule,0.249,122.4,
Acetylcholine Recept. Modulating Ab QSTC,13864533,LOCAL,86043,CPT,,,,,,Outpatient,,,360,14.46,Viva Med ADV,Viva Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
Adenovirus DNA Qual RT PCR QSTC,10100374,LOCAL,87798,CPT,,,,,,Outpatient,,,360,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"B.pertussis/para DNA,Ql Rl-Time PCR QSTC",8873570,LOCAL,87798,CPT,,,,,,Outpatient,,,360,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Bartonella Sp Ab IgG,IgM w/rf Titer QSTC",9777261,LOCAL,86611,CPT,,,,,,Outpatient,,,360,12.22,Viva Med ADV,Viva Med ADV,10.18,,,,,,,Fee Schedule,10.18,15.29,
Copeptin QSTC,9039409,LOCAL,86255,CPT,,,,,,Outpatient,,,360,14.46,Viva Med ADV,Viva Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
Hepatitis C Viral RNA Genotype LiPA QSTC,8764578,LOCAL,87902,CPT,,,,,,Outpatient,,,360,308.94,Viva Med ADV,Viva Med ADV,257.45,,,,,,,Fee Schedule,158.39,257.45,
Histamine QSTC,13864456,LOCAL,83088,CPT,,,,,,Outpatient,,,360,35.44,Viva Med ADV,Viva Med ADV,29.53,,,,,,,Fee Schedule,17.73,29.53,
HSV 1 QST,9775428,LOCAL,87529,CPT,,,,,,Outpatient,,,360,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
HSV 2 QST,9775429,LOCAL,87529,CPT,,,,,,Outpatient,,,360,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Mycobacterium Avium Complex MIC QST,13344174,LOCAL,87186,CPT,,,,,,Outpatient,,,360,10.38,Viva Med ADV,Viva Med ADV,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
methylPREDNISolone sodium succinate 2 g injection [CULL],11201958,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,361.92,,Viva Med ADV,Viva Med ADV,0.21,,,,,,,Fee Schedule,0.21,0.21,
XR Mandible Less Than 4 Views,1170303,LOCAL,70100,CPT,,,,,,Outpatient,,,362.58,194.7,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
Babesia microti Ab (IgG) QSTC,13872991,LOCAL,86753,CPT,,,,,,Outpatient,,,367.5,14.87,Viva Med ADV,Viva Med ADV,12.39,,,,,,,Fee Schedule,12.39,15.29,
Ehrlichia chaffeensis Ab IgG QSTC,13872999,LOCAL,86753,CPT,,,,,,Outpatient,,,367.5,14.87,Viva Med ADV,Viva Med ADV,12.39,,,,,,,Fee Schedule,12.39,15.29,
Lyme Ab Screen QSTC,13872998,LOCAL,86618,CPT,,,,,,Outpatient,,,367.5,20.44,Viva Med ADV,Viva Med ADV,17.03,,,,,,,Fee Schedule,15.29,17.03,
XR Clavicle Left,1170075,LOCAL,73000,CPT,,,,,LT,Outpatient,,,370.53,198.83,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Clavicle Right,1170077,LOCAL,73000,CPT,,,,,RT,Outpatient,,,370.53,198.83,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Humerus Limited Left,13554999,LOCAL,73060,CPT,,,,,52|LT,Outpatient,,,372.34,223.58,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Humerus Limited Right,13555002,LOCAL,73060,CPT,,,,,52|RT,Outpatient,,,372.34,223.58,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
Reptilase Clotting Time QSTC,13864513,LOCAL,85635,CPT,,,,,,Outpatient,,,372.42,11.82,Viva Med ADV,Viva Med ADV,9.85,,,,,,,Fee Schedule,8.21,9.85,
XR Tibia/Fibula Left,1170516,LOCAL,73590,CPT,,,,,LT,Outpatient,,,373.27,200.48,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Tibia/Fibula Right,1170518,LOCAL,73590,CPT,,,,,RT,Outpatient,,,373.27,200.48,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
27095 INJ PROC FOR HIP ARTHROGRAPHY W/ ANESTH,5661071,LOCAL,27095,CPT,,,,,,Outpatient,,,373.99,,Viva Med ADV,Viva Med ADV,64.91,,,,,,,Fee Schedule,64.91,863,
"64454 - Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imagin",12897048,LOCAL,64454,CPT,,,,,,Outpatient,,,375,244,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
"64454 Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging",9520502,LOCAL,64454,CPT,,,,,,Outpatient,,,375,244,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
caspofungin 50 mg intravenous injection [CULL],11201273,LOCAL,J0637,CPT,,,,,,Outpatient,1,EA,376,,Viva Med ADV,Viva Med ADV,3.82,,,,,,,Fee Schedule,3.818,3.818,
"Bill Only Adsorption (Pheno, Rest, Wrm)",13517195,LOCAL,86978,CPT,,,,,,Outpatient,,,378,,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,38.88,54.31,
"Bill Only Rare Unit, Outside Search",13517199,LOCAL,86999,CPT,,,,,,Outpatient,,,378,,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,6.29,22.39,
tuberculin purified protein derivative 5 tuberculin units/0.1 mL intradermal solution 1 mL [CULL],11200764,LOCAL,86580,CPT,,,,,,Outpatient,1,ML,379.84,,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,15.29,22.39,
"SureSwab(R) Trich. Vag. RNA,QL TMA QSTC",8853247,LOCAL,87661,CPT,,,,,,Outpatient,,,382.5,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Trichomonas Vaginalis RNA, Ql, TMA QST",8853247,LOCAL,87661,CPT,,,,,,Outpatient,,,382.5,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
XR Femur 1 View Left,7520564,LOCAL,73551,CPT,,,,,LT,Outpatient,,,382.59,205.43,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Femur 1 View Right,7520567,LOCAL,73551,CPT,,,,,RT,Outpatient,,,382.59,205.43,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
Hereditary Hemochroma DNA Mut Analy QSTC,8764601,LOCAL,81256,CPT,,,,,,Outpatient,,,387,78.43,Viva Med ADV,Viva Med ADV,65.36,,,,,,,Fee Schedule,63.34,65.36,
Bill Only Absorption,7967780,LOCAL,86978,CPT,,,,,,Outpatient,,,391.5,,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,38.88,54.31,
Food and Tree Nut Allergy Panel QSTC,14884175,LOCAL,86003,CPT,,,,,,Outpatient,,,393.21,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
99282 - Level 2,2644298,LOCAL,99282,CPT,,,,,25,Outpatient,,,393.64,256,Viva Med ADV,Viva Med ADV,144.78,,,,,,,Fee Schedule,144.78,144.78,
BRACE COOL X-ACT DON-JOY (USE),4852073,LOCAL,,,L1833,HCPCS,,,,Outpatient,,,394.02,994,Viva Med ADV,Viva Med ADV,556.31,,,,,,,Fee Schedule,556.31,556.31,
93797 Cardiac Rehab without ECG monitoring,10411210,LOCAL,93797,CPT,,,,,,Outpatient,,,394.32,256,Viva Med ADV,Viva Med ADV,115.11,,,,,,,Fee Schedule,115.11,219.28,
93798 Cardiac Rehab Phase II,10411000,LOCAL,93798,CPT,,,,,,Outpatient,,,394.32,256,Viva Med ADV,Viva Med ADV,115.11,,,,,,,Fee Schedule,115.11,219.28,
DUP ARTERIAL & VENOUS MAPPING UNI,8200502,LOCAL,93986,CPT,,,,,,Outpatient,,,395.6,257,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Vein Mapping Lower Extremity Left,12175098,LOCAL,93986,CPT,,,,,LT,Outpatient,,,395.6,257,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Vein Mapping Lower Extremity Right,12175101,LOCAL,93986,CPT,,,,,RT,Outpatient,,,395.6,257,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Vein Mapping Upper Extremity Left,12175107,LOCAL,93986,CPT,,,,,LT,Outpatient,,,395.6,257,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Vein Mapping Upper Extremity Right,12175110,LOCAL,93986,CPT,,,,,RT,Outpatient,,,395.6,257,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
caspofungin 70 mg intravenous injection [CULL],11201274,LOCAL,J0637,CPT,,,,,,Outpatient,1,EA,396,,Viva Med ADV,Viva Med ADV,3.82,,,,,,,Fee Schedule,3.818,3.818,
71046 XR Chest 2 Views: AddOn,13632841,LOCAL,71046,CPT,,,,,,Outpatient,,,397.38,212.85,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Chest 2 Views,689607,LOCAL,71046,CPT,,,,,,Outpatient,,,397.38,212.85,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
Heparin Anti-Xa QSTC,8972922,LOCAL,85520,CPT,,,,,,Outpatient,,,400.5,15.71,Viva Med ADV,Viva Med ADV,13.09,,,,,,,Fee Schedule,5.42,13.09,
XR Abdomen KUB 1 View,1169926,LOCAL,74018,CPT,,,,,,Outpatient,,,401.12,215.33,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Knee 1 or 2 Views Left,1170263,LOCAL,73560,CPT,,,,,LT,Outpatient,,,401.12,215.33,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Knee 1 or 2 Views Right,1170265,LOCAL,73560,CPT,,,,,RT,Outpatient,,,401.12,215.33,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
21- Hydroxylase Antibody QSTC,9708927,LOCAL,83516,CPT,,,,,,Outpatient,,,402.53,13.84,Viva Med ADV,Viva Med ADV,11.53,,,,,,,Fee Schedule,11.53,17.73,
"96360 - Hydration, first hour",1928297,LOCAL,96360,CPT,,,,,,Outpatient,,,403.29,262,Viva Med ADV,Viva Med ADV,192.63,,,,,,,Fee Schedule,192.63,442.94,
"96360 IV HYDRATION, INITIAL 31-90 MINS",7904529,LOCAL,96360,CPT,,,,,,Outpatient,,,403.29,262,Viva Med ADV,Viva Med ADV,192.63,,,,,,,Fee Schedule,192.63,442.94,
Inhibin B QSTC,6210082,LOCAL,83520,CPT,,,,,,Outpatient,,,405,20.72,Viva Med ADV,Viva Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rituxan Sensitivity (CD20) QSTC,13864421,LOCAL,86356,CPT,,,,,,Outpatient,,,405,32.14,Viva Med ADV,Viva Med ADV,26.78,,,,,,,Fee Schedule,15.29,26.78,
XR Hip 1 View Left,1170225,LOCAL,73501,CPT,,,,,LT,Outpatient,,,407.12,218.63,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 1 View Right,1170227,LOCAL,73501,CPT,,,,,RT,Outpatient,,,407.12,218.63,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
A. phagocytophilum Ab IgG IgM QSTC,13864527,LOCAL,86666,CPT,,,,,,Outpatient,,,407.25,12.22,Viva Med ADV,Viva Med ADV,10.18,,,,,,,Fee Schedule,10.18,15.29,
XR Bone Length Studies Scanograms,1170016,LOCAL,77073,CPT,,,,,,Outpatient,,,407.59,218.63,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
DOP ABI-ANKLE BRACHIAL INDEX,8230017,LOCAL,93922,CPT,,,,,,Outpatient,,,408.25,265,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,117.85,161.71,
US ABI,8206802,LOCAL,93922,CPT,,,,,,Outpatient,,,408.25,265,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,117.85,161.71,
US Segmental Pressures LE 1-2 Lvls Bilat,1169757,LOCAL,93922,CPT,,,,,,Outpatient,,,408.25,265,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,117.85,161.71,
XR Sacrum/Coccyx 2+ Views,1170391,LOCAL,72220,CPT,,,,,,Outpatient,,,408.83,219.45,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Sniff Test,8602547,LOCAL,71046,CPT,,,,,,Outpatient,,,409.11,212.85,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Sternoclavicular Joint(s),1170494,LOCAL,71130,CPT,,,,,,Outpatient,,,411.41,220.28,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
Bill Only Antigen Type Group 1,13517191,LOCAL,86902,CPT,,,,,,Outpatient,,,414,7.62,Viva Med ADV,Viva Med ADV,328.88,,,,,,,Fee Schedule,6.29,328.88,
Proinsulin QSTC,8972777,LOCAL,84206,CPT,,,,,,Outpatient,,,414,32.03,Viva Med ADV,Viva Med ADV,26.69,,,,,,,Fee Schedule,18.43,26.69,
XR Elbow Complete 3+ Views Left,1170127,LOCAL,73080,CPT,,,,,LT,Outpatient,,,414.29,221.93,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Elbow Complete 3+ Views Right,1170129,LOCAL,73080,CPT,,,,,RT,Outpatient,,,414.29,221.93,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
DOPP ART EXT BIL MULTIPLE,8200300,LOCAL,93923,CPT,,,,,,Outpatient,,,414.94,401,Viva Med ADV,Viva Med ADV,143.05,,,,,,,Fee Schedule,143.05,244.97,
DOPP ART EXT BIL W/EXERCISE,8200310,LOCAL,93924,CPT,,,,,,Outpatient,,,414.94,302,Viva Med ADV,Viva Med ADV,143.05,,,,,,,Fee Schedule,143.05,161.71,
XR Shoulder Complete 2 Plus Views Left,1170415,LOCAL,73030,CPT,,,,,LT,Outpatient,,,416.12,222.75,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Shoulder Complete 2 Plus Views Right,1170417,LOCAL,73030,CPT,,,,,RT,Outpatient,,,416.12,222.75,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Femur 2 Views Left,7520570,LOCAL,73552,CPT,,,,,LT,Outpatient,,,417.02,223.58,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Femur 2 Views Right,7520573,LOCAL,73552,CPT,,,,,RT,Outpatient,,,417.02,223.58,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Humerus Left,1170245,LOCAL,73060,CPT,,,,,LT,Outpatient,,,417.02,223.58,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Humerus Right,1170247,LOCAL,73060,CPT,,,,,RT,Outpatient,,,417.02,223.58,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 1 View w/ AP Pelvis Left,7520576,LOCAL,73501,CPT,,,,,LT,Outpatient,,,418.32,218.63,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 1 View w/ AP Pelvis Right,7520579,LOCAL,73501,CPT,,,,,RT,Outpatient,,,418.32,218.63,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
15272 APP SKN SUB GRFT TAL 100 SQ CM ADDT FAC CHARGE,12831013,LOCAL,15272,CPT,,,,,,Outpatient,,,419.53,273,Viva Med ADV,Viva Med ADV,13.68,,,,,,,Fee Schedule,13.68,2862.92,
"epoetin alfa-epbx 10,000 units/mL preservative-free injectable solution 1 mL [CULL]",11202387,LOCAL,Q5105,CPT,,,,,,Outpatient,1,ML,423.552,,Viva Med ADV,Viva Med ADV,0.79,,,,,,,Fee Schedule,0.79,233.26,
"11055 BENIGN LESION PARING/CUTTING, SINGLE",13043366,LOCAL,11055,CPT,,,,,,Outpatient,,,426.97,278,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
"Enterovirus RNA, QL Real-Time PCR QSTC",8873564,LOCAL,87498,CPT,,,,,,Outpatient,,,427.5,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
CULL US Echo Dop w/ Spectr Ltd,13734793,LOCAL,93321,CPT,,,,,,Outpatient,,,428.24,278,Viva Med ADV,Viva Med ADV,15.78,,,,,,,Fee Schedule,15.78,678.38,
ECHO DOP W/SPECTR LTD,8200175,LOCAL,93321,CPT,,,,,,Outpatient,,,428.24,278,Viva Med ADV,Viva Med ADV,15.78,,,,,,,Fee Schedule,15.78,678.38,
CPAP Charge -> Initial,8365859,LOCAL,94660,CPT,,,,,,Outpatient,,,429.93,279,Viva Med ADV,Viva Med ADV,185.95,,,,,,,Fee Schedule,181.37,185.95,
"S. pneumoniae Ab (IgG), MAID QSTC",13864418,LOCAL,87899,CPT,,,,,,Outpatient,,,431.1,19.28,Viva Med ADV,Viva Med ADV,16.07,,,,,,,Fee Schedule,10.57,16.07,
XR Foot Complete 3 Plus Views Left,1170191,LOCAL,73630,CPT,,,,,LT,Outpatient,,,431.43,231,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Foot Complete 3 plus Views Right,1170193,LOCAL,73630,CPT,,,,,RT,Outpatient,,,431.43,231,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
ER US VASCULAR ACCESS GUIDANCE,8200565,LOCAL,76937,CPT,,,,,,Outpatient,,,431.69,231.83,Viva Med ADV,Viva Med ADV,23.28,,,,,,,Fee Schedule,23.28,165.47,
US VASCULAR ACCESS GUIDANCE,8200560,LOCAL,76937,CPT,,,,,,Outpatient,,,431.69,231.83,Viva Med ADV,Viva Med ADV,23.28,,,,,,,Fee Schedule,23.28,165.47,
E0181 RBC CPD 500 LR,7266548,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Viva Med ADV,Viva Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E0226 RBC CPDA1 500 LR,7266556,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Viva Med ADV,Viva Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E0366 RBC CP2D AS3 500,7266579,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Viva Med ADV,Viva Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E0382 RBC CP2D AS3 500 LR,7266659,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Viva Med ADV,Viva Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E0424 RBC CPD AS5 500 LR,7266667,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Viva Med ADV,Viva Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E4531 Aph RBC ACDA AS1 LR,7266601,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Viva Med ADV,Viva Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E4532 Aph RBC ACDA AS1 LR 1,7266602,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Viva Med ADV,Viva Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E4533 Aph RBC ACDA AS1 LR 2,7266603,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Viva Med ADV,Viva Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E4543 Aph RBC ACDA AS3 LR,7266613,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Viva Med ADV,Viva Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E4544 Aph RBC ACDA AS3 LR 1,7266614,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Viva Med ADV,Viva Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E4545 Aph RBC ACDA AS3 LR 2,7266615,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Viva Med ADV,Viva Med ADV,182,,,,,,,Fee Schedule,182,217.45,
E5157 RBC CPD AS1 LR LV,8069011,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Viva Med ADV,Viva Med ADV,182,,,,,,,Fee Schedule,182,217.45,
XR Hip 2-3 Views Left,7520582,LOCAL,73502,CPT,,,,,LT,Outpatient,,,434.37,232.65,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 2-3 Views Right,7520585,LOCAL,73502,CPT,,,,,RT,Outpatient,,,434.37,232.65,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
fondaparinux 7.5 mg/0.6 mL subcutaneous solution 0.6 mL [CULL],11260585,LOCAL,J1652,CPT,,,,,,Outpatient,0.6,ML,434.56,,Viva Med ADV,Viva Med ADV,0.88,,,,,,,Fee Schedule,0.877,0.877,
XR Ankle Complete 3 Plus Views Left,1169942,LOCAL,73610,CPT,,,,,LT,Outpatient,,,434.8,233.48,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ankle Complete 3 Plus Views Right,1169944,LOCAL,73610,CPT,,,,,RT,Outpatient,,,434.8,233.48,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hand Complete 3 Plus Views Right,1170223,LOCAL,73130,CPT,,,,,RT,Outpatient,,,438.91,235.13,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hand Complete 3 Views Left,1170221,LOCAL,73130,CPT,,,,,LT,Outpatient,,,438.91,235.13,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
E0336 RBC CPD AS1 500 LR,7266574,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,439,282,Viva Med ADV,Viva Med ADV,182,,,,,,,Fee Schedule,182,217.45,
11056 BENIGN LESION PARING(2-4),13029575,LOCAL,11056,CPT,,,,,,Outpatient,,,439.05,285,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
11103 TANGENTIAL BIOP EA ADDT CHARGE,9322081,LOCAL,11103,CPT,,,,,,Outpatient,,,439.05,285,Viva Med ADV,Viva Med ADV,16.62,,,,,,,Fee Schedule,16.62,863,
11721 DEBRIDE NAIL 6 OR MORE WC CHARGE,8726776,LOCAL,11721,CPT,,,,,,Outpatient,,,439.05,285,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,54.31,863,
97602 DEBRIDE MAGGOT THERAPY NON-EXC,11633062,LOCAL,97602,CPT,,,,,,Outpatient,,,439.05,285,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,549.61,
97605 Wound VAC <=50 sq cm,10015643,LOCAL,97605,CPT,,,,,,Outpatient,,,439.05,285,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,273.27,
XR Sacroiliac Joints 3+ Views,1170387,LOCAL,72202,CPT,,,,,,Outpatient,,,440.26,235.95,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
BD Bone Density DEXA Axial w/Frac Assess,5017920,LOCAL,77085,CPT,,,,,,Outpatient,,,442.63,237.6,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,116.02,
US PSEUDOANEURYSM COMPRESSION,8200520,LOCAL,76936,CPT,,,,,,Outpatient,,,443.14,237.6,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,262.79,284.7,
US Pseudoaneurysm Compression Repair,7936316,LOCAL,76936,CPT,,,,,,Outpatient,,,443.14,237.6,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,262.79,284.7,
XR Sinuses Paranasal Complete,1170434,LOCAL,70220,CPT,,,,,,Outpatient,,,445.06,238.43,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
92523 SPEECH SOUND LANGUAGE COMPREHENS CHARGE,9630058,LOCAL,92523,CPT,,,,,GN,Outpatient,,,445.57,290,Viva Med ADV,Viva Med ADV,214.08,,,,,,,Fee Schedule,214.08,337.75,
SLP Analysis of Voice & Resonance Minutes,7897211,LOCAL,92523,CPT,,,,,GN,Outpatient,,,445.57,290,Viva Med ADV,Viva Med ADV,214.08,,,,,,,Fee Schedule,103.27,337.75,
SLP Sound Prod w/ Lang Comp Eval Units,7897209,LOCAL,92523,CPT,,,,,GN,Outpatient,,,445.57,290,Viva Med ADV,Viva Med ADV,214.08,,,,,,,Fee Schedule,214.08,337.75,
Speech Sound Prod w/ Language Charge,7896929,LOCAL,92523,CPT,,,,,GN,Outpatient,,,445.57,290,Viva Med ADV,Viva Med ADV,214.08,,,,,,,Fee Schedule,214.08,337.75,
XR Hip 2-3 Views w/AP Pelvis Left,7520588,LOCAL,73502,CPT,,,,,LT,Outpatient,,,446.32,232.65,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 2-3 Views w/AP Pelvis Right,7520591,LOCAL,73502,CPT,,,,,RT,Outpatient,,,446.32,232.65,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
L3931 Forearm based radial nerve orthosis,9646083,LOCAL,,,L3931,HCPCS,,,GP,Outpatient,,,447.23,291,Viva Med ADV,Viva Med ADV,229.01,,,,,,,Fee Schedule,229.01,229.01,
L3931 OT WRIST HAND FINGER ORTHOSIS,9856104,LOCAL,,,L3931,HCPCS,,,,Outpatient,,,447.23,291,Viva Med ADV,Viva Med ADV,229.01,,,,,,,Fee Schedule,229.01,229.01,
L3931 Wrst/thmb Spic Spnt,9800062,LOCAL,,,L3931,HCPCS,,,,Outpatient,,,447.23,291,Viva Med ADV,Viva Med ADV,229.01,,,,,,,Fee Schedule,229.01,229.01,
US Breast Limited Left.,8068444,LOCAL,76642,CPT,,,,,LT,Outpatient,,,449.55,240.9,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,161.71,
US Breast Limited Right.,8068447,LOCAL,76642,CPT,,,,,RT,Outpatient,,,449.55,240.9,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,161.71,
pneumococcal 23-polyvalent vaccine injectable solution 0.5 mL [CULL],11212160,LOCAL,90732,CPT,,,,,,Outpatient,0.5,ML,449.59104,,Viva Med ADV,Viva Med ADV,133.47,,,,,,,Fee Schedule,39.58,133.472,
Adalimumab Level for IBD QSTC,13864453,LOCAL,80145,CPT,,,,,,Outpatient,,,450,46.28,Viva Med ADV,Viva Med ADV,38.57,,,,,,,Fee Schedule,15.38,38.57,
"Amino Acid Analysis, Plasma QSTC",9039235,LOCAL,82139,CPT,,,,,,Outpatient,,,450,20.24,Viva Med ADV,Viva Med ADV,16.87,,,,,,,Fee Schedule,16.87,17.73,
"BK Virus DNA, Quant, RT PCR, Ur QSTC",8764640,LOCAL,87799,CPT,,,,,,Outpatient,,,450,51.41,Viva Med ADV,Viva Med ADV,42.84,,,,,,,Fee Schedule,40.19,42.84,
CULL CV Nurse MRI Monitoring,14671862,LOCAL,76018,CPT,,,,,,Outpatient,,,450,75.9,Viva Med ADV,Viva Med ADV,83.92,,,,,,,Fee Schedule,83.92,83.92,
Histamine Release Chronic Urticaria QSTC,8764646,LOCAL,86343,CPT,,,,,,Outpatient,,,450,14.95,Viva Med ADV,Viva Med ADV,12.46,,,,,,,Fee Schedule,12.46,15.29,
Infliximab Anti-drug Antibody for IBD QSTC,12552286,LOCAL,83520,CPT,,,,,,Outpatient,,,450,20.72,Viva Med ADV,Viva Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Infliximab Level for IBD QSTC,13864454,LOCAL,80230,CPT,,,,,,Outpatient,,,450,46.28,Viva Med ADV,Viva Med ADV,38.57,,,,,,,Fee Schedule,15.38,38.57,
"Interleukin-6 (IL-6), Serum QSTC",9708918,LOCAL,83529,CPT,,,,,,Outpatient,,,450,20.72,Viva Med ADV,Viva Med ADV,17.27,,,,,,,Fee Schedule,17.27,17.73,
SJMC 76018 MR Safety Implant Electronics Preparation,14671862,LOCAL,76018,CPT,,,,,,Outpatient,,,450,75.9,Viva Med ADV,Viva Med ADV,83.92,,,,,,,Fee Schedule,83.92,83.92,
"VZV DNA, QL RT PCR QSTC",9777241,LOCAL,87798,CPT,,,,,,Outpatient,,,450,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"99202 LEVEL II INITIAL VISIT, FAC CHARGE",12832515,LOCAL,99202,CPT,,,,,,Outpatient,,,452.19,294,Viva Med ADV,Viva Med ADV,39.11,,,,,,,Fee Schedule,39.11,39.11,
99202 Office Visit New Pt. Level 2,10168481,LOCAL,99202,CPT,,,,,,Outpatient,,,452.19,294,Viva Med ADV,Viva Med ADV,39.11,,,,,,,Fee Schedule,39.11,39.11,
99212 LEVEL II VISIT CHARGE,9319021,LOCAL,99212,CPT,,,,,,Outpatient,,,452.19,294,Viva Med ADV,Viva Med ADV,29.48,,,,,,,Fee Schedule,29.48,29.48,
99212 Office Visit Established Pt. Level 2,10168486,LOCAL,99212,CPT,,,,,,Outpatient,,,452.19,294,Viva Med ADV,Viva Med ADV,29.48,,,,,,,Fee Schedule,29.48,29.48,
12001 SIMPLE REPAIR OF WOUND TRUNK,13029607,LOCAL,12001,CPT,,,,,,Outpatient,,,454.38,295,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
FIRST HOUR DIRECT OBSERVATION CHARGE,8566355,LOCAL,,,G0379,HCPCS,,,25,Outpatient,,,457.38,297,Viva Med ADV,Viva Med ADV,560.53,,,,,,,Fee Schedule,560.53,560.53,
CHOLANGIO W EXIST CATH S&I,8210339,LOCAL,47531,CPT,,,,,,Outpatient,,,458,298,Viva Med ADV,Viva Med ADV,3226.48,,,,,,,Fee Schedule,2599,3226.48,
esmolol 10 mg/mL-sterile water Sol 250 mL [CULL],11201727,LOCAL,J1806,CPT,,,,,,Outpatient,250,ML,458.88,,Viva Med ADV,Viva Med ADV,0.41,,,,,,,Fee Schedule,0.41,0.41,
Pregabalin QSTC,8853245,LOCAL,80299,CPT,,,,,,Outpatient,,,459,22.37,Viva Med ADV,Viva Med ADV,18.64,,,,,,,Fee Schedule,15.38,18.64,
29580 Application of a Paste Boot (Bilateral),12642335,LOCAL,29580,CPT,,,,,,Outpatient,,,462.53,301,Viva Med ADV,Viva Med ADV,144.26,,,,,,,Fee Schedule,144.26,863,
29580 PT UNNA BOOT APPL,9410275,LOCAL,29580,CPT,,,,,GP,Outpatient,,,462.53,301,Viva Med ADV,Viva Med ADV,144.26,,,,,,,Fee Schedule,144.26,863,
US EXT NONVASC COMPLETE,8230013,LOCAL,76881,CPT,,,,,,Outpatient,,,462.67,248.33,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US EXT NONVASC LIMITED ANATOMIC SPEC,8230014,LOCAL,76882,CPT,,,,,,Outpatient,,,462.67,248.33,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
Bill Only Elution,7967778,LOCAL,86860,CPT,,,,,,Outpatient,,,463.5,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.27,156.67,
XR Pelvis Complete 3+ Views,1170353,LOCAL,72190,CPT,,,,,,Outpatient,,,463.51,248.33,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
DOP ART - LEA W/ TREADMILL,8230021,LOCAL,93924,CPT,,,,,,Outpatient,,,465.08,302,Viva Med ADV,Viva Med ADV,143.05,,,,,,,Fee Schedule,143.05,161.71,
US Lower Ext Doppler w/ Stress Test,1169765,LOCAL,93924,CPT,,,,,,Outpatient,,,465.08,302,Viva Med ADV,Viva Med ADV,143.05,,,,,,,Fee Schedule,143.05,161.71,
XR Osseous Survey Infant,1170020,LOCAL,77076,CPT,,,,,,Outpatient,,,466.03,249.98,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Facial Bones < 3 Views,1170139,LOCAL,70140,CPT,,,,,,Outpatient,,,471.62,253.28,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Orbits Limited,13555005,LOCAL,70140,CPT,,,,,,Outpatient,,,471.62,253.28,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
US Hips Infant Limited/Static,8206871,LOCAL,76886,CPT,,,,,,Outpatient,,,472.34,253.28,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,161.71,
US Spinal Canal,1169879,LOCAL,76800,CPT,,,,,,Outpatient,,,472.34,253.28,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
Bill Only Rare Donor Fee,13517197,LOCAL,86999,CPT,,,,,,Outpatient,,,472.5,,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,6.29,22.39,
96373- Intra-Arterial Injection,1928304,LOCAL,96373,CPT,,,,,59,Outpatient,,,473.98,308,Viva Med ADV,Viva Med ADV,192.63,,,,,,,Fee Schedule,64.56,192.63,
96373 S-INJ NON CHEMO IA CHARGE,8049127,LOCAL,96373,CPT,,,,,59,Outpatient,,,473.98,308,Viva Med ADV,Viva Med ADV,192.63,,,,,,,Fee Schedule,64.56,192.63,
DOP VENOUS LOWER EXT UNILATERAL,8200430,LOCAL,93971,CPT,,,,,,Outpatient,,,476.32,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
DOP VENOUS UPPER EXT UNI OR LTD,8200431,LOCAL,93971,CPT,,,,,,Outpatient,,,476.32,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUP AO IVC ILIAC LIMITED,8200531,LOCAL,93979,CPT,,,,,,Outpatient,,,476.32,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Aorta IVC Iliac Duplex Limited,1169579,LOCAL,93979,CPT,,,,,,Outpatient,,,476.32,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Venous Duplex Left,1169771,LOCAL,93971,CPT,,,,,LT,Outpatient,,,476.32,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Venous Duplex Right,1169773,LOCAL,93971,CPT,,,,,RT,Outpatient,,,476.32,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Upper Ext Venous Duplex Left,1169903,LOCAL,93971,CPT,,,,,LT,Outpatient,,,476.32,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Upper Ext Venous Duplex Right,1169905,LOCAL,93971,CPT,,,,,RT,Outpatient,,,476.32,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUP AV FISTULA OR DIALYSIS GRAFT,8200500,LOCAL,93990,CPT,,,,,,Outpatient,,,476.33,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUPLEX ARTERAL UPPER EXT UNI OR LTD,8200490,LOCAL,93931,CPT,,,,,,Outpatient,,,476.33,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUPLEX ARTERIAL LOWER EXT UNI OR LTD,8200470,LOCAL,93926,CPT,,,,,,Outpatient,,,476.33,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Hemodialysis Duplex Access Lt,8206865,LOCAL,93990,CPT,,,,,,Outpatient,,,476.33,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Hemodialysis Duplex Access Rt,8206868,LOCAL,93990,CPT,,,,,RT,Outpatient,,,476.33,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Arterial Duplex Left,1169761,LOCAL,93926,CPT,,,,,LT,Outpatient,,,476.33,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Arterial Duplex Right,1169763,LOCAL,93926,CPT,,,,,RT,Outpatient,,,476.33,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Upper Ext Arterial Duplex Left,1169897,LOCAL,93931,CPT,,,,,LT,Outpatient,,,476.33,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Upper Ext Arterial Duplex Right,1169899,LOCAL,93931,CPT,,,,,RT,Outpatient,,,476.33,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
DAPTOmycin 500 mg intravenous injection [CULL],11210536,LOCAL,J0878,CPT,,,,,,Outpatient,1,EA,480,480,Viva Med ADV,Viva Med ADV,0.03,,,,,,,Fee Schedule,0.01,122.4,
CULL MG Needle/Wire Loc Breast,13720943,LOCAL,19281,CPT,,,,,,Outpatient,,,481.51,313,Viva Med ADV,Viva Med ADV,1481.32,,,,,,,Fee Schedule,1200.99,1496,
MG Mammo Guided Needle Loc Left,8206592,LOCAL,19281,CPT,,,,,LT,Outpatient,,,481.51,313,Viva Med ADV,Viva Med ADV,1481.32,,,,,,,Fee Schedule,1200.99,1496,
MG Mammo Guided Needle Loc Right,8206595,LOCAL,19281,CPT,,,,,RT,Outpatient,,,481.51,313,Viva Med ADV,Viva Med ADV,1481.32,,,,,,,Fee Schedule,1200.99,1496,
Bill Tissue Exam Level 6,14048000,LOCAL,88309,CPT,,,,,,Outpatient,,,485.96,,Viva Med ADV,Viva Med ADV,746.86,,,,,,,Fee Schedule,59.06,746.86,
IA-2 Antibody QSTC,9039410,LOCAL,86341,CPT,,,,,,Outpatient,,,486,28.28,Viva Med ADV,Viva Med ADV,23.57,,,,,,,Fee Schedule,15.29,23.57,
Low LSO,9400072,LOCAL,,,L0642,HCPCS,,,,Outpatient,,,486.86,,Viva Med ADV,Viva Med ADV,319.33,,,,,,,Fee Schedule,319.33,319.33,
96422 CHEMO ARTERIAL INFUS UP TO 1HR CHARGE,9404492,LOCAL,96422,CPT,,,,,,Outpatient,,,488.94,318,Viva Med ADV,Viva Med ADV,303.25,,,,,,,Fee Schedule,303.25,442.94,
L3933 OT FINGER ORTHOSIS,9856060,LOCAL,,,L3933,HCPCS,,,,Outpatient,,,488.97,318,Viva Med ADV,Viva Med ADV,239.92,,,,,,,Fee Schedule,239.92,239.92,
Bill Only Reticulocyte Separation,8629513,LOCAL,86972,CPT,,,,,,Outpatient,,,490.5,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.88,156.67,
"11105 Punch Biopsy of Skin, Ea Separate/Additional CRRH_GA",13243078,LOCAL,11105,CPT,,,,,,Outpatient,,,491.38,319,Viva Med ADV,Viva Med ADV,19.82,,,,,,,Fee Schedule,19.82,863,
A. phagocytophilum/E chaffeensis Ab QSTC,13864420,LOCAL,86666,CPT,,,,,,Outpatient,,,492.75,12.22,Viva Med ADV,Viva Med ADV,10.18,,,,,,,Fee Schedule,10.18,15.29,
XR Spine Cervical 2 or 3 Views,1170452,LOCAL,72040,CPT,,,,,,Outpatient,,,496.68,266.48,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
96125 ST-COGNITIVE TEST PER 1HR,9630086,LOCAL,96125,CPT,,,,,GN,Outpatient,,,497.34,323,Viva Med ADV,Viva Med ADV,96.7,,,,,,,Fee Schedule,96.7,846.56,
SLP Cognitive Test Units,7897180,LOCAL,96125,CPT,,,,,GN,Outpatient,,,497.34,323,Viva Med ADV,Viva Med ADV,96.7,,,,,,,Fee Schedule,96.7,846.56,
Standardized Cognitive Eval Charge,7897180,LOCAL,96125,CPT,,,,,GN,Outpatient,,,497.34,323,Viva Med ADV,Viva Med ADV,96.7,,,,,,,Fee Schedule,96.7,846.56,
"45300 PROCTOSIGMOIDOSCOPY, RIGID, DIAGNOSTIC, W OR W/O COLLECTION BY BRUSHING OR WASHING",8934255,LOCAL,45300,CPT,,,,,,Outpatient,,,498,129,Viva Med ADV,Viva Med ADV,833.54,,,,,,,Fee Schedule,833.54,1419.32,
BD Bone Density DEXA Axial Skeleton,1167839,LOCAL,77080,CPT,,,,,,Outpatient,,,499.09,267.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,116.02,
OASIS MATRIX WOUND 3X3.5,13962593,LOCAL,,,Q4102,HCPCS,,,,Outpatient,,,501.86,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
G0463 CR REHAB ASSESSMENT CHARGE,10470016,LOCAL,,,G0463,HCPCS,,,,Outpatient,,,502.12,326,Viva Med ADV,Viva Med ADV,117.82,,,,,,,Fee Schedule,117.82,117.82,
G0463 HOSPITAL OP CLINIC VISIT W PROC MCR ONLY,13436347,LOCAL,,,G0463,HCPCS,,,25,Outpatient,,,502.12,326,Viva Med ADV,Viva Med ADV,117.82,,,,,,,Fee Schedule,117.82,117.82,
G0463 HOSPITAL OUTPATIENT VISIT CHARGE,10470015,LOCAL,,,G0463,HCPCS,,,25,Outpatient,,,502.12,326,Viva Med ADV,Viva Med ADV,117.82,,,,,,,Fee Schedule,117.82,117.82,
G0463 OUTPATIENT CLINIC VISIT,13043743,LOCAL,,,G0463,HCPCS,,,25,Outpatient,,,502.12,326,Viva Med ADV,Viva Med ADV,117.82,,,,,,,Fee Schedule,117.82,117.82,
IVUS ADDL VESSEL,8230049,LOCAL,92979,CPT,,,,,,Outpatient,,,506,329,Viva Med ADV,Viva Med ADV,130.59,,,,,,,Fee Schedule,130.59,863,
"Susceptibility Aerobic Bacteria,MIC QSTC",9039459,LOCAL,87186,CPT,,,,,,Outpatient,,,506.25,10.38,Viva Med ADV,Viva Med ADV,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
"Susceptibility, Aerobic Bacterium QST",8389539,LOCAL,87186,CPT,,,,,,Outpatient,,,506.25,10.38,Viva Med ADV,Viva Med ADV,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
Administration of Blood (Bridge),8019084,LOCAL,36430,CPT,,,,,,Outpatient,,,509,99,Viva Med ADV,Viva Med ADV,399.7,,,,,,,Fee Schedule,399.7,863,
TRANSFUSE Fresh Frozen Plasma (Bridge),8482691,LOCAL,36430,CPT,,,,,,Outpatient,,,509,99,Viva Med ADV,Viva Med ADV,399.7,,,,,,,Fee Schedule,399.7,863,
TRANSFUSE Platelet Product (Bridge),8482692,LOCAL,36430,CPT,,,,,,Outpatient,,,509,99,Viva Med ADV,Viva Med ADV,399.7,,,,,,,Fee Schedule,399.7,863,
TRANSFUSE Red Blood Cells Leukoreduced (Bridge),8482690,LOCAL,36430,CPT,,,,,,Outpatient,,,509,99,Viva Med ADV,Viva Med ADV,399.7,,,,,,,Fee Schedule,399.7,863,
XR Nasal Bones 3+ Views,1170329,LOCAL,70160,CPT,,,,,,Outpatient,,,510.81,273.9,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
"Bill Only RBC Pretreatment, Chemicals",8629511,LOCAL,86970,CPT,,,,,,Outpatient,,,513,,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,38.88,54.31,
"Bill Only RBC Pretreatment, Enyzme",8629512,LOCAL,86971,CPT,,,,,,Outpatient,,,513,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.88,156.67,
XR Arthrogram Injection Ankle Left,1169950,LOCAL,20605,CPT,,,,,LT,Outpatient,,,517.48,336,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrogram Injection Ankle Right,1169952,LOCAL,20605,CPT,,,,,RT,Outpatient,,,517.48,336,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrogram Injection Elbow Right,1169958,LOCAL,20605,CPT,,,,,RT,Outpatient,,,517.48,336,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrogram Injection Wrist Left,1169996,LOCAL,20605,CPT,,,,,LT,Outpatient,,,517.48,336,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrogram Injection Wrist Right,1169998,LOCAL,20605,CPT,,,,,RT,Outpatient,,,517.48,336,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
IMPLANT ALLODERM 1/2,13962573,LOCAL,,,Q4116,HCPCS,,,,Outpatient,,,517.5,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
ECHO DOP COLOR FLOW MAPPING,8200220,LOCAL,93325,CPT,,,,,,Outpatient,,,517.63,336,Viva Med ADV,Viva Med ADV,17.83,,,,,,,Fee Schedule,17.83,161.71,
XR Spine Lumbosacral 2 or 3 Views,1170470,LOCAL,72100,CPT,,,,,,Outpatient,,,520.24,278.85,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
"G0399 HOME SLEEP STUDY, CHARGE",8303751,LOCAL,,,G0399,HCPCS,,,,Outpatient,,,523.26,340,Viva Med ADV,Viva Med ADV,143.05,,,,,,,Fee Schedule,143.05,206.62,
11057 BENIGN LESION PARING(4+),13029576,LOCAL,11057,CPT,,,,,,Outpatient,,,523.3,340,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
16030 Dressing/Debridement Large More than one ext or >10% total body,9400041,LOCAL,16030,CPT,,,,,,Outpatient,,,523.3,863,Viva Med ADV,Viva Med ADV,365.27,,,,,,,Fee Schedule,365.27,863,
15276 APPL-HC SKSB GRT F/N/H/G-AD 25CM CHARGE,9709030,LOCAL,15276,CPT,,,,,,Outpatient,,,526.26,342,Viva Med ADV,Viva Med ADV,20.61,,,,,,,Fee Schedule,20.61,2862.92,
XR Knee 3 Views Left,1170269,LOCAL,73562,CPT,,,,,LT,Outpatient,,,527.77,282.98,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Knee 3 Views Right,1170271,LOCAL,73562,CPT,,,,,RT,Outpatient,,,527.77,282.98,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Barium Swallow,9756897,LOCAL,74220,CPT,,,,,,Outpatient,,,527.78,282.98,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,83.69,162.76,
XR Swallowing Function w/ Speech,1170500,LOCAL,74230,CPT,,,,,,Outpatient,,,527.78,282.98,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
RT CHARGE PFT -> Bronchoprovocation,5267129,LOCAL,94070,CPT,,,,,,Outpatient,,,530,345,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,149.57,284.7,
Ertapenem Sodium 1 gram intravenous injection [CULL],11201820,LOCAL,J1335,CPT,,,,,,Outpatient,1,EA,532.992,,Viva Med ADV,Viva Med ADV,9.16,,,,,,,Fee Schedule,9.16,9.16,
XR Mandible Complete 4+ Views,1170301,LOCAL,70110,CPT,,,,,,Outpatient,,,533.23,286.28,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Facial Bones 3+ Views,1170141,LOCAL,70150,CPT,,,,,,Outpatient,,,533.25,286.28,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Skull < 4 Views,1170436,LOCAL,70250,CPT,,,,,,Outpatient,,,533.25,286.28,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Hips 3-4 Views Bilat,7520612,LOCAL,73522,CPT,,,,,,Outpatient,,,534.2,286.28,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Hips 3-4 Views w/AP Pelvis Bilat,7520615,LOCAL,73522,CPT,,,,,,Outpatient,,,534.2,286.28,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
93799 INPATIENT TEACH CARDIAC REHAB CHARGE,8230066,LOCAL,93799,CPT,,,,,,Outpatient,,,535.14,348,Viva Med ADV,Viva Med ADV,143.05,,,,,,,Fee Schedule,38.53,863,
XR Wrist Complete 3 Plus Views Right,1170614,LOCAL,73110,CPT,,,,,RT,Outpatient,,,538.7,288.75,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Wrist Complete 3+ Views Left,1170612,LOCAL,73110,CPT,,,,,LT,Outpatient,,,538.7,288.75,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
"COVID-19, Respiratory Panel 2.1(Biofire)",9624028,LOCAL,0202U,CPT,,,,,,Outpatient,,,540,500.14,Viva Med ADV,Viva Med ADV,443.38,,,,,,,Fee Schedule,173.68,443.38,
Bill Only Antigen Type Group 2,10312940,LOCAL,86902,CPT,,,,,,Outpatient,,,544.5,7.62,Viva Med ADV,Viva Med ADV,328.88,,,,,,,Fee Schedule,6.29,328.88,
XR Abdomen 2 Views,8132826,LOCAL,74019,CPT,,,,,,Outpatient,,,546.49,292.88,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
L3807 Tko Splint,9646038,LOCAL,,,L3807,HCPCS,,,,Outpatient,,,549.15,357,Viva Med ADV,Viva Med ADV,281.19,,,,,,,Fee Schedule,281.19,281.19,
96132 NEUROPSYCH TESTING EVAL; FIRST HOUR CHARGE,9496220,LOCAL,96132,CPT,,,,,,Outpatient,,,549.45,357,Viva Med ADV,Viva Med ADV,485.11,,,,,,,Fee Schedule,485.11,846.56,
XR Spine Cervical 4 or 5 Views,1170454,LOCAL,72050,CPT,,,,,,Outpatient,,,552.95,296.18,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
albumin human 25% intravenous solution 100 mL [CULL],11281015,LOCAL,P9047,CPT,,,,,,Outpatient,100,ML,552.96,,Viva Med ADV,Viva Med ADV,53.08,,,,,,,Fee Schedule,53.077,217.45,
G0277 HBO Full Body 30 Min Interval,10015694,LOCAL,,,G0277,HCPCS,,,,Outpatient,,,553.52,360,Viva Med ADV,Viva Med ADV,126.08,,,,,,,Fee Schedule,126.08,549.61,
XR Knee Complete 4 Plus Views Left,1170287,LOCAL,73564,CPT,,,,,LT,Outpatient,,,554.16,297,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Knee Complete 4 Plus Views Right,1170289,LOCAL,73564,CPT,,,,,RT,Outpatient,,,554.16,297,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
"penicillin G benzathine 600,000 units/mL intramuscular suspension 1 mL [CULL]",11202082,LOCAL,J0561,CPT,,,,,,Outpatient,1,ML,558.848,,Viva Med ADV,Viva Med ADV,30.01,,,,,,,Fee Schedule,30.01,122.4,
ADAMTS13 Activity w/Rfx Inhibitor QSTC,9777262,LOCAL,85397,CPT,,,,,,Outpatient,,,562.5,37.03,Viva Med ADV,Viva Med ADV,30.86,,,,,,,Fee Schedule,26.47,30.86,
"Chromosome Analysis, Blood QSTC",8848485,LOCAL,88262,CPT,,,,,,Outpatient,,,562.5,150.59,Viva Med ADV,Viva Med ADV,125.49,,,,,,,Fee Schedule,63.34,125.49,
Clinical Indication: QSTC,8848484,LOCAL,88230,CPT,,,,,,Outpatient,,,562.5,139.79,Viva Med ADV,Viva Med ADV,116.49,,,,,,,Fee Schedule,58.01,116.49,
Kleihauer-Betke Stain QSTC,9956031,LOCAL,85460,CPT,,,,,,Outpatient,,,562.5,9.28,Viva Med ADV,Viva Med ADV,7.73,,,,,,,Fee Schedule,7.73,8.21,
Respirat. Allergy Profile Region VI QSTC,9039268,LOCAL,86003,CPT,,,,,,Outpatient,,,564.39,6.26,Viva Med ADV,Viva Med ADV,5.22,,,,,,,Fee Schedule,5.22,15.29,
Respirat. Allergy Profile Region VI QSTC,9041102,LOCAL,82785,CPT,,,,,,Outpatient,,,564.39,19.75,Viva Med ADV,Viva Med ADV,203.96,,,,,,,Fee Schedule,17.73,203.9616667,
Respiratory Allergy Panel Region VI with Reflexes QSTC,14884176,LOCAL,82785,CPT,,,,,,Outpatient,,,564.39,19.75,Viva Med ADV,Viva Med ADV,203.96,,,,,,,Fee Schedule,17.73,203.9616667,
XR Spine Thoracic 3 Views,1170486,LOCAL,72072,CPT,,,,,,Outpatient,,,567.43,304.43,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Ribs 2 Views Left,1170371,LOCAL,71100,CPT,,,,,LT,Outpatient,,,567.44,304.43,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ribs 2 Views Right,1170373,LOCAL,71100,CPT,,,,,RT,Outpatient,,,567.44,304.43,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
US Breast ABUS Left,8746657,LOCAL,76641,CPT,,,,,LT,Outpatient,,,571.63,306.9,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Breast ABUS Left.,8567804,LOCAL,76641,CPT,,,,,LT,Outpatient,,,571.63,306.9,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Breast ABUS Right.,8567807,LOCAL,76641,CPT,,,,,RT,Outpatient,,,571.63,306.9,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Breast Complete Left.,8068438,LOCAL,76641,CPT,,,,,LT,Outpatient,,,571.63,306.9,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Breast Complete Right.,8068441,LOCAL,76641,CPT,,,,,RT,Outpatient,,,571.63,306.9,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
Electrocardiogram 12 Lead,2322786,LOCAL,93005,CPT,,,,,,Outpatient,,,573,178,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,38.53,54.31,
99283 - Level 3,2644299,LOCAL,99283,CPT,,,,,25,Outpatient,,,578.6,376,Viva Med ADV,Viva Med ADV,253.15,,,,,,,Fee Schedule,253.15,253.15,
pneumococcal 21-valent conjugate vaccine (cvx 327) - Sus [CULL],11200021,LOCAL,90684,CPT,,,,,,Outpatient,0.5,ML,579.792,,Viva Med ADV,Viva Med ADV,344.25,,,,,,,Fee Schedule,160.4,344.252,
29581 APPL MULTLAY COMPRS LWR LEG,9739188,LOCAL,29581,CPT,,,,,,Outpatient,,,580.2,195,Viva Med ADV,Viva Med ADV,144.26,,,,,,,Fee Schedule,144.26,863,
XR Ribs 3 Views Bilateral,1170375,LOCAL,71110,CPT,,,,,,Outpatient,,,580.49,311.03,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Spine Thoracic 4+ Views,1170488,LOCAL,72074,CPT,,,,,,Outpatient,,,581.11,311.85,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Sinus Tract SI,2425614,LOCAL,76080,CPT,,,,,,Outpatient,,,583.56,312.68,Viva Med ADV,Viva Med ADV,501.29,,,,,,,Fee Schedule,176.48,501.29,
Bill Only Rare Unit,8196052,LOCAL,86999,CPT,,,,,,Outpatient,,,585,,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,6.29,22.39,
Oviduct chromotubation 58350,9093091,LOCAL,58350,CPT,,,,,,Outpatient,,,585,4936,Viva Med ADV,Viva Med ADV,4513.2,,,,,,,Fee Schedule,2599,4513.2,
ER ECHOCARDIOGRAM 2D LIMITED,8200203,LOCAL,93308,CPT,,,,,,Outpatient,,,586,564,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,678.38,
TRANSPAC REUSABLE CABLE 42661-03,8200204,LOCAL,93308,CPT,,,,,,Outpatient,,,586,564,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,678.38,
64445 NERV BLOCK SCIATIC,5661029,LOCAL,64445,CPT,,,,,,Outpatient,,,587.24,382,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
"FISH, Chromosome Specific 1 Pr QSTC",13864683,LOCAL,88271,CPT,,,,,,Outpatient,,,587.34,25.7,Viva Med ADV,Viva Med ADV,21.42,,,,,,,Fee Schedule,21.42,63.34,
Specimen Source: FISH Chrom Pr x1 QSTC,13864676,LOCAL,88273,CPT,,,,,,Outpatient,,,587.34,41.77,Viva Med ADV,Viva Med ADV,34.81,,,,,,,Fee Schedule,34.81,63.34,
rifAMPin 600 mg intravenous injection [CULL],11211144,LOCAL,J2804,CPT,,,,,,Outpatient,1,EA,587.52,,Viva Med ADV,Viva Med ADV,0.15,,,,,,,Fee Schedule,0.153,0.153,
REF Antibody ID,7032173,LOCAL,86870,CPT,,,,,,Outpatient,,,589.5,,Viva Med ADV,Viva Med ADV,328.88,,,,,,,Fee Schedule,38.27,328.88,
US Head Newborn,8206862,LOCAL,76506,CPT,,,,,,Outpatient,,,590.44,316.8,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
Very Long Chain Fatty Acids QSTC,8764801,LOCAL,82726,CPT,,,,,,Outpatient,,,590.63,23.7,Viva Med ADV,Viva Med ADV,19.75,,,,,,,Fee Schedule,17.73,19.75,
US Fetal Biophysical Profile w/ Non-Str,1169687,LOCAL,76818,CPT,,,,,,Outpatient,,,591.07,316.8,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,148.61,
99203  New Patient-Detailed,12642291,LOCAL,99203,CPT,,,,,,Outpatient,,,595.04,387,Viva Med ADV,Viva Med ADV,67.57,,,,,,,Fee Schedule,67.57,67.57,
99203 Office Visit New Pt. Level 3,10168482,LOCAL,99203,CPT,,,,,,Outpatient,,,595.04,387,Viva Med ADV,Viva Med ADV,67.57,,,,,,,Fee Schedule,67.57,67.57,
99203 Office Visit New Pt. Level 3,10168482,LOCAL,99203,CPT,,,,,,Outpatient,,,595.04,387,Viva Med ADV,Viva Med ADV,67.57,,,,,,,Fee Schedule,67.57,67.57,
99213 Established patient visit- level 3,7947777,LOCAL,99213,CPT,,,,,,Outpatient,,,595.04,387,Viva Med ADV,Viva Med ADV,54.77,,,,,,,Fee Schedule,54.77,54.77,
99213 Established patient visit- level 3,7947777,LOCAL,99213,CPT,,,,,,Outpatient,,,595.04,387,Viva Med ADV,Viva Med ADV,54.77,,,,,,,Fee Schedule,54.77,54.77,
99213 LEVEL III VISIT CHARGE,9319022,LOCAL,99213,CPT,,,,,,Outpatient,,,595.04,387,Viva Med ADV,Viva Med ADV,54.77,,,,,,,Fee Schedule,54.77,54.77,
99213 Office Visit Established Pt. Level 3,10168487,LOCAL,99213,CPT,,,,,,Outpatient,,,595.04,387,Viva Med ADV,Viva Med ADV,54.77,,,,,,,Fee Schedule,54.77,54.77,
LENS #SA60AT,4832535,LOCAL,,,V2632,HCPCS,,,,Outpatient,,,599.5,392,Viva Med ADV,Viva Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
"Creatinine, Random, Ur QSTC",13873086,LOCAL,82570,CPT,,,,,,Outpatient,,,599.63,6.22,Viva Med ADV,Viva Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"N-Methylhistamine, Random, Ur QSTC",13873083,LOCAL,82542,CPT,,,,,,Outpatient,,,599.63,28.91,Viva Med ADV,Viva Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.09,
XR Ribs w/ PA Chest Bilateral,1170377,LOCAL,71111,CPT,,,,,,Outpatient,,,601.59,322.58,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
36010 INTRO CATH SUP/INF VENA CAVA,8266890,LOCAL,36010,CPT,,,,,,Outpatient,,,604.59,393,Viva Med ADV,Viva Med ADV,87.95,,,,,,,Fee Schedule,87.95,929.12,
INTRO CATH VENA CAVA,8267101,LOCAL,36010,CPT,,,,,,Outpatient,,,604.59,393,Viva Med ADV,Viva Med ADV,87.95,,,,,,,Fee Schedule,87.95,929.12,
Antenatal Testing Type -> Contraction stress test,10446024,LOCAL,59020,CPT,,,,,,Outpatient,,,607.55,94,Viva Med ADV,Viva Med ADV,183.92,,,,,,,Fee Schedule,183.92,863,
97597 ACTIVE WOUND CARE MANAGEMENT FIRST 20 CM,13048047,LOCAL,97597,CPT,,,,,59,Outpatient,,,608.25,395,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
97597 DEBRIDE SCISSOR/SCAPEL 20SQ CM,9410251,LOCAL,97597,CPT,,,,,GP,Outpatient,,,608.25,395,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
97597 DEBRIDEMENT,9866113,LOCAL,97597,CPT,,,,,GO|CO,Outpatient,,,608.25,395,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
97597 OT SELECT DEBRIDE ME CHARGE,9856113,LOCAL,97597,CPT,,,,,GO,Outpatient,,,608.25,395,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
97598 Debrid Open wound > 20 sq cm charge,12511973,LOCAL,97598,CPT,,,,,,Outpatient,,,608.25,395,Viva Med ADV,Viva Med ADV,20.42,,,,,,,Fee Schedule,20.42,1466.58,
OT Removal Devitalized Tissue < 20 cm Units,7897756,LOCAL,97597,CPT,,,,,GO,Outpatient,,,608.25,395,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
OT Removal Tissue <20 Assist Units,7897756,LOCAL,97597,CPT,,,,,CQ,Outpatient,,,608.25,395,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
OT Selective Debridement Charge,7895252,LOCAL,97597,CPT,,,,,GO,Outpatient,,,608.25,395,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
Selective Debridement Charge,7895942,LOCAL,97597,CPT,,,,,GP,Outpatient,,,608.25,395,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
"Selective Debridement Charge -> Yes, total wound surface area, first 20 sq cm or less",8968080,LOCAL,97597,CPT,,,,,GP,Outpatient,,,608.25,395,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
XR Cystogram Limited,13703435,LOCAL,74430,CPT,,,,,52,Outpatient,,,612.55,554.4,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
US Chest,1169635,LOCAL,76604,CPT,,,,,,Outpatient,,,612.93,328.35,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
XR Ribs w/ PA Chest Left,1170379,LOCAL,71101,CPT,,,,,LT,Outpatient,,,615.08,330,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Ribs w/ PA Chest Right,1170381,LOCAL,71101,CPT,,,,,RT,Outpatient,,,615.08,330,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
Strep Pneumoniae Ab IgG 23 Serotypes QST,10217037,LOCAL,86581,CPT,,,,,,Outpatient,,,615.83,,Viva Med ADV,Viva Med ADV,92.03,,,,,,,Fee Schedule,44.29,92.03,
"Strep pneumoniae IgG Abs, 23 Serotypes QST",14006318,LOCAL,86581,CPT,,,,,,Outpatient,,,615.83,,Viva Med ADV,Viva Med ADV,92.03,,,,,,,Fee Schedule,44.29,92.03,
DUP ARTERIAL & VENOUS MAPPING BIL,8200501,LOCAL,93985,CPT,,,,,,Outpatient,,,616.92,401,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Vein Mapping Lower Extremity Bilat,12175095,LOCAL,93985,CPT,,,,,,Outpatient,,,616.92,401,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Vein Mapping Upper Extremity Bilat,12175104,LOCAL,93985,CPT,,,,,,Outpatient,,,616.92,401,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Vessel Mapping for Hemo Access Bilat,10216429,LOCAL,93985,CPT,,,,,,Outpatient,,,616.92,401,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,161.71,220.99,
DOP ART-LEA WITH ABI SEG PRESSURES,8230018,LOCAL,93923,CPT,,,,,,Outpatient,,,617.64,401,Viva Med ADV,Viva Med ADV,143.05,,,,,,,Fee Schedule,143.05,244.97,
DOP ART-UEA W/ PRESSURES UPPER,8230064,LOCAL,93923,CPT,,,,,,Outpatient,,,617.64,401,Viva Med ADV,Viva Med ADV,143.05,,,,,,,Fee Schedule,143.05,244.97,
US Segmental Pressures LE 3+ Lvls Bilat,1169755,LOCAL,93923,CPT,,,,,,Outpatient,,,617.64,401,Viva Med ADV,Viva Med ADV,143.05,,,,,,,Fee Schedule,143.05,244.97,
US Segmental Pressures UE 3+ Lvls Bilat,9759154,LOCAL,93923,CPT,,,,,,Outpatient,,,617.64,401,Viva Med ADV,Viva Med ADV,143.05,,,,,,,Fee Schedule,143.05,244.97,
L3913 Hand finger orthosis (HFO) without joints may include soft interface straps custom fabricated,9856095,LOCAL,,,L3913,HCPCS,,,,Outpatient,,,620.7,403,Viva Med ADV,Viva Med ADV,304.58,,,,,,,Fee Schedule,304.58,304.58,
L3913 HFO W/O JOINTS CF CHARGE,9856102,LOCAL,,,L3913,HCPCS,,,,Outpatient,,,620.7,403,Viva Med ADV,Viva Med ADV,304.58,,,,,,,Fee Schedule,304.58,304.58,
MG Mammo Diagnostic Left w/ Tomo.,8058649,LOCAL,77065,CPT,,,,,LT,Outpatient,,,623.77,334.13,Viva Med ADV,Viva Med ADV,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Diagnostic Right w/ Tomo.,8058652,LOCAL,77065,CPT,,,,,RT,Outpatient,,,623.77,334.13,Viva Med ADV,Viva Med ADV,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Digital Diagnostic Left.,7918560,LOCAL,77065,CPT,,,,,LT,Outpatient,,,623.77,334.13,Viva Med ADV,Viva Med ADV,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Digital Diagnostic Right.,7918563,LOCAL,77065,CPT,,,,,RT,Outpatient,,,623.77,334.13,Viva Med ADV,Viva Med ADV,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Implant Diag Left w/ Tomo.,8058658,LOCAL,77065,CPT,,,,,LT,Outpatient,,,623.77,334.13,Viva Med ADV,Viva Med ADV,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Implant Diag Right w/ Tomo.,8058661,LOCAL,77065,CPT,,,,,RT,Outpatient,,,623.77,334.13,Viva Med ADV,Viva Med ADV,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Implant Digital Diag Left.,8058667,LOCAL,77065,CPT,,,,,LT,Outpatient,,,623.77,334.13,Viva Med ADV,Viva Med ADV,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Implant Digital Diag Right.,8058670,LOCAL,77065,CPT,,,,,RT,Outpatient,,,623.77,334.13,Viva Med ADV,Viva Med ADV,75.3,,,,,,,Fee Schedule,74,75.3,
XR Osseous Survey Limited,1170022,LOCAL,77074,CPT,,,,,,Outpatient,,,626.27,335.78,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
94625 OUTPATIENT PULMONARY REHAB W/O CONTINIOUS MONITORING,10470029,LOCAL,94625,CPT,,,,,,Outpatient,,,626.86,407,Viva Med ADV,Viva Med ADV,54.31,,,,,,,Fee Schedule,51.98,54.31,
Newborn Screen,8165282,LOCAL,84035,CPT,,,,,,Outpatient,,,629.03,4.78,Viva Med ADV,Viva Med ADV,3.98,,,,,,,Fee Schedule,3.98,7.16,
"Phenylketonuria, Blood SO",9565050,LOCAL,84030,CPT,,,,,,Outpatient,,,629.03,6.6,Viva Med ADV,Viva Med ADV,5.5,,,,,,,Fee Schedule,5.5,7.16,
"Susceptibility, Yeast, Comp. Panel QSTC",6250013,LOCAL,87186,CPT,,,,,,Outpatient,,,630,10.38,Viva Med ADV,Viva Med ADV,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
US OB Limited,1169856,LOCAL,76815,CPT,,,,,,Outpatient,,,632.6,339.08,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,148.61,
"L3702 Elbow orthosis, without joints, may include soft interface, straps, custom fabricated",9646073,LOCAL,,,L3702,HCPCS,,,,Outpatient,,,634.13,412,Viva Med ADV,Viva Med ADV,324.72,,,,,,,Fee Schedule,324.72,324.72,
L3702 ELBOW SPLINT,9856096,LOCAL,,,L3702,HCPCS,,,,Outpatient,,,634.13,412,Viva Med ADV,Viva Med ADV,324.72,,,,,,,Fee Schedule,324.72,324.72,
CULL US Echo Dop w/ Spectral Complete,13736513,LOCAL,93320,CPT,,,,,,Outpatient,,,636.3,414,Viva Med ADV,Viva Med ADV,29.71,,,,,,,Fee Schedule,29.71,678.38,
ECHO DOP W/SPECTRAL COMPLETE,8200180,LOCAL,93320,CPT,,,,,,Outpatient,,,636.3,414,Viva Med ADV,Viva Med ADV,29.71,,,,,,,Fee Schedule,29.71,678.38,
"epoetin alfa 10,000 units/mL preservative-free Sol 1 mL [CULL]",11202387,LOCAL,J0885,CPT,,,,,,Outpatient,1,ML,636.672,,Viva Med ADV,Viva Med ADV,8.54,,,,,,,Fee Schedule,0.79,233.26,
74248 XR Small Bowel Follow Thru: AddOn,13626886,LOCAL,74248,CPT,,,,,,Outpatient,,,636.99,341.55,Viva Med ADV,Viva Med ADV,41.4,,,,,,,Fee Schedule,41.4,176.48,
CULL XR Small Bowel Follow Thru,13626886,LOCAL,74248,CPT,,,,,,Outpatient,,,636.99,341.55,Viva Med ADV,Viva Med ADV,41.4,,,,,,,Fee Schedule,41.4,176.48,
64486 TAP BLOCK UNILATERAL BY INJECTION(S),5661023,LOCAL,64486,CPT,,,,,,Outpatient,,,637.75,415,Viva Med ADV,Viva Med ADV,46.33,,,,,,,Fee Schedule,46.33,863,
INTRO CATH RT HEART PA,8267102,LOCAL,36013,CPT,,,,,,Outpatient,,,638.52,415,Viva Med ADV,Viva Med ADV,104.34,,,,,,,Fee Schedule,104.34,929.12,
alteplase 2 mg injection [CULL],11201047,LOCAL,J2997,CPT,,,,,,Outpatient,1,EA,644.928,,Viva Med ADV,Viva Med ADV,94.45,,,,,,,Fee Schedule,94.45,122.4,
"Supersaturation, U24 SO",13938669,LOCAL,83945,CPT,,,,,,Outpatient,,,645.39,17.34,Viva Med ADV,Viva Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.085,
10060 DRAINAGE OF SKIN ABSCESS CHARGE,9704026,LOCAL,10060,CPT,,,,,,Outpatient,,,646.72,420,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
10061 I & D COMPLEX,13048116,LOCAL,10061,CPT,,,,,,Outpatient,,,646.72,420,Viva Med ADV,Viva Med ADV,365.27,,,,,,,Fee Schedule,239.03,863,
Bill Prostate Biopsy,14048008,LOCAL,,,G0416,HCPCS,,,,Outpatient,,,646.83,,Viva Med ADV,Viva Med ADV,328.88,,,,,,,Fee Schedule,59.06,328.88,
XR Spine Thoracolumbar 2 Views,1170490,LOCAL,72080,CPT,,,,,,Outpatient,,,651.93,349.8,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
High LSO,9400071,LOCAL,,,L0648,HCPCS,,,,Outpatient,,,655.66,,Viva Med ADV,Viva Med ADV,797.49,,,,,,,Fee Schedule,797.49,797.49,
"11102 Tangential Biopsy of Skin, 1 lesion",9620037,LOCAL,11102,CPT,,,,,,Outpatient,,,656.43,427,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
16020 BURN DEBRIDEMENT/DRESSING INITIAL OR SUB,13043448,LOCAL,16020,CPT,,,,,,Outpatient,,,656.43,427,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
16020 Chemical Canterizaiton,9400039,LOCAL,16020,CPT,,,,,,Outpatient,,,656.43,427,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
17250 CAUTERY OF WOUND (ELECTRICAL),13033473,LOCAL,17250,CPT,,,,,,Outpatient,,,656.43,427,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
97606 Wound VAC >50 sq cm HBO,10015644,LOCAL,97606,CPT,,,,,,Outpatient,,,656.43,427,Viva Med ADV,Viva Med ADV,365.27,,,,,,,Fee Schedule,365.27,549.61,
REF ABO Discrep (ABSC),13481254,LOCAL,86850,CPT,,,,,,Outpatient,,,657,11.72,Viva Med ADV,Viva Med ADV,48.85,,,,,,,Fee Schedule,6.29,48.85,
TELEMETRY DAILY CHARGE,9341351,LOCAL,93229,CPT,,,,,,Outpatient,,,659,311,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,99.86,284.7,
13133 >  Each additional 5 cm or less (List separately in addition to primary procedure),12788295,LOCAL,13133,CPT,,,,,,Outpatient,,,660,,Viva Med ADV,Viva Med ADV,95.58,,,,,,,Fee Schedule,95.58,863,
"13133-Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; e",14746903,LOCAL,13133,CPT,,,,,,Outpatient,,,660,,Viva Med ADV,Viva Med ADV,95.58,,,,,,,Fee Schedule,95.58,863,
82570 QST,14798876,LOCAL,82570,CPT,,,,,,Outpatient,,,662,6.22,Viva Med ADV,Viva Med ADV,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Leukotriene E4, Random, Urine QST",14798876,LOCAL,82542,CPT,,,,,,Outpatient,,,662.05,28.91,Viva Med ADV,Viva Med ADV,24.09,,,,,,,Fee Schedule,7.16,40.97514925,
Bill Only Antigen Type Group 3,10312933,LOCAL,86902,CPT,,,,,,Outpatient,,,666,7.62,Viva Med ADV,Viva Med ADV,328.88,,,,,,,Fee Schedule,6.29,328.88,
"JC Polyoma Virus DNA, Qual PCR CSF QSTC",10170129,LOCAL,87798,CPT,,,,,,Outpatient,,,666,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
XR Skull Complete,1170438,LOCAL,70260,CPT,,,,,,Outpatient,,,672.73,360.53,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
Bill Only REF Washing,13514969,LOCAL,86999,CPT,,,,,,Outpatient,,,675,,Viva Med ADV,Viva Med ADV,22.39,,,,,,,Fee Schedule,6.29,22.39,
US AAA Screening,8058767,LOCAL,76706,CPT,,,,,,Outpatient,,,675.12,362.18,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Abdomen Limited,1169569,LOCAL,76705,CPT,,,,,,Outpatient,,,675.12,362.18,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Renal,7936319,LOCAL,76770,CPT,,,,,,Outpatient,,,675.12,362.18,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,245.49,
US Retroperitoneal Complete,1169867,LOCAL,76770,CPT,,,,,,Outpatient,,,675.12,362.18,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,245.49,
MG Mammo Digital Screening Bilateral.,7918566,LOCAL,77067,CPT,,,,,,Outpatient,,,676.43,363,Viva Med ADV,Viva Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Digital Screening Left.,7949062,LOCAL,77067,CPT,,,,,52|LT,Outpatient,,,676.43,363,Viva Med ADV,Viva Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Digital Screening Right.,7949065,LOCAL,77067,CPT,,,,,52|RT,Outpatient,,,676.43,363,Viva Med ADV,Viva Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Implant Digital Screening Bil.,8058673,LOCAL,77067,CPT,,,,,,Outpatient,,,676.43,363,Viva Med ADV,Viva Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Implant Screening Bil w/ Tomo.,8058682,LOCAL,77067,CPT,,,,,,Outpatient,,,676.43,363,Viva Med ADV,Viva Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Screening Bilateral w/ Tomo.,8058685,LOCAL,77067,CPT,,,,,,Outpatient,,,676.43,363,Viva Med ADV,Viva Med ADV,79.68,,,,,,,Fee Schedule,74,79.68,
64450 INJECTION PERIPHERAL NERVE OR BRANCH,5661030,LOCAL,64450,CPT,,,,,,Outpatient,,,680,1613,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
57105 - BIOPSY VAGINAL MUCOSA EXTENSIVE,14749499,LOCAL,57105,CPT,,,,,,Outpatient,,,685,3180,Viva Med ADV,Viva Med ADV,2906.92,,,,,,,Fee Schedule,2315,3558.77,
adenosine 3 mg/mL intravenous solution 30 mL [CULL],11201017,LOCAL,J0153,CPT,,,,,,Outpatient,30,ML,686.4,,Viva Med ADV,Viva Med ADV,0.53,,,,,,,Fee Schedule,0.529,0.529,
"Immunoglobulins Panel, CSF QSTC",13864507,LOCAL,82784,CPT,,,,,,Outpatient,,,687.2,11.16,Viva Med ADV,Viva Med ADV,34.96,,,,,,,Fee Schedule,7.16,34.958,
LENS PRELOADED #PCB00,4851541,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,687.5,410,Viva Med ADV,Viva Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
LENS PRELOADED DCB00,4855985,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,687.5,410,Viva Med ADV,Viva Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
US Fetal Biophysical Profile w/o N-Str,1169689,LOCAL,76819,CPT,,,,,,Outpatient,,,688.53,369.6,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,148.61,
"FISH, Prenatal Scr Interp QSTC",13864670,LOCAL,88274,CPT,,,,,,Outpatient,,,690.75,50.86,Viva Med ADV,Viva Med ADV,42.38,,,,,,,Fee Schedule,42.38,63.34,
"FISH, Prenatal Screen QSTC",13864673,LOCAL,88271,CPT,,,,,,Outpatient,,,690.75,25.7,Viva Med ADV,Viva Med ADV,21.42,,,,,,,Fee Schedule,21.42,63.34,
zoledronic acid 4 mg/100 mL intravenous solution 100 mL [CULL],11211397,LOCAL,J3489,CPT,,,,,,Outpatient,100,ML,691.2,,Viva Med ADV,Viva Med ADV,5.08,,,,,,,Fee Schedule,5.082,5.082,
11104 Punch Biopsy,10017193,LOCAL,11104,CPT,,,,,,Outpatient,,,691.38,449,Viva Med ADV,Viva Med ADV,365.27,,,,,,,Fee Schedule,365.27,863,
XR Abdomen Series Chest 1 View,1169932,LOCAL,74022,CPT,,,,,,Outpatient,,,691.86,53.63,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Osseous Survey Complete,1170018,LOCAL,77075,CPT,,,,,,Outpatient,,,694.85,372.9,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,176.48,
XR Spine Cervical 6+ Views,1170461,LOCAL,72052,CPT,,,,,,Outpatient,,,701.96,376.2,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
"96365 IV INFUSION, MEDS, INITIAL 16-90 MINS",7904531,LOCAL,96365,CPT,,,,,,Outpatient,,,702.66,457,Viva Med ADV,Viva Med ADV,192.63,,,,,,,Fee Schedule,192.63,442.94,
"96365- IV tx, first hour",1928299,LOCAL,96365,CPT,,,,,,Outpatient,,,702.66,457,Viva Med ADV,Viva Med ADV,192.63,,,,,,,Fee Schedule,192.63,442.94,
US Aorta,7936256,LOCAL,76775,CPT,,,,,,Outpatient,,,702.79,377.03,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Retroperitoneal Limited,1169869,LOCAL,76775,CPT,,,,,,Outpatient,,,702.79,377.03,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
F/U EMBOLIZATION/INFUSION,8210730,LOCAL,75898,CPT,,,,,,Outpatient,,,707.78,379.5,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,1231.66,2877.63,
US Extremity Nonvascular Limited Left,2425338,LOCAL,76882,CPT,,,,,LT,Outpatient,,,708.51,248.33,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Extremity Nonvascular Limited Right,2425341,LOCAL,76882,CPT,,,,,RT,Outpatient,,,708.51,248.33,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Head/Neck Soft Tissue,1169729,LOCAL,76536,CPT,,,,,,Outpatient,,,708.51,380.33,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
76000 XR Fluoroscopy Under 1 Hour: AddOn,13658083,LOCAL,76000,CPT,,,,,,Outpatient,,,709.31,380.33,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,176.48,220.99,
64495 - INJ PARAVERT F JNT L/S 3 LEV,5661079,LOCAL,64495,CPT,,,,,,Outpatient,,,710.23,462,Viva Med ADV,Viva Med ADV,42.72,,,,,,,Fee Schedule,42.72,1250.53,
INTRO CAROTID VERTEBRAL ARTERY,8267188,LOCAL,36100,CPT,,,,,,Outpatient,,,710.94,462,Viva Med ADV,Viva Med ADV,122.25,,,,,,,Fee Schedule,122.25,929.12,
XR Urography Retrograde,10454609,LOCAL,74420,CPT,,,,,,Outpatient,,,714.75,383.63,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
97607 Disp NP Wound Tx <=50 Sq Cm.,10017200,LOCAL,97607,CPT,,,,,,Outpatient,,,716.42,466,Viva Med ADV,Viva Med ADV,365.27,,,,,,,Fee Schedule,365.27,549.61,
".Thyroglobulin, LC/MS/MS QSTC",13864486,LOCAL,84432,CPT,,,,,,Outpatient,,,720,19.27,Viva Med ADV,Viva Med ADV,46.24,,,,,,,Fee Schedule,18.43,46.235,
93017 CARDIAC STRESS TEST CHARGE,7938407,LOCAL,93017,CPT,,,,,,Outpatient,,,721.43,469,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,244.97,284.7,
CARDIAC STRESS W/TRACING,8200041,LOCAL,93017,CPT,,,,,,Outpatient,,,721.43,469,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,244.97,284.7,
NM Stress Test Trace,2426005,LOCAL,93017,CPT,,,,,,Outpatient,,,721.43,469,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,244.97,284.7,
64405 Occipital Nerve Block Unilateral,5661077,LOCAL,64405,CPT,,,,,,Outpatient,,,724.33,879,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
MRI 3D Reconstruction w/o Workstation,8108472,LOCAL,76376,CPT,,,,,,Outpatient,,,730.14,391.88,Viva Med ADV,Viva Med ADV,13.93,,,,,,,Fee Schedule,13.93,13.93,
Bill Only REF Thawing & Washing RBC,13514967,LOCAL,86931,CPT,,,,,,Outpatient,,,733.5,,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,38.88,156.67,
L3808 Forearm based orthosis w/o dynamic,9856093,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,733.5,89,Viva Med ADV,Viva Med ADV,375.59,,,,,,,Fee Schedule,375.59,375.59,
OT CARPAL TUNNEL SPLINTS,9646074,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,733.5,89,Viva Med ADV,Viva Med ADV,375.59,,,,,,,Fee Schedule,375.59,375.59,
REF HLA ABSC,13484120,LOCAL,86829,CPT,,,,,,Outpatient,,,733.5,77.03,Viva Med ADV,Viva Med ADV,64.19,,,,,,,Fee Schedule,6.29,64.19,
REF HPA-1 Typing,13481256,LOCAL,81105,CPT,,,,,,Outpatient,,,733.5,146.66,Viva Med ADV,Viva Med ADV,122.22,,,,,,,Fee Schedule,63.34,122.22,
93571 Cor Flow Wire 1st Measure,8230055,LOCAL,93571,CPT,,,,,,Outpatient,,,734.27,477,Viva Med ADV,Viva Med ADV,143.66,,,,,,,Fee Schedule,143.66,2669.67,
LENS #ACU0T0,4853561,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,737,410,Viva Med ADV,Viva Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
LENS #SN60WF,4891100,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,737,410,Viva Med ADV,Viva Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
XR Arthrocentesis Asp/Inj Intmed Jt Lt,14807134,LOCAL,20605,CPT,,,,,LT,Outpatient,,,740,336,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Intmed Jt Rt,14807137,LOCAL,20605,CPT,,,,,RT,Outpatient,,,740,336,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Major Jt Bilat,14807140,LOCAL,20610,CPT,,,,,50,Outpatient,,,740,650,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Major Jt Lt,14807143,LOCAL,20610,CPT,,,,,LT,Outpatient,,,740,650,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Major Jt Rt,14807146,LOCAL,20610,CPT,,,,,RT,Outpatient,,,740,650,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Small Jt Lt,14807149,LOCAL,20600,CPT,,,,,LT,Outpatient,,,740,295,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Small Jt Rt,14807152,LOCAL,20600,CPT,,,,,RT,Outpatient,,,740,295,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
XR Colon Barium Enema,9427624,LOCAL,74270,CPT,,,,,,Outpatient,,,740.46,396.83,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
DOP VENOUS LOWER EXT BILATERAL,8200420,LOCAL,93970,CPT,,,,,,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
DOP VENOUS UPPER EXT BIL,8200421,LOCAL,93970,CPT,,,,,,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP AO IVC ILIAC COMPLETE,8200530,LOCAL,93978,CPT,,,,,,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP CAROTID BILATERAL,8200370,LOCAL,93880,CPT,,,,,,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP CAROTID UNI,8200380,LOCAL,93882,CPT,,,,,,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUP HEPATOPORTAL INFLOW/OUTFLOW COMP,8200434,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP MESENTERIC/CELIAC ARTERY IN/OUT COMP,8200433,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP RENAL ARTERIES INFLOW/OUTFLOW COMP,8200432,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUPLEX ARTERIAL LOWER EXT BIL,8200460,LOCAL,93925,CPT,,,,,,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUPLEX ARTERIAL UPPER EXT BIL,8200480,LOCAL,93930,CPT,,,,,,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Abdomen Vascular Limited,8206811,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Aorta IVC Iliac Duplex Complete,1169577,LOCAL,93978,CPT,,,,,,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Art/Vein Abd/Pelvis/Scrotal Complete,1169581,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Carotid Duplex Bilateral,1169631,LOCAL,93880,CPT,,,,,,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Carotid Duplex Left,8814383,LOCAL,93882,CPT,,,,,LT,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Carotid Duplex Right,8814386,LOCAL,93882,CPT,,,,,RT,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Arterial Duplex Bilateral,1169759,LOCAL,93925,CPT,,,,,,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Lower Ext Venous Duplex Bilateral,1169769,LOCAL,93970,CPT,,,,,,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Renal Artery Duplex Bilateral,4246822,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Upper Ext Arterial Duplex Bilateral,1169895,LOCAL,93930,CPT,,,,,,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Upper Ext Venous Duplex Bilateral,1169901,LOCAL,93970,CPT,,,,,,Outpatient,,,742.12,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP RENAL ARTERIES UNI,8200585,LOCAL,93976,CPT,,,,,,Outpatient,,,742.13,482,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,245.49,
US Renal Artery Duplex Left,4246828,LOCAL,93976,CPT,,,,,LT,Outpatient,,,742.13,482,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,245.49,
US Renal Artery Duplex Right,4246843,LOCAL,93976,CPT,,,,,RT,Outpatient,,,742.13,482,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,245.49,
Acetylcholine Receptor Binding Ab QSTC,8853232,LOCAL,86041,CPT,,,,,,Outpatient,,,743,22.08,Viva Med ADV,Viva Med ADV,18.4,,,,,,,Fee Schedule,15.29,18.4,
XR Small Bowel Series,12908279,LOCAL,74250,CPT,,,,,,Outpatient,,,748.74,401.78,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
Chlamydophila pneumoniae QSTC,9727429,LOCAL,87486,CPT,,,,,,Outpatient,,,750,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
Human RSV A QSTC,9727398,LOCAL,87633,CPT,,,,,,Outpatient,,,750,500.14,Viva Med ADV,Viva Med ADV,610.31,,,,,,,Fee Schedule,158.39,610.305625,
Mycoplasma pneumoniae QSTC,9727431,LOCAL,87581,CPT,,,,,,Outpatient,,,750,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
REF Antibody Titer,7943112,LOCAL,86886,CPT,,,,,,Outpatient,,,756,6.22,Viva Med ADV,Viva Med ADV,156.67,,,,,,,Fee Schedule,6.29,156.67,
64494 - INJ PARAVERT F JNT L/S 2 LEV,5661036,LOCAL,64494,CPT,,,,,,Outpatient,,,761,495,Viva Med ADV,Viva Med ADV,41.55,,,,,,,Fee Schedule,41.55,1250.53,
REF HLA PLT ABSC,13479160,LOCAL,86829,CPT,,,,,,Outpatient,,,767.25,77.03,Viva Med ADV,Viva Med ADV,64.19,,,,,,,Fee Schedule,6.29,64.19,
REF PLT ABSC,13484122,LOCAL,86022,CPT,,,,,,Outpatient,,,767.25,22.04,Viva Med ADV,Viva Med ADV,18.37,,,,,,,Fee Schedule,15.29,18.37,
95822 EEG COMA OR SLEEP ONLY CHARGE,8687098,LOCAL,95822,CPT,,,,,,Outpatient,,,768.44,499,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,284.7,466.96,
EEG EXTENDED 41-60 MINUTES CHARGE,13515636,LOCAL,95812,CPT,,,,,,Outpatient,,,768.44,499,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,284.7,740.58,
MG Mammo Diagnostic Bilateral w/ Tomo.,8058646,LOCAL,77066,CPT,,,,,,Outpatient,,,770.81,413.33,Viva Med ADV,Viva Med ADV,96.53,,,,,,,Fee Schedule,74,96.53,
MG Mammo Digital Diagnostic Bilat.,7918557,LOCAL,77066,CPT,,,,,,Outpatient,,,770.81,413.33,Viva Med ADV,Viva Med ADV,96.53,,,,,,,Fee Schedule,74,96.53,
MG Mammo Implant Diag Bilateral w/ Tomo.,8058655,LOCAL,77066,CPT,,,,,,Outpatient,,,770.81,413.33,Viva Med ADV,Viva Med ADV,96.53,,,,,,,Fee Schedule,11.11,96.53,
MG Mammo Implant Diag Bilateral w/ Tomo.,8058655,LOCAL,G0279,CPT,,,,,,Outpatient,,,770.81,,Viva Med ADV,Viva Med ADV,11.11,,,,,,,Fee Schedule,11.11,96.53,
MG Mammo Implant Digital Diag Bilateral.,8058664,LOCAL,77066,CPT,,,,,,Outpatient,,,770.81,413.33,Viva Med ADV,Viva Med ADV,96.53,,,,,,,Fee Schedule,74,96.53,
Pen G Benz/Proc (Bicillin CR) [CULL],11202075,LOCAL,J0558,CPT,,,,,,Outpatient,2,ML,771.5488,,Viva Med ADV,Viva Med ADV,19.52,,,,,,,Fee Schedule,19.52,122.4,
97608 Disp NP Wound Tx >50 Sq Cm.,10017187,LOCAL,97608,CPT,,,,,,Outpatient,,,777.46,505,Viva Med ADV,Viva Med ADV,365.27,,,,,,,Fee Schedule,365.27,549.61,
Bill Only Antigen Type Group 4,10312939,LOCAL,86902,CPT,,,,,,Outpatient,,,778.5,7.62,Viva Med ADV,Viva Med ADV,328.88,,,,,,,Fee Schedule,6.29,328.88,
64491 INJ PARAVER CERV/THOR 2ND LEVEL,5661064,LOCAL,64491,CPT,,,,,,Outpatient,,,782.44,509,Viva Med ADV,Viva Med ADV,48.01,,,,,,,Fee Schedule,48.01,1250.53,
64492 FACET CERV/THOR 3RD ADDTL LEVEL CHARGE,5661080,LOCAL,64492,CPT,,,,,,Outpatient,,,782.44,509,Viva Med ADV,Viva Med ADV,48.5,,,,,,,Fee Schedule,48.5,1250.53,
"FISH, Locus Specific X2 100 QSTC",13864693,LOCAL,88271,CPT,,,,,,Outpatient,,,787.5,25.7,Viva Med ADV,Viva Med ADV,21.42,,,,,,,Fee Schedule,21.42,63.34,
KERECIS OMEGA 3 - DISK 14MM 2,13962583,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,787.5,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
"Liver Fibrosis, Fibro-ActiTest Pnl QSTC",8764813,LOCAL,81596,CPT,,,,,,Outpatient,,,787.5,86.63,Viva Med ADV,Viva Med ADV,429.13,,,,,,,Fee Schedule,63.34,429.125,
Specimen Source: FISH Locus Pr x2 QSTC,13864687,LOCAL,88275,CPT,,,,,,Outpatient,,,787.5,61.43,Viva Med ADV,Viva Med ADV,51.19,,,,,,,Fee Schedule,51.19,63.34,
ICD DFT TESTING,8231015,LOCAL,93641,CPT,,,,,,Outpatient,,,788,512,Viva Med ADV,Viva Med ADV,205.74,,,,,,,Fee Schedule,205.74,9059.73,
99204 New patient-level 4 specialty clinic,13538609,LOCAL,,,G0463,HCPCS,,,,Outpatient,,,788.5,326,Viva Med ADV,Viva Med ADV,117.82,,,,,,,Fee Schedule,117.82,117.82,
99204 Office Visit New Pt. Level 4,10168483,LOCAL,99204,CPT,,,,,,Outpatient,,,788.5,513,Viva Med ADV,Viva Med ADV,110.67,,,,,,,Fee Schedule,110.67,110.67,
99204 Office Visit New Pt. Level 4,10168483,LOCAL,99204,CPT,,,,,,Outpatient,,,788.5,513,Viva Med ADV,Viva Med ADV,110.67,,,,,,,Fee Schedule,110.67,110.67,
99214 LEVEL IV VISIT CHARGE,9319023,LOCAL,99214,CPT,,,,,,Outpatient,,,788.5,513,Viva Med ADV,Viva Med ADV,80.51,,,,,,,Fee Schedule,80.51,80.51,
99214 Office Visit Established Pt. Level 4,10168488,LOCAL,99214,CPT,,,,,,Outpatient,,,788.5,513,Viva Med ADV,Viva Med ADV,80.51,,,,,,,Fee Schedule,80.51,80.51,
New Patient Level 4,13436278,LOCAL,99204,CPT,,,,,25,Outpatient,,,788.5,513,Viva Med ADV,Viva Med ADV,110.67,,,,,,,Fee Schedule,110.67,117.82,
New Patient Level 4,13436278,LOCAL,G0463,CPT,,,,,25,Outpatient,,,788.5,326,Viva Med ADV,Viva Med ADV,117.82,,,,,,,Fee Schedule,110.67,117.82,
36593 DECLOT IMPLANT DEVICE/CATHETER CHARGE,8700839,LOCAL,36593,CPT,,,,,,Outpatient,,,794.92,517,Viva Med ADV,Viva Med ADV,303.25,,,,,,,Fee Schedule,303.25,863,
64590  Insertion or replacement of peripheral or gastric neurostimulator pulse generator,8529396,LOCAL,64590,CPT,,,,,,Outpatient,,,798,519,Viva Med ADV,Viva Med ADV,19605.75,,,,,,,Fee Schedule,9233,30196.67,
US Transvaginal Non-OB,1169889,LOCAL,76830,CPT,,,,,,Outpatient,,,798,428.18,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
JAK2 V617F Mutation Analysis QSTC,9039438,LOCAL,81270,CPT,,,,,,Outpatient,,,810,109.99,Viva Med ADV,Viva Med ADV,449.92,,,,,,,Fee Schedule,63.34,449.915,
TPMT Genotype QSTC,10168397,LOCAL,81335,CPT,,,,,,Outpatient,,,810,209.77,Viva Med ADV,Viva Med ADV,174.81,,,,,,,Fee Schedule,173.68,174.81,
LENS CLAREON CCA0T0,4802028,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,819.5,410,Viva Med ADV,Viva Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
LENS CLAREON CNA0T0,4890000,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,819.5,410,Viva Med ADV,Viva Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
95816 EEG AWAKE AND DROWSY CHARGE,8303772,LOCAL,95816,CPT,,,,,,Outpatient,,,820.05,533,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,284.7,466.96,
ADD'L ART 2ND/3RD ABD,8267115,LOCAL,36248,CPT,,,,,,Outpatient,,,820.1,533,Viva Med ADV,Viva Med ADV,39.09,,,,,,,Fee Schedule,39.09,929.12,
XR Spine Lumbosacral 4 Plus Views,1170476,LOCAL,72110,CPT,,,,,,Outpatient,,,823.1,441.38,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
"GAD65, IA-2 and Insulin Autoantibody QSTC",14105691,LOCAL,86337,CPT,,,,,,Outpatient,,,823.5,25.69,Viva Med ADV,Viva Med ADV,21.41,,,,,,,Fee Schedule,15.29,21.41,
"GAD65, IA-2 and Insulin Autoantibody QSTC.",14621959,LOCAL,86337,CPT,,,,,,Outpatient,,,823.5,25.69,Viva Med ADV,Viva Med ADV,21.41,,,,,,,Fee Schedule,15.29,21.41,
LENS #DIB00,4803761,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,825,410,Viva Med ADV,Viva Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
92978 Cath IVUS First Vessel,8230048,LOCAL,92978,CPT,,,,,,Outpatient,,,828.2,538,Viva Med ADV,Viva Med ADV,164.22,,,,,,,Fee Schedule,164.22,863,
"Rho D Immune Globulin, Human, full dose, 300 micrograms, INJ",90620010,LOCAL,J2790,CPT,,,,,,Outpatient,,,829.08,,Viva Med ADV,Viva Med ADV,80.53,,,,,,,Fee Schedule,80.532,122.4,
XR Arthrogram Knee SI Left,2425410,LOCAL,73580,CPT,,,,,LT,Outpatient,,,834.05,447.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Arthrogram Knee SI Right,2425413,LOCAL,73580,CPT,,,,,RT,Outpatient,,,834.05,447.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
Abeta 40 - QST,13874686,LOCAL,82233,CPT,,,,,,Outpatient,,,844,,Viva Med ADV,Viva Med ADV,128.92,,,,,,,Fee Schedule,128.92,173.68,
Abeta 42 - QST,13874685,LOCAL,82234,CPT,,,,,,Outpatient,,,844,,Viva Med ADV,Viva Med ADV,128.92,,,,,,,Fee Schedule,128.92,173.68,
PASSY-MUIR PMV2001- 703-2001,8800100,LOCAL,,,L8501,HCPCS,,,,Outpatient,,,846.95,,Viva Med ADV,Viva Med ADV,179.42,,,,,,,Fee Schedule,179.42,179.42,
"epoetin alfa-epbx 20,000 units/mL injectable solution 1 mL [CULL]",11202388,LOCAL,Q5106,CPT,,,,,,Outpatient,1,ML,847.104,,Viva Med ADV,Viva Med ADV,7.85,,,,,,,Fee Schedule,7.85,525.49,
36005 Venogram Injection,8212037,LOCAL,36005,CPT,,,,,,Outpatient,,,847.39,551,Viva Med ADV,Viva Med ADV,38.76,,,,,,,Fee Schedule,38.76,929.12,
levothyroxine 40 mcg (0.04 mg)/mL intravenous solution 5 mL [CULL],11202740,LOCAL,J0650,CPT,,,,,,Outpatient,5,ML,851.392,,Viva Med ADV,Viva Med ADV,5.98,,,,,,,Fee Schedule,5.983,122.4,
XR Upper GI w/ Air Contrast,1170566,LOCAL,74246,CPT,,,,,,Outpatient,,,862.77,492.53,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
XR Upper GI w/ Air w/ Small Bowel,1170570,LOCAL,74246,CPT,,,,,,Outpatient,,,862.77,492.53,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
EPINEPHrine 1 mg/mL injectable solution 30 mL [CULL],11202381,LOCAL,J0165,CPT,,,,,,Outpatient,30,ML,864,,Viva Med ADV,Viva Med ADV,0.43,,,,,,,Fee Schedule,0.433,0.433,
US Scrotum (Contents),8206982,LOCAL,76870,CPT,,,,,,Outpatient,,,864.82,463.65,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
US OB Transvaginal,1169861,LOCAL,76817,CPT,,,,,,Outpatient,,,865.47,464.48,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,148.61,
93308 LMTD STUDENT ECHOCARDIOGRAM CHARGE,6011002,LOCAL,93308,CPT,,,,,,Outpatient,,,867.64,564,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,678.38,
ECHO 2D LTD,8200150,LOCAL,93308,CPT,,,,,,Outpatient,,,867.64,564,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,678.38,
US Echo 2D Limited,8071400,LOCAL,93308,CPT,,,,,,Outpatient,,,867.64,564,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,678.38,
Pneumonia Panel (Biofire),9594219,LOCAL,87633,CPT,,,,,,Outpatient,,,868.73,500.14,Viva Med ADV,Viva Med ADV,610.31,,,,,,,Fee Schedule,158.39,610.305625,
tbo-filgrastim 300 mcg/0.5 mL subcutaneous solution 0.5 mL [CULL],11202449,LOCAL,J1447,CPT,,,,,,Outpatient,0.5,ML,872.2368,,Viva Med ADV,Viva Med ADV,0.28,,,,,,,Fee Schedule,0.28,525.49,
XR Colon Barium Enema w/ Air Contrast,9427627,LOCAL,74280,CPT,,,,,,Outpatient,,,872.33,467.78,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
CARDIAC THROMBOLYTICS IV,8267127,LOCAL,92977,CPT,,,,,,Outpatient,,,874.14,568,Viva Med ADV,Viva Med ADV,303.25,,,,,,,Fee Schedule,303.25,863,
NM Thyroid Imaging,2426008,LOCAL,78013,CPT,A9512,HCPCS,,,,Outpatient,,,879.12,471.08,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
92612 - ENDOSCOPY SWALLOW TST (FEES),9636010,LOCAL,92612,CPT,,,,,GN,Outpatient,,,884,575,Viva Med ADV,Viva Med ADV,52.01,,,,,,,Fee Schedule,52.01,162.41,
92612 Fiber Endo Eval Swallow Video Charge,9410192,LOCAL,92612,CPT,,,,,GN,Outpatient,,,884,575,Viva Med ADV,Viva Med ADV,52.01,,,,,,,Fee Schedule,52.01,162.41,
SLP Fiberoptic Swallow Eval Units,1373844,LOCAL,92612,CPT,,,,,GN,Outpatient,,,884,575,Viva Med ADV,Viva Med ADV,52.01,,,,,,,Fee Schedule,52.01,162.41,
Speech Fiberoptic Swallow Eval Charge,1373844,LOCAL,92612,CPT,,,,,GN,Outpatient,,,884,575,Viva Med ADV,Viva Med ADV,52.01,,,,,,,Fee Schedule,52.01,162.41,
99284 - Level 4,2644300,LOCAL,99284,CPT,,,,,25,Outpatient,,,886.65,576,Viva Med ADV,Viva Med ADV,389.31,,,,,,,Fee Schedule,389.31,389.31,
3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase (HMGCR) Antibody (IgG) QSTC,13864471,LOCAL,83520,CPT,,,,,,Outpatient,,,888.75,20.72,Viva Med ADV,Viva Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
XR Hips 5+ Views Bilat,7520618,LOCAL,73523,CPT,,,,,,Outpatient,,,890.34,477.68,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Hips 5+ Views w/AP Pelvis Bilat,7520621,LOCAL,73523,CPT,,,,,,Outpatient,,,890.34,477.68,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Barium Swallow w/ Upper GI + KUB,8912828,LOCAL,74240,CPT,,,,,,Outpatient,,,891.48,477.68,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
XR Upper GI,1170562,LOCAL,74240,CPT,,,,,,Outpatient,,,891.48,477.68,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
XR Upper GI w/ Small Bowel,1170574,LOCAL,74240,CPT,,,,,,Outpatient,,,891.48,477.68,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
ceftaroline 600 mg intravenous injection [CULL],11201425,LOCAL,J0712,CPT,,,,,,Outpatient,1,EA,896.73216,,Viva Med ADV,Viva Med ADV,4.23,,,,,,,Fee Schedule,4.23,233.26,
"ANNA3 Ab, IFA, CSF QSTC",13873554,LOCAL,86255,CPT,,,,,,Outpatient,,,900,14.46,Viva Med ADV,Viva Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
"GAD65 Ab, IFA, CSF QSTC",13873575,LOCAL,86341,CPT,,,,,,Outpatient,,,900,28.28,Viva Med ADV,Viva Med ADV,23.57,,,,,,,Fee Schedule,15.29,23.57,
TPMT Activity QSTC,8764663,LOCAL,84433,CPT,,,,,,Outpatient,,,900,26.6,Viva Med ADV,Viva Med ADV,22.17,,,,,,,Fee Schedule,17.73,22.17,
CATH PL 1ST ORDER VENOUS,8267186,LOCAL,36011,CPT,,,,,,Outpatient,,,908.34,590,Viva Med ADV,Viva Med ADV,126.74,,,,,,,Fee Schedule,126.74,929.12,
VENOGRAM INJ BILATERAL,8267755,LOCAL,36005,CPT,,,,,,Outpatient,,,914.51,551,Viva Med ADV,Viva Med ADV,38.76,,,,,,,Fee Schedule,38.76,929.12,
XR Barium Swallow w/ Upper GI w/ Air,13554969,LOCAL,74246,CPT,,,,,,Outpatient,,,918.22,492.53,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
95819 EEG AWAKE & ASLEEP CHARGE,8704890,LOCAL,95819,CPT,,,,,,Outpatient,,,922.13,599,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,284.7,466.96,
US Biopsy Abdomen/Retroperitoneal Mass,8565247,LOCAL,76942,CPT,,,,,,Outpatient,,,927.16,497.48,Viva Med ADV,Viva Med ADV,28.54,,,,,,,Fee Schedule,28.54,165.47,
US Biopsy Liver,1169599,LOCAL,76942,CPT,,,,,,Outpatient,,,927.16,497.48,Viva Med ADV,Viva Med ADV,28.54,,,,,,,Fee Schedule,28.54,165.47,
US Breast Needle Loc Left,7936259,LOCAL,19285,CPT,,,,,LT,Outpatient,,,927.16,603,Viva Med ADV,Viva Med ADV,643.26,,,,,,,Fee Schedule,643.26,1291,
US Breast Needle Loc Right,7936262,LOCAL,19285,CPT,,,,,RT,Outpatient,,,927.16,603,Viva Med ADV,Viva Med ADV,643.26,,,,,,,Fee Schedule,643.26,1291,
US NEEDLE PLACEMENT CVS,8200510,LOCAL,76942,CPT,,,,,,Outpatient,,,927.16,497.48,Viva Med ADV,Viva Med ADV,28.54,,,,,,,Fee Schedule,28.54,165.47,
XR Cholangiogram T-Tube Check,8207012,LOCAL,47531,CPT,,,,,,Outpatient,,,927.38,298,Viva Med ADV,Viva Med ADV,3226.48,,,,,,,Fee Schedule,2599,3226.48,
KERECIS OMEGA 3 - DISK 16MM 2,13962585,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,929.25,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
XR Arthrogram Elbow SI Left,2425398,LOCAL,73085,CPT,,,,,LT,Outpatient,,,934.13,500.78,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Arthrogram Elbow SI Right,2425401,LOCAL,73085,CPT,,,,,RT,Outpatient,,,934.13,500.78,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
"Bartonella DNA, Qual, RT PCR QSTC",13864512,LOCAL,87471,CPT,,,,,,Outpatient,,,940.5,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
BiPAP Charge -> Subsequent,2678299,LOCAL,94003,CPT,,,,,,Outpatient,,,943.5,613,Viva Med ADV,Viva Med ADV,604.42,,,,,,,Fee Schedule,604.42,941,
NM Lung Perfusion Imaging,1169328,LOCAL,78580,CPT,A9540,HCPCS,,,,Outpatient,,,948.45,508.2,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,1409.71,
64999 PERI-INFILTRATION HARDWARE,5661083,LOCAL,64999,CPT,,,,,,Outpatient,,,953.35,620,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
L3806 OT WRIST HAND FINGER ORTHOSIS,9856094,LOCAL,,,L3806,HCPCS,,,,Outpatient,,,966.78,628,Viva Med ADV,Viva Med ADV,510.8,,,,,,,Fee Schedule,510.8,510.8,
"penicillin G benzathine 1,200,000 units/2 mL intramuscular suspension 2 mL [CULL]",11202076,LOCAL,J0561,CPT,,,,,,Outpatient,2,ML,967.8944,,Viva Med ADV,Viva Med ADV,30.01,,,,,,,Fee Schedule,30.01,122.4,
ADD'L ART 2ND/3RD THORAC,8267111,LOCAL,36218,CPT,,,,,,Outpatient,,,970.36,631,Viva Med ADV,Viva Med ADV,42.55,,,,,,,Fee Schedule,42.55,929.12,
CATH PLACE SEG SUBSEG PA,8267104,LOCAL,36015,CPT,,,,,,Outpatient,,,980.22,637,Viva Med ADV,Viva Med ADV,139.57,,,,,,,Fee Schedule,139.57,929.12,
US Abdomen Complete,1169567,LOCAL,76700,CPT,,,,,,Outpatient,,,984.47,528,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,245.49,
BiPAP Charge -> Initial,2678300,LOCAL,94002,CPT,,,,,,Outpatient,,,990,663,Viva Med ADV,Viva Med ADV,604.42,,,,,,,Fee Schedule,604.42,941,
BiPAP/CPAP Mode -> NIMV,2678300,LOCAL,94002,CPT,,,,,,Outpatient,,,990,663,Viva Med ADV,Viva Med ADV,604.42,,,,,,,Fee Schedule,604.42,941,
ECHOCARDIOGRAM 2D W/STRESS,8200440,LOCAL,93350,CPT,,,,,,Outpatient,,,990,644,Viva Med ADV,Viva Med ADV,501.29,,,,,,,Fee Schedule,501.29,678.38,
16025 DRESS AN/OR DEBMT BURN INI MED CHARGE,8020080,LOCAL,16025,CPT,,,,,,Outpatient,,,991.5,644,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
CT Angio Heart/Coronary Arteries,9515210,LOCAL,75574,CPT,,,,,,Outpatient,,,992.21,532.13,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,565.59,
20610 INJECT MAJOR JOINT,5661087,LOCAL,20610,CPT,,,,,,Outpatient,,,1000,650,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
methylene blue 5 mg/mL intravenous solution 10 mL [CULL],11202913,LOCAL,Q9968,CPT,,,,,,Outpatient,10,ML,1000.0512,,Viva Med ADV,Viva Med ADV,8.73,,,,,,,Fee Schedule,8.73,8.73,
OASIS MATRIX WOUND 3 X 7 CM,13962592,LOCAL,,,Q4102,HCPCS,,,,Outpatient,,,1003.01,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
NM Parathyroid Imaging w/ Spect Inj/Scan,2425984,LOCAL,78071,CPT,A9500,HCPCS,,,,Outpatient,,,1004.58,331.65,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
XR Arthrogram Hip SI Left,2425404,LOCAL,73525,CPT,,,,,LT,Outpatient,,,1004.84,538.73,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Arthrogram Hip SI Right,2425407,LOCAL,73525,CPT,,,,,RT,Outpatient,,,1004.84,538.73,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
INTRO EXTREMITY ARTERY,8267105,LOCAL,36140,CPT,,,,,,Outpatient,,,1022.12,664,Viva Med ADV,Viva Med ADV,72.34,,,,,,,Fee Schedule,72.34,929.12,
PERC CHANGE TUBE OR DRAINAGE CATH S&I,8210742,LOCAL,75984,CPT,,,,,,Outpatient,,,1029.19,551.93,Viva Med ADV,Viva Med ADV,49.58,,,,,,,Fee Schedule,49.58,262.79,
XR Drainage Perc Cath Replace,9343679,LOCAL,75984,CPT,,,,,,Outpatient,,,1029.19,551.93,Viva Med ADV,Viva Med ADV,49.58,,,,,,,Fee Schedule,49.58,262.79,
11107 INCAL BX SKN EA SEP/ADDL CHARGE,9704096,LOCAL,11107,CPT,,,,,,Outpatient,,,1030.62,670,Viva Med ADV,Viva Med ADV,23.51,,,,,,,Fee Schedule,23.51,863,
CYSTOGRAM S&I,8211185,LOCAL,74430,CPT,,,,,,Outpatient,,,1033.41,554.4,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Cystogram,4126362,LOCAL,74430,CPT,,,,,,Outpatient,,,1033.41,554.4,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
US Joint/Bursa Lw Int Arth/Asp/Inj Left,3148332,LOCAL,20606,CPT,,,,,LT,Outpatient,,,1035.43,673,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
US Joint/Bursa Lw Int Arth/Asp/Inj Right,3148335,LOCAL,20606,CPT,,,,,RT,Outpatient,,,1035.43,673,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
US Joint/Bursa Lw Maj Arth/Asp/Inj Left,3148338,LOCAL,20611,CPT,,,,,LT,Outpatient,,,1035.43,673,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Lw Maj Arth/Asp/Inj Right,3148341,LOCAL,20611,CPT,,,,,RT,Outpatient,,,1035.43,673,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Lw Sm Arth/Asp/Inj Left,6130396,LOCAL,20604,CPT,,,,,LT,Outpatient,,,1035.43,673,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Lw Sm Arth/Asp/Inj Right,6130399,LOCAL,20604,CPT,,,,,RT,Outpatient,,,1035.43,673,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Up Int Arth/Asp/Inj Left,2425353,LOCAL,20606,CPT,,,,,LT,Outpatient,,,1035.43,673,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
US Joint/Bursa Up Int Arth/Asp/Inj Right,2425356,LOCAL,20606,CPT,,,,,RT,Outpatient,,,1035.43,673,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
US Joint/Bursa Up Maj Arth/Asp/Inj Left,2425359,LOCAL,20611,CPT,,,,,LT,Outpatient,,,1035.43,673,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Up Maj Arth/Asp/Inj Right,2425362,LOCAL,20611,CPT,,,,,RT,Outpatient,,,1035.43,673,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Up Sm Arth/Asp/Inj Left,6130402,LOCAL,20604,CPT,,,,,LT,Outpatient,,,1035.43,673,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Up Sm Arth/Asp/Inj Right,6130405,LOCAL,20604,CPT,,,,,RT,Outpatient,,,1035.43,673,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
GASTRO-JEJUNOSTOMY TUBE REPLACEMENT,8200254,LOCAL,49452,CPT,,,,,,Outpatient,,,1040.53,676,Viva Med ADV,Viva Med ADV,857.17,,,,,,,Fee Schedule,857.17,1496,
"Chikungunya Virus RNA, Qual RT PCR QSTC",13864475,LOCAL,87798,CPT,,,,,,Outpatient,,,1050.75,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
ARTERIAL LINE PLACEMENT,8210320,LOCAL,36620,CPT,,,,,,Outpatient,,,1052.64,684,Viva Med ADV,Viva Med ADV,38.92,,,,,,,Fee Schedule,38.92,929.12,
NM Hepatobiliary Imaging,2425957,LOCAL,78226,CPT,,,,,,Outpatient,,,1059,567.6,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
DART FIRE EDGE SCREW,4810328,LOCAL,,,C1716,HCPCS,,,,Outpatient,,,1062.93,,Viva Med ADV,Viva Med ADV,868.33,,,,,,,Fee Schedule,612.6,868.33,
NEPHROSTOGRAM S&I,8212039,LOCAL,74425,CPT,,,,,,Outpatient,,,1072.47,575.03,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
glucagon 1 mg injection [CULL],11282210,LOCAL,J1610,CPT,,,,,,Outpatient,1,EA,1075.2,,Viva Med ADV,Viva Med ADV,182.45,,,,,,,Fee Schedule,182.45,233.26,
99205 LEVEL V INITIAL VISIT FAC CHARGE,12832503,LOCAL,99205,CPT,,,,,,Outpatient,,,1078.84,701,Viva Med ADV,Viva Med ADV,151.18,,,,,,,Fee Schedule,151.18,151.18,
99205 New patient-level 5 specialty clinic,13538610,LOCAL,,,G0463,HCPCS,,,,Outpatient,,,1078.84,326,Viva Med ADV,Viva Med ADV,117.82,,,,,,,Fee Schedule,117.82,117.82,
99205 Office Visit New Pt. Level 5,10168484,LOCAL,99205,CPT,,,,,,Outpatient,,,1078.84,701,Viva Med ADV,Viva Med ADV,151.18,,,,,,,Fee Schedule,151.18,151.18,
99205 Office Visit New Pt. Level 5,10168484,LOCAL,99205,CPT,,,,,,Outpatient,,,1078.84,701,Viva Med ADV,Viva Med ADV,151.18,,,,,,,Fee Schedule,151.18,151.18,
99215 LEVEL V VISIT CHARGE,9322144,LOCAL,99215,CPT,,,,,,Outpatient,,,1078.84,701,Viva Med ADV,Viva Med ADV,119.41,,,,,,,Fee Schedule,119.41,119.41,
99215 Office Visit Established Pt. Level 5,10168489,LOCAL,99215,CPT,,,,,,Outpatient,,,1078.84,701,Viva Med ADV,Viva Med ADV,119.41,,,,,,,Fee Schedule,119.41,119.41,
"Leptospira DNA, Qual RT PCR QSTC",13864445,LOCAL,87798,CPT,,,,,,Outpatient,,,1096.88,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Fungal Sequencing, ITS Region QSTC",13864438,LOCAL,87153,CPT,,,,,,Outpatient,,,1102.5,138.43,Viva Med ADV,Viva Med ADV,115.36,,,,,,,Fee Schedule,115.36,158.39,
"Cortisol, Free, LC/MS, Serum QSTC",8972878,LOCAL,82530,CPT,,,,,,Outpatient,,,1104.43,20.05,Viva Med ADV,Viva Med ADV,29.79,,,,,,,Fee Schedule,17.73,29.79,
acetylcysteine 20% intravenous solution 30 mL [CULL],11200013,LOCAL,J0132,CPT,,,,,,Outpatient,30,ML,1120.00032,,Viva Med ADV,Viva Med ADV,0.37,,,,,,,Fee Schedule,0.367,0.367,
"Pneumocystis jirovecii,Qual Real-Time PCR QSTC",9215420,LOCAL,87798,CPT,,,,,,Outpatient,,,1120.91,42.11,Viva Med ADV,Viva Med ADV,35.09,,,,,,,Fee Schedule,35.09,40.19,
CATH PL 2ND ORDER VENOUS,8267187,LOCAL,36012,CPT,,,,,,Outpatient,,,1122.44,730,Viva Med ADV,Viva Med ADV,142.32,,,,,,,Fee Schedule,142.32,929.12,
NM Gastrointestinal Blood Loss Imaging,1169242,LOCAL,78278,CPT,A9512,HCPCS,,,,Outpatient,,,1123.93,603.08,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,1409.71,
Bird Fancier's Precipitin Panel I QSTC,13864443,LOCAL,86331,CPT,,,,,,Outpatient,,,1133.1,14.38,Viva Med ADV,Viva Med ADV,11.98,,,,,,,Fee Schedule,11.98,15.29,
99285 - Level 5,2644301,LOCAL,99285,CPT,,,,,25,Outpatient,,,1135.13,738,Viva Med ADV,Viva Med ADV,560.53,,,,,,,Fee Schedule,560.53,560.53,
chlorothiazide 0.5 g intravenous injection [CULL],11240810,LOCAL,J1205,CPT,,,,,,Outpatient,1,EA,1143.168,,Viva Med ADV,Viva Med ADV,58.13,,,,,,,Fee Schedule,58.126,58.126,
US Breast ABUS Bilateral.,13939856,LOCAL,76641,CPT,,,,,50,Outpatient,,,1143.26,306.9,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
XR ERCP Biliary,8649296,LOCAL,74328,CPT,,,,,,Outpatient,,,1143.36,612.98,Viva Med ADV,Viva Med ADV,121.3,,,,,,,Fee Schedule,121.3,262.79,
XR ERCP Pancreatic,8649299,LOCAL,74329,CPT,,,,,,Outpatient,,,1143.36,612.98,Viva Med ADV,Viva Med ADV,23.05,,,,,,,Fee Schedule,23.05,262.79,
amphotericin B liposomal 50 mg intravenous injection [CULL],11202015,LOCAL,J0289,CPT,,,,,,Outpatient,1,EA,1152.16,,Viva Med ADV,Viva Med ADV,21.48,,,,,,,Fee Schedule,21.48,1293.51,
GUIDED PERC DRAIN W CATH S&I,8210333,LOCAL,75989,CPT,,,,,,Outpatient,,,1153.62,618.75,Viva Med ADV,Viva Med ADV,50.75,,,,,,,Fee Schedule,50.75,262.79,
US Pelvic Comp,8206964,LOCAL,76856,CPT,,,,,,Outpatient,,,1159.45,622.05,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,245.49,
29445 APPL RIGID LEG CAST,9739196,LOCAL,29445,CPT,,,,,,Outpatient,,,1160.76,266,Viva Med ADV,Viva Med ADV,242.81,,,,,,,Fee Schedule,242.81,863,
NM Hyperthyroid Therapy,8567789,LOCAL,79005,CPT,A9517,HCPCS,,,,Outpatient,,,1161.71,622.88,Viva Med ADV,Viva Med ADV,23.13,,,,,,,Fee Schedule,23.13,456.65,
XR Spine Scoliosis 1 View,7520627,LOCAL,72081,CPT,,,,,,Outpatient,,,1170.74,627.83,Viva Med ADV,Viva Med ADV,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Arthrogram Wrist SI Left,2425422,LOCAL,73115,CPT,,,,,LT,Outpatient,,,1176.56,631.13,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Arthrogram Wrist SI Right,2425425,LOCAL,73115,CPT,,,,,RT,Outpatient,,,1176.56,631.13,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,176.48,326.51,
E3077 Aph Plt ACDA LR,7266775,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Viva Med ADV,Viva Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E3087 Aph Plt ACDA LR 1,7266780,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Viva Med ADV,Viva Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E3088 Aph Plt ACDA LR 2,7266781,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Viva Med ADV,Viva Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E3089 Aph Plt ACDA LR 3,7266782,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Viva Med ADV,Viva Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E4643 Aph Plt ACDA LR <3E11,7266909,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Viva Med ADV,Viva Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5030 Aph Plt ACDA LR BM,8058823,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Viva Med ADV,Viva Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5032 Aph Plt ACDA LR BM 2,8029134,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Viva Med ADV,Viva Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5033 Aph Plt ACDA LR BM 3,8058812,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Viva Med ADV,Viva Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5036 Aph Plt ACDA LR Irr BM 2,8029108,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Viva Med ADV,Viva Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5075 Aph Plt ACDA LR <3E11 BM,8058809,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Viva Med ADV,Viva Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E9232 Aph Plt ACDA LR BT6,10074919,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Viva Med ADV,Viva Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5031  Aph Plt ACDA LR BM 1,8029138,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1188,768,Viva Med ADV,Viva Med ADV,487.1,,,,,,,Fee Schedule,487.1,546.55,
64480 CERVICAL THORACIC TRANSFORAMINAL EACH AD,5661052,LOCAL,64480,CPT,,,,,,Outpatient,,,1193.14,776,Viva Med ADV,Viva Med ADV,50.22,,,,,,,Fee Schedule,50.22,1250.53,
95824 EEG CEREBRAL DEATH EVALUATION ONLY CHARGE,9646722,LOCAL,95824,CPT,,,,,,Outpatient,,,1194.07,776,Viva Med ADV,Viva Med ADV,485.11,,,,,,,Fee Schedule,466.96,485.11,
BREAST SIZER SMOOTH ROUND HIGH 565CC,4850931,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,1210,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE 505HP,4840154,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,1210,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
"RT CHARGE Ventilator Restart, Ongoing -> Yes",12109384,LOCAL,94003,CPT,,,,,,Outpatient,,,1224,613,Viva Med ADV,Viva Med ADV,604.42,,,,,,,Fee Schedule,604.42,941,
KERECIS OMEGA 3 - 1.75 X 1.75CM,13962575,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,1228.5,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
"Prostaglandin D2 (Pg D2), Urine QST",12667576,LOCAL,84150,CPT,,,,,,Outpatient,,,1230,50.12,Viva Med ADV,Viva Med ADV,41.77,,,,,,,Fee Schedule,41.77,47.35,
15274 App Skin Sub Graft (TWSA>100cm2) t/s/l ; add 100 cm 2,12642329,LOCAL,15274,CPT,,,,,,Outpatient,,,1230.36,800,Viva Med ADV,Viva Med ADV,35.4,,,,,,,Fee Schedule,35.4,2862.92,
15278 APPL-HC SKSB GRT F/N/H/G-KD A100 CHARGE,9709036,LOCAL,15278,CPT,,,,,,Outpatient,,,1230.36,800,Viva Med ADV,Viva Med ADV,44.7,,,,,,,Fee Schedule,44.7,2862.92,
11106 INCAL BX SKN SINGLE LES CHARGE,9704095,LOCAL,11106,CPT,,,,,,Outpatient,,,1230.62,800,Viva Med ADV,Viva Med ADV,559.65,,,,,,,Fee Schedule,559.65,1291,
"Aquaporin-4 (AQP4) (NMO-IgG) Antibody with Reflex to Titer, Serum QSTC",10041610,LOCAL,86052,CPT,,,,,,Outpatient,,,1237.5,14.46,Viva Med ADV,Viva Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
"JC Polyoma Virus DNA, Qnt PCR, Serum QSTC",10274092,LOCAL,87799,CPT,,,,,,Outpatient,,,1237.5,51.41,Viva Med ADV,Viva Med ADV,42.84,,,,,,,Fee Schedule,40.19,42.84,
"NMO Spectrum Eval (AQP4 w/Rflx toMOG), Serum QSTC",10274088,LOCAL,86052,CPT,,,,,,Outpatient,,,1237.5,14.46,Viva Med ADV,Viva Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
"64520 Injection Lumbar or Thoracic, Paravertebral Sympathetic",5661043,LOCAL,64520,CPT,,,,,,Outpatient,,,1239.7,806,Viva Med ADV,Viva Med ADV,813.96,,,,,,,Fee Schedule,813.96,1291,
96413 CHEMO IV INFUSION 1ST HR INF CHARGE,9665725,LOCAL,96413,CPT,,,,,,Outpatient,,,1244.66,809,Viva Med ADV,Viva Med ADV,303.25,,,,,,,Fee Schedule,303.25,442.94,
REF Genetic RBC Phenotyping,13481257,LOCAL,81403,CPT,,,,,,Outpatient,,,1246.5,222.24,Viva Med ADV,Viva Med ADV,185.2,,,,,,,Fee Schedule,173.68,185.2,
NM Liver/Spleen Imaging Injection/Scan,1169286,LOCAL,78215,CPT,A9541,HCPCS,,,,Outpatient,,,1248.36,669.08,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,1409.71,
"CBFB/MYH11 inv(16), Quant RT PCR QSTC",13864502,LOCAL,81401,CPT,,,,,,Outpatient,,,1260,164.4,Viva Med ADV,Viva Med ADV,137,,,,,,,Fee Schedule,63.34,137,
REF PLT Crossmatch,13481259,LOCAL,86022,CPT,,,,,,Outpatient,,,1269,22.04,Viva Med ADV,Viva Med ADV,18.37,,,,,,,Fee Schedule,15.29,18.37,
epoetin alfa 20000 units/mL Sol 1 mL [CULL],11202388,LOCAL,J0885,CPT,,,,,,Outpatient,1,ML,1273.344,,Viva Med ADV,Viva Med ADV,8.54,,,,,,,Fee Schedule,7.85,525.49,
Admark Phospho Tau/Ttl Ab42 Comments QST,13877904,LOCAL,83520,CPT,,,,,,Outpatient,,,1277.25,20.72,Viva Med ADV,Viva Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Admark Phospho Tau/Ttl Ab42 Interp QST,13877902,LOCAL,83520,CPT,,,,,,Outpatient,,,1277.25,20.72,Viva Med ADV,Viva Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Admark Phospho Tau/Ttl Ab42 Methods QST,13877905,LOCAL,83520,CPT,,,,,,Outpatient,,,1277.25,20.72,Viva Med ADV,Viva Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
62320 Cervical/Thoracic Epidural without Fluor,5661014,LOCAL,62320,CPT,,,,,,Outpatient,,,1284.42,835,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
11042 DEB SQ TISSUE-1ST 20SQCM/< CHARGE,9704056,LOCAL,11042,CPT,,,,,,Outpatient,,,1286.64,836,Viva Med ADV,Viva Med ADV,365.27,,,,,,,Fee Schedule,365.27,863,
11043 DEB MUS/FASCIA-1ST 20SQCM/< CHARGE,9704059,LOCAL,11043,CPT,,,,,,Outpatient,,,1286.64,836,Viva Med ADV,Viva Med ADV,559.65,,,,,,,Fee Schedule,549.61,863,
11045 Debrid bone 1st 20 sq cm charge,12510099,LOCAL,11045,CPT,,,,,,Outpatient,,,1286.64,836,Viva Med ADV,Viva Med ADV,20.61,,,,,,,Fee Schedule,20.61,1466.58,
11045 Debrid Sub Tissue > 20 sq cm charge,12511974,LOCAL,11045,CPT,,,,,,Outpatient,,,1286.64,836,Viva Med ADV,Viva Med ADV,20.61,,,,,,,Fee Schedule,20.61,1466.58,
11046 DEB MUS/FASCIA-EA ADDL 20SQCM CHARGE,9704068,LOCAL,11046,CPT,,,,,,Outpatient,,,1286.64,836,Viva Med ADV,Viva Med ADV,44.01,,,,,,,Fee Schedule,44.01,1466.58,
XR Urethrocystography Retrograde,1170578,LOCAL,74450,CPT,,,,,,Outpatient,,,1300.84,697.95,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,176.48,220.99,
MTB Complex Rifampin Resist PCR Sput QSTC,8873578,LOCAL,87801,CPT,,,,,,Outpatient,,,1316.25,84.24,Viva Med ADV,Viva Med ADV,70.2,,,,,,,Fee Schedule,40.19,70.2,
US OB Greater Than 14 Weeks Single,8583651,LOCAL,76805,CPT,,,,,,Outpatient,,,1319.46,130.35,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,148.61,
NM Parathyroid Imaging Injection/Scan,1169316,LOCAL,78070,CPT,A9500,HCPCS,,,,Outpatient,,,1324.92,710.33,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,1409.71,
NM Bone Marrow Imaging Whole Body,1169186,LOCAL,78104,CPT,A9541,HCPCS,,,,Outpatient,,,1327.01,711.98,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
16030 DRESS AN/OR DEBMT BURN INI LG CHARGE,8020081,LOCAL,16030,CPT,,,,,,Outpatient,,,1328,863,Viva Med ADV,Viva Med ADV,365.27,,,,,,,Fee Schedule,365.27,863,
93660 STRESS TILT TABLE CHARGE,8200435,LOCAL,93660,CPT,,,,,,Outpatient,,,1338.01,870,Viva Med ADV,Viva Med ADV,485.11,,,,,,,Fee Schedule,244.97,863,
JEJUNOSTOMY PERC,8200251,LOCAL,49441,CPT,,,,,,Outpatient,,,1339,870,Viva Med ADV,Viva Med ADV,1734.34,,,,,,,Fee Schedule,983.02,1734.34,
Bacterial 16S rDNA Sequencing QSTC,8873571,LOCAL,87153,CPT,,,,,,Outpatient,,,1344.6,138.43,Viva Med ADV,Viva Med ADV,115.36,,,,,,,Fee Schedule,115.36,158.39,
64620 DESTR INTERCOSTAL NERVE,5661066,LOCAL,64620,CPT,,,,,,Outpatient,,,1345.12,874,Viva Med ADV,Viva Med ADV,813.96,,,,,,,Fee Schedule,813.96,1695.82,
64634 DESTR FACET CRV/THR EA ADL LVL,5661058,LOCAL,64634,CPT,,,,,,Outpatient,,,1345.12,874,Viva Med ADV,Viva Med ADV,54.71,,,,,,,Fee Schedule,54.71,1250.53,
15002 SITE PREP -100 SQCM(TAL),12625535,LOCAL,15002,CPT,,,,,,Outpatient,,,1348.68,877,Viva Med ADV,Viva Med ADV,1672.39,,,,,,,Fee Schedule,1466.58,1672.39,
64405 OCCIPITAL - BILATERAL CHARGE,5661078,LOCAL,64405,CPT,,,,,,Outpatient,,,1352.9,879,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
conjugated estrogens 25 mg injection [CULL],11201516,LOCAL,J1410,CPT,,,,,,Outpatient,1,EA,1372.1472,,Viva Med ADV,Viva Med ADV,392.06,,,,,,,Fee Schedule,233.26,392.06,
10120 Incision & removal of Foreign Body Simple,9620024,LOCAL,10120,CPT,,,,,,Outpatient,,,1373.45,893,Viva Med ADV,Viva Med ADV,365.27,,,,,,,Fee Schedule,239.03,863,
62321 CERVICAL THORACIC EPIDURAL,5661016,LOCAL,62321,CPT,,,,,,Outpatient,,,1375.34,894,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
64520 LUMBAR OR THORACIC Sympathetic Charge,5661033,LOCAL,64520,CPT,,,,,,Outpatient,,,1375.34,806,Viva Med ADV,Viva Med ADV,813.96,,,,,,,Fee Schedule,813.96,1291,
64490 INJ PARAVER CERV/THOR 1ST LEVEL,5661063,LOCAL,64490,CPT,,,,,,Outpatient,,,1376.78,895,Viva Med ADV,Viva Med ADV,813.96,,,,,,,Fee Schedule,813.96,1291,
INTRO CATH AORTA,8267107,LOCAL,36200,CPT,,,,,,Outpatient,,,1379.82,897,Viva Med ADV,Viva Med ADV,112.42,,,,,,,Fee Schedule,112.42,929.12,
tbo-filgrastim 480 mcg/0.8 mL subcutaneous solution 0.8 mL [CULL],11202451,LOCAL,J1447,CPT,,,,,,Outpatient,0.8,ML,1395.9776,,Viva Med ADV,Viva Med ADV,0.28,,,,,,,Fee Schedule,0.28,525.49,
64479 CERVICAL THORACIC TRANSFORAMINAL EPIDRL,5661051,LOCAL,64479,CPT,,,,,,Outpatient,,,1397.93,909,Viva Med ADV,Viva Med ADV,813.96,,,,,,,Fee Schedule,813.96,1291,
BUPivacaine liposome 1.3% (13.3 mg/mL) injectable suspension 20 mL [CULL],11202119,LOCAL,J0666,CPT,,,,,,Outpatient,20,ML,1402.224,,Viva Med ADV,Viva Med ADV,1.34,,,,,,,Fee Schedule,1.34,1.34,
62323 LUMBAR OR CAUDAL EPIDURAL,5661015,LOCAL,62323,CPT,,,,,,Outpatient,,,1408.03,915,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
PERC ASPIRATION DISC,8230054,LOCAL,62267,CPT,,,,,,Outpatient,,,1409.73,916,Viva Med ADV,Viva Med ADV,643.26,,,,,,,Fee Schedule,643.26,1291,
EPIFIX SKIN SUBSTITUTE 14MM,13962560,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,1410.75,1755,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
64510 NERV BLK STELLATE GANGLION,5661032,LOCAL,64510,CPT,,,,,,Outpatient,,,1418.86,922,Viva Med ADV,Viva Med ADV,813.96,,,,,,,Fee Schedule,813.96,1695.82,
"64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when per",9520503,LOCAL,64624,CPT,,,,,,Outpatient,,,1425,926,Viva Med ADV,Viva Med ADV,1785.34,,,,,,,Fee Schedule,1695.82,2315,
64640 DESTR OTH PERIPHERAL NERVE/BRCH,5661065,LOCAL,64640,CPT,,,,,,Outpatient,,,1425.83,927,Viva Med ADV,Viva Med ADV,813.96,,,,,,,Fee Schedule,813.96,1695.82,
62290 INJ DISKOGRAPH LUMBAR EA LVL,5661062,LOCAL,62290,CPT,,,,,,Outpatient,,,1432.9,931,Viva Med ADV,Viva Med ADV,134.34,,,,,,,Fee Schedule,134.34,863,
11400 EXC BENIGN LES-T/A/L 0.5CM OR < CHARGE FACILITY,9704107,LOCAL,11400,CPT,,,,,,Outpatient,,,1438,935,Viva Med ADV,Viva Med ADV,643.26,,,,,,,Fee Schedule,643.26,1291,
PLACE ART 2ND ABD & BELOW,8267113,LOCAL,36246,CPT,,,,,,Outpatient,,,1441.95,937,Viva Med ADV,Viva Med ADV,203.35,,,,,,,Fee Schedule,203.35,929.12,
NM Kidney Imaging Single w/ Pharm,1169262,LOCAL,78708,CPT,A9562,HCPCS,,,,Outpatient,,,1446.62,775.5,Viva Med ADV,Viva Med ADV,492.12,,,,,,,Fee Schedule,492.12,560.96,
"92950 Cardiopulmonary resuscitation (eg, in cardiac arrest)",7968980,LOCAL,92950,CPT,,,,,,Outpatient,,,1448.28,941,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,284.7,1328.28,
92950 Cardiopulmonary Resuscitation Cath Lab,8212013,LOCAL,92950,CPT,,,,,,Outpatient,,,1448.28,941,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,284.7,1328.28,
92950 CARDIOPULMONARY RESUSCITATION CHARGE,8207219,LOCAL,92950,CPT,,,,,,Outpatient,,,1448.28,941,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,284.7,1328.28,
RT CHARGE Ventilator Initiate -> Yes,12109383,LOCAL,94002,CPT,,,,,,Outpatient,,,1453.5,663,Viva Med ADV,Viva Med ADV,604.42,,,,,,,Fee Schedule,604.42,941,
NM Inflammation Loc Limited,1226092,LOCAL,78800,CPT,,,,,,Outpatient,,,1461.78,783.75,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,1409.71,
NM Inflammation Loc Limited - Ceretec,1169144,LOCAL,78800,CPT,A9521,HCPCS,,,,Outpatient,,,1461.78,783.75,Viva Med ADV,Viva Med ADV,802.34,,,,,,,Fee Schedule,802.34,1409.71,
11402 EXC BENIGN LES-T/A/L 1.1-2.0 CM CHARGE,9704151,LOCAL,11402,CPT,,,,,,Outpatient,,,1481.17,963,Viva Med ADV,Viva Med ADV,643.26,,,,,,,Fee Schedule,643.26,1291,
62273 BLOOD PATCH,5661017,LOCAL,62273,CPT,,,,,,Outpatient,,,1494.18,971,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
"13131-Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1",14749500,LOCAL,13131,CPT,,,,,,Outpatient,,,1505,400,Viva Med ADV,Viva Med ADV,365.27,,,,,,,Fee Schedule,365.27,863,
MRI Fingers w/ Contrast Left,9343664,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Fingers w/ Contrast Right,9343667,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Forearm w/ Contrast Left,8206725,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Forearm w/ Contrast Right,8206727,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hand w/ Contrast Left,1168924,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hand w/ Contrast Right,1168926,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Humerus w/ Contrast Left,8206756,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Humerus w/ Contrast Right,8206758,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Scapula w/ Contrast Left,12912778,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Scapula w/ Contrast Right,12912781,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
NM Intestine Imaging Meckels,1169254,LOCAL,78290,CPT,A9512,HCPCS,,,,Outpatient,,,1535.86,823.35,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
XR Spine Scoliosis 2-3 Views,7520630,LOCAL,72082,CPT,,,,,,Outpatient,,,1542.91,827.48,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR ERCP Biliary and Pancreatic,8207021,LOCAL,74330,CPT,,,,,,Outpatient,,,1543.36,827.48,Viva Med ADV,Viva Med ADV,151.62,,,,,,,Fee Schedule,151.62,262.79,
XR IVP,1170251,LOCAL,74400,CPT,,,,,,Outpatient,,,1550,831.6,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,176.48,
64493 - INJ PARAVERT F JNT L/S 1 LEV,5661035,LOCAL,64493,CPT,,,,,,Outpatient,,,1563.68,1016,Viva Med ADV,Viva Med ADV,813.96,,,,,,,Fee Schedule,813.96,1291,
G0260 INJ SACRO JNT ARTHR ANEST/STER,8132863,LOCAL,G0260,CPT,,,,,,Outpatient,,,1564.95,1017,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
NM Bone Imaging Limited Injection,1169176,LOCAL,78300,CPT,,,,,,Outpatient,,,1566.92,839.85,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
"62272 SPINAL PUNC, THERAP",5661019,LOCAL,62272,CPT,,,,,,Outpatient,,,1587.32,693,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
64425 NERV BLK ILIOINGUINAL,5661024,LOCAL,64425,CPT,,,,,,Outpatient,,,1587.32,1032,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
64483 TRANS INJ LUMB/SACR-UNILATERAL CHARGE,5661053,LOCAL,64483,CPT,,,,,,Outpatient,,,1587.72,1812,Viva Med ADV,Viva Med ADV,813.96,,,,,,,Fee Schedule,813.96,1291,
64484 TRANS INJ LUMB/SACR EA ADD UIL CHARGE,5661054,LOCAL,64484,CPT,,,,,,Outpatient,,,1587.72,1812,Viva Med ADV,Viva Med ADV,41.55,,,,,,,Fee Schedule,41.55,1250.53,
ECHO COMPLETE W/ DOPPLER,8200137,LOCAL,93306,CPT,,,,,,Outpatient,,,1593.2,1036,Viva Med ADV,Viva Med ADV,501.29,,,,,,,Fee Schedule,501.29,678.38,
ECHOCARDIOGRAM 2D COMPLETE,8200140,LOCAL,93307,CPT,,,,,,Outpatient,,,1593.2,1036,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,678.38,
US Echo Doppler Complete,7936277,LOCAL,93306,CPT,,,,,,Outpatient,,,1593.2,1036,Viva Med ADV,Viva Med ADV,501.29,,,,,,,Fee Schedule,501.29,678.38,
XR Spine Scoliosis 4-5 Views,7520624,LOCAL,72083,CPT,,,,,,Outpatient,,,1597.41,856.35,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
phentolamine 5 mg injection [CULL],11211090,LOCAL,J2760,CPT,,,,,,Outpatient,1,EA,1605.12,,Viva Med ADV,Viva Med ADV,432.02,,,,,,,Fee Schedule,122.4,432.02,
TLSO,9400067,LOCAL,,,L0648,HCPCS,,,,Outpatient,,,1611.78,,Viva Med ADV,Viva Med ADV,797.49,,,,,,,Fee Schedule,797.49,797.49,
64636 DESTR FACET LUM/SAC EA ADL LVL,5661056,LOCAL,64636,CPT,,,,,,Outpatient,,,1614.14,1049,Viva Med ADV,Viva Med ADV,48.01,,,,,,,Fee Schedule,48.01,1250.53,
"12020 SIMP CLOSURE, SUPERF WOUND CHARGE",9303466,LOCAL,12020,CPT,,,,,,Outpatient,,,1615.12,1050,Viva Med ADV,Viva Med ADV,559.65,,,,,,,Fee Schedule,549.61,863,
"rabies vaccine, human diploid cell 2.5 intl units intramuscular injection [CULL]",11212261,LOCAL,90675,CPT,,,,,,Outpatient,1,EA,1633.664,328,Viva Med ADV,Viva Med ADV,313.68,,,,,,,Fee Schedule,160.4,313.68,
BAL Fluid Count with Differential,12449847,LOCAL,0202U,CPT,,,,,,Outpatient,,,1642.5,500.14,Viva Med ADV,Viva Med ADV,443.38,,,,,,,Fee Schedule,173.68,443.38,
XR Spine Scoliosis 6+ Views,7520633,LOCAL,72084,CPT,,,,,,Outpatient,,,1651.91,886.05,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,83.69,97.22,
NM Non-Cardiac Vascular Flow Imaging,1169314,LOCAL,78445,CPT,,,,,,Outpatient,,,1652.88,886.05,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
63650 IMPLANT NEURSTIM ELEC EPIDURAL,10283945,LOCAL,63650,CPT,,,,,,Outpatient,,,1660,6563,Viva Med ADV,Viva Med ADV,6000.2,,,,,,,Fee Schedule,5787,8672.71,
63650 IMPLANT NEURSTIM ELEC EPIDURAL,8132877,LOCAL,63650,CPT,,,,,,Outpatient,,,1660,6563,Viva Med ADV,Viva Med ADV,6000.2,,,,,,,Fee Schedule,5787,8672.71,
63650-IMPLANT NEURSTIM ELEC EPIDURAL,8132877,LOCAL,63650,CPT,,,,,,Outpatient,,,1660,6563,Viva Med ADV,Viva Med ADV,6000.2,,,,,,,Fee Schedule,5787,8672.71,
"rabies vaccine, human diploid cell 2.5 intl units Pow [CULL]",11212261,LOCAL,90675,CPT,,,,,,Outpatient,1,EA,1665.824,328,Viva Med ADV,Viva Med ADV,313.68,,,,,,,Fee Schedule,160.4,313.68,
XR Nephrostogram,8115644,LOCAL,50430,CPT,,,,,,Outpatient,,,1670,1389,Viva Med ADV,Viva Med ADV,610.24,,,,,,,Fee Schedule,555.55,1291,
XR Nephrostogram Existing Access,10454588,LOCAL,50431,CPT,,,,,,Outpatient,,,1670,1389,Viva Med ADV,Viva Med ADV,610.24,,,,,,,Fee Schedule,555.55,1291,
36568 INTRO CATH VENA CAVA PICC CHARGE,13709100,LOCAL,36568,CPT,,,,,,Outpatient,,,1678,1091,Viva Med ADV,Viva Med ADV,1420.25,,,,,,,Fee Schedule,1291,1644.1,
REPOSITION CVL UNDER FLUORO,8210300,LOCAL,36597,CPT,,,,,,Outpatient,,,1678,1091,Viva Med ADV,Viva Med ADV,1420.25,,,,,,,Fee Schedule,1068.64,1420.25,
omadacycline 100 mg injection [CULL],11290183,LOCAL,J0121,CPT,,,,,,Outpatient,1,EA,1678.2144,,Viva Med ADV,Viva Med ADV,4.02,,,,,,,Fee Schedule,4.02,2110.36,
15271 APP SKN SUB GRFT T/A/L 100 SQ CM FAC CHARGE,12831012,LOCAL,15271,CPT,,,,,,Outpatient,,,1680.09,1092,Viva Med ADV,Viva Med ADV,1672.39,,,,,,,Fee Schedule,1496,2862.92,
"15275 App Skin Sub Graft (TWSA<100cm2) f/a/h-ft/aig; 1""25 sp cm",12641291,LOCAL,15275,CPT,,,,,,Outpatient,,,1680.09,1092,Viva Med ADV,Viva Med ADV,1672.39,,,,,,,Fee Schedule,1496,2862.92,
"Zika Virus RNA, Qual TMA QSTC",13864496,LOCAL,87662,CPT,,,,,,Outpatient,,,1687.5,61.57,Viva Med ADV,Viva Med ADV,51.31,,,,,,,Fee Schedule,40.19,51.31,
CATH LAB STRESS ECHO,8200161,LOCAL,93351,CPT,,,,,,Outpatient,,,1697.74,1104,Viva Med ADV,Viva Med ADV,501.29,,,,,,,Fee Schedule,501.29,678.38,
US Stress Echo,7936322,LOCAL,93351,CPT,,,,,,Outpatient,,,1697.74,1104,Viva Med ADV,Viva Med ADV,501.29,,,,,,,Fee Schedule,501.29,678.38,
64581 Incision for implantation of neurostimulator electrode array; sacral nerve,8603595,LOCAL,64581,CPT,,,,,,Outpatient,,,1704,1108,Viva Med ADV,Viva Med ADV,6000.2,,,,,,,Fee Schedule,6000.2,8672.71,
CASPR2 Ab QSTC,13864490,LOCAL,86255,CPT,,,,,,Outpatient,,,1704.38,14.46,Viva Med ADV,Viva Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
IMPLANT 625CC 350-1695,4802349,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,1710.5,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
"KIT D816, Mutation Analysis  QSTC",13864489,LOCAL,81273,CPT,,,,,,Outpatient,,,1721.25,149.84,Viva Med ADV,Viva Med ADV,124.87,,,,,,,Fee Schedule,63.34,124.87,
Ganglioside Ab Panel 6 QSTC,13864481,LOCAL,83520,CPT,,,,,,Outpatient,,,1734.26,20.72,Viva Med ADV,Viva Med ADV,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
64418 - suprascapular nerve block,10452404,LOCAL,64418,CPT,,,,,,Outpatient,,,1735,693,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
64420 NERV BLK INTERCSTL NERV SNGL,5661025,LOCAL,64420,CPT,,,,,,Outpatient,,,1735,693,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
64454 Genicular block,13776911,LOCAL,64454,CPT,,,,,,Outpatient,,,1735,244,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
64461 THORACIC PARAVERTEBRAL BLOCK,13786726,LOCAL,64461,CPT,,,,,,Outpatient,,,1735,50,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
Injection Blood Patch Epidural,7633812,LOCAL,62273,CPT,,,,,,Outpatient,,,1735,971,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
LGI1 Ab QSTC,13864491,LOCAL,86255,CPT,,,,,,Outpatient,,,1738.13,14.46,Viva Med ADV,Viva Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
PULM ANGIO DURING CORONARIES,8230012,LOCAL,93568,CPT,,,,,,Outpatient,,,1744,1134,Viva Med ADV,Viva Med ADV,37.1,,,,,,,Fee Schedule,37.1,863,
92960 ELEC CARDIOVERSION/DEFIBRILATION OP Tech Fee,7969852,LOCAL,92960,CPT,,,,,,Outpatient,,,1759.91,1144,Viva Med ADV,Viva Med ADV,598.27,,,,,,,Fee Schedule,598.27,1291,
Perc Cor Stent-Drug Eluding LD,4221012,LOCAL,92960,CPT,,,,,,Outpatient,,,1759.91,1144,Viva Med ADV,Viva Med ADV,598.27,,,,,,,Fee Schedule,598.27,1291,
10030 FLUID DRAIN SOFT TIS PERC GUID,8266849,LOCAL,10030,CPT,,,,,,Outpatient,,,1760,704,Viva Med ADV,Viva Med ADV,643.26,,,,,,,Fee Schedule,643.26,1605.05,
NM Thyroid Uptake Single/Multi,2426011,LOCAL,78014,CPT,,,,,,Outpatient,,,1775.09,952.05,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
NM Thyroid w/ Uptake Single,12109219,LOCAL,78014,CPT,A9516,HCPCS,,,,Outpatient,,,1775.09,952.05,Viva Med ADV,Viva Med ADV,482.33,,,,,,,Fee Schedule,482.3325,560.96,
NUSHIELD 1.6CM DISC,13962586,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,1777.5,1155,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
MG Surgical Specimen,9437784,LOCAL,76098,CPT,,,,,,Outpatient,,,1778.77,953.7,Viva Med ADV,Viva Med ADV,501.29,,,,,,,Fee Schedule,176.48,501.29,
GASTROSTOMY TUBE REPLACEMENT,8200253,LOCAL,49450,CPT,,,,,,Outpatient,,,1793.73,1166,Viva Med ADV,Viva Med ADV,857.17,,,,,,,Fee Schedule,857.17,1496,
JEJUNOSTOMY REPLACEMENT PERC,8200252,LOCAL,49451,CPT,,,,,,Outpatient,,,1793.73,1166,Viva Med ADV,Viva Med ADV,857.17,,,,,,,Fee Schedule,857.17,1496,
Critical Care Ill/Injured Patient Init 30-74 Min 99291,2389455,LOCAL,99291,CPT,,,,,25,Outpatient,,,1816.43,1181,Viva Med ADV,Viva Med ADV,770.36,,,,,,,Fee Schedule,770.36,770.36,
"13132 -Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet;",14751269,LOCAL,13132,CPT,,,,,,Outpatient,,,1830,612,Viva Med ADV,Viva Med ADV,559.65,,,,,,,Fee Schedule,559.65,863,
NM Myocardial Planar Single Study,2425978,LOCAL,78481,CPT,A9500,HCPCS,,,,Outpatient,,,1832.02,982.58,Viva Med ADV,Viva Med ADV,492.12,,,,,,,Fee Schedule,492.12,560.96,
MRI Breast w/o Contrast Left.,9386272,LOCAL,77046,CPT,,,,,LT,Outpatient,,,1833.89,983.4,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Breast w/o Contrast Right.,9386275,LOCAL,77046,CPT,,,,,RT,Outpatient,,,1833.89,983.4,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
CULL US OB Greater Than 14 Wks Add'l Gest,13579115,LOCAL,76810,CPT,,,,,,Outpatient,,,1847.31,990.83,Viva Med ADV,Viva Med ADV,36.14,,,,,,,Fee Schedule,36.14,148.61,
US OB Greater Than 14 Weeks Multi,8108499,LOCAL,76810,CPT,,,,,,Outpatient,,,1847.31,990.83,Viva Med ADV,Viva Med ADV,36.14,,,,,,,Fee Schedule,36.14,148.61,
NM Tumor Loc Limited,1169410,LOCAL,78800,CPT,,,,,,Outpatient,,,1850.54,783.75,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,1409.71,
NM Tumor Loc Multiple Areas,1169412,LOCAL,78801,CPT,,,,,,Outpatient,,,1850.54,2895.75,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,1409.71,
PARACENTESIS ABDOMINAL WITH IMAGING,8267134,LOCAL,49083,CPT,,,,,,Outpatient,,,1857.81,1208,Viva Med ADV,Viva Med ADV,857.17,,,,,,,Fee Schedule,857.17,1496,
NM Cardiac MUGA,1169208,LOCAL,78472,CPT,A9512,HCPCS,,,,Outpatient,,,1861.6,998.25,Viva Med ADV,Viva Med ADV,1118.05,,,,,,,Fee Schedule,560.96,1118.045,
Meningitis Panel (BioFire),7909558,LOCAL,87483,CPT,,,,,,Outpatient,,,1875.71,500.14,Viva Med ADV,Viva Med ADV,416.78,,,,,,,Fee Schedule,158.39,416.78,
PLACE ART 1ST ABD & BELOW,8267112,LOCAL,36245,CPT,,,,,,Outpatient,,,1882.73,1224,Viva Med ADV,Viva Med ADV,191.24,,,,,,,Fee Schedule,191.24,929.12,
GRAFIX PRIME 16MM,13962570,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,1883.25,3671,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
PLACE ART 1ST THORAC/BRAC,8267108,LOCAL,36215,CPT,,,,,,Outpatient,,,1917.07,1246,Viva Med ADV,Viva Med ADV,175.13,,,,,,,Fee Schedule,175.13,929.12,
PLACE ART 2ND THORAC/BRAC,8267109,LOCAL,36216,CPT,,,,,,Outpatient,,,1917.07,1246,Viva Med ADV,Viva Med ADV,222.85,,,,,,,Fee Schedule,222.85,929.12,
PLACE ART 3RD THORAC/BRAC,8267110,LOCAL,36217,CPT,,,,,,Outpatient,,,1917.07,1246,Viva Med ADV,Viva Med ADV,273.71,,,,,,,Fee Schedule,273.71,929.12,
NM Lung Vent/Perf Imaging,2425966,LOCAL,78582,CPT,A9540,HCPCS,,,,Outpatient,,,1919.6,1029.6,Viva Med ADV,Viva Med ADV,492.12,,,,,,,Fee Schedule,492.12,1409.71,
PLACE ART 3RD ABD & BELOW,8267114,LOCAL,36247,CPT,,,,,,Outpatient,,,1927.08,1253,Viva Med ADV,Viva Med ADV,240.87,,,,,,,Fee Schedule,240.87,929.12,
NM Lymphoscintigraphy Injection/Scan,1169292,LOCAL,78195,CPT,,,,,,Outpatient,,,1928.84,1034.55,Viva Med ADV,Viva Med ADV,492.12,,,,,,,Fee Schedule,492.12,1409.71,
Alpha-Globin Gene Deletion/Dupl. QSTC,13864435,LOCAL,81269,CPT,,,,,,Outpatient,,,1940.63,242.88,Viva Med ADV,Viva Med ADV,202.4,,,,,,,Fee Schedule,173.68,202.4,
NM Kidney Imaging Single w/o Pharm,1169264,LOCAL,78707,CPT,A9562,HCPCS,,,,Outpatient,,,1959.43,1051.05,Viva Med ADV,Viva Med ADV,492.12,,,,,,,Fee Schedule,492.12,560.96,
REF HLA Antibody ID,13479161,LOCAL,86830,CPT,,,,,,Outpatient,,,1962,114.62,Viva Med ADV,Viva Med ADV,95.52,,,,,,,Fee Schedule,38.27,95.52,
PERICARDIOCENTESIS INITIAL,8230050,LOCAL,33016,CPT,,,,,,Outpatient,,,1966.67,1278,Viva Med ADV,Viva Med ADV,1420.25,,,,,,,Fee Schedule,1291,1420.25,
REMOVAL BILIARY DRAIN CATH,8200538,LOCAL,47537,CPT,,,,,,Outpatient,,,1966.67,1278,Viva Med ADV,Viva Med ADV,857.17,,,,,,,Fee Schedule,291.97,1496,
"Apolipoprotein E Isoform, CSF QST",12677744,LOCAL,82542,CPT,,,,,,Outpatient,,,1975.5,28.91,Viva Med ADV,Viva Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.09,
KERECIS OMEGA 3 - DISK 14MM,13962582,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,1975.5,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
CULL Selective Add'l Vessel S&I,13635231,LOCAL,75774,CPT,,,,,,Outpatient,,,1975.99,1059.3,Viva Med ADV,Viva Med ADV,44.32,,,,,,,Fee Schedule,44.32,6018.68,
SELECTIVE ADD'L VESSEL S&I,8210640,LOCAL,75774,CPT,,,,,,Outpatient,,,1975.99,1059.3,Viva Med ADV,Viva Med ADV,44.32,,,,,,,Fee Schedule,44.32,6018.68,
CATH PLACE LT RT PA,8267103,LOCAL,36014,CPT,,,,,,Outpatient,,,1986.67,1291,Viva Med ADV,Viva Med ADV,121.59,,,,,,,Fee Schedule,121.59,929.12,
remdesivir 100 mg Injection [CULL],11201128,LOCAL,J0248,CPT,,,,,,Outpatient,1,EA,1996.8,,Viva Med ADV,Viva Med ADV,6.73,,,,,,,Fee Schedule,6.73,771.25,
ECHO LIMITED WITH CONTRAST,8200178,LOCAL,,,C8924,HCPCS,,,,Outpatient,,,2022.58,1315,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,678.38,
US Echo 2D Limited w/ Contrast,7936274,LOCAL,93308,CPT,C8924,HCPCS,,,,Outpatient,,,2022.58,564,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,678.38,
".MOG Ab, CBA, Serum QSTC",10274091,LOCAL,86362,CPT,,,,,,Outpatient,,,2025,14.46,Viva Med ADV,Viva Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
"Myelin Oligodendrocyte Glycoprotein w/Rfx Titer, Serum QSTC",12613098,LOCAL,86362,CPT,,,,,,Outpatient,,,2025,14.46,Viva Med ADV,Viva Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
PURAPLY AM COMMERCIAL 1.6CM DISC,13962603,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,2025,3861,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
36589 - Removal of tunneled central venous catheter,12431092,LOCAL,36589,CPT,,,,,,Outpatient,,,2025.12,1316,Viva Med ADV,Viva Med ADV,565.25,,,,,,,Fee Schedule,565.25,1291,
37253 Invasc US Each Addl Vessel,8230057,LOCAL,37253,CPT,,,,,,Outpatient,,,2035,1323,Viva Med ADV,Viva Med ADV,57.61,,,,,,,Fee Schedule,57.61,2669.67,
"64449 N BLOCK INJ, LUMBAR PLEXUS",8882246,LOCAL,64449,CPT,,,,,,Outpatient,,,2035,890,Viva Med ADV,Viva Med ADV,813.96,,,,,,,Fee Schedule,813.96,1695.82,
"CRMP5/CV2 Ab, LB QSTC",13873513,LOCAL,84182,CPT,,,,,,Outpatient,,,2036.25,35.05,Viva Med ADV,Viva Med ADV,29.21,,,,,,,Fee Schedule,15.29,29.21,
"GAD65 Ab, LB QSTC",13873519,LOCAL,86341,CPT,,,,,,Outpatient,,,2036.25,28.28,Viva Med ADV,Viva Med ADV,23.57,,,,,,,Fee Schedule,15.29,23.57,
tocilizumab 20 mg/mL Sol 4 mL [CULL],11260558,LOCAL,J3262,CPT,,,,,,Outpatient,4,ML,2039.6544,,Viva Med ADV,Viva Med ADV,5.71,,,,,,,Fee Schedule,5.71,1641.22,
92953 TRANSCUTANEOUS PACING TechFee,8057710,LOCAL,92953,CPT,,,,,,Outpatient,,,2060.2,1339,Viva Med ADV,Viva Med ADV,598.27,,,,,,,Fee Schedule,598.27,1291,
92953-Temp transcutaneous pacing Charge,8212036,LOCAL,92953,CPT,,,,,,Outpatient,,,2060.2,1339,Viva Med ADV,Viva Med ADV,598.27,,,,,,,Fee Schedule,598.27,1291,
EXTERNAL PACER,4221033,LOCAL,92953,CPT,,,,,,Outpatient,,,2060.2,1339,Viva Med ADV,Viva Med ADV,598.27,,,,,,,Fee Schedule,598.27,1291,
NM Testicular Imaging w/ Vasc Flow,8733473,LOCAL,78761,CPT,A9512,HCPCS,,,,Outpatient,,,2063.03,1106.33,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
11750 EXCISION NAIL MATRIX PERMANENT CHARGE,9303447,LOCAL,11750,CPT,,,,,,Outpatient,,,2064.41,1342,Viva Med ADV,Viva Med ADV,365.27,,,,,,,Fee Schedule,365.27,863,
33967 Insertion Intra-aortic Percutaneous Device Charge,8211150,LOCAL,33967,CPT,,,,,,Outpatient,,,2102.51,1367,Viva Med ADV,Viva Med ADV,205.15,,,,,,,Fee Schedule,205.15,12132.94,
KERECIS OMEGA 3 - 3 X 3.5CM,13962577,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,2106,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
ibutilide 0.1 mg/mL intravenous solution 10 mL [CULL],11201842,LOCAL,J1742,CPT,,,,,,Outpatient,10,ML,2107.584,,Viva Med ADV,Viva Med ADV,172.31,,,,,,,Fee Schedule,172.31,233.26,
NM Hepatobiliary Imaging w/ Drug,2425957,LOCAL,78226,CPT,A9537,HCPCS,,,,Outpatient,,,2134.97,567.6,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
NM Hepatobiliary Imaging w/ EF,12894248,LOCAL,78227,CPT,A9537,HCPCS,,,,Outpatient,,,2134.97,1145.1,Viva Med ADV,Viva Med ADV,1384.56,,,,,,,Fee Schedule,560.96,1384.5568,
VENOGRAM BILATERAL EXT S&I,8211110,LOCAL,75822,CPT,,,,,,Outpatient,,,2159,1157.48,Viva Med ADV,Viva Med ADV,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
XR Venogram Extremity Bilateral,13085158,LOCAL,75822,CPT,,,,,,Outpatient,,,2159,1157.48,Viva Med ADV,Viva Med ADV,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
NUSHIELD 1.6CM DISC,10510071,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,2172.5,1155,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
64633 DESTR FACET CERV/THOR SNG LVL,5661057,LOCAL,64633,CPT,,,,,,Outpatient,,,2179,1416,Viva Med ADV,Viva Med ADV,1785.34,,,,,,,Fee Schedule,1250.53,2315,
64635 DESTR FACET LUM/SAC SINGLE LVL,5661055,LOCAL,64635,CPT,,,,,,Outpatient,,,2179,1416,Viva Med ADV,Viva Med ADV,1785.34,,,,,,,Fee Schedule,1250.53,2315,
93567 Inj Supra Aortography,8230011,LOCAL,93567,CPT,,,,,,Outpatient,,,2187.66,1422,Viva Med ADV,Viva Med ADV,29.54,,,,,,,Fee Schedule,29.54,863,
NM Gastric Emptying Study,1169236,LOCAL,78264,CPT,,,,,,Outpatient,,,2193.29,1176.45,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
NM Bone Spect,1169188,LOCAL,78803,CPT,,,,,,Outpatient,,,2202.35,1181.4,Viva Med ADV,Viva Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
APPLY SKIN SUB 1ST 255Q CM LEG UP TO 100,13531303,LOCAL,15271,CPT,,,,,25,Outpatient,,,2221.65,1092,Viva Med ADV,Viva Med ADV,1672.39,,,,,,,Fee Schedule,1496,2862.92,
CT Ankle w/o Contrast Left,1167903,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Ankle w/o Contrast Right,1167905,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Clavicle w/o Contrast Left,12885310,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Clavicle w/o Contrast Right,12885313,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Elbow w/o Contrast Left,1168002,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Elbow w/o Contrast Right,1168004,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Femur w/o Contrast Left,8202922,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Femur w/o Contrast Right,8202924,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Foot w/o Contrast Left,1168040,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Foot w/o Contrast Right,1168042,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Forearm w/o Contrast Left,8202950,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Forearm w/o Contrast Right,8202952,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Hand w/o Contrast Left,1168086,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Hand w/o Contrast Right,1168088,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Hip w/o Contrast Left,1168116,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Hip w/o Contrast Right,1168118,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Humerus w/o Contrast Left,8202997,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Humerus w/o Contrast Right,8202999,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Knee w/o Contrast Left,1168158,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Knee w/o Contrast Right,1168160,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Shoulder w/o Contrast Left,1168220,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Shoulder w/o Contrast Right,1168222,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Tibia/Fibula w/o Contrast Left,8203045,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Tibia/Fibula w/o Contrast Right,8203047,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Wrist w/o Contrast Left,1168341,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Wrist w/o Contrast Right,1168343,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Angio Abdomen Aorta + Iliofemoral,1167851,LOCAL,75635,CPT,,,,,,Outpatient,,,2242.64,1202.85,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
37252 Invasc US Initial Vessel,8230056,LOCAL,37252,CPT,,,,,,Outpatient,,,2252.25,1464,Viva Med ADV,Viva Med ADV,72.79,,,,,,,Fee Schedule,72.79,2669.67,
15277 App Skin Sub Graft(TWSA>100cm2 f/a/h-ft diag add 100 cm2,12635466,LOCAL,15277,CPT,,,,,,Outpatient,,,2263.33,1471,Viva Med ADV,Viva Med ADV,1672.39,,,,,,,Fee Schedule,1496,2862.92,
93312 TEE 2D MM COMPLETE WO CHARGE,8200160,LOCAL,93312,CPT,,,,,,Outpatient,,,2279.37,1482,Viva Med ADV,Viva Med ADV,501.29,,,,,,,Fee Schedule,501.29,678.38,
US Echo Transesophageal,7936283,LOCAL,93312,CPT,,,,,,Outpatient,,,2279.37,1482,Viva Med ADV,Viva Med ADV,501.29,,,,,,,Fee Schedule,501.29,678.38,
G0278-CL ILIAC/FEM ANGIO FOR CLOSURE Charge,8212025,LOCAL,,,G0278,HCPCS,,,,Outpatient,,,2301.79,1496,Viva Med ADV,Viva Med ADV,10.66,,,,,,,Fee Schedule,10.66,6018.68,
NM Gastric Emptying w/ SB,10110882,LOCAL,78265,CPT,,,,,,Outpatient,,,2302.29,1234.2,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
onabotulinumtoxinA 100 units injection [CULL],11212323,LOCAL,J0585,CPT,,,,,,Outpatient,1,EA,2307.84,,Viva Med ADV,Viva Med ADV,6.5,,,,,,,Fee Schedule,6.5,771.25,
MRI Brachial Plexus w/o Contrast Lt,8784911,LOCAL,73221,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Brachial Plexus w/o Contrast Rt,8784914,LOCAL,73221,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Clavicle w/o Contrast Left,9647312,LOCAL,71550,CPT,,,,,LT,Outpatient,,,2317.56,1765.5,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Clavicle w/o Contrast Right,9647315,LOCAL,71550,CPT,,,,,RT,Outpatient,,,2317.56,1765.5,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Fingers w/o Contrast Left,8513078,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Fingers w/o Contrast Right,8513081,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Forearm w/o Contrast Lt,8058719,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Forearm w/o Contrast Rt,8058722,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Hand w/o Contrast Left,1168930,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Hand w/o Contrast Right,1168932,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Humerus w/o Contrast Left,8203080,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Humerus w/o Contrast Right,8203082,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Scapula w/o Contrast Left,9647339,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Scapula w/o Contrast Right,9647342,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRA Neck w/o Contrast,1168683,LOCAL,70547,CPT,,,,,,Outpatient,,,2317.57,1242.45,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,729.93,
KERECIS OMEGA 3 - DISK 16MM,13962584,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,2331,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRA Pelvis w/o Contrast,1168691,LOCAL,72198,CPT,,,,,,Outpatient,,,2338.16,1767.15,Viva Med ADV,Viva Med ADV,222.29,,,,,,,Fee Schedule,220.99,729.93,
MRA Pelvis w/o Contrast,1168691,LOCAL,C8919,CPT,,,,,,Outpatient,,,2338.16,,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,729.93,
XR Myelogram Cervical Spine,1170319,LOCAL,62302,CPT,,,,,,Outpatient,,,2349.36,1527,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,722.32,1291,
XR Myelogram Thoracic Spine,1170327,LOCAL,62303,CPT,,,,,,Outpatient,,,2349.36,1527,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,722.32,1291,
MRI Spine Thoracic w/o Contrast,1169066,LOCAL,72146,CPT,,,,,,Outpatient,,,2365.31,1268.03,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
ILR REMOVAL,8267777,LOCAL,33286,CPT,,,,,,Outpatient,,,2381.18,1548,Viva Med ADV,Viva Med ADV,643.26,,,,,,,Fee Schedule,643.26,2484.2,
CT Spine Lumbar w/o Contrast,1168246,LOCAL,72131,CPT,,,,,,Outpatient,,,2398.23,1286.18,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
NM Bone Three Phase Study Injection/Scan,1169190,LOCAL,78315,CPT,,,,,,Outpatient,,,2428.11,1301.85,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
36002 Pseudoanrsm Repair W Thrombin Us Gud,8212049,LOCAL,36002,CPT,,,,,,Outpatient,,,2429.28,1579,Viva Med ADV,Viva Med ADV,565.25,,,,,,,Fee Schedule,565.25,1291,
AV FISTULAGRAM S&I,8210332,LOCAL,36901,CPT,,,,,,Outpatient,,,2442.76,1588,Viva Med ADV,Viva Med ADV,1420.25,,,,,,,Fee Schedule,1420.25,2669.67,
"CRMP5/CV2 Ab, LB, CSF QSTC",13873605,LOCAL,84182,CPT,,,,,,Outpatient,,,2443.5,35.05,Viva Med ADV,Viva Med ADV,29.21,,,,,,,Fee Schedule,15.29,29.21,
"GAD65 Ab, LB, CSF QSTC",13873611,LOCAL,86341,CPT,,,,,,Outpatient,,,2443.5,28.28,Viva Med ADV,Viva Med ADV,23.57,,,,,,,Fee Schedule,15.29,23.57,
INTERNAL MAMMARY S&I,8210631,LOCAL,75756,CPT,,,,,,Outpatient,,,2455.14,1316.7,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
PULMONARY NONSELECTIVE S&I,8210620,LOCAL,75746,CPT,,,,,,Outpatient,,,2455.14,1316.7,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
CT Angio Pelvis,1167881,LOCAL,72191,CPT,,,,,,Outpatient,,,2457.05,1317.53,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Thoracentesis w/ CT Guidance,2424869,LOCAL,77012,CPT,,,,,,Outpatient,,,2458.4,1318.35,Viva Med ADV,Viva Med ADV,48.7,,,,,,,Fee Schedule,48.7,136.03,
KERECIS OMEGA 3 - 1.75 X 1.75 CM,13962574,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,2475,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
CT Neck Soft Tissue w/o Contrast,1168234,LOCAL,70490,CPT,,,,,,Outpatient,,,2479.06,1329.08,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
64450 INJECTION ANESTHETIC AGENT PERIPHERAL NE,13437921,LOCAL,64450,CPT,,,,,,Outpatient,,,2482.29,1613,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
tetanus immune globulin 250 units/mL intramuscular solution 1 mL [CULL],11212346,LOCAL,J1670,CPT,,,,,,Outpatient,1,ML,2492.8,,Viva Med ADV,Viva Med ADV,593,,,,,,,Fee Schedule,525.49,593,
CT Ankle w/ Contrast Left,1167897,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Ankle w/ Contrast Right,1167899,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Clavicle w/ Contrast Left,12885304,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Clavicle w/ Contrast Right,12885307,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Elbow w/ Contrast Left,1167996,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Elbow w/ Contrast Right,1167998,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Femur w/ Contrast Left,8202918,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Femur w/ Contrast Right,8202920,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Foot w/ Contrast Left,1168034,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Foot w/ Contrast Right,1168036,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Forearm w/ Contrast Left,8202943,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Forearm w/ Contrast Right,8202945,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Hand w/ Contrast Left,1168080,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Hand w/ Contrast Right,1168082,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Hip w/ Contrast Left,1168110,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hip w/ Contrast Right,1168112,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Humerus w/ Contrast Left,8202990,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Humerus w/ Contrast Right,8202992,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Knee w/ Contrast Left,1168152,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Knee w/ Contrast Right,1168154,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Shoulder w/ Contrast Left,1168214,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Shoulder w/ Contrast Right,1168216,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Tibia/Fibula w/ Contrast Left,8203041,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Tibia/Fibula w/ Contrast Right,8203043,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Wrist w/ Contrast Left,1168335,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Wrist w/ Contrast Right,1168337,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
64454 - Injection of anesthetic agent into genicular nerve branches including imaging guidance.,14144343,LOCAL,64454,CPT,,,,,,Outpatient,,,2500,244,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
"64624 Destruction by neurolytic agent, genicular nerve branches",9487180,LOCAL,64624,CPT,,,,,,Outpatient,,,2500,926,Viva Med ADV,Viva Med ADV,1785.34,,,,,,,Fee Schedule,1695.82,2315,
64421 NERVE BLOCK INTERCOSTAL MULTIPLE NERVES,5661026,LOCAL,64421,CPT,,,,,,Outpatient,,,2501.54,890,Viva Med ADV,Viva Med ADV,813.96,,,,,,,Fee Schedule,813.96,1695.82,
15273 ACELLULAR DERM REPL LTH 100 SQ CM,8716218,LOCAL,15273,CPT,,,,,,Outpatient,,,2508.54,1631,Viva Med ADV,Viva Med ADV,3347.08,,,,,,,Fee Schedule,2599,3347.08,
PRIMATRIX 3X3,13962595,LOCAL,,,Q4110,HCPCS,,,,Outpatient,,,2528.69,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
dimethyl sulfoxide 50% irrigation solution 50 mL [CULL],11205390,LOCAL,J1212,CPT,,,,,,Outpatient,50,ML,2541.664,,Viva Med ADV,Viva Med ADV,748.85,,,,,,,Fee Schedule,525.49,748.85,
INJ PERC CHOL W EXIS CATH,8210336,LOCAL,47531,CPT,,,,,,Outpatient,,,2566.23,298,Viva Med ADV,Viva Med ADV,3226.48,,,,,,,Fee Schedule,2599,3226.48,
MRI Elbow w/o Contrast Left,1168848,LOCAL,73221,CPT,,,,,LT,Outpatient,,,2584.17,1242.45,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Elbow w/o Contrast Right,1168850,LOCAL,73221,CPT,,,,,RT,Outpatient,,,2584.17,1242.45,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Shoulder w/o Contrast Left,1169044,LOCAL,73221,CPT,,,,,LT,Outpatient,,,2584.17,1242.45,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Shoulder w/o Contrast Right,1169046,LOCAL,73221,CPT,,,,,RT,Outpatient,,,2584.17,1242.45,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Wrist w/o Contrast Left,1169140,LOCAL,73221,CPT,,,,,LT,Outpatient,,,2584.17,1242.45,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Wrist w/o Contrast Right,1169142,LOCAL,73221,CPT,,,,,RT,Outpatient,,,2584.17,1242.45,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
ASPIRATION / INJECTION OF RENAL PELVIS,8210655,LOCAL,50390,CPT,,,,,,Outpatient,,,2587.86,1682,Viva Med ADV,Viva Med ADV,643.26,,,,,,,Fee Schedule,555.55,1291,
MRI Femur w/o Contrast Lt,8058707,LOCAL,73718,CPT,,,,,LT,Outpatient,,,2591.03,1389.3,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Femur w/o Contrast Rt,8058710,LOCAL,73718,CPT,,,,,RT,Outpatient,,,2591.03,1389.3,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Foot w/o Contrast Left,1168890,LOCAL,73718,CPT,,,,,LT,Outpatient,,,2591.03,1389.3,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Foot w/o Contrast Right,1168892,LOCAL,73718,CPT,,,,,RT,Outpatient,,,2591.03,1389.3,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Tibia/Fibula w/o Contrast Left,8206789,LOCAL,73718,CPT,,,,,LT,Outpatient,,,2591.03,1389.3,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Tibia/Fibula w/o Contrast Right,8206791,LOCAL,73718,CPT,,,,,RT,Outpatient,,,2591.03,1389.3,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRA Neck w/ Contrast,1168681,LOCAL,70548,CPT,,,,,,Outpatient,,,2591.04,1389.3,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,729.93,
AMNIOEXCEL SKIN SUBSTITUTE 18MM,13962552,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,2593.13,3028,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
LENS TORIC #SA6AT4,4853560,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,2596,410,Viva Med ADV,Viva Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
LENS TORIC ABSORBING SA6AT5,4853594,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,2596,410,Viva Med ADV,Viva Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
IR Venogram Cava Superior1,8071895,LOCAL,75827,CPT,,,,,,Outpatient,,,2596.75,1392.6,Viva Med ADV,Viva Med ADV,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
SUPERIOR VENA CAVA S&I,8210670,LOCAL,75827,CPT,,,,,,Outpatient,,,2596.75,1392.6,Viva Med ADV,Viva Med ADV,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
VENOGRAM UNILATERAL EXT S&I,8211100,LOCAL,75820,CPT,,,,,,Outpatient,,,2596.75,1392.6,Viva Med ADV,Viva Med ADV,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
XR Venogram Extremity Left,8115647,LOCAL,75820,CPT,,,,,LT,Outpatient,,,2596.75,1392.6,Viva Med ADV,Viva Med ADV,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
XR Venogram Extremity Right,8115650,LOCAL,75820,CPT,,,,,RT,Outpatient,,,2596.75,1392.6,Viva Med ADV,Viva Med ADV,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
Procedure Performed. -> Paracentesis,9739222,LOCAL,49082,CPT,,,,,,Outpatient,,,2601.5,1691,Viva Med ADV,Viva Med ADV,857.17,,,,,,,Fee Schedule,857.17,1496,
MRA Pelvis w/ Contrast,1168689,LOCAL,72198,CPT,,,,,,Outpatient,,,2611.62,1767.15,Viva Med ADV,Viva Med ADV,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Pelvis w/ Contrast,1168689,LOCAL,C8918,CPT,,,,,,Outpatient,,,2611.62,,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,222.29,729.93,
NM Bone Imaging Whole Body Injection,1169180,LOCAL,78306,CPT,,,,,,Outpatient,,,2623.86,1407.45,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,560.96,
CT Angio Lower Extremity Bilateral,8058637,LOCAL,73706,CPT,,,,,,Outpatient,,,2637.85,1414.88,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Lower Extremity Left,1167875,LOCAL,73706,CPT,,,,,LT,Outpatient,,,2637.85,1414.88,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Lower Extremity Right,1167877,LOCAL,73706,CPT,,,,,RT,Outpatient,,,2637.85,1414.88,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
MRI Spine Thoracic w/ Contrast,1169064,LOCAL,72147,CPT,,,,,,Outpatient,,,2638.77,1414.88,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
AMNIOEXCEL PLUS 17MM,13962547,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,2639.25,3028,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
C8925 TEE COMPLETE 2D WWO CHARGE,8200184,LOCAL,,,C8925,HCPCS,,,,Outpatient,,,2643.51,1718,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,678.38,722.32,
ECHO COMPLETE WITH DOP/CONTRAST,8200176,LOCAL,,,C8929,HCPCS,,,,Outpatient,,,2643.51,1718,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,678.38,722.32,
US Echo Doppler Complete w/ Contrast,13780988,LOCAL,93306,CPT,C8929,HCPCS,,,,Outpatient,,,2643.51,1036,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,678.38,722.32,
95805 MAINTENANCE OF WAKEFULNESS CHARGE,9569825,LOCAL,95805,CPT,,,,,,Outpatient,,,2652.34,1724,Viva Med ADV,Viva Med ADV,485.11,,,,,,,Fee Schedule,485.11,1113.98,
95805 MSLT CHARGES,8795717,LOCAL,95805,CPT,,,,,,Outpatient,,,2652.34,1724,Viva Med ADV,Viva Med ADV,485.11,,,,,,,Fee Schedule,485.11,1113.98,
95805 MSLT/MWT CHARGES,9442365,LOCAL,95805,CPT,,,,,,Outpatient,,,2652.34,1724,Viva Med ADV,Viva Med ADV,485.11,,,,,,,Fee Schedule,485.11,1113.98,
".MOG Ab, Titer QSTC",13864468,LOCAL,86362,CPT,,,,,,Outpatient,,,2653.38,14.46,Viva Med ADV,Viva Med ADV,12.05,,,,,,,Fee Schedule,12.05,15.29,
PURAPLY AM 2X2 COMMERCIAL 4SQ CM,13962597,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,2664,3861,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
CT Spine Lumbar w/ Contrast,1168244,LOCAL,72132,CPT,,,,,,Outpatient,,,2671.69,1433.03,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
MRA Brain/Head w/o Contrast,1168653,LOCAL,70544,CPT,,,,,,Outpatient,,,2690.84,1442.93,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,729.93,
MRA Lower Extremity w/ + w/o Cnt Left,1168663,LOCAL,73725,CPT,,,,,LT,Outpatient,,,2690.84,1442.93,Viva Med ADV,Viva Med ADV,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Lower Extremity w/ + w/o Cnt Right,1168665,LOCAL,73725,CPT,,,,,RT,Outpatient,,,2690.84,1442.93,Viva Med ADV,Viva Med ADV,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRV Head w/o Contrast,8450965,LOCAL,70544,CPT,,,,,,Outpatient,,,2690.84,1442.93,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,729.93,
CT Clavicle w/ + w/o Contrast Left,12885298,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Clavicle w/ + w/o Contrast Right,12885301,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Elbow w/ + w/o Contrast Left,8202901,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Elbow w/ + w/o Contrast Right,8202903,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Forearm w/ + w/o Contrast Left,8202936,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Forearm w/ + w/o Contrast Right,8202938,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hand w/ + w/o Contrast Left,8202957,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hand w/ + w/o Contrast Right,8202959,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Humerus w/ + w/o Contrast Left,8202983,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Humerus w/ + w/o Contrast Right,8202985,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Shoulder w/ + w/o Contrast Left,8203023,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Shoulder w/ + w/o Contrast Right,8203025,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Wrist w/ + w/o Contrast Left,8203057,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Wrist w/ + w/o Contrast Right,8203059,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Spine Thoracic w/o Contrast,1168252,LOCAL,72128,CPT,,,,,,Outpatient,,,2704.58,1450.35,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Spine Cervical w/o Contrast,1168240,LOCAL,72125,CPT,,,,,,Outpatient,,,2712.02,1454.48,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Abdomen w/ Oral Contrast Only,8206354,LOCAL,74150,CPT,,,,,,Outpatient,,,2720.92,1459.43,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Abdomen w/o Contrast,1167849,LOCAL,74150,CPT,,,,,,Outpatient,,,2720.92,1459.43,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Pelvis w/ Oral Contrast Only,8206452,LOCAL,72192,CPT,,,,,,Outpatient,,,2720.92,1459.43,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Pelvis w/o Contrast,1168198,LOCAL,72192,CPT,,,,,,Outpatient,,,2720.92,1459.43,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
MRI Ankle w/o Contrast Left,1168750,LOCAL,73721,CPT,,,,,LT,Outpatient,,,2733.23,1466.03,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Ankle w/o Contrast Right,1168752,LOCAL,73721,CPT,,,,,RT,Outpatient,,,2733.23,1466.03,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Hip w/o Contrast Left,1168948,LOCAL,73721,CPT,,,,,LT,Outpatient,,,2733.23,1466.03,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Hip w/o Contrast Right,1168950,LOCAL,73721,CPT,,,,,RT,Outpatient,,,2733.23,1466.03,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Knee w/o Contrast Left,1168984,LOCAL,73721,CPT,,,,,LT,Outpatient,,,2733.23,1466.03,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Knee w/o Contrast Right,1168986,LOCAL,73721,CPT,,,,,RT,Outpatient,,,2733.23,1466.03,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Neck Soft Tissue w/ Contrast,1168232,LOCAL,70491,CPT,,,,,,Outpatient,,,2752.53,1475.93,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRA Abdomen w/o Contrast,1168639,LOCAL,74185,CPT,,,,,,Outpatient,,,2786.55,2017.13,Viva Med ADV,Viva Med ADV,221.41,,,,,,,Fee Schedule,221.41,729.93,
64483 TRANS INJ LUMB/SACR-BILATERAL CHARGE,5661040,LOCAL,64483,CPT,,,,,,Outpatient,,,2788.44,1812,Viva Med ADV,Viva Med ADV,813.96,,,,,,,Fee Schedule,813.96,1291,
64484 TRANS INJ LUMB/SACR EA ADD BIL CHARGE,5661049,LOCAL,64484,CPT,,,,,,Outpatient,,,2788.44,1812,Viva Med ADV,Viva Med ADV,41.55,,,,,,,Fee Schedule,41.55,1250.53,
MRA Chest w/o Contrast,1168647,LOCAL,71555,CPT,,,,,,Outpatient,,,2794.75,1645.05,Viva Med ADV,Viva Med ADV,220.24,,,,,,,Fee Schedule,220.24,729.93,
MRA Chest w/o Contrast,1168647,LOCAL,C8910,CPT,,,,,,Outpatient,,,2794.75,,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.24,729.93,
MRI Abdomen w/o Contrast,1168734,LOCAL,74181,CPT,,,,,,Outpatient,,,2804.32,1503.98,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI MRCP w/o Contrast,8203102,LOCAL,74181,CPT,,,,,,Outpatient,,,2804.32,1503.98,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Spine Cervical w/o Contrast,1169054,LOCAL,72141,CPT,,,,,,Outpatient,,,2804.32,1503.98,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Spine Lumbar w/o Contrast,1169060,LOCAL,72148,CPT,,,,,,Outpatient,,,2804.32,1503.98,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Brain/Head Stroke Alert,8202967,LOCAL,70450,CPT,,,,,,Outpatient,,,2816.63,1510.58,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,461.98,
CT Brain/Head w/o Contrast,1168094,LOCAL,70450,CPT,,,,,,Outpatient,,,2816.63,1510.58,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,461.98,
PLACE CENTRAL VENOUS LINE,8210290,LOCAL,36556,CPT,,,,,,Outpatient,,,2850.87,1853,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,1291,2877.63,
MRI Brachial Plexus w/ Contrast Lt,10558521,LOCAL,73222,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Brachial Plexus w/ Contrast Rt,10558524,LOCAL,73222,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Clavicle w/ Contrast Left,12912772,LOCAL,71551,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Clavicle w/ Contrast Right,12912775,LOCAL,71551,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Elbow w/ Contrast Left,1168842,LOCAL,73222,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Elbow w/ Contrast Right,1168844,LOCAL,73222,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Shoulder w/ Contrast Left,1169038,LOCAL,73222,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Shoulder w/ Contrast Right,1169040,LOCAL,73222,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Wrist w/ Contrast Left,1169134,LOCAL,73222,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Wrist w/ Contrast Right,1169136,LOCAL,73222,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
AMNIOEXCEL SKIN SUBSTITUTE 1.5CM X 1.5CM,13962551,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,2862.09,3028,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRI Femur w/ Contrast Left,8206704,LOCAL,73719,CPT,,,,,LT,Outpatient,,,2864.49,1536.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Femur w/ Contrast Right,8206706,LOCAL,73719,CPT,,,,,RT,Outpatient,,,2864.49,1536.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Foot w/ Contrast Left,1168884,LOCAL,73719,CPT,,,,,LT,Outpatient,,,2864.49,1536.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Foot w/ Contrast Right,1168886,LOCAL,73719,CPT,,,,,RT,Outpatient,,,2864.49,1536.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Tibia/Fibula w/ Contrast Left,8206783,LOCAL,73719,CPT,,,,,LT,Outpatient,,,2864.49,1536.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Tibia/Fibula w/ Contrast Right,8206785,LOCAL,73719,CPT,,,,,RT,Outpatient,,,2864.49,1536.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Angio Chest,1167863,LOCAL,71275,CPT,,,,,,Outpatient,,,2871.32,1539.45,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
20220 BIOPSY BONE TROC/NDL SUPERFICL CHARGE,9709066,LOCAL,20220,CPT,,,,,,Outpatient,,,2874.06,1868,Viva Med ADV,Viva Med ADV,1481.32,,,,,,,Fee Schedule,923.18,1481.32,
CT Orbit Sella etc. or IAC w/o Cont,8362458,LOCAL,70480,CPT,,,,,,Outpatient,,,2874.06,1541.1,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
Antenatal Testing Type -> Non-Stress test,9848446,LOCAL,59025,CPT,,,,,,Outpatient,,,2886.2,1876,Viva Med ADV,Viva Med ADV,183.92,,,,,,,Fee Schedule,183.92,863,
Non Stress Test Charge,9919812,LOCAL,59025,CPT,,,,,,Outpatient,,,2886.2,1876,Viva Med ADV,Viva Med ADV,183.92,,,,,,,Fee Schedule,183.92,863,
Abeta 40 QST,13873829,LOCAL,82542,CPT,,,,,,Outpatient,,,2925,28.91,Viva Med ADV,Viva Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.09,
Abeta 42/40 Ratio QST,13873830,LOCAL,82172,CPT,,,,,,Outpatient,,,2925,25.31,Viva Med ADV,Viva Med ADV,37.52,,,,,,,Fee Schedule,17.73,37.515,
MRI Pelvis w/o Contrast,1169028,LOCAL,72195,CPT,,,,,,Outpatient,,,2958.83,1586.48,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRA Lower Extremity w/o Contrast Left,1168675,LOCAL,73725,CPT,,,,,LT,Outpatient,,,2964.3,1442.93,Viva Med ADV,Viva Med ADV,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Lower Extremity w/o Contrast Right,1168677,LOCAL,73725,CPT,,,,,RT,Outpatient,,,2964.3,1442.93,Viva Med ADV,Viva Med ADV,222.29,,,,,,,Fee Schedule,222.29,729.93,
CT Angio Abdomen,1167853,LOCAL,74175,CPT,,,,,,Outpatient,,,2965.92,1590.6,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
MRI TMJ,1169068,LOCAL,70336,CPT,,,,,,Outpatient,,,2973.87,1594.73,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Spine Thoracic w/ Contrast,1168250,LOCAL,72129,CPT,,,,,,Outpatient,,,2978.05,1597.2,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Spine Cervical w/ Contrast,1168238,LOCAL,72126,CPT,,,,,,Outpatient,,,2985.5,1601.33,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
NM Cisternography Injection,1169226,LOCAL,78630,CPT,A9548,HCPCS,,,,Outpatient,,,2985.52,1601.33,Viva Med ADV,Viva Med ADV,715.29,,,,,,,Fee Schedule,715.29,1409.71,
CT Angio Brain/Head,1167871,LOCAL,70496,CPT,,,,,,Outpatient,,,2990.01,1603.8,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Upper Extremity Bilateral,8058640,LOCAL,73206,CPT,,,,,,Outpatient,,,2990.01,1603.8,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Upper Extremity Left,1167885,LOCAL,73206,CPT,,,,,LT,Outpatient,,,2990.01,1603.8,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Upper Extremity Right,1167887,LOCAL,73206,CPT,,,,,RT,Outpatient,,,2990.01,1603.8,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Abdomen w/ Contrast,1167847,LOCAL,74160,CPT,,,,,,Outpatient,,,2994.38,1605.45,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Abdomen w/ Contrast + Oral,13452972,LOCAL,74160,CPT,,,,,,Outpatient,,,2994.38,1605.45,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Pelvis w/ Contrast,1168196,LOCAL,72193,CPT,,,,,,Outpatient,,,2994.38,1605.45,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Pelvis w/ Contrast + Oral,13554960,LOCAL,72193,CPT,,,,,,Outpatient,,,2994.38,1605.45,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRI Ankle w/ Contrast Left,1168744,LOCAL,73722,CPT,,,,,LT,Outpatient,,,3006.69,1612.05,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Ankle w/ Contrast Right,1168746,LOCAL,73722,CPT,,,,,RT,Outpatient,,,3006.69,1612.05,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Hip w/ Contrast Left,1168942,LOCAL,73722,CPT,,,,,LT,Outpatient,,,3006.69,1612.05,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Hip w/ Contrast Right,1168944,LOCAL,73722,CPT,,,,,RT,Outpatient,,,3006.69,1612.05,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Knee w/ Contrast Left,1168978,LOCAL,73722,CPT,,,,,LT,Outpatient,,,3006.69,1612.05,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Knee w/ Contrast Right,1168980,LOCAL,73722,CPT,,,,,RT,Outpatient,,,3006.69,1612.05,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,652.35,722.32,
IMPLANT BREAST 360CC,4850676,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3025,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
CT Angio Neck,1167879,LOCAL,70498,CPT,,,,,,Outpatient,,,3039.77,1630.2,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Chest High Resolution,8658939,LOCAL,71250,CPT,,,,,,Outpatient,,,3049.07,1635.15,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,461.98,
CT Chest High Resolution w/o Contrast,8658939,LOCAL,71250,CPT,,,,,,Outpatient,,,3049.07,1635.15,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,461.98,
CT Chest w/o Contrast,8071395,LOCAL,71250,CPT,,,,,,Outpatient,,,3049.07,1635.15,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Low Dose Lung Screening,8090304,LOCAL,71271,CPT,,,,,,Outpatient,,,3049.07,1635.15,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
MRA Abdomen w/ Contrast,1168637,LOCAL,74185,CPT,,,,,,Outpatient,,,3060.01,2017.13,Viva Med ADV,Viva Med ADV,221.41,,,,,,,Fee Schedule,221.41,729.93,
MRA Chest w/ Contrast,1168645,LOCAL,71555,CPT,,,,,,Outpatient,,,3068.21,1645.05,Viva Med ADV,Viva Med ADV,220.24,,,,,,,Fee Schedule,220.24,729.93,
MRA Chest w/ Contrast,1168645,LOCAL,C8909,CPT,,,,,,Outpatient,,,3068.21,,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,220.24,729.93,
MRI Abdomen w/ Contrast,1168732,LOCAL,74182,CPT,,,,,,Outpatient,,,3077.78,1650.83,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Spine Cervical w/ Contrast,1169052,LOCAL,72142,CPT,,,,,,Outpatient,,,3077.78,1650.83,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Spine Lumbar w/ Contrast,1169058,LOCAL,72149,CPT,,,,,,Outpatient,,,3077.78,1650.83,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Brain/Head w/ Contrast,1168092,LOCAL,70460,CPT,,,,,,Outpatient,,,3090.07,1657.43,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
immune globulin intravenous and subcutaneous 10% injectable solution 50 mL [CULL],11205108,LOCAL,J1561,CPT,,,,,,Outpatient,50,ML,3099.84,,Viva Med ADV,Viva Med ADV,48.96,,,,,,,Fee Schedule,48.96,2110.36,
CT Maxillofacial w/o Contrast,1168186,LOCAL,70486,CPT,,,,,,Outpatient,,,3131.11,1678.88,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,170.53,
Central Line Access Type. -> Peripherally inserted central catheter (PICC),9344166,LOCAL,36569,CPT,,,,,,Outpatient,,,3141.6,2042,Viva Med ADV,Viva Med ADV,1420.25,,,,,,,Fee Schedule,1291,1644.1,
CT Orbit Sella etc. or IAC w/ Cont,8362455,LOCAL,70481,CPT,,,,,,Outpatient,,,3147.52,1687.95,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
NM Tumor Loc Whole Body 2+ Days,1169416,LOCAL,78804,CPT,,,,,,Outpatient,,,3150.27,1689.6,Viva Med ADV,Viva Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
NM Tumor Loc Whole Body 2+ Days Gallium,1169418,LOCAL,78804,CPT,A9556,HCPCS,,,,Outpatient,,,3150.27,1689.6,Viva Med ADV,Viva Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
CT Ankle w/ + w/o Contrast Left,8202894,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Ankle w/ + w/o Contrast Right,8202896,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Femur w/ + w/o Contrast Left,8202914,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Femur w/ + w/o Contrast Right,8202916,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Foot w/ + w/o Contrast Left,8202926,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Foot w/ + w/o Contrast Right,8202928,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hip w/ + w/o Contrast Left,8202973,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hip w/ + w/o Contrast Right,8202975,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Knee w/ + w/o Contrast Left,8203007,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Knee w/ + w/o Contrast Right,8203009,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Tibia/Fibula w/ + w/o Contrast Left,8203037,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Tibia/Fibula w/ + w/o Contrast Right,8203039,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CHOLECYSTOSTOMY DRAIN PLACEMENT,8267773,LOCAL,47490,CPT,,,,,,Outpatient,,,3200,2080,Viva Med ADV,Viva Med ADV,3226.48,,,,,,,Fee Schedule,2599,3682.65,
"11047  Debridement Sub-Q, bone each add l 20sq cm",10013082,LOCAL,11047,CPT,,,,,,Outpatient,,,3218.96,2092,Viva Med ADV,Viva Med ADV,78.26,,,,,,,Fee Schedule,78.26,1466.58,
11047 Debrid bone > 20 sq cm charge,12508109,LOCAL,11047,CPT,,,,,,Outpatient,,,3218.96,2092,Viva Med ADV,Viva Med ADV,78.26,,,,,,,Fee Schedule,78.26,1466.58,
CT Guided Perc Drain/Placement,7936217,LOCAL,75989,CPT,,,,,,Outpatient,,,3232.87,618.75,Viva Med ADV,Viva Med ADV,50.75,,,,,,,Fee Schedule,50.75,262.79,
XR Drainage Perc Cath Placement,8058781,LOCAL,75989,CPT,,,,,,Outpatient,,,3232.87,618.75,Viva Med ADV,Viva Med ADV,50.75,,,,,,,Fee Schedule,50.75,262.79,
LENS DIU450,4852298,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,3272.5,410,Viva Med ADV,Viva Med ADV,145.73,,,,,,,Fee Schedule,145.73,145.73,
MRA Neck w/ + w/o Contrast,1168679,LOCAL,70549,CPT,,,,,,Outpatient,,,3274.68,1756.43,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,729.93,
MRI Brachial Plexus w/ + w/o Contrast Lt,8784905,LOCAL,73223,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Brachial Plexus w/ + w/o Contrast Rt,8784908,LOCAL,73223,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Clavicle w/ + w/o Contrast Left,9647306,LOCAL,71552,CPT,,,,,LT,Outpatient,,,3274.68,2131.8,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Clavicle w/ + w/o Contrast Right,9647309,LOCAL,71552,CPT,,,,,RT,Outpatient,,,3274.68,2131.8,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Fingers w/ + w/o Contrast Left,8513072,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Fingers w/ + w/o Contrast Right,8513075,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Forearm w/ + w/o Contrast Lt,8058713,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Forearm w/ + w/o Contrast Rt,8058716,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hand w/ + w/o Contrast Left,1168918,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hand w/ + w/o Contrast Right,1168920,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Humerus w/ + w/o Contrast Left,8203076,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Humerus w/ + w/o Contrast Right,8203078,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Scapula w/ + w/o Contrast Left,9647333,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Scapula w/ + w/o Contrast Right,9647336,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
XR Myelogram 2 or More Regions,10386814,LOCAL,62305,CPT,,,,,,Outpatient,,,3282.36,2134,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,722.32,1291,
MRI Chest w/o Contrast,1168824,LOCAL,71550,CPT,,,,,,Outpatient,,,3292.3,1765.5,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRA Pelvis w/ + w/o Contrast,1168687,LOCAL,72198,CPT,,,,,,Outpatient,,,3295.27,1767.15,Viva Med ADV,Viva Med ADV,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Pelvis w/ + w/o Contrast,1168687,LOCAL,C8920,CPT,,,,,,Outpatient,,,3295.27,,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,222.29,729.93,
CT Chest w/ Contrast,8071392,LOCAL,71260,CPT,,,,,,Outpatient,,,3322.53,1782,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,162.76,
US Echo Transesophag w/ Cont,13770878,LOCAL,93312,CPT,C8925,HCPCS,,,,Outpatient,,,3329.37,1482,Viva Med ADV,Viva Med ADV,722.32,,,,,,,Fee Schedule,678.38,722.32,
PERC PLEURAL INSERTION/DRAINAGE AND S&I,8230068,LOCAL,32557,CPT,,,,,,Outpatient,,,3332.77,2166,Viva Med ADV,Viva Med ADV,1420.25,,,,,,,Fee Schedule,1291,1420.25,
GRAFIX PRIME 1.5 X 2CM,13962569,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,3348,3671,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 18MM,13962561,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,3350.25,1755,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
CT Spine Lumbar w/ + w/o Contrast,1168242,LOCAL,72133,CPT,,,,,,Outpatient,,,3355.34,1799.33,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
EPIFIX SKIN SUBSTITUTE 18MM,10510009,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,3359.95,1755,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
"Poliovirus 1, 3 Ab, Neutralization QSTC",13864497,LOCAL,86382,CPT,,,,,,Outpatient,,,3375,20.29,Viva Med ADV,Viva Med ADV,16.91,,,,,,,Fee Schedule,15.29,16.91,
MRA Lower Extremity w/ Contrast Left,90720012,LOCAL,73725,CPT,,,,,LT,Outpatient,,,3383,1442.93,Viva Med ADV,Viva Med ADV,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Lower Extremity w/ Contrast Right,90720013,LOCAL,73725,CPT,,,,,RT,Outpatient,,,3383,1442.93,Viva Med ADV,Viva Med ADV,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Upper Extremity w/ Contrast Left,90720010,LOCAL,73225,CPT,,,,,LT,Outpatient,,,3383,2038.58,Viva Med ADV,Viva Med ADV,214.69,,,,,,,Fee Schedule,214.69,729.93,
MRA Upper Extremity w/ Contrast Right,90720011,LOCAL,73225,CPT,,,,,RT,Outpatient,,,3383,2038.58,Viva Med ADV,Viva Med ADV,214.69,,,,,,,Fee Schedule,214.69,729.93,
MRI Face Neck Orbit w/o Contrast,1168856,LOCAL,70540,CPT,,,,,,Outpatient,,,3383.36,1814.18,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Maxillofacial w/ Contrast,1168184,LOCAL,70487,CPT,,,,,,Outpatient,,,3404.57,1825.73,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
KERECIS OMEGA 3 - 3 X 3.5 CM,13962576,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,3406.5,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
TRANSCATH EMBOLIZATION S&I,8267120,LOCAL,75894,CPT,,,,,,Outpatient,,,3428.95,1838.93,Viva Med ADV,Viva Med ADV,165.4,,,,,,,Fee Schedule,165.4,262.79,
CT Neck Soft Tissue w/ + w/o Contrast,1168230,LOCAL,70492,CPT,,,,,,Outpatient,,,3436.18,1843.05,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Parathyroid 4-Phase Study,13554957,LOCAL,70492,CPT,,,,,,Outpatient,,,3436.18,1843.05,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRI Brain + IAC w/o Contrast,9427804,LOCAL,70551,CPT,,,,,,Outpatient,,,3446.61,1848,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Brain w/o Contrast,1168800,LOCAL,70551,CPT,,,,,,Outpatient,,,3446.61,1848,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Pituitary w/o Contrast,8203111,LOCAL,70551,CPT,,,,,,Outpatient,,,3446.61,1848,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
DISKOGRAM LUMBAR S & I,8299004,LOCAL,72295,CPT,,,,,,Outpatient,,,3452,1851.3,Viva Med ADV,Viva Med ADV,1785.34,,,,,,,Fee Schedule,857.13,1785.34,
NM Tumor Loc Spect,1169408,LOCAL,78803,CPT,,,,,,Outpatient,,,3466,1181.4,Viva Med ADV,Viva Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
NM Tumor Loc Whole Body 1 Day,1169414,LOCAL,78802,CPT,,,,,,Outpatient,,,3466,2870.18,Viva Med ADV,Viva Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
NUSHIELD 2X3CM,13962587,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,3487.5,1155,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
28090 EXCISION GANGLION CYST FOOT,13436341,LOCAL,28090,CPT,,,,,,Outpatient,,,3532.98,2296,Viva Med ADV,Viva Med ADV,1463.19,,,,,,,Fee Schedule,1463.19,3153.58,
ICD REMOVAL SC/DC LEAD TV EXTRACT,8231010,LOCAL,33244,CPT,,,,,,Outpatient,,,3541,2302,Viva Med ADV,Viva Med ADV,3327.27,,,,,,,Fee Schedule,2484.2,3327.27,
MRI Elbow w/ + w/o Contrast Left,1168836,LOCAL,73223,CPT,,,,,LT,Outpatient,,,3541.3,1756.43,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Elbow w/ + w/o Contrast Right,1168838,LOCAL,73223,CPT,,,,,RT,Outpatient,,,3541.3,1756.43,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Shoulder w/ + w/o Contrast Left,1169032,LOCAL,73223,CPT,,,,,LT,Outpatient,,,3541.3,1756.43,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Shoulder w/ + w/o Contrast Right,1169034,LOCAL,73223,CPT,,,,,RT,Outpatient,,,3541.3,1756.43,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Wrist w/ + w/o Contrast Left,1169128,LOCAL,73223,CPT,,,,,LT,Outpatient,,,3541.3,1756.43,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Wrist w/ + w/o Contrast Right,1169130,LOCAL,73223,CPT,,,,,RT,Outpatient,,,3541.3,1756.43,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Femur w/ + w/o Contrast Lt,8058701,LOCAL,73720,CPT,,,,,LT,Outpatient,,,3548.14,1902.45,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Femur w/ + w/o Contrast Rt,8058704,LOCAL,73720,CPT,,,,,RT,Outpatient,,,3548.14,1902.45,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Foot w/ + w/o Contrast Left,1168878,LOCAL,73720,CPT,,,,,LT,Outpatient,,,3548.14,1902.45,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Foot w/ + w/o Contrast Right,1168880,LOCAL,73720,CPT,,,,,RT,Outpatient,,,3548.14,1902.45,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Tibia/Fibula w/ + w/o Contrast Left,8206777,LOCAL,73720,CPT,,,,,LT,Outpatient,,,3548.14,1902.45,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Tibia/Fibula w/ + w/o Contrast Right,8206779,LOCAL,73720,CPT,,,,,RT,Outpatient,,,3548.14,1902.45,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
THERASKIN 1.75 X 1.75,13962605,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,3577.5,2431,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
L3900 WHFO DYNAMIC,9856098,LOCAL,,,L3900,HCPCS,,,,Outpatient,,,3580.05,2327,Viva Med ADV,Viva Med ADV,1756.7,,,,,,,Fee Schedule,1756.7,1756.7,
"L3900 Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger",9856099,LOCAL,,,L3900,HCPCS,,,,Outpatient,,,3580.05,2327,Viva Med ADV,Viva Med ADV,1756.7,,,,,,,Fee Schedule,1756.7,1756.7,
11044 DEBRID BONE FIRST 20SQ CM OR < CHARGE,8019965,LOCAL,11044,CPT,,,,,,Outpatient,,,3581.67,2328,Viva Med ADV,Viva Med ADV,1481.32,,,,,,,Fee Schedule,1291,1481.32,
MRI Face Neck Orbit w/ Contrast,1168854,LOCAL,70542,CPT,,,,,,Outpatient,,,3633.36,1948.65,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
bivalirudin 250 mg intravenous injection [CULL],11220339,LOCAL,J0583,CPT,,,,,,Outpatient,1,EA,3639.2608,,Viva Med ADV,Viva Med ADV,0.16,,,,,,,Fee Schedule,0.157,233.26,
MRI Pelvis w/ + w/o Contrast,1169024,LOCAL,72197,CPT,,,,,,Outpatient,,,3642.47,1953.6,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Prostate w/ + w/o Contrast,4126347,LOCAL,72197,CPT,,,,,,Outpatient,,,3642.47,1953.6,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Spine Thoracic w/ + w/o Contrast,1168248,LOCAL,72130,CPT,,,,,,Outpatient,,,3661.7,1963.5,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRI Breast w/o Contrast Bilateral.,8784923,LOCAL,77047,CPT,,,,,,Outpatient,,,3667.77,1966.8,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Spine Cervical w/ + w/o Contrast,1168236,LOCAL,72127,CPT,,,,,,Outpatient,,,3669.14,1967.63,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Abdomen w/ + w/o Contrast,1167845,LOCAL,74170,CPT,,,,,,Outpatient,,,3678.03,1972.58,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Pelvis w/ + w/o Contrast,1168194,LOCAL,72194,CPT,,,,,,Outpatient,,,3678.03,1972.58,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
28190 Appy Rigid Leg Cast (Professional Charge only if Provider Applies),12642333,LOCAL,28190,CPT,,,,,,Outpatient,,,3680.71,2392,Viva Med ADV,Viva Med ADV,643.26,,,,,,,Fee Schedule,643.26,1291,
MRI Ankle w/ + w/o Contrast Left,1168738,LOCAL,73723,CPT,,,,,LT,Outpatient,,,3690.34,1979.18,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Ankle w/ + w/o Contrast Right,1168740,LOCAL,73723,CPT,,,,,RT,Outpatient,,,3690.34,1979.18,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hip w/ + w/o Contrast Left,1168936,LOCAL,73723,CPT,,,,,LT,Outpatient,,,3690.34,1979.18,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hip w/ + w/o Contrast Right,1168938,LOCAL,73723,CPT,,,,,RT,Outpatient,,,3690.34,1979.18,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Knee w/ + w/o Contrast Left,1168972,LOCAL,73723,CPT,,,,,LT,Outpatient,,,3690.34,1979.18,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Knee w/ + w/o Contrast Right,1168974,LOCAL,73723,CPT,,,,,RT,Outpatient,,,3690.34,1979.18,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
IMPLANT BREAST #350-2004BC,4802098,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-3004 300cc,4801298,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-3504bc,4801299,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-4754BC,4852770,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-5504BC,4803723,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-6501BC,4805039,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST 445ML,4855517,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST GEL 700CC,4850683,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST MEMORY GEL 510CC,4853454,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT MEMORY GEL 225CC,4830332,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
MRA Brain/Head w/ + w/o Contrast,1168649,LOCAL,70546,CPT,,,,,,Outpatient,,,3690.84,1979.18,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,729.93,
MRI Brain + IAC w/ Contrast,9427801,LOCAL,70552,CPT,,,,,,Outpatient,,,3720.07,1994.85,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Brain w/ Contrast,1168798,LOCAL,70552,CPT,,,,,,Outpatient,,,3720.07,1994.85,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
THERASKIN 2.5 X 2.5 CM,13962606,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,3739.5,2431,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRA Abdomen w/ + w/o Contrast,1168635,LOCAL,74185,CPT,,,,,,Outpatient,,,3761.43,2017.13,Viva Med ADV,Viva Med ADV,221.41,,,,,,,Fee Schedule,221.41,729.93,
MRI Abdomen w/ + w/o Contrast,1168730,LOCAL,74183,CPT,,,,,,Outpatient,,,3761.43,2017.13,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Brain/Head w/ + w/o Contrast,1168090,LOCAL,70470,CPT,,,,,,Outpatient,,,3773.72,2023.73,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
10140 DRAINAGE OF HEMATOMA,8715913,LOCAL,10140,CPT,,,,,,Outpatient,,,3775.02,2454,Viva Med ADV,Viva Med ADV,1481.32,,,,,,,Fee Schedule,1481.32,1605.05,
MRA Upper Extremity w/ + w/o Cnt Left,1168704,LOCAL,73225,CPT,,,,,LT,Outpatient,,,3801.65,2038.58,Viva Med ADV,Viva Med ADV,214.69,,,,,,,Fee Schedule,214.69,729.93,
MRA Upper Extremity w/ + w/o Cnt Left,1168704,LOCAL,C8936,CPT,,,,,LT,Outpatient,,,3801.65,,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,214.69,729.93,
MRA Upper Extremity w/ + w/o Cnt Right,1168707,LOCAL,73225,CPT,,,,,RT,Outpatient,,,3801.65,2038.58,Viva Med ADV,Viva Med ADV,214.69,,,,,,,Fee Schedule,214.69,729.93,
MRA Upper Extremity w/ + w/o Cnt Right,1168707,LOCAL,C8936,CPT,,,,,RT,Outpatient,,,3801.65,,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,214.69,729.93,
CT Orbit Sella etc. or IAC w/ + w/o Cont,8362452,LOCAL,70482,CPT,,,,,,Outpatient,,,3831.16,2054.25,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
IMPLANT BREAST #350-2504 250CC,4801300,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3844.5,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-3501BC,4803006,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3844.5,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST 565CC,4851020,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3850,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
CT Abdomen and Pelvis w/ Oral Contrast,8206351,LOCAL,74176,CPT,,,,,,Outpatient,,,3869.45,2074.88,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,461.98,
CT Abdomen and Pelvis w/o Contrast,2424650,LOCAL,74176,CPT,,,,,,Outpatient,,,3869.45,2074.88,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,461.98,
AMNIOEXCEL SKIN SUBSTITUTE 2CM X 3CM,13962553,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,3902.85,3028,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
11404 EXCISION BENIGN LESION 3.1 CM TO 4.0 CM CHARGE,8726719,LOCAL,11404,CPT,,,,,,Outpatient,,,3913.86,2544,Viva Med ADV,Viva Med ADV,1481.32,,,,,,,Fee Schedule,1481.32,1679.75,
OASIS ULTRA THIN DRESSING 7 X 10 CM,13962594,LOCAL,,,Q4124,HCPCS,,,,Outpatient,,,3937.5,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
KERECIS OMEGA 3 - 3 X 7CM,13962579,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,3960,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRI Chest w/ + w/o Contrast,1168820,LOCAL,71552,CPT,,,,,,Outpatient,,,3975.96,2131.8,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
IMPLANT BREAST #350-3754BC,4804163,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3982,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
CT Chest High Resolution w/ + w/o Contrast,8658939,LOCAL,71270,CPT,,,,,,Outpatient,,,4006.18,2148.3,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,97.22,461.98,
CT Chest w/ + w/o Contrast,8071389,LOCAL,71270,CPT,,,,,,Outpatient,,,4006.18,2148.3,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRI Breast w/ + w/o Contrast Left.,8784917,LOCAL,77048,CPT,,,,,LT,Outpatient,,,4030.86,2161.5,Viva Med ADV,Viva Med ADV,207.49,,,,,,,Fee Schedule,207.49,652.35,
MRI Breast w/ + w/o Contrast Left.,8784917,LOCAL,C8905,CPT,,,,,LT,Outpatient,,,4030.86,,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,207.49,652.35,
MRI Breast w/ + w/o Contrast Right.,8784920,LOCAL,77048,CPT,,,,,RT,Outpatient,,,4030.86,2161.5,Viva Med ADV,Viva Med ADV,207.49,,,,,,,Fee Schedule,207.49,652.35,
MRI Breast w/ + w/o Contrast Right.,8784920,LOCAL,C8905,CPT,,,,,RT,Outpatient,,,4030.86,,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,207.49,652.35,
PACEMAKER POCKET,8210140,LOCAL,33222,CPT,,,,,,Outpatient,,,4031.48,2620,Viva Med ADV,Viva Med ADV,1672.39,,,,,,,Fee Schedule,1496,2484.2,
PURAPLY AM 2X4 COMMERCIAL 8SQ CM,13962598,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,4032,3861,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
AMNIOEXCEL PLUS 2CMX2CM,13962548,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,4050,3028,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRI Face Neck Orbit w/ + w/o Contrast,1168852,LOCAL,70543,CPT,,,,,,Outpatient,,,4067.02,2181.3,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Maxillofacial w/ + w/o Contrast,1168182,LOCAL,70488,CPT,,,,,,Outpatient,,,4088.22,2192.03,Viva Med ADV,Viva Med ADV,162.76,,,,,,,Fee Schedule,162.76,461.98,
"64625 Radiofrequency ablation, nerves innervating the SI joint",5661090,LOCAL,64625,CPT,,,,,,Outpatient,,,4100,2665,Viva Med ADV,Viva Med ADV,1785.34,,,,,,,Fee Schedule,1785.34,2315,
CT Abdomen and Pelvis w/ Contrast,2424647,LOCAL,74177,CPT,,,,,,Outpatient,,,4142.9,2221.73,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Abdomen and Pelvis w/ Contrast + Oral,13452969,LOCAL,74177,CPT,,,,,,Outpatient,,,4142.9,2221.73,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
95808 SLEEP STAGING CHARGE,13485403,LOCAL,95808,CPT,,,,,,Outpatient,,,4155.71,2701,Viva Med ADV,Viva Med ADV,930.16,,,,,,,Fee Schedule,930.16,1113.98,
PRIMATRIX 4X4 MESH,13962596,LOCAL,,,Q4110,HCPCS,,,,Outpatient,,,4162.5,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
THERASKIN 2.5 X 5.1 CM,13962607,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,4167,2431,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
"Beta Amyloid 42/40 Ratio, CSF QST",13873765,LOCAL,82542,CPT,,,,,,Outpatient,,,4168.13,28.91,Viva Med ADV,Viva Med ADV,24.09,,,,,,,Fee Schedule,17.73,24.09,
INSERTION OF INTRAPERITONEAL CATHETER,8267131,LOCAL,49418,CPT,,,,,,Outpatient,,,4189,2723,Viva Med ADV,Viva Med ADV,3226.48,,,,,,,Fee Schedule,2599,5444.44,
US Insert Tun IP Cath Perc,10460131,LOCAL,49418,CPT,,,,,,Outpatient,,,4189,2723,Viva Med ADV,Viva Med ADV,3226.48,,,,,,,Fee Schedule,2599,5444.44,
AMNIOEXCEL SKIN SUBSTITUTE 3.5CM X 3.5CM,13962554,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,4213.58,3028,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
NUSHIELD 2X3CM,10510072,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,4262.5,1155,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
NUSHIELD 2X4CM,13962588,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,4275,1155,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRI Breast w/ + w/o Contrast Bilateral.,8145272,LOCAL,77049,CPT,,,,,,Outpatient,,,4351.43,2333.1,Viva Med ADV,Viva Med ADV,204.56,,,,,,,Fee Schedule,204.56,652.35,
IR Nephro Plcmt New Access W Cath,8267190,LOCAL,50432,CPT,,,,,,Outpatient,,,4351.75,2829,Viva Med ADV,Viva Med ADV,1872.87,,,,,,,Fee Schedule,1872.87,2315,
NEPHROSTOGRAM CATHETER PLACEMENT S&I,8267190,LOCAL,50432,CPT,,,,,,Outpatient,,,4351.75,2829,Viva Med ADV,Viva Med ADV,1872.87,,,,,,,Fee Schedule,1872.87,2315,
EXCHANGE NEPHROSTOMY TUBE,8212021,LOCAL,50435,CPT,,,,,,Outpatient,,,4357.87,2833,Viva Med ADV,Viva Med ADV,1872.87,,,,,,,Fee Schedule,1291,2206.55,
ACTIGRAFT PRO-RD2301,10510000,LOCAL,,,G0460,HCPCS,,,,Outpatient,,,4400,,Viva Med ADV,Viva Med ADV,1672.39,,,,,,,Fee Schedule,1466.58,1672.39,
MRI Brain + IAC w/ + w/o Contrast,9427798,LOCAL,70553,CPT,,,,,,Outpatient,,,4403.72,2361.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Brain w/ + w/o Contrast,1168796,LOCAL,70553,CPT,,,,,,Outpatient,,,4403.72,2361.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Pituitary w/ + w/o Contrast,8058740,LOCAL,70553,CPT,,,,,,Outpatient,,,4403.72,2361.15,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
AMNIOEXCEL SKIN SUBSTITUTE 4CM X 4CM,13962555,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,4423.23,3028,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
PULMONARY UNILATERAL S&I,8210600,LOCAL,75741,CPT,,,,,,Outpatient,,,4485,2404.88,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
VENOUS SAMPLING WO/W ANGIO,8210720,LOCAL,75893,CPT,,,,,,Outpatient,,,4485,2404.88,Viva Med ADV,Viva Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
VISCERAL S&I,8210570,LOCAL,75726,CPT,,,,,,Outpatient,,,4485,2404.88,Viva Med ADV,Viva Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
CT Angio Abdomen and Pelvis,2424686,LOCAL,74174,CPT,,,,,,Outpatient,,,4538.98,2433.75,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,565.59,
THERASKIN 2.5 X 2.5 CM,10510018,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,4570.5,2431,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
IMPLANT BREAST #350-4004BC,4803833,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,4598,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-4504BC,4841089,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,4598,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT MEMORY GEL 300CC,4852825,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,4598,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
GRAFIX PRIME 2 X 3CM,13962571,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,4612.5,3671,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
PTA URETERAL STRICTURE WITH IMAGING,8267792,LOCAL,50706,CPT,,,,,,Outpatient,,,4747.36,3086,Viva Med ADV,Viva Med ADV,147.16,,,,,,,Fee Schedule,147.16,10138.5,
MRI Spine Cervical w/ + w/o Contrast,1169050,LOCAL,72156,CPT,,,,,,Outpatient,,,4747.92,2545.95,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
EPIFIX SKIN SUBSTITUTE 2 X 2 CM,13962562,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,4790.25,1755,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
CT Abdomen and Pelvis w/ + w/o Contrast,2424644,LOCAL,74178,CPT,,,,,,Outpatient,,,4826.55,2588.03,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Urogram,8203051,LOCAL,74178,CPT,,,,,,Outpatient,,,4826.55,2588.03,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,461.98,
EPIFIX SKIN SUBSTITUTE 2 X 2 CM,10510011,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,4950,1755,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
NM Inflammation Loc Spect,1169158,LOCAL,78803,CPT,,,,,,Outpatient,,,5051.75,1181.4,Viva Med ADV,Viva Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
antivenin (Crotalidae equine) polyvalent intravenous injection [CULL],11250856,LOCAL,J0841,CPT,,,,,,Outpatient,1,EA,5068.8,,Viva Med ADV,Viva Med ADV,1045.15,,,,,,,Fee Schedule,1045.15,11608.84,
THERASKIN 2.5 X 5.1 CM,10510019,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,5093,2431,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
tocilizumab 20 mg/mL Sol 10 mL [CULL],11260565,LOCAL,J3262,CPT,,,,,,Outpatient,10,ML,5099.1744,,Viva Med ADV,Viva Med ADV,5.71,,,,,,,Fee Schedule,5.71,1641.22,
MRI Spine Thoracic w/ + w/o Contrast,1169062,LOCAL,72157,CPT,,,,,,Outpatient,,,5102.75,2736.53,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
CATH LAB INSERTION OF PLEURAL CATHETER,8230067,LOCAL,32550,CPT,,,,,,Outpatient,,,5132.46,3336,Viva Med ADV,Viva Med ADV,3226.48,,,,,,,Fee Schedule,1392.67,3226.48,
95782 PEDI POLYSOMNOGRAPHY (<6YO) CHARGE,9303178,LOCAL,95782,CPT,,,,,,Outpatient,,,5141.48,3342,Viva Med ADV,Viva Med ADV,930.16,,,,,,,Fee Schedule,930.16,1113.98,
95810 POLYSOMNOGRAPHY CHARGE.,8303749,LOCAL,95810,CPT,,,,,,Outpatient,,,5141.48,3342,Viva Med ADV,Viva Med ADV,930.16,,,,,,,Fee Schedule,930.16,1113.98,
NUSHIELD 2X4CM,10510073,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,5225,1155,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
NM Cardiac Amyloid PYP Spect,9955566,LOCAL,78803,CPT,A9538,HCPCS,,,,Outpatient,,,5230.76,1181.4,Viva Med ADV,Viva Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
MRI Spine Lumbar w/ + w/o Contrast,1169056,LOCAL,72158,CPT,,,,,,Outpatient,,,5301.01,2842.95,Viva Med ADV,Viva Med ADV,326.51,,,,,,,Fee Schedule,326.51,652.35,
95783 POLYSOM <6 YRS SLP W/CPAP CHARGE,10732463,LOCAL,95783,CPT,,,,,,Outpatient,,,5349.1,3477,Viva Med ADV,Viva Med ADV,930.16,,,,,,,Fee Schedule,930.16,1113.98,
95811 POLYSOMMOGRAPHY w/ CPAP CHARGE,8303770,LOCAL,95811,CPT,,,,,,Outpatient,,,5349.1,3477,Viva Med ADV,Viva Med ADV,930.16,,,,,,,Fee Schedule,930.16,930.16,
NM Inflammation Loc Whole Body - Ceretec,1169152,LOCAL,78802,CPT,A9521,HCPCS,,,,Outpatient,,,5351.75,2870.18,Viva Med ADV,Viva Med ADV,802.34,,,,,,,Fee Schedule,802.34,1409.71,
EPIFIX SKIN SUBSTITUTE 2 X 3 CM,13962563,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,5377.5,1755,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
NM Inflammation Loc Limited - Indium,1169148,LOCAL,78801,CPT,,,,,,Outpatient,,,5399.5,2895.75,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,1409.71,
NM Inflammation Loc Multi,12113627,LOCAL,78801,CPT,,,,,,Outpatient,,,5399.5,2895.75,Viva Med ADV,Viva Med ADV,367.38,,,,,,,Fee Schedule,367.38,1409.71,
AMNIOEXCEL PLUS 3X3,13962549,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,5400,3028,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY VENOUS ADDL,8210394,LOCAL,37188,CPT,,,,,,Outpatient,,,5419.5,3523,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2599,5228.12,
KERECIS OMEGA 3 - 3 X 7,13962578,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,5436,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
THERASKIN 5.1 X 7.6 CM,13962608,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,5449.5,2431,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
NEW ACCESS NEPHROSTOMY TUBE,8200537,LOCAL,50433,CPT,,,,,,Outpatient,,,5454.2,3545,Viva Med ADV,Viva Med ADV,3153.26,,,,,,,Fee Schedule,2315,4301.28,
PTA RENAL ARTERY (ADD'L),8210240,LOCAL,37247,CPT,,,,,,Outpatient,,,5488.12,3567,Viva Med ADV,Viva Med ADV,140.82,,,,,,,Fee Schedule,140.82,8616.54,
IMPLANT BREAST #350-6504BC 650CC,4801608,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,5500,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-8004BC,4803074,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,5500,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST 700CC #350-7004BC MENTOR,4803075,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,5500,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST SILICONE 500CC,4805180,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,5500,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT SILICONE 750CC,4851569,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,5500,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
PURAPLY AM 3.76 CM X 4.76 CM,13962601,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,5512.5,3861,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
27603 DRAIN LOWER LEG LESION,13043453,LOCAL,27603,CPT,,,,,LT,Outpatient,,,5526.21,3592,Viva Med ADV,Viva Med ADV,2616.66,,,,,,,Fee Schedule,2315,2616.66,
NM Myocardial Planar Rest and Stress,2425972,LOCAL,78454,CPT,A9500,HCPCS,,,,Outpatient,,,5593.52,2999.7,Viva Med ADV,Viva Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
EPIFIX SKIN SUBSTITUTE 3.5 X 3.5 CM,13962565,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,5602.5,1755,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
GRAFIX PRIME 2 X 3CM,10510014,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,5637.5,3671,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
GRAFIX PL 3.0 X 4.0CM,13962568,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,5647.5,3671,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
REVISION REPLACE GENERATOR  BLADDER,8268108,LOCAL,64595,CPT,,,,,,Outpatient,,,5690.13,3699,Viva Med ADV,Viva Med ADV,3144.15,,,,,,,Fee Schedule,2599,5487.33,
REVISION REPLACE LEAD BLADDER STIMULATOR,8268107,LOCAL,64585,CPT,,,,,,Outpatient,,,5690.13,3699,Viva Med ADV,Viva Med ADV,3144.15,,,,,,,Fee Schedule,2599,5487.33,
AMNIOEXCEL PLUS 2CMX2CM,10510060,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,5693.33,3028,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
INTRO AV SHUNT W S&I,8267106,LOCAL,36902,CPT,,,,,,Outpatient,,,5734.69,11107,Viva Med ADV,Viva Med ADV,5212.67,,,,,,,Fee Schedule,5212.67,5787,
APLIGRAF-COM,13962557,LOCAL,,,Q4101,HCPCS,,,,Outpatient,,,5737.5,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 4 X 4.5 CM,13962566,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,5737.5,1755,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 4 X 4.5CM,13962567,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,5737.5,1755,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
15120 SKN SPLT A-GRFT FAC/NCK/HF/G 100 SQ CM/1% BA,10006441,LOCAL,15120,CPT,,,,,,Outpatient,,,5746.86,3735,Viva Med ADV,Viva Med ADV,3347.08,,,,,,,Fee Schedule,2599,3347.08,
REPOSITION IVC FILTER,8267129,LOCAL,37192,CPT,,,,,,Outpatient,,,5771.49,3751,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2599,5228.12,
EPICORD 2CM X 3CM,13962558,LOCAL,,,Q4187,HCPCS,,,,Outpatient,,,5827.5,3788,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
VENOUS PTA EACH ADD'L,8267100,LOCAL,37249,CPT,,,,,,Outpatient,,,5876.95,3820,Viva Med ADV,Viva Med ADV,118.76,,,,,,,Fee Schedule,118.76,8616.54,
PURAPLY AM 3 CM X 4 CM,13962599,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,5940,3861,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
PURAPLY AM 3 X 4CM FEN FINISHED PROD,13962600,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,5940,3861,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
Central Line Access Type. -> Tunneled,13449753,LOCAL,36810,CPT,,,,,,Outpatient,,,5960.36,3874,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2599,3211.33,
NUSHIELD 3X4CM,13962589,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,5962.5,1155,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
NUSHIELD 4X4CM,13962590,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,5962.5,1155,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
prothrombin complex - Pow [CULL],11220535,LOCAL,J7168,CPT,,,,,,Outpatient,1,EA,6048,,Viva Med ADV,Viva Med ADV,2.14,,,,,,,Fee Schedule,2.14,3347.61,
AFFINITY 1.5 CM X 1.5 CM,10500119,LOCAL,,,Q4159,HCPCS,,,,Outpatient,,,6075,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 2 X 4 CM,13962564,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,6075,1755,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
33215 Reposition Pacing Defibrillator Lead,8212027,LOCAL,33215,CPT,,,,,,Outpatient,,,6104.24,3968,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2484.2,2877.63,
ICD REMOVAL ONLY,8231005,LOCAL,33241,CPT,,,,,,Outpatient,,,6104.24,3968,Viva Med ADV,Viva Med ADV,3327.27,,,,,,,Fee Schedule,2599,10220.8,
EXTREMITY UNILATERAL S&I,8210530,LOCAL,75710,CPT,,,,,,Outpatient,,,6132.32,3288.45,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
XR Angio Extremity in OR SI Left,2425383,LOCAL,75710,CPT,,,,,LT,Outpatient,,,6132.32,3288.45,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
XR Angio Extremity in OR SI Right,2425386,LOCAL,75710,CPT,,,,,RT,Outpatient,,,6132.32,3288.45,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
immune globulin intravenous and subcutaneous 10% injectable solution 100 mL [CULL],11205089,LOCAL,J1561,CPT,,,,,,Outpatient,100,ML,6199.68,,Viva Med ADV,Viva Med ADV,48.96,,,,,,,Fee Schedule,48.96,2110.36,
TRANSCATH THER.ART.INF.(FINAL DAY),8210027,LOCAL,37214,CPT,,,,,,Outpatient,,,6313.68,4104,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,1291,5228.12,
BULKAMID URETHRAL BULKING SYSTEM,4830058,LOCAL,,,L8603,HCPCS,,,,Outpatient,,,6325,3364,Viva Med ADV,Viva Med ADV,536.91,,,,,,,Fee Schedule,536.91,536.91,
EXPANDER TISSUE 750-900ML,4854109,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6325,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE DERMASPAN 600-720CC,4805041,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6325,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE LPP-FH13S,4832956,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6325,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE LPP-FH14S,4803623,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6325,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
93503 INSERTION OF SWAN GANZ CHARGE,8210870,LOCAL,93503,CPT,,,,,,Outpatient,,,6394.68,4157,Viva Med ADV,Viva Med ADV,1420.25,,,,,,,Fee Schedule,1291,1644.1,
PA CATHETER SV02,4221129,LOCAL,93503,CPT,,,,,,Outpatient,,,6394.68,4157,Viva Med ADV,Viva Med ADV,1420.25,,,,,,,Fee Schedule,1291,1644.1,
GENERATOR REMOVAL ONLY,8210160,LOCAL,33233,CPT,,,,,,Outpatient,,,6446.76,4190,Viva Med ADV,Viva Med ADV,7566.4,,,,,,,Fee Schedule,2599,10220.8,
fomepizole 1 g/mL intravenous solution 1.5 mL [CULL],11290124,LOCAL,J1451,CPT,,,,,,Outpatient,1.5,ML,6649.376,,Viva Med ADV,Viva Med ADV,6.28,,,,,,,Fee Schedule,6.28,525.49,
NM Myocardial SPECT Drug Stress Multi,8567792,LOCAL,78452,CPT,,,,,,Outpatient,,,6759.97,3625.05,Viva Med ADV,Viva Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
NM Myocardial SPECT Rest and Stress,2425975,LOCAL,78452,CPT,,,,,,Outpatient,,,6759.97,3625.05,Viva Med ADV,Viva Med ADV,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
dalbavancin 500 mg Pow [CULL],11287452,LOCAL,J0875,CPT,,,,,,Outpatient,1,UN,6831.8592,4440,Viva Med ADV,Viva Med ADV,15.61,,,,,,,Fee Schedule,0.21,5685.74,
IMPLANT BREAST SHPB-235,4852442,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6875,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST SHPB-585,4851979,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6875,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST SHPB-635,4805161,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6875,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
GRAFIX PL 3.0 X 4.0CM,10510066,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,6902.5,3671,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
PERC URETERAL STENT REMOVAL & REPLACE,8210741,LOCAL,50382,CPT,,,,,,Outpatient,,,6922.86,4500,Viva Med ADV,Viva Med ADV,1872.87,,,,,,,Fee Schedule,1872.87,2315,
CULL NM TC99M Ceretec Per Dose,13644947,LOCAL,,,A9521,HCPCS,,,,Outpatient,,,6990.26,4544,Viva Med ADV,Viva Med ADV,802.34,,,,,,,Fee Schedule,802.34,802.34,
EPICORD 2CM X 3CM,10510051,LOCAL,,,Q4187,HCPCS,,,,Outpatient,,,7122.5,3788,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
IMPLANT BREAST 775,4850675,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,7150,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
"BRCAvantage(R), Comprehensive QSTC",9039435,LOCAL,81162,CPT,,,,,,Outpatient,,,7200,2189.86,Viva Med ADV,Viva Med ADV,1824.88,,,,,,,Fee Schedule,590.67,1824.88,
PURAPLY AM 3 X 4CM FEN FINISHED PROD,10510076,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,7260,3861,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
NUSHIELD 4X4CM,10510075,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,7287.5,1155,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY ARTERIAL SECONDARY PERC,8210390,LOCAL,37186,CPT,,,,,,Outpatient,,,7383.75,4799,Viva Med ADV,Viva Med ADV,199.65,,,,,,,Fee Schedule,199.65,16037.41,
"15100 AUTO-SPLIT THICK T/A/L, 1ST 100 SQCM CHARGE",12816476,LOCAL,15100,CPT,,,,,,Outpatient,,,7387.97,4802,Viva Med ADV,Viva Med ADV,1672.39,,,,,,,Fee Schedule,1496,2862.92,
AFFINITY 1.5CM X 1.5CM,10500119,LOCAL,,,Q4159,HCPCS,,,,Outpatient,,,7425,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY VENOUS PRIMARY,8210393,LOCAL,37187,CPT,,,,,,Outpatient,,,7579,4926,Viva Med ADV,Viva Med ADV,10368.23,,,,,,,Fee Schedule,5228.12,10368.23,
GRAFT STRAVIX 2 X 4,13962572,LOCAL,,,Q4132,HCPCS,,,,Outpatient,,,7650,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 4 X 4.5 CM,10510064,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,7672.5,1755,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
EXCHANGE OF BILIARY DRAIN CATH,8267769,LOCAL,47536,CPT,,,,,,Outpatient,,,7882.57,5124,Viva Med ADV,Viva Med ADV,3226.48,,,,,,,Fee Schedule,2599,3682.65,
PLACEMENT BILIARY DRAIN CATH INT/EXT,8201219,LOCAL,47534,CPT,,,,,,Outpatient,,,7882.57,5124,Viva Med ADV,Viva Med ADV,3226.48,,,,,,,Fee Schedule,2599,3682.65,
36253 Insertion Of Cath Renal Arterial 2Nd Unilateral,8212045,LOCAL,36253,CPT,,,,,,Outpatient,,,8050.63,5233,Viva Med ADV,Viva Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
CERVICOCEREBRAL S&I,8201615,LOCAL,36221,CPT,,,,,,Outpatient,,,8050.63,5233,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2599,6018.68,
COMMON CAROTID UNI S&I,8201600,LOCAL,36223,CPT,,,,,,Outpatient,,,8050.63,5233,Viva Med ADV,Viva Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
EXTERNAL CAROTID UNI S&I,8201610,LOCAL,36222,CPT,,,,,,Outpatient,,,8050.63,5233,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2599,6018.68,
INFERIOR VENA CAVA S&I,8210660,LOCAL,75825,CPT,,,,,,Outpatient,,,8050.63,4317.23,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
IR Angio Pulmonary Bilateral,7949335,LOCAL,75743,CPT,,,,,,Outpatient,,,8050.63,4317.23,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
PULMONARY BILATERAL S&I,8210610,LOCAL,75743,CPT,,,,,,Outpatient,,,8050.63,4317.23,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
RENAL UNILATERAL PLACEMENT & SI,8210550,LOCAL,36251,CPT,,,,,,Outpatient,,,8050.63,5233,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2599,6018.68,
VERTEBRAL SUBCLAVIAN OR INNOMINATE,8201625,LOCAL,36225,CPT,,,,,,Outpatient,,,8050.63,5233,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2599,6018.68,
XR Venogram Cava Inferior,10386826,LOCAL,75825,CPT,,,,,,Outpatient,,,8050.63,4317.23,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
25040 FOREIGN BODY REMOVAL FOREARM LEFT,13416875,LOCAL,25040,CPT,,,,,LT,Outpatient,,,8076.78,5250,Viva Med ADV,Viva Med ADV,2966.42,,,,,,,Fee Schedule,2528.75,2966.42,
FOREIGN BODY RETRIEVAL,8201630,LOCAL,37197,CPT,,,,,,Outpatient,,,8080.32,5252,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2599,5228.12,
FOREIGN BODY RETRIEVAL S&I,8201635,LOCAL,37197,CPT,,,,,,Outpatient,,,8080.32,5252,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2599,5228.12,
REMOVAL IVC FILTER,8267130,LOCAL,37193,CPT,,,,,,Outpatient,,,8080.32,5252,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2599,5228.12,
CULL NM Indium WBC Per 0.5 MCI,13644939,LOCAL,,,A9547,HCPCS,,,,Outpatient,,,8102.03,5266,Viva Med ADV,Viva Med ADV,772.64,,,,,,,Fee Schedule,772.64,772.64,
CULL NM Kinevac Per 5 MCG Vial,13644941,LOCAL,,,A9547,HCPCS,,,,Outpatient,,,8102.03,5266,Viva Med ADV,Viva Med ADV,772.64,,,,,,,Fee Schedule,772.64,772.64,
PERC INTRO CATH/STENT URETERAL PREEXIST,8200532,LOCAL,50693,CPT,,,,,,Outpatient,,,8122.9,5280,Viva Med ADV,Viva Med ADV,3153.26,,,,,,,Fee Schedule,2599,4301.28,
PERC INTRO URETERAL NEW ACCESS W CATH,8200534,LOCAL,50695,CPT,,,,,,Outpatient,,,8122.9,5280,Viva Med ADV,Viva Med ADV,3153.26,,,,,,,Fee Schedule,2599,4301.28,
PERC INTRO URETERAL NEW ACCESS WO CATH,8200533,LOCAL,50694,CPT,,,,,,Outpatient,,,8122.9,5280,Viva Med ADV,Viva Med ADV,3153.26,,,,,,,Fee Schedule,2599,4301.28,
VERTEBROPLASTY ADDL THOR/LUMB,8267765,LOCAL,22512,CPT,,,,,,Outpatient,,,8365.99,5438,Viva Med ADV,Viva Med ADV,167.55,,,,,,,Fee Schedule,167.55,6803.47,
VERTEBROPLASTY LUMBAR,8211170,LOCAL,22511,CPT,,,,,,Outpatient,,,8365.99,5438,Viva Med ADV,Viva Med ADV,2966.42,,,,,,,Fee Schedule,2599,6803.47,
VERTEBROPLASTY THORACIC,8211160,LOCAL,22510,CPT,,,,,,Outpatient,,,8365.99,5438,Viva Med ADV,Viva Med ADV,2966.42,,,,,,,Fee Schedule,2599,6803.47,
RENAL BILATERAL PLACEMENT & SI,8210560,LOCAL,36252,CPT,,,,,,Outpatient,,,8539.16,5550,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2599,6018.68,
93452 Left Heart Cath,8230003,LOCAL,93452,CPT,,,,,,Outpatient,,,8778,5706,Viva Med ADV,Viva Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
TEMP SACRAL ELECTRODE WITH IMAGING,8268102,LOCAL,64561,CPT,,,,,,Outpatient,,,8900,5785,Viva Med ADV,Viva Med ADV,6000.2,,,,,,,Fee Schedule,5787,8672.71,
27372 FOREIGN BODY REMOVAL KNEE,13435628,LOCAL,27372,CPT,,,,,,Outpatient,,,8946.89,5815,Viva Med ADV,Viva Med ADV,2616.66,,,,,,,Fee Schedule,2315,2616.66,
IMPLANT BREAST ARTOURA 455CC SMOOTH,4853890,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,8976,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
75630-IR Aortogram Abdominal + Iliofemoral1,8071871,LOCAL,75630,CPT,,,,,,Outpatient,,,9016.7,4835.33,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
AORTO ABD+ILIOFEMORAL SERIAL,8210430,LOCAL,75630,CPT,,,,,,Outpatient,,,9016.7,4835.33,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
AORTOGRAM THORACIC S&I,8210410,LOCAL,75605,CPT,,,,,,Outpatient,,,9016.7,4835.33,Viva Med ADV,Viva Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
EXTREMITY BILATERAL S&I,8210540,LOCAL,75716,CPT,,,,,,Outpatient,,,9016.7,4835.33,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
IR Aortogram Thoracic w/ Serialography,7949377,LOCAL,75605,CPT,,,,,,Outpatient,,,9016.7,4835.33,Viva Med ADV,Viva Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
XR Angio Extremity in OR SI Bilat,9343676,LOCAL,75716,CPT,,,,,,Outpatient,,,9016.7,4835.33,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
20240 BIOPSY BONE EXCISIONAL SUPERFI CHARGE,8020082,LOCAL,20240,CPT,,,,,,Outpatient,,,9171.4,5961,Viva Med ADV,Viva Med ADV,2616.66,,,,,,,Fee Schedule,2315,2616.66,
20240-BIOPSY BONE EXCISIONAL SUPERFI CHARGE,8020082,LOCAL,20240,CPT,,,,,,Outpatient,,,9171.4,5961,Viva Med ADV,Viva Med ADV,2616.66,,,,,,,Fee Schedule,2315,2616.66,
EXPANDER TISSUE ALLOX2,4850383,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,9350,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE ALLOX2-15SE,4800802,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,9350,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE ALLOX2-FH13E,4800497,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,9350,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE ALLOX2-FH14E,4840653,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,9350,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
TISSUE EXPANDER ALLOX2-FH15E,4810961,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,9350,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
AMINOFIX 7CM X 6CM,13962545,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,9515.25,3028,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
AMNIOEXCEL PLUS  3 X 4CM,13962546,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,9548.1,3028,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
"93451 Catheterization, Right Heart",8230000,LOCAL,93451,CPT,,,,,,Outpatient,,,9609.02,6246,Viva Med ADV,Viva Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
93453 Combined Left and Right Heart Cath,8230006,LOCAL,93453,CPT,,,,,,Outpatient,,,9609.02,6246,Viva Med ADV,Viva Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
AMNIOFIX 4X6CM,13962556,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,9654.75,3028,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY ARTERIAL ADDL,8210392,LOCAL,37185,CPT,,,,,,Outpatient,,,9751.88,6339,Viva Med ADV,Viva Med ADV,130.9,,,,,,,Fee Schedule,130.9,8616.54,
93454 HT Left Heart Cath WO LV,8210890,LOCAL,93454,CPT,,,,,,Outpatient,,,9833.36,6392,Viva Med ADV,Viva Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
92973 PTC Thromebectomy Add On,8200030,LOCAL,92973,CPT,,,,,,Outpatient,,,9838.19,6395,Viva Med ADV,Viva Med ADV,74.32,,,,,,,Fee Schedule,74.32,12572.64,
NUSHIELD 6CM X 6CM,13962591,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,10012.5,1155,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
TRANSCATH THER ART INFUSION FOR THROM,8210026,LOCAL,37211,CPT,,,,,,Outpatient,,,10140.58,6591,Viva Med ADV,Viva Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,5787,
CATH LAB IVC FILTER PLACEMENT,8210330,LOCAL,37191,CPT,,,,,,Outpatient,,,10180.79,6618,Viva Med ADV,Viva Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,5787,
INSERTION IVC FILTER,8267128,LOCAL,37191,CPT,,,,,,Outpatient,,,10180.79,6618,Viva Med ADV,Viva Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,5787,
PERC PLACE IVC FILTER S&I,8210740,LOCAL,37191,CPT,,,,,,Outpatient,,,10180.79,6618,Viva Med ADV,Viva Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,5787,
leuprolide 45 mg/6 months Pow [CULL],11299002,LOCAL,J9217,CPT,,,,,,Outpatient,1,ML,10406.8992,,Viva Med ADV,Viva Med ADV,176.45,,,,,,,Fee Schedule,176.45,733.68,
CULL NM Indium DTPA Per 0.5 MCI,13644937,LOCAL,,,A9548,HCPCS,,,,Outpatient,,,10432.89,6781,Viva Med ADV,Viva Med ADV,715.29,,,,,,,Fee Schedule,715.29,715.29,
KERECIS OMEGA 3 - 7 X 10CM,13962581,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,10552.5,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY ARTERIAL PRIMARY,8210391,LOCAL,37184,CPT,,,,,,Outpatient,,,10806,7024,Viva Med ADV,Viva Med ADV,16417.11,,,,,,,Fee Schedule,5787,16417.11,
AORTOGRAM ABDOMEN S&I,8210420,LOCAL,75625,CPT,,,,,,Outpatient,,,10898.6,5844.3,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
IR Aortogram Abdominal w/ Serialography1,8071874,LOCAL,75625,CPT,,,,,,Outpatient,,,10898.6,5844.3,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
XR Aorta Abdomen Catheter in OR SI,2425389,LOCAL,75625,CPT,,,,,,Outpatient,,,10898.6,5844.3,Viva Med ADV,Viva Med ADV,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
PURAPLY AM 5 CM X 5 CM,13962602,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,11025,3861,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
EXPANDER BREAST TISSUE ARTOURA 375CC,4853226,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,11385,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE ARTOURA SDC100UH,4803722,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,11385,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDERS TISSUE 475CC SDC-130H,4852707,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,11385,644,Viva Med ADV,Viva Med ADV,764.47,,,,,,,Fee Schedule,764.47,764.47,
TRANSCATH STENT CERV CAROTID WITH DEVICE,8210025,LOCAL,37215,CPT,,,,,,Outpatient,,,11474.94,7459,Viva Med ADV,Viva Med ADV,802.87,,,,,,,Fee Schedule,802.87,16429.41,
VERTEBRAL CERVICAL/CRANIAL S&I,8201620,LOCAL,36226,CPT,,,,,,Outpatient,,,11520.61,7488,Viva Med ADV,Viva Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
LEAD REPLACEMENT DUAL,8210110,LOCAL,33217,CPT,,,,,,Outpatient,,,11951.06,7768,Viva Med ADV,Viva Med ADV,7566.4,,,,,,,Fee Schedule,2484.2,7566.4,
LEAD REPLACEMENT SGL,8210100,LOCAL,33216,CPT,,,,,,Outpatient,,,11951.06,7768,Viva Med ADV,Viva Med ADV,7566.4,,,,,,,Fee Schedule,2484.2,7566.4,
calcitonin 200 intl units/mL Sol [CULL],J0630,CPT,,,,,,,,Outpatient,200,ML,12023.04,,Viva Med ADV,Viva Med ADV,484.97,,,,,,,Fee Schedule,484.97,2110.36,
93455 HT Left Cath W Cor Inj WO LV,8230002,LOCAL,93455,CPT,,,,,,Outpatient,,,12026.07,7817,Viva Med ADV,Viva Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
immune globulin intravenous and subcutaneous 10% injectable solution 200 mL [CULL],11205107,LOCAL,J1561,CPT,,,,,,Outpatient,200,ML,12399.36,,Viva Med ADV,Viva Med ADV,48.96,,,,,,,Fee Schedule,48.96,2110.36,
ALLOGRAFT DERMAPURE 7X10CM,4810278,LOCAL,Q4152,CPT,Q4152,HCPCS,,,,Outpatient,,,12446.5,,Viva Med ADV,Viva Med ADV,111.35,,,,,,,Fee Schedule,111.35,111.35,
93458 HT Cath Left W LV and Cor Angio,8230004,LOCAL,93458,CPT,,,,,,Outpatient,,,12512.89,8133,Viva Med ADV,Viva Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
93460 HT Cath L or R W LV and Cor Angio,8230007,LOCAL,93460,CPT,,,,,,Outpatient,,,12512.89,8133,Viva Med ADV,Viva Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
33210 INSERTION TEMP PACEMAKER SINGLE CHAMBER CHARGE,13707085,LOCAL,33210,CPT,,,,,,Outpatient,,,12542.69,8153,Viva Med ADV,Viva Med ADV,7566.4,,,,,,,Fee Schedule,2484.2,7566.4,
TEMP PACEMAKER SGL CHAMBER,8210050,LOCAL,33210,CPT,,,,,,Outpatient,,,12542.69,8153,Viva Med ADV,Viva Med ADV,7566.4,,,,,,,Fee Schedule,2484.2,7566.4,
92920 PTCA 1st Vessel,8201256,LOCAL,92920,CPT,,,,,,Outpatient,,,12766.62,8298,Viva Med ADV,Viva Med ADV,5212.67,,,,,,,Fee Schedule,5212.67,12572.64,
PTA RENAL ARTERY (INITIAL),8267124,LOCAL,37246,CPT,,,,,,Outpatient,,,12766.62,17592,Viva Med ADV,Viva Med ADV,5212.67,,,,,,,Fee Schedule,5212.67,5787,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ANGIO CPLX 1,8230034,LOCAL,37224,CPT,,,,,,Outpatient,,,12766.62,8298,Viva Med ADV,Viva Med ADV,5212.67,,,,,,,Fee Schedule,5212.67,5787,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS IVT ANGIO CPLX1,8230030,LOCAL,37220,CPT,,,,,,Outpatient,,,12766.62,8298,Viva Med ADV,Viva Med ADV,5212.67,,,,,,,Fee Schedule,5212.67,5787,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS TPVT ANGIO SF 1ST,8230022,LOCAL,37228,CPT,,,,,,Outpatient,,,12766.62,8298,Viva Med ADV,Viva Med ADV,10368.23,,,,,,,Fee Schedule,5787,10368.23,
THERASKIN 7.6 X 15.2 CM,13962609,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,12802.5,2431,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
93459 HT Cath Left W LV and Cor Grf Angio,8230005,LOCAL,93459,CPT,,,,,,Outpatient,,,13484.51,8765,Viva Med ADV,Viva Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
93461 HT Cath L or R W LV Cor Grf Angio,8230008,LOCAL,93461,CPT,,,,,,Outpatient,,,13484.51,8765,Viva Med ADV,Viva Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
riTUXimab pvvr 10 mg/mL Sol 50 mL [CULL],11211085,LOCAL,Q5119,CPT,,,,,,Outpatient,50,ML,13762.56,,Viva Med ADV,Viva Med ADV,27.85,,,,,,,Fee Schedule,27.85,7537.07,
"C1 esterase inhibitor, human 500 intl units intravenous kit [CULL]",11201256,LOCAL,J0597,CPT,,,,,,Outpatient,1,EA,13903.4496,,Viva Med ADV,Viva Med ADV,75.86,,,,,,,Fee Schedule,75.86,5685.74,
AMNIOEXCEL PLUS 4X5CM,13962550,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,13974.52,3028,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
ATHERECTOMY ABD AORTA,8230043,LOCAL,0236T,CPT,,,,,,Outpatient,,,14443,9388,Viva Med ADV,Viva Med ADV,10368.23,,,,,,,Fee Schedule,6417,16037.41,
ATHERECTOMY BRACHIOCEPHALIC & BRANCHES,8230044,LOCAL,0237T,CPT,,,,,,Outpatient,,,14443,9388,Viva Med ADV,Viva Med ADV,10368.23,,,,,,,Fee Schedule,6417,16037.41,
ATHERECTOMY ILIAC EACH,8230045,LOCAL,0238T,CPT,,,,,,Outpatient,,,14443,12175,Viva Med ADV,Viva Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
ATHERECTOMY RENAL,8230041,LOCAL,0234T,CPT,,,,,,Outpatient,,,14443,9388,Viva Med ADV,Viva Med ADV,10368.23,,,,,,,Fee Schedule,6417,26140.53,
ATHERECTOMY VISCERAL,8230042,LOCAL,0235T,CPT,,,,,,Outpatient,,,14443,9388,Viva Med ADV,Viva Med ADV,515.34,,,,,,,Fee Schedule,515.34,8616.54,
EPICORD 3 X 5,13962559,LOCAL,,,Q4187,HCPCS,,,,Outpatient,,,14445,3788,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
INTERNAL CAROTID UNI S&I,8201636,LOCAL,36224,CPT,,,,,,Outpatient,,,14812.21,9628,Viva Med ADV,Viva Med ADV,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
37239 STENT ANGIO VEIN EA ADDL CHARGE,8230063,LOCAL,37239,CPT,,,,,,Outpatient,,,15683.4,10194,Viva Med ADV,Viva Med ADV,121.17,,,,,,,Fee Schedule,121.17,16037.41,
ARTERY STENT ADD'L (NONCORONARY),8230061,LOCAL,37237,CPT,,,,,,Outpatient,,,15683.4,10194,Viva Med ADV,Viva Med ADV,171.21,,,,,,,Fee Schedule,171.21,16037.41,
93456 Right Heart Catheterization With Angiography,8230009,LOCAL,93456,CPT,,,,,,Outpatient,,,16019.61,10413,Viva Med ADV,Viva Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
33285 Implant Pt Activated Cardiac Event Recorder,8267776,LOCAL,33285,CPT,,,,,,Outpatient,,,16029.82,10419,Viva Med ADV,Viva Med ADV,7566.4,,,,,,,Fee Schedule,6417,12132.94,
92928 Trnscath Plcmnt Metal Single,8201254,LOCAL,92928,CPT,,,,,,Outpatient,,,16620.58,10803,Viva Med ADV,Viva Med ADV,10368.23,,,,,,,Fee Schedule,5787,12572.64,
CULL Octreotide,14874647,LOCAL,,,A9572,HCPCS,,,,Outpatient,,,16720.11,,Viva Med ADV,Viva Med ADV,1914.61,,,,,,,Fee Schedule,1914.61,1914.61,
alteplase 50 mg intravenous injection [CULL],11201048,LOCAL,J2997,CPT,,,,,,Outpatient,1,ML,16896.704,,Viva Med ADV,Viva Med ADV,94.45,,,,,,,Fee Schedule,94.45,122.4,
93457 Right or Left Heart Cath with No LV Gram Charge,8230010,LOCAL,93457,CPT,,,,,,Outpatient,,,16991.23,11044,Viva Med ADV,Viva Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
AV FISTULAGRAM WITH ANGIOPLASTY,8210331,LOCAL,36902,CPT,,,,,,Outpatient,,,17087.76,11107,Viva Med ADV,Viva Med ADV,5212.67,,,,,,,Fee Schedule,5212.67,5787,
"C9764 Revasculation, Endovascular, With Intravascular Lithotripsy, Includes Angioplasty",8230070,LOCAL,,,C9764,HCPCS,,,,Outpatient,,,17339,11270,Viva Med ADV,Viva Med ADV,10368.23,,,,,,,Fee Schedule,5228.12,10368.23,
digoxin immune FAB 40 mg intravenous injection [CULL],11201675,LOCAL,J1162,CPT,,,,,,Outpatient,1,EA,17660.16,,Viva Med ADV,Viva Med ADV,5168.23,,,,,,,Fee Schedule,5168.23,7537.07,
KERECIS OMEGA 3 - 7 X 10,13962580,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,17959.5,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
GENERATOR ONLY SGL CHAMBER INSERTION,8210070,LOCAL,33212,CPT,,,,,,Outpatient,,,17985.84,11691,Viva Med ADV,Viva Med ADV,7566.4,,,,,,,Fee Schedule,6417,12132.94,
PACEMAKER REMOVAL SINGLE,8210171,LOCAL,33227,CPT,,,,,,Outpatient,,,17985.84,11691,Viva Med ADV,Viva Med ADV,7566.4,,,,,,,Fee Schedule,6417,12132.94,
immune globulin intravenous and subcutaneous 10% injectable solution 300 mL [CULL],11205109,LOCAL,J1561,CPT,,,,,,Outpatient,300,ML,18599.04,,Viva Med ADV,Viva Med ADV,48.96,,,,,,,Fee Schedule,48.96,2110.36,
0238T Iliac Athrectomy with or without PTA,8230069,LOCAL,0238T,CPT,,,,,,Outpatient,,,18730.19,12175,Viva Med ADV,Viva Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
INSERTION NEUROSTIMULATOR GENERATOR,8268101,LOCAL,64590,CPT,,,,,,Outpatient,,,19804,519,Viva Med ADV,Viva Med ADV,19605.75,,,,,,,Fee Schedule,9233,30196.67,
GENERATOR REMOVAL AND REPLACEMENT DUAL,8210172,LOCAL,33228,CPT,,,,,,Outpatient,,,20984.23,13640,Viva Med ADV,Viva Med ADV,9568.03,,,,,,,Fee Schedule,6417,12132.94,
C9604 Revasc thru Bypass Single Vessel w DES (M'care),8201640,LOCAL,,,C9604,HCPCS,,,,Outpatient,,,21116.1,13725,Viva Med ADV,Viva Med ADV,10368.23,,,,,,,Fee Schedule,6417,12572.64,
C9607 Revasc CTO Single Vessel w DES (M'care),8201642,LOCAL,,,C9607,HCPCS,,,,Outpatient,,,21116.1,13725,Viva Med ADV,Viva Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
PERQ BM STENT ADD ON  RAMUS,8201252,LOCAL,,,C9600,HCPCS,,,,Outpatient,,,21116.1,13725,Viva Med ADV,Viva Med ADV,10368.23,,,,,,,Fee Schedule,6417,12572.64,
TIB/PER REVASC W/ATHER ADD ON  LT,8210020,LOCAL,33206,CPT,,,,,,Outpatient,,,21534.36,13997,Viva Med ADV,Viva Med ADV,9568.03,,,,,,,Fee Schedule,6417,12132.94,
C9772 Revasc Lithotrip Tibi/Peroneal Artery (Shockwave IVL),8230074,LOCAL,,,C9772,HCPCS,,,,Outpatient,,,22157.75,14403,Viva Med ADV,Viva Med ADV,10368.23,,,,,,,Fee Schedule,6417,10368.23,
PTA VENOUS PERC W S&I,8267099,LOCAL,37248,CPT,,,,,,Outpatient,,,22271.43,14476,Viva Med ADV,Viva Med ADV,5212.67,,,,,,,Fee Schedule,5212.67,5787,
VENTRICULAR PACEMAKER IMPLANT INS OR REP,8210030,LOCAL,33207,CPT,,,,,,Outpatient,,,22386.25,14551,Viva Med ADV,Viva Med ADV,9568.03,,,,,,,Fee Schedule,6417,12132.94,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ATHRC CPLX 1,8230035,LOCAL,37225,CPT,,,,,,Outpatient,,,23546.83,15305,Viva Med ADV,Viva Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ST CPLX 1ST,8230036,LOCAL,37226,CPT,,,,,,Outpatient,,,23546.83,15305,Viva Med ADV,Viva Med ADV,10368.23,,,,,,,Fee Schedule,6417,10368.23,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS IVT ST CPLX 1ST,8230031,LOCAL,37221,CPT,,,,,,Outpatient,,,23546.83,15305,Viva Med ADV,Viva Med ADV,10368.23,,,,,,,Fee Schedule,6417,10368.23,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS TPVT ATHRC CPLX 1,8230023,LOCAL,37229,CPT,,,,,,Outpatient,,,23546.83,15305,Viva Med ADV,Viva Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
VASC EMBOLIZE OCCLUDE ARTERY,8210362,LOCAL,37242,CPT,,,,,,Outpatient,,,23819.19,15482,Viva Med ADV,Viva Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
VASC EMBOLIZE OCCLUDE BLEED,8210364,LOCAL,37244,CPT,,,,,,Outpatient,,,23819.19,15482,Viva Med ADV,Viva Med ADV,10368.23,,,,,,,Fee Schedule,6417,16037.41,
VASC EMBOLIZE OCCLUDE ORGAN,8210363,LOCAL,37243,CPT,,,,,,Outpatient,,,23819.19,15482,Viva Med ADV,Viva Med ADV,10368.23,,,,,,,Fee Schedule,6417,16037.41,
VASC EMBOLIZE OCCLUDE VENOUS,8210361,LOCAL,37241,CPT,,,,,,Outpatient,,,23819.19,15482,Viva Med ADV,Viva Med ADV,10368.23,,,,,,,Fee Schedule,6417,16037.41,
37238 STENT ANGIO VEIN INITIAL CHARGE,8230062,LOCAL,37238,CPT,,,,,,Outpatient,,,24322.23,15809,Viva Med ADV,Viva Med ADV,10368.23,,,,,,,Fee Schedule,6417,16037.41,
37236 Stent Angioplasty Artery Int,8230060,LOCAL,37236,CPT,,,,,,Outpatient,,,24565.45,15968,Viva Med ADV,Viva Med ADV,10368.23,,,,,,,Fee Schedule,6417,16037.41,
SACRAL NERVE (TRANSFORAMINAL PLACEMENT),8268100,LOCAL,64581,CPT,,,,,,Outpatient,,,25121.42,1108,Viva Med ADV,Viva Med ADV,6000.2,,,,,,,Fee Schedule,6000.2,8672.71,
SHOULDER SYSTEMHEAD DWF041,4811086,LOCAL,,,L3975,HCPCS,,,,Outpatient,,,25817,,Viva Med ADV,Viva Med ADV,1889.33,,,,,,,Fee Schedule,1889.33,1889.33,
PTA BRACHIOCEPHALIC TRUNK W S&I,8210280,LOCAL,37246,CPT,,,,,,Outpatient,,,27065.23,17592,Viva Med ADV,Viva Med ADV,5212.67,,,,,,,Fee Schedule,5212.67,5787,
A V PACEMAKER IMPLANT INS OR REPLACE,8210040,LOCAL,33208,CPT,,,,,,Outpatient,,,27707.8,18010,Viva Med ADV,Viva Med ADV,9568.03,,,,,,,Fee Schedule,8379,12132.94,
UPGRADE SGL DUAL LEAD/CHAMBER,8210090,LOCAL,33214,CPT,,,,,,Outpatient,,,27707.8,18010,Viva Med ADV,Viva Med ADV,9568.03,,,,,,,Fee Schedule,8379,12132.94,
C9773 Revasc Lithotrip-Stent Tib/Peroneal Atr (Shockwave IVL),8230075,LOCAL,,,C9773,HCPCS,,,,Outpatient,,,28353.6,18430,Viva Med ADV,Viva Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
C9774 Revasc Lithotr-Ather Tib/Peroneal Atr (Shockwave IVL),8230076,LOCAL,,,C9774,HCPCS,,,,Outpatient,,,28353.6,18430,Viva Med ADV,Viva Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
C9775 Revasc Lithotr-Stent-Ather-Peroneal Atr (Shockwave IVL),8230077,LOCAL,,,C9775,HCPCS,,,,Outpatient,,,28353.6,18430,Viva Med ADV,Viva Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
"C9765 Revasculation, Endovascular, With Intravascular Lithotripsy, With Stent Placement Includes Ang",8230071,LOCAL,,,C9765,HCPCS,,,,Outpatient,,,29724,19321,Viva Med ADV,Viva Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
"C9766 Revasculation, Endovascular, With Intravascular Lithotripsy, Includes Atherectomy",8230072,LOCAL,,,C9766,HCPCS,,,,Outpatient,,,29724,19321,Viva Med ADV,Viva Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
tenecteplase 50 mg intravenous injection [CULL],11211269,LOCAL,J3101,CPT,,,,,,Outpatient,1,EA,31861.472,,Viva Med ADV,Viva Med ADV,172.22,,,,,,,Fee Schedule,172.22,7537.07,
PTA STENT TIBPERONEAL INITIAL,8230024,LOCAL,37230,CPT,,,,,,Outpatient,,,32737,21279,Viva Med ADV,Viva Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ST ATHRC CPX 1,8230037,LOCAL,37227,CPT,,,,,,Outpatient,,,33085.18,21505,Viva Med ADV,Viva Med ADV,16417.11,,,,,,,Fee Schedule,9233,16417.11,
alteplase 100 mg intravenous injection [CULL],11201042,LOCAL,J2997,CPT,,,,,,Outpatient,1,ML,33793.376,,Viva Med ADV,Viva Med ADV,94.45,,,,,,,Fee Schedule,94.45,122.4,
SIMPLIDERM ACELLULAR DERMAL,13962604,LOCAL,,,Q4116,HCPCS,,,,Outpatient,,,38160,,Viva Med ADV,Viva Med ADV,111.91,,,,,,,Fee Schedule,111.91,111.91,
"C9767 Revasculation, Endovascular, With Intravascular Lithotripsy, With Stent Placement And Atherect",8230073,LOCAL,,,C9767,HCPCS,,,,Outpatient,,,39850,25903,Viva Med ADV,Viva Med ADV,16417.11,,,,,,,Fee Schedule,6417,16417.11,
IMPLANTABLE STIM 2-LEAD EBI 10-1335M,4802519,LOCAL,,,E0749,HCPCS,,,,Outpatient,,,43032,22885,Viva Med ADV,Viva Med ADV,347.98,,,,,,,Fee Schedule,347.98,347.98,
PTA ARTHRECTOMY STENT TIBPERONEAL INITIA,8230025,LOCAL,37231,CPT,,,,,,Outpatient,,,50564,32867,Viva Med ADV,Viva Med ADV,16417.11,,,,,,,Fee Schedule,9233,16417.11,
ICD INSERTION WITH EXISTING SINGLE LEAD,8231000,LOCAL,33240,CPT,,,,,,Outpatient,,,51027.88,33168,Viva Med ADV,Viva Med ADV,20521.65,,,,,,,Fee Schedule,12499,36378.11,
ICD REMOVAL&REPLACE SINGLE,8267790,LOCAL,33262,CPT,,,,,,Outpatient,,,65510.7,42582,Viva Med ADV,Viva Med ADV,20521.65,,,,,,,Fee Schedule,12499,36378.11,
ICD REMOVAL&REPLACE DUAL LEAD,8267778,LOCAL,33263,CPT,,,,,,Outpatient,,,67510.7,43882,Viva Med ADV,Viva Med ADV,20521.65,,,,,,,Fee Schedule,12499,36378.11,
ICD REMOVAL&REPLACE MULTIPLE,8267791,LOCAL,33264,CPT,,,,,,Outpatient,,,70510.7,45832,Viva Med ADV,Viva Med ADV,29312.62,,,,,,,Fee Schedule,12499,36378.11,
"45300 Proctosigmoidoscopy, rigid; diagnostic, w/ or w/o collection by brushing or washing",7962380,LOCAL,45300,CPT,,,,,,Outpatient,,,198,129,Viva Med ADV,Viva Med ADV,833.54,,,,,,,Fee Schedule,833.54,1419.32,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,90471,CPT,,,,,,Outpatient,,,216.15,140,Viva Med ADV,Viva Med ADV,65.07,,,,,,,Fee Schedule,42.18,65.07,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,G0010,CPT,,,,,,Outpatient,,,216.15,,Viva Med ADV,Viva Med ADV,42.18,,,,,,,Fee Schedule,42.18,65.07,
"25105 ARTHROTOMY, WRIST JOINT WITH SYNOVECTOMY",14130163,LOCAL,25105,CPT,,,,,,Outpatient,,,895,3245,Viva Med ADV,Viva Med ADV,2966.42,,,,,,,Fee Schedule,2528.75,2966.42,
PC DOPP ART BIL REST MULTIPLE/SINGLE,8230015,LOCAL,93923,CPT,,,,,26,Outpatient,,,57.19,401,Viva Med ADV,Viva Med ADV,143.05,,,,,,,Fee Schedule,143.05,244.97,
PC DOPP ART W/TREADMILL,8230020,LOCAL,93924,CPT,,,,,26,Outpatient,,,241,302,Viva Med ADV,Viva Med ADV,143.05,,,,,,,Fee Schedule,143.05,161.71,
PC DOPP LEA LIMITED,8230019,LOCAL,93922,CPT,,,,,26,Outpatient,,,150,265,Viva Med ADV,Viva Med ADV,117.85,,,,,,,Fee Schedule,117.85,161.71,
PC DUP ABD RENAL COMPLETE,8200571,LOCAL,93975,CPT,,,,,26,Outpatient,,,229.11,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP ABD RENAL LIMITED,8200581,LOCAL,93976,CPT,,,,,26,Outpatient,,,134.88,482,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,245.49,
PC DUP AO IVC COMPLETE,8200570,LOCAL,93978,CPT,,,,,26,Outpatient,,,74.95,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP AO IVC LIMITED,8200580,LOCAL,93979,CPT,,,,,26,Outpatient,,,50.12,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP CAROTID BILATERAL,8200229,LOCAL,93880,CPT,,,,,26,Outpatient,,,76.13,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP CAROTID UNILATERAL,8200228,LOCAL,93882,CPT,,,,,26,Outpatient,,,46.65,482,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP HEMODIALYSIS ACCESS,8200582,LOCAL,93990,CPT,,,,,26,Outpatient,,,29.64,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP LEA BIL,8200577,LOCAL,93925,CPT,,,,,26,Outpatient,,,66.27,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP LEA UNI,8200576,LOCAL,93926,CPT,,,,,26,Outpatient,,,45.08,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP UPPER ART BIL,8200575,LOCAL,93930,CPT,,,,,26,Outpatient,,,53.18,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,161.71,220.99,
PC DUP UPPER ART UNI,8200574,LOCAL,93931,CPT,,,,,26,Outpatient,,,35.48,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP VENOUS BIL,8200573,LOCAL,93970,CPT,,,,,26,Outpatient,,,87.58,482,Viva Med ADV,Viva Med ADV,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP VENOUS UNI,8200572,LOCAL,93971,CPT,,,,,26,Outpatient,,,57.12,310,Viva Med ADV,Viva Med ADV,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC US PSEUDOANEURYSM COMPRESSION REPAIR,8200583,LOCAL,76936,CPT,,,,,26,Outpatient,,,285.6,237.6,Viva Med ADV,Viva Med ADV,284.7,,,,,,,Fee Schedule,262.79,284.7,
97802 MEDICAL NUTRITIONAL THERAPY PROF CHARGE,13475611,LOCAL,97802,CPT,,,,,,Outpatient,,,70,55,Viva Med ADV,Viva Med ADV,25.2,,,,,,,Fee Schedule,25.2,287.34,
97803 MEDICAL NUTRITIONAL RE-ASSESSMENT PROF CHARG,13481228,LOCAL,97803,CPT,,,,,,Outpatient,,,60,48,Viva Med ADV,Viva Med ADV,21.06,,,,,,,Fee Schedule,21.06,287.34,
"64640 Destruction by neurolytic agent, other perip",13959658,LOCAL,64640,CPT,,,,,,Outpatient,,,500,927,Viva Med ADV,Viva Med ADV,813.96,,,,,,,Fee Schedule,813.96,1695.82,
10060 PROFEE Drainage of skin abscess,13954453,LOCAL,10060,CPT,,,,,,Outpatient,,,220,420,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
10061  I&D abscess complicated/multiple Profee,13769279,LOCAL,10061,CPT,,,,,,Outpatient,,,385,420,Viva Med ADV,Viva Med ADV,365.27,,,,,,,Fee Schedule,239.03,863,
10120 Incision & Removal Foreign Body Simp PROFEE,14006132,LOCAL,10120,CPT,,,,,,Outpatient,,,285,893,Viva Med ADV,Viva Med ADV,365.27,,,,,,,Fee Schedule,239.03,863,
"11042 PROFEE Debride subcutaneous tissue, 1st 20 s",13962336,LOCAL,11042,CPT,,,,,,Outpatient,,,145,836,Viva Med ADV,Viva Med ADV,365.27,,,,,,,Fee Schedule,365.27,863,
11043 PROFEE DEB MUSC/FASCIA 20 SQ CM/<,13967660,LOCAL,11043,CPT,,,,,,Outpatient,,,340,836,Viva Med ADV,Viva Med ADV,559.65,,,,,,,Fee Schedule,549.61,863,
"11044 Debride bone, 1st 20 sq cm or less Pro Fee",11221020,LOCAL,11044,CPT,,,,,,Outpatient,,,465,2328,Viva Med ADV,Viva Med ADV,1481.32,,,,,,,Fee Schedule,1291,1481.32,
"11045 Debride subq tissue, ea addl 20 sq cm Pro Fe",11221021,LOCAL,11045,CPT,,,,,,Outpatient,,,50,836,Viva Med ADV,Viva Med ADV,20.61,,,,,,,Fee Schedule,20.61,1466.58,
11046 PROFEE Debride muscle and/or fascia; ea addl,13954830,LOCAL,11046,CPT,,,,,,Outpatient,,,128,836,Viva Med ADV,Viva Med ADV,44.01,,,,,,,Fee Schedule,44.01,1466.58,
"11047 PROFEE Debridement, sus tissue each add 20 s",13967661,LOCAL,11047,CPT,,,,,,Outpatient,,,195,2092,Viva Med ADV,Viva Med ADV,78.26,,,,,,,Fee Schedule,78.26,1466.58,
11104 Punch Biopsy of Skin; Single Lesion ProFee,8768419,LOCAL,11104,CPT,,,,,,Outpatient,,,243.42,449,Viva Med ADV,Viva Med ADV,365.27,,,,,,,Fee Schedule,365.27,863,
11106  Incisional biopsy of skin single lesion Pro,13759967,LOCAL,11106,CPT,,,,,,Outpatient,,,296,800,Viva Med ADV,Viva Med ADV,559.65,,,,,,,Fee Schedule,559.65,1291,
"11400 EXCISION, BENIGN LESION INCLUDING MARGINS, E",7929974,LOCAL,11400,CPT,,,,,,Outpatient,,,160,935,Viva Med ADV,Viva Med ADV,643.26,,,,,,,Fee Schedule,643.26,1291,
"11406 EXCISION, BENIGN LESION INCLUDING MARGINS, E",7929979,LOCAL,11406,CPT,,,,,,Outpatient,,,470,1620,Viva Med ADV,Viva Med ADV,1481.32,,,,,,,Fee Schedule,1481.32,2584.84,
"11604 EXCISION, MALIGNANT LESION INCLUDING MARGINS",7930002,LOCAL,11604,CPT,,,,,,Outpatient,,,410,704,Viva Med ADV,Viva Med ADV,643.26,,,,,,,Fee Schedule,643.26,1679.75,
"11730 PROFEE Avulsion nail plate simple, single",13967650,LOCAL,11730,CPT,,,,,,Outpatient,,,195,228,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,95.93,863,
"11750 PROFEE Excision of nail and nail matrix, par",13954836,LOCAL,11750,CPT,,,,,,Outpatient,,,305,1342,Viva Med ADV,Viva Med ADV,365.27,,,,,,,Fee Schedule,365.27,863,
15271 PROFEE Application of skin substitute graft,13967652,LOCAL,15271,CPT,,,,,,Outpatient,,,296,1092,Viva Med ADV,Viva Med ADV,1672.39,,,,,,,Fee Schedule,1496,2862.92,
15275 PROFEE APPLICATION OF SKIN SUBSTITUTE GRAFT,13954832,LOCAL,15275,CPT,,,,,,Outpatient,,,306,1092,Viva Med ADV,Viva Med ADV,1672.39,,,,,,,Fee Schedule,1496,2862.92,
"28810 AMPUTATION, METATARSAL, WITH TOE, SINGLE Pro",7931853,LOCAL,28810,CPT,,,,,,Outpatient,,,820,3245,Viva Med ADV,Viva Med ADV,2966.42,,,,,,,Fee Schedule,2315,7645.84,
29445 PROFEE APPLICATION OF RIGID TOTAL CONTACT LE,13962328,LOCAL,29445,CPT,,,,,,Outpatient,,,200,266,Viva Med ADV,Viva Med ADV,242.81,,,,,,,Fee Schedule,242.81,863,
31502 Tracheotomy tube change prior to establishme,14397259,LOCAL,31502,CPT,,,,,,Outpatient,,,80,232,Viva Med ADV,Viva Med ADV,212.31,,,,,,,Fee Schedule,162.41,863,
"31899 UNLISTED PROCEDURE, TRACHEA, BRONCHI ProFee",7932202,LOCAL,31899,CPT,,,,,,Outpatient,,,91,194,Viva Med ADV,Viva Med ADV,177.49,,,,,,,Fee Schedule,177.49,2400.33,
"58573 LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTO",14831670,LOCAL,58573,CPT,,,,,,Outpatient,,,2172,10411,Viva Med ADV,Viva Med ADV,9518.56,,,,,,,Fee Schedule,5787,9518.56,
64454 Genicular Nerve Block Profee,13911832,LOCAL,64454,CPT,,,,,,Outpatient,,,227,244,Viva Med ADV,Viva Med ADV,633.14,,,,,,,Fee Schedule,633.14,1291,
64999 XX UNLISTED NERVOUS SYSTEM INJECTION,7939552,LOCAL,64999,CPT,,,,,,Outpatient,,,250,620,Viva Med ADV,Viva Med ADV,269.88,,,,,,,Fee Schedule,269.88,863,
93010 EKG INTERPRETATION,7939709,LOCAL,93010,CPT,,,,,,Outpatient,,,65,,Viva Med ADV,Viva Med ADV,10.44,,,,,,,Fee Schedule,10.44333333,38.53,
93451 RIGHT HEART CATHERIZATION (OR),8192212,LOCAL,93451,CPT,,,,,26,Outpatient,,,1008,6246,Viva Med ADV,Viva Med ADV,2940.64,,,,,,,Fee Schedule,2940.64,4325,
97597 WOUND DEBRIDEMENT ProFee,7935939,LOCAL,97597,CPT,,,,,,Outpatient,,,188.32,395,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,863,
97598 DEBRID SELCT EA ADD20SQCM ProFee,7935940,LOCAL,97598,CPT,,,,,,Outpatient,,,83,395,Viva Med ADV,Viva Med ADV,20.42,,,,,,,Fee Schedule,20.42,1466.58,
97605 Negative pressure wound therapy less than 50,14327888,LOCAL,97605,CPT,,,,,,Outpatient,,,80,285,Viva Med ADV,Viva Med ADV,181.66,,,,,,,Fee Schedule,181.66,273.27,
99183 HBO PER SESSION ProFee,7935966,LOCAL,99183,CPT,,,,,,Outpatient,,,210,,Viva Med ADV,Viva Med ADV,145.15,,,,,,,Fee Schedule,145.1479032,145.1479032,
99202 LEVEL 2 VISIT NEW PT ProFee,7935970,LOCAL,99202,CPT,,,,,,Outpatient,,,140,294,Viva Med ADV,Viva Med ADV,39.11,,,,,,,Fee Schedule,39.11,39.11,
99203 LEVEL 3 VISIT NEW PT ProFee,7935971,LOCAL,99203,CPT,,,,,,Outpatient,,,200,387,Viva Med ADV,Viva Med ADV,67.57,,,,,,,Fee Schedule,67.57,67.57,
99204 LEVEL 4 NEW PT PROF CHARGE,8700762,LOCAL,99204,CPT,,,,,,Outpatient,,,305,513,Viva Med ADV,Viva Med ADV,110.67,,,,,,,Fee Schedule,110.67,110.67,
99205 PROFEE OFFICE VISIT LEV 5 NEW PT,13962366,LOCAL,99205,CPT,,,,,,Outpatient,,,385,701,Viva Med ADV,Viva Med ADV,151.18,,,,,,,Fee Schedule,151.18,151.18,
99211 LEVEL 1 EST PT PROF CHARGE,8700763,LOCAL,99211,CPT,,,,,,Outpatient,,,40,226,Viva Med ADV,Viva Med ADV,7.37,,,,,,,Fee Schedule,7.37,7.37,
99212 LEVEL 2 EST PT PROF CHARGE,8700764,LOCAL,99212,CPT,,,,,,Outpatient,,,100,294,Viva Med ADV,Viva Med ADV,29.48,,,,,,,Fee Schedule,29.48,29.48,
99213 LEVEL 3 EST PT PROF CHARGE,8700765,LOCAL,99213,CPT,,,,,,Outpatient,,,135,387,Viva Med ADV,Viva Med ADV,54.77,,,,,,,Fee Schedule,54.77,54.77,
99214 LEVEL 4 EST PT PROF CHARGE,8700766,LOCAL,99214,CPT,,,,,,Outpatient,,,200,513,Viva Med ADV,Viva Med ADV,80.51,,,,,,,Fee Schedule,80.51,80.51,
99215 LEVEL 5 EST PT PROF CHARGE,8700767,LOCAL,99215,CPT,,,,,,Outpatient,,,270,701,Viva Med ADV,Viva Med ADV,119.41,,,,,,,Fee Schedule,119.41,119.41,
G0108 DIABETES SERVICE 30 MIN PROF CHARGE,13484119,LOCAL,G0108,CPT,,,,,,Outpatient,,,105,128,Viva Med ADV,Viva Med ADV,52.15,,,,,,,Fee Schedule,52.15,95.93,
G0109 DSMT DIABETES GROUP 30 MIN ProFee,7936084,LOCAL,G0109,CPT,,,,,,Outpatient,,,30,18,Viva Med ADV,Viva Med ADV,14.97,,,,,,,Fee Schedule,14.97,67.18,
IMPLANT MEMORY GEL #350-6004BC,4803876,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,0.01,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
"Protein, Tot & Prot Electrop Interp QSTC",8852423,LOCAL,84165,CPT,,,,,,Outpatient,,,3.92,12.89,Humana,Humana,2.8,,,,,,,Fee Schedule,2.796363636,17.73,
"Protein, Total QSTC",8852413,LOCAL,84165,CPT,,,,,,Outpatient,,,3.92,12.89,Humana,Humana,2.8,,,,,,,Fee Schedule,2.796363636,17.73,
DRESSING TELFA ISLAND 4X10,11074306,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,4.29,86,Humana,Humana,67.37,,,,,,,Fee Schedule,67.37,67.37,
.RPR Titer QSTC,6231113,LOCAL,86593,CPT,,,,,,Outpatient,,,5.9,5.28,Humana,Humana,4.4,,,,,,,Fee Schedule,4.4,15.29,
UA Microscopic,633864,LOCAL,81015,CPT,,,,,,Outpatient,,,6,3.66,Humana,Humana,1.68,,,,,,,Fee Schedule,1.68192607,4.02,
Urinalysis Review Manual,8502419,LOCAL,81015,CPT,,,,,,Outpatient,,,6,3.66,Humana,Humana,1.68,,,,,,,Fee Schedule,1.68192607,4.02,
Hematocrit QSTC,8852782,LOCAL,85014,CPT,,,,,,Outpatient,,,7.21,2.84,Humana,Humana,12.62,,,,,,,Fee Schedule,8.21,12.62068493,
Hemoglobin A2 (Quant) QSTC,8852791,LOCAL,83020,CPT,,,,,,Outpatient,,,7.21,15.44,Humana,Humana,12.87,,,,,,,Fee Schedule,12.87,17.73,
Hemoglobin QSTC,8852780,LOCAL,85018,CPT,,,,,,Outpatient,,,7.21,2.84,Humana,Humana,10.94,,,,,,,Fee Schedule,8.21,10.94316176,
Red Blood Cell Count QSTC,8852779,LOCAL,85041,CPT,,,,,,Outpatient,,,7.21,3.62,Humana,Humana,3.02,,,,,,,Fee Schedule,3.02,8.21,
87107 Fungal Isolate Identification QST,14813753,LOCAL,87107,CPT,,,,,,Outpatient,,,7.5,12.38,Humana,Humana,10.32,,,,,,,Fee Schedule,10.32,20.05,
87143 Fungal Isolate Identification QST,14815667,LOCAL,87143,CPT,,,,,,Outpatient,,,7.5,15.02,Humana,Humana,12.52,,,,,,,Fee Schedule,10.57,12.52,
87149 Fungal Isolate Identification QST,14813753,LOCAL,87149,CPT,,,,,,Outpatient,,,7.5,24.06,Humana,Humana,20.05,,,,,,,Fee Schedule,10.32,20.05,
Glucose Fasting Urine,7974487,LOCAL,81003,CPT,,,,,,Outpatient,,,7.88,2.7,Humana,Humana,3.8,,,,,,,Fee Schedule,3.795286195,4.02,
"Uric Acid, Synovial Fluid QSTC",9607980,LOCAL,84560,CPT,,,,,,Outpatient,,,8.37,6.1,Humana,Humana,19.49,,,,,,,Fee Schedule,7.16,19.49,
Alkaline Phosphatase QSTC,8848272,LOCAL,84075,CPT,,,,,,Outpatient,,,9.11,6.22,Humana,Humana,5.18,,,,,,,Fee Schedule,5.18,7.16,
Bone Isoenzymes QSTC,8848275,LOCAL,84080,CPT,,,,,,Outpatient,,,9.11,17.74,Humana,Humana,14.78,,,,,,,Fee Schedule,14.78,17.73,
SLING ARM MEDIUM,11070727,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,9.3,158,Humana,Humana,77.23,,,,,,,Fee Schedule,77.23,77.23,
acetylcysteine 20% Inhalation Sol [CULL],11208888,LOCAL,J7608,CPT,,,,,,Outpatient,1,ML,10,,Humana,Humana,8.46,,,,,,,Fee Schedule,8.455,8.455,
albuterol 1.25 mg/3 mL (0.042%) Sol [CULL],11203025,LOCAL,J7613,CPT,,,,,,Outpatient,3,ML,10,,Humana,Humana,4.66,,,,,,,Fee Schedule,4.66,4.66,
albuterol 2.5 mg/3 mL (0.083%) inhalation solution 3 mL [CULL],11203024,LOCAL,J7613,CPT,,,,,,Outpatient,3,ML,10,,Humana,Humana,4.66,,,,,,,Fee Schedule,4.66,4.66,
albuterol 5 mg/mL (0.5%) inhalation solution [CULL],11203026,LOCAL,J7611,CPT,,,,,,Outpatient,1,ML,10,,Humana,Humana,0.26,,,,,,,Fee Schedule,0.262,0.262,
amiodarone 50 mg/mL intravenous solution 3 mL [CULL],11200004,LOCAL,J0282,CPT,,,,,,Outpatient,3,ML,10,,Humana,Humana,0.41,,,,,,,Fee Schedule,0.409,0.409,
azaTHIOprine 50 mg oral tablet [CULL],11200492,LOCAL,J7500,CPT,,,,,,Outpatient,1,EA,10,,Humana,Humana,0.06,,,,,,,Fee Schedule,0.057,0.057,
BUPivacaine 0.25% preservative-free Sol [CULL],11282035,LOCAL,J0665,CPT,,,,,,Outpatient,10,ML,10,,Humana,Humana,0.01,,,,,,,Fee Schedule,0.01,0.011,
BUPivacaine 0.75%-D8.25% preservative-free intrathecal solution 2 mL [CULL],11202136,LOCAL,J0665,CPT,,,,,,Outpatient,2,ML,10,,Humana,Humana,0.01,,,,,,,Fee Schedule,0.01,0.011,
cycloSPORINE modified 25 mg oral capsule [CULL],11210499,LOCAL,J7515,CPT,,,,,,Outpatient,1,EA,10,,Humana,Humana,0.53,,,,,,,Fee Schedule,0.526,0.526,
dexAMETHasone 10 mg/mL injectable solution 1 mL [CULL],11202292,LOCAL,J1100,CPT,,,,,,Outpatient,1,ML,10,,Humana,Humana,10.49,,,,,,,Fee Schedule,10.48743758,10.48743758,
ipratropium 500 mcg/2.5 mL inhalation solution 2.5 mL [CULL],11203105,LOCAL,J7644,CPT,,,,,,Outpatient,2.5,ML,10,,Humana,Humana,0.4,,,,,,,Fee Schedule,0.4,0.4,
ketorolac 60 mg/2 mL Sol [CULL],11202716,LOCAL,J1885,CPT,,,,,,Outpatient,2,ML,10,,Humana,Humana,0.27,,,,,,,Fee Schedule,0.27,0.27,
levalbuterol 0.31 mg/3 mL inhalation solution 3 mL [CULL],11203125,LOCAL,J7614,CPT,,,,,,Outpatient,3,ML,10,,Humana,Humana,0.08,,,,,,,Fee Schedule,0.083,0.083,
levalbuterol 0.63 mg/3 mL inhalation solution 3 mL [CULL],11203127,LOCAL,J7614,CPT,,,,,,Outpatient,3,ML,10,,Humana,Humana,0.08,,,,,,,Fee Schedule,0.083,0.083,
levalbuterol 1.25 mg/3 mL inhalation solution 3 mL [CULL],11203128,LOCAL,J7614,CPT,,,,,,Outpatient,3,ML,10,,Humana,Humana,0.08,,,,,,,Fee Schedule,0.083,0.083,
methylPREDNISolone 4 mg oral tablet [CULL],11230944,LOCAL,J7509,CPT,,,,,,Outpatient,1,EA,10,,Humana,Humana,0.14,,,,,,,Fee Schedule,0.139,0.139,
mitoMYcin 20 mg/40 mL Sol [CULL],11205507,LOCAL,J9280,CPT,,,,,,Outpatient,0.5,ML,10,,Humana,Humana,20.35,,,,,,,Fee Schedule,20.35,525.49,
ondansetron 2 mg/mL injectable solution 2 mL [CULL],11211057,LOCAL,J2405,CPT,,,,,,Outpatient,2,ML,10,,Humana,Humana,0.06,,,,,,,Fee Schedule,0.057806268,0.057806268,
phenytoin 50 mg/mL injectable solution 2 mL [CULL],11282560,LOCAL,J1165,CPT,,,,,,Outpatient,2,ML,10,,Humana,Humana,0.6,,,,,,,Fee Schedule,0.595,0.595,
phenytoin 50 mg/mL injectable solution 5 mL [CULL],11212135,LOCAL,J1165,CPT,,,,,,Outpatient,5,ML,10,,Humana,Humana,0.6,,,,,,,Fee Schedule,0.595,0.595,
prednisoLONE sodium phosphate 15 mg/5 mL Liq [CULL],11250339,LOCAL,J7510,CPT,,,,,,Outpatient,5,ML,10,,Humana,Humana,0.92,,,,,,,Fee Schedule,0.919,0.919,
"rabies immune globulin, human 150 intl units/mL intramuscular solution 2 mL [CULL]",11212251,LOCAL,90376,CPT,,,,,,Outpatient,0.007,ML,10,347,Humana,Humana,347.32,,,,,,,Fee Schedule,347.32,2110.36,
tacrolimus 0.5 mg oral capsule [CULL],11205999,LOCAL,J7507,CPT,,,,,,Outpatient,1,EA,10,,Humana,Humana,0.2,,,,,,,Fee Schedule,0.197,0.197,
tobramycin 40 mg/mL injectable solution 2 mL [CULL],11212375,LOCAL,J3260,CPT,,,,,,Outpatient,2,ML,10,,Humana,Humana,2.07,,,,,,,Fee Schedule,2.071,2.071,
BUPivacaine 0.25% preservative-free injectable solution 30 mL [CULL],11202111,LOCAL,J0665,CPT,,,,,,Outpatient,30,ML,10.24,,Humana,Humana,0.01,,,,,,,Fee Schedule,0.01,0.011,
"Protein, Total, Peritoneal Fluid QSTC",9039313,LOCAL,84157,CPT,,,,,,Outpatient,,,10.44,4.8,Humana,Humana,4,,,,,,,Fee Schedule,4,7.16,
Rheumatoid Factor QSTC,9039252,LOCAL,86431,CPT,,,,,,Outpatient,,,10.8,6.8,Humana,Humana,6.3,,,,,,,Fee Schedule,6.29875,15.29,
ketorolac 30 mg/mL injectable solution 1 mL [CULL],11202715,LOCAL,J1885,CPT,,,,,,Outpatient,1,ML,10.944,,Humana,Humana,0.27,,,,,,,Fee Schedule,0.27,0.27,
RPR (Dx) w/Refl Titer/Confrm Testing QST,8972905,LOCAL,86592,CPT,,,,,,Outpatient,,,11.16,5.12,Humana,Humana,19.99,,,,,,,Fee Schedule,15.29,19.99375,
RPR (Monitor) w/Refl Titer QSTC,8972905,LOCAL,86592,CPT,,,,,,Outpatient,,,11.16,5.12,Humana,Humana,19.99,,,,,,,Fee Schedule,15.29,19.99375,
cefuroxime 750 mg injection [CULL],11201445,LOCAL,J0697,CPT,,,,,,Outpatient,1,EA,11.22304,,Humana,Humana,2.05,,,,,,,Fee Schedule,2.054,2.054,
"Creatinine, Random Ur QSTC",9320766,LOCAL,82570,CPT,,,,,,Outpatient,,,11.25,6.22,Humana,Humana,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
BUPivacaine 0.5% preservative-free injectable solution 10 mL [CULL],11282050,LOCAL,J0665,CPT,,,,,,Outpatient,10,ML,11.52,,Humana,Humana,0.01,,,,,,,Fee Schedule,0.01,0.011,
ciprofloxacin 200 mg/100 mL-D5% intravenous solution 100 mL [CULL],11201485,LOCAL,J0744,CPT,,,,,,Outpatient,100,ML,11.52,,Humana,Humana,2,,,,,,,Fee Schedule,1.997,1.997,
diphenhydrAMINE 50 mg/mL injectable solution 1 mL [CULL],11202342,LOCAL,J1200,CPT,,,,,,Outpatient,1,ML,11.5584,,Humana,Humana,0.14,,,,,,,Fee Schedule,0.143,0.143,
HYDROmorphone 2 mg/mL Sol [CULL],11202621,LOCAL,J1171,CPT,,,,,,Outpatient,1,ML,11.7504,,Humana,Humana,1.84,,,,,,,Fee Schedule,1.836603774,1.836603774,
Source QSTC,8983584,LOCAL,87209,CPT,,,,,,Outpatient,,,13.19,21.58,Humana,Humana,17.98,,,,,,,Fee Schedule,10.57,17.98,
ampicillin 500 mg injection [CULL],11201162,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,13.28,,Humana,Humana,0.59,,,,,,,Fee Schedule,0.591,0.591,
ampicillin 250 mg injection [CULL],11201150,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,13.3952,,Humana,Humana,0.59,,,,,,,Fee Schedule,0.591,0.591,
clindamycin 150 mg/mL injectable solution 4 mL [CULL],11202228,LOCAL,J0736,CPT,,,,,,Outpatient,4,ML,13.4784,,Humana,Humana,0.82,,,,,,,Fee Schedule,0.819,0.819,
"ANA IFA Scrn w/Rfx Titr & Patt, IFA QSTC",8764654,LOCAL,86038,CPT,,,,,,Outpatient,,,13.5,14.51,Humana,Humana,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
"ANA Scr,IFA w/R Tit/Ptn/MPX Ab Casc QSTC",8764642,LOCAL,86038,CPT,,,,,,Outpatient,,,13.5,14.51,Humana,Humana,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
"Bacterial Identification, Aerobic QST",13344175,LOCAL,87077,CPT,,,,,,Outpatient,,,13.5,9.7,Humana,Humana,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
T3 Uptake QSTC,9039244,LOCAL,84479,CPT,,,,,,Outpatient,,,13.5,7.76,Humana,Humana,6.47,,,,,,,Fee Schedule,6.47,18.43,
COLLAR CERVICAL SOFT MEDIUM,11071045,LOCAL,,,L0120,HCPCS,,,,Outpatient,,,13.75,44,Humana,Humana,34.57,,,,,,,Fee Schedule,34.57,34.57,
HYDROmorphone 1 mg/mL Sol,11202620,LOCAL,J1171,CPT,,,,,,Outpatient,1,ML,13.824,,Humana,Humana,1.84,,,,,,,Fee Schedule,1.836603774,1.836603774,
tacrolimus 1 mg oral capsule [CULL],11205998,LOCAL,J7507,CPT,,,,,,Outpatient,1,EA,14.2704,,Humana,Humana,0.2,,,,,,,Fee Schedule,0.197,0.197,
Measles Antibody (IgG) QSTC,8764682,LOCAL,86765,CPT,,,,,,Outpatient,,,14.63,15.46,Humana,Humana,12.88,,,,,,,Fee Schedule,12.88,15.29,
gentamicin 60 mg/50 mL-NaCl 0.9% intravenous solution 50 mL [CULL],11201825,LOCAL,J1580,CPT,,,,,,Outpatient,50,ML,14.69466667,,Humana,Humana,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
SLING ARM LARGE,11071011,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,14.8,158,Humana,Humana,77.23,,,,,,,Fee Schedule,77.23,77.23,
HYDROmorphone 10 mg/mL Sol [CULL],11202625,LOCAL,J1171,CPT,,,,,,Outpatient,1,ML,14.96064,,Humana,Humana,1.84,,,,,,,Fee Schedule,1.836603774,1.836603774,
"hCG, Total, QN Male Only QSTC",8853229,LOCAL,84702,CPT,,,,,,Outpatient,,,15,18.06,Humana,Humana,15.05,,,,,,,Fee Schedule,15.05,18.43,
"Herpes Simplex Virus 2 (IgG), with Reflex to HSV-2 Inhibition QST",14811888,LOCAL,86696,CPT,,,,,,Outpatient,,,15,23.22,Humana,Humana,19.35,,,,,,,Fee Schedule,15.29,19.35,
gentamicin 80 mg/50 mL-NaCl 0.9% intravenous solution 50 mL [CULL],11201824,LOCAL,J1580,CPT,,,,,,Outpatient,50,ML,15.62533333,,Humana,Humana,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
gentamicin 40 mg/mL injectable solution 2 mL [CULL],11282205,LOCAL,J1580,CPT,,,,,,Outpatient,2,ML,15.6288,,Humana,Humana,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
HYDROmorphone 0.5 mg/0.5 mL Sol [CULL],11202622,LOCAL,J1171,CPT,,,,,,Outpatient,0.5,ML,15.936,,Humana,Humana,1.84,,,,,,,Fee Schedule,1.836603774,1.836603774,
gentamicin 120 mg/100 mL-NaCl 0.9% intravenous solution 100 mL [CULL],11209100,LOCAL,J1580,CPT,,,,,,Outpatient,100,ML,15.98666667,,Humana,Humana,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
alpha 1-proteinase inhibitor human Sol 10 mg [CULL],11211124,LOCAL,J0256,CPT,,,,,,Outpatient,1,EA,16,,Humana,Humana,5.46,,,,,,,Fee Schedule,5.46,2110.36,
"Chloride, Random Urine without Creatinine QSTC",10011691,LOCAL,82436,CPT,,,,,,Outpatient,,,16.25,6.9,Humana,Humana,5.75,,,,,,,Fee Schedule,5.75,7.16,
"Potassium, U24 w/o Creatinine QSTC",13864422,LOCAL,84133,CPT,,,,,,Outpatient,,,16.25,5.68,Humana,Humana,19.32,,,,,,,Fee Schedule,7.16,19.32,
Sickle Cell Screen QSTC,10073685,LOCAL,85660,CPT,,,,,,Outpatient,,,16.25,6.61,Humana,Humana,5.51,,,,,,,Fee Schedule,5.51,8.21,
gentamicin 100 mg/100 mL-NaCl 0.9% intravenous solution 100 mL [CULL],11201827,LOCAL,J1580,CPT,,,,,,Outpatient,100,ML,16.41066667,,Humana,Humana,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
"Creatinine, Random Ur, Microalbumin QSTC",9041589,LOCAL,82570,CPT,,,,,,Outpatient,,,16.88,6.22,Humana,Humana,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Ratio, Microalbumin Random Ur QSTC",9041592,LOCAL,82043,CPT,,,,,,Outpatient,,,16.88,6.94,Humana,Humana,20.16,,,,,,,Fee Schedule,4.02,20.15557971,
Protein Level 24 Hour Urine,633811,LOCAL,84156,CPT,,,,,,Outpatient,,,17,4.4,Humana,Humana,11.68,,,,,,,Fee Schedule,7.16,11.68,
Thrombin Clotting Time QSTC,8764547,LOCAL,85670,CPT,,,,,,Outpatient,,,17.1,6.92,Humana,Humana,5.77,,,,,,,Fee Schedule,5.42,5.77,
"Urea Nitrogen Ur, Rand QSTC",13864416,LOCAL,84540,CPT,,,,,,Outpatient,,,17.1,6.67,Humana,Humana,5.56,,,,,,,Fee Schedule,5.56,7.16,
nalbuphine 10 mg/mL Sol,J2300,CPT,,,,,,,,Outpatient,10,ML,17.12,,Humana,Humana,3.45,,,,,,,Fee Schedule,3.45,3.45,
cycloSPORINE modified 100 mg oral capsule [CULL],11210500,LOCAL,J7502,CPT,,,,,,Outpatient,1,EA,17.58826667,,Humana,Humana,1.81,,,,,,,Fee Schedule,1.81,1.81,
SPLINT WRIST FOREARM LEFT LG,11071054,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,Humana,Humana,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM LT MED,11071053,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,Humana,Humana,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM LT SM,11071052,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,Humana,Humana,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM RT LG,11071050,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,Humana,Humana,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM RT MED,11071049,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,Humana,Humana,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM RT PED,11071047,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,Humana,Humana,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM RT SM,11071048,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,Humana,Humana,67.37,,,,,,,Fee Schedule,67.37,67.37,
95852 RANGE OF MOTION-HAND 15 MIN CHARGE,9410221,LOCAL,95852,CPT,,,,,GP,Outpatient,,,17.86,12,Humana,Humana,4.74,,,,,,,Fee Schedule,4.74,4.74,
SPLINT WRIST FOREARM LEFT X L,11074363,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.88,86,Humana,Humana,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT XLG WRIST FOREARM RIGHT,11074362,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.88,86,Humana,Humana,67.37,,,,,,,Fee Schedule,67.37,67.37,
Creatine Kinase Isoenzyme Interp. QSTC,8852390,LOCAL,82550,CPT,,,,,,Outpatient,,,18,7.81,Humana,Humana,23.74,,,,,,,Fee Schedule,7.16,23.7373913,
Creatine Kinase Isoenzyme w/ Tot CK QSTC,8764767,LOCAL,82552,CPT,,,,,,Outpatient,,,18,16.07,Humana,Humana,13.39,,,,,,,Fee Schedule,13.39,17.73,
Creatine Kinase Isoenzymes w/o Ttl QSTC,13864524,LOCAL,82552,CPT,,,,,,Outpatient,,,18,16.07,Humana,Humana,13.39,,,,,,,Fee Schedule,13.39,17.73,
"Creatine Kinase, Total QSTC",8852386,LOCAL,82552,CPT,,,,,,Outpatient,,,18,16.07,Humana,Humana,13.39,,,,,,,Fee Schedule,13.39,17.73,
Rubella Antibody (IgG) QSTC,8853250,LOCAL,86762,CPT,,,,,,Outpatient,,,18,17.27,Humana,Humana,14.39,,,,,,,Fee Schedule,14.39,15.29,
Urine Creatinine,7050475,LOCAL,82570,CPT,,,,,,Outpatient,,,18,6.22,Humana,Humana,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
Urine Protein Level,7412757,LOCAL,84156,CPT,,,,,,Outpatient,,,18,4.4,Humana,Humana,11.68,,,,,,,Fee Schedule,7.16,11.68,
phytonadione 1 mg/0.5 mL injectable solution 0.5 mL [CULL],11212147,LOCAL,J3430,CPT,,,,,,Outpatient,0.5,ML,18.223104,,Humana,Humana,2.81,,,,,,,Fee Schedule,2.808,2.808,
SPLINT WRIST FOREARM LT PED,11070883,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,18.43,86,Humana,Humana,67.37,,,,,,,Fee Schedule,67.37,67.37,
fosphenytoin 100 mgPE/2 mL Sol [CULL],11205072,LOCAL,Q2009,CPT,,,,,,Outpatient,2,ML,18.432,,Humana,Humana,1.47,,,,,,,Fee Schedule,1.47,1.47,
methylPREDNISolone 40 mg Pow [CULL],11204478,LOCAL,J2919,CPT,,,,,,Outpatient,1,UN,18.432,,Humana,Humana,0.21,,,,,,,Fee Schedule,0.21,0.21,
Almond (F20) IgE QST,14586519,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Alternaria Alternata (M6) IgE QST,14586545,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Brazil Nut (F18) IgE QST,14586553,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cashew Nut (F202) IgE QST,14586555,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cat Dander (E1) IgE QST,14586539,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cladosporium Herbarum (M2) IgE QST,14586543,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cockroach (I6) IgE QST,14586549,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Codfish (F3) IgE QST,14586521,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cow's Milk (F2) IgE QST,14586529,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dermatophagoides Farinae (D2) IgE QST,14586537,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dermatophagoides Pteronyssinu D1 IgE QST,14586535,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dog Dander (E5) IgE QST,14586541,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Egg White (F1) IgE QST,14586527,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Hazelnut (F17) IgE QST,14586551,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Immunoglobulin E QST,14586516,LOCAL,82785,CPT,,,,,,Outpatient,,,18.5,19.75,Humana,Humana,203.96,,,,,,,Fee Schedule,17.73,203.9616667,
Macadamia Nut (RF345) IgE QST,14586525,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Mouse Urine Proteins (E72) IgE QST,14586547,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Peanut (F13) IgE QST,14586517,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Shrimp (F24) IgE QST,14586523,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Soybean (F14) IgE QST,14586533,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Walnut (F256) IgE QST,14586557,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Wheat (F4) IgE QST,14586531,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
droNABinol 2.5 mg Cap [CULL],11220183,LOCAL,Q0167,CPT,,,,,,Outpatient,1,EA,18.853344,,Humana,Humana,1.35,,,,,,,Fee Schedule,1.352,1.352,
"HPV mRNA E6/E7, POST-$HYST, VAGINAL W/REFL QST",14782711,LOCAL,87624,CPT,,,,,,Outpatient,,,18.9,42.11,Humana,Humana,67.2,,,,,,,Fee Schedule,40.19,67.195,
Lead Capillary QSTC,14116315,LOCAL,83655,CPT,,,,,,Outpatient,,,19.12,14.53,Humana,Humana,13.99,,,,,,,Fee Schedule,13.99076923,16.07,
"Lead, Blood QSTC",8764839,LOCAL,83655,CPT,,,,,,Outpatient,,,19.13,14.53,Humana,Humana,13.99,,,,,,,Fee Schedule,13.99076923,16.07,
"Lead, Blood QSTC",13864923,LOCAL,83655,CPT,,,,,,Outpatient,,,19.13,14.53,Humana,Humana,13.99,,,,,,,Fee Schedule,13.99076923,16.07,
fluconazole 100 mg/50 mL-NaCl 0.9% intravenous solution 50 mL [CULL],11291246,LOCAL,J1450,CPT,,,,,,Outpatient,50,ML,19.2,,Humana,Humana,4.48,,,,,,,Fee Schedule,4.48,4.48,
"Albumin, Peritoneal Fluid QSTC",8972935,LOCAL,82042,CPT,,,,,,Outpatient,,,19.4,9.34,Humana,Humana,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Albumin, Pleural Fluid QST",12130816,LOCAL,82042,CPT,,,,,,Outpatient,,,19.4,9.34,Humana,Humana,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Albumin, Pleural Fluid QSTC",12130706,LOCAL,82042,CPT,,,,,,Outpatient,,,19.4,9.34,Humana,Humana,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Glucose, Peritoneal Fluid QSTC",9039310,LOCAL,82945,CPT,,,,,,Outpatient,,,19.4,4.72,Humana,Humana,3.93,,,,,,,Fee Schedule,3.93,7.16,
Cardiolipin Ab (IgA)QSTC,9215429,LOCAL,86147,CPT,,,,,,Outpatient,,,19.58,30.54,Humana,Humana,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Antibody IgG QSTC,10100354,LOCAL,86147,CPT,,,,,,Outpatient,,,19.58,30.54,Humana,Humana,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Antibody IgM QSTC,10100355,LOCAL,86147,CPT,,,,,,Outpatient,,,19.58,30.54,Humana,Humana,25.45,,,,,,,Fee Schedule,15.29,25.45,
24hr Urine Creatinine QSTC,10005155,LOCAL,82570,CPT,,,,,,Outpatient,,,19.76,6.22,Humana,Humana,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Creatinine, Random U QSTC",12290061,LOCAL,82570,CPT,,,,,,Outpatient,,,19.76,6.22,Humana,Humana,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
Interp: QSTC,8851928,LOCAL,84166,CPT,,,,,,Outpatient,,,19.76,21.4,Humana,Humana,18.62,,,,,,,Fee Schedule,17.73,18.62,
Interp: QSTC,8851952,LOCAL,84166,CPT,,,,,,Outpatient,,,19.76,21.4,Humana,Humana,18.62,,,,,,,Fee Schedule,17.73,18.62,
"Protein, Total, Random Urine QSTC",8851945,LOCAL,84156,CPT,,,,,,Outpatient,,,19.76,4.4,Humana,Humana,11.68,,,,,,,Fee Schedule,7.16,11.68,
SHOE POST OP MALE LARGE,11070723,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,19.86,223,Humana,Humana,175.72,,,,,,,Fee Schedule,175.72,175.72,
SHOE POST OP MALE MD,11071019,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,19.86,12,Humana,Humana,67.31,,,,,,,Fee Schedule,67.31,67.31,
SHOE POST OP MALE SMALL,11070721,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,19.86,223,Humana,Humana,175.72,,,,,,,Fee Schedule,175.72,175.72,
methotrexate 2.5 mg oral tablet [CULL],11240138,LOCAL,J8610,CPT,,,,,,Outpatient,1,EA,19.9584,,Humana,Humana,0.15,,,,,,,Fee Schedule,0.151,0.151,
cefTAZidime 1 g injection [CULL],11201385,LOCAL,J0713,CPT,,,,,,Outpatient,1,EA,19.968,,Humana,Humana,1.47,,,,,,,Fee Schedule,1.468,1.468,
Carbon Dioxide Level,7903173,LOCAL,82374,CPT,,,,,,Outpatient,,,20,5.86,Humana,Humana,4.88,,,,,,,Fee Schedule,4.88,7.16,
Creatinine,3454470,LOCAL,82565,CPT,,,,,,Outpatient,,,20,6.14,Humana,Humana,10.06,,,,,,,Fee Schedule,7.16,10.061625,
COLLAR CERVICAL SOFT SMALL,11071044,LOCAL,,,L0120,HCPCS,,,,Outpatient,,,20.13,44,Humana,Humana,34.57,,,,,,,Fee Schedule,34.57,34.57,
Gastric Occult Blood,7974128,LOCAL,82271,CPT,,,,,,Outpatient,,,20.16,6.38,Humana,Humana,5.32,,,,,,,Fee Schedule,5.32,7.16,
Immunoglobulin A QSTC,8764567,LOCAL,82784,CPT,,,,,,Outpatient,,,20.25,11.16,Humana,Humana,34.96,,,,,,,Fee Schedule,7.16,34.958,
Immunoglobulin M QSTC,8853219,LOCAL,82784,CPT,,,,,,Outpatient,,,20.25,11.16,Humana,Humana,34.96,,,,,,,Fee Schedule,7.16,34.958,
"PSA, Free QSTC",8852652,LOCAL,84154,CPT,,,,,,Outpatient,,,20.25,22.07,Humana,Humana,19.14,,,,,,,Fee Schedule,17.73,19.14,
COLLAR CERVICAL SOFT LARGE,11071046,LOCAL,,,L0120,HCPCS,,,,Outpatient,,,20.63,44,Humana,Humana,34.57,,,,,,,Fee Schedule,34.57,34.57,
gentamicin 10 mg/mL injectable solution 2 mL [CULL],11201813,LOCAL,J1580,CPT,,,,,,Outpatient,2,ML,20.7744,,Humana,Humana,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
.Manual Differential (CULL),13467987,LOCAL,85007,CPT,,,,,,Outpatient,,,20.81,4.56,Humana,Humana,3.34,,,,,,,Fee Schedule,3.338698061,8.21,
.Manual Differential (CULL_AL),6237143,LOCAL,85007,CPT,,,,,,Outpatient,,,20.81,4.56,Humana,Humana,3.34,,,,,,,Fee Schedule,3.338698061,8.21,
cefuroxime 1.5 g injection [CULL],11201459,LOCAL,J0697,CPT,,,,,,Outpatient,1,EA,20.83712,,Humana,Humana,2.05,,,,,,,Fee Schedule,2.054,2.054,
"Albumin, CSF QSTC",13873322,LOCAL,82042,CPT,,,,,,Outpatient,,,20.95,9.34,Humana,Humana,7.78,,,,,,,Fee Schedule,7.16,7.78,
"IgG, CSF QSTC",13873321,LOCAL,82784,CPT,,,,,,Outpatient,,,20.95,11.16,Humana,Humana,34.96,,,,,,,Fee Schedule,7.16,34.958,
"Amylase, Pleural Fluid QSTC",9039309,LOCAL,82150,CPT,,,,,,Outpatient,,,20.97,7.78,Humana,Humana,1.24,,,,,,,Fee Schedule,1.237209302,7.16,
"Calcium, Random Ur QSTC",13864744,LOCAL,82310,CPT,,,,,,Outpatient,,,20.99,6.19,Humana,Humana,5.16,,,,,,,Fee Schedule,5.16,7.16,
"Creatinine, Random U QSTC",13864745,LOCAL,82570,CPT,,,,,,Outpatient,,,20.99,6.22,Humana,Humana,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
Fructosamine QSTC,8853273,LOCAL,82985,CPT,,,,,,Outpatient,,,21.02,20.11,Humana,Humana,16.76,,,,,,,Fee Schedule,16.76,17.73,
butorphanol 1 mg/mL Sol [CULL],11202144,LOCAL,J0595,CPT,,,,,,Outpatient,1,ML,21.40416,,Humana,Humana,5.54,,,,,,,Fee Schedule,5.544,5.544,
Direct LDL QSTC,9039357,LOCAL,83721,CPT,,,,,,Outpatient,,,21.6,12.6,Humana,Humana,10.5,,,,,,,Fee Schedule,10.5,17.73,
Hemoglobin A1c QSTC,6213055,LOCAL,83036,CPT,,,,,,Outpatient,,,21.6,11.65,Humana,Humana,28.6,,,,,,,Fee Schedule,7.16,28.59604426,
Varicella-Zoster Virus Ab (IgG) QSTC,8853252,LOCAL,86787,CPT,,,,,,Outpatient,,,21.6,15.46,Humana,Humana,12.88,,,,,,,Fee Schedule,12.88,15.29,
Serum Osmolality QSTC,8972765,LOCAL,83930,CPT,,,,,,Outpatient,,,21.65,7.93,Humana,Humana,6.61,,,,,,,Fee Schedule,6.61,7.16,
76376 3D RENDER W/O POSTPR CHARGE,9284912,LOCAL,76376,CPT,,,,,,Outpatient,,,22,391.88,Humana,Humana,13.93,,,,,,,Fee Schedule,13.93,13.93,
POC Hgb,7160347,LOCAL,83036,CPT,,,,,,Outpatient,,,22,11.65,Humana,Humana,28.6,,,,,,,Fee Schedule,7.16,28.59604426,
Creatinine Level 24 Hour Urine,1634894,LOCAL,82570,CPT,,,,,,Outpatient,,,22.03,6.22,Humana,Humana,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Albumin, 24 Hour Urine w/o Creat QSTC",13864523,LOCAL,82043,CPT,,,,,,Outpatient,,,22.5,6.94,Humana,Humana,20.16,,,,,,,Fee Schedule,4.02,20.15557971,
"Folate, RBC QSTS",13899938,LOCAL,82747,CPT,,,,,,Outpatient,,,22.5,21.18,Humana,Humana,17.65,,,,,,,Fee Schedule,17.65,46.74,
Hepatitis C Ab rfx HCV RNA Qnt PCR QSTC,8764583,LOCAL,86803,CPT,,,,,,Outpatient,,,22.5,17.12,Humana,Humana,32.1,,,,,,,Fee Schedule,15.29,32.10014925,
IMMOBILIZER  SHOULDER MEDIUM,11070739,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,22.5,12,Humana,Humana,67.31,,,,,,,Fee Schedule,67.31,67.31,
IMMOBILIZER SHOULDER XL,11070165,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,22.5,12,Humana,Humana,67.31,,,,,,,Fee Schedule,67.31,67.31,
"PSA, Total QSTC",8852651,LOCAL,84153,CPT,,,,,,Outpatient,,,22.5,22.07,Humana,Humana,104.84,,,,,,,Fee Schedule,17.73,104.8447059,
"T4, Free QSTC",9291013,LOCAL,84439,CPT,,,,,,Outpatient,,,22.5,10.82,Humana,Humana,28.58,,,,,,,Fee Schedule,18.43,28.58065455,
DRAIN ROUND JP 10FR----OR,11071535,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,22.55,12,Humana,Humana,67.31,,,,,,,Fee Schedule,67.31,67.31,
"Heterophile, Mono Screen QSTC",13864506,LOCAL,86308,CPT,,,,,,Outpatient,,,22.68,6.22,Humana,Humana,5.18,,,,,,,Fee Schedule,5.18,15.29,
"T3, Free QSTC",8972902,LOCAL,84481,CPT,,,,,,Outpatient,,,22.68,20.33,Humana,Humana,34.46,,,,,,,Fee Schedule,18.43,34.46424242,
IMMOBILIZER SHOULDER SMALL,11071014,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,22.72,12,Humana,Humana,67.31,,,,,,,Fee Schedule,67.31,67.31,
COLLECTION: Venous Draw,1779389,LOCAL,36415,CPT,,,,,,Outpatient,,,22.73,10.91,Humana,Humana,6.74,,,,,,,Fee Schedule,3.41,6.740753664,
IMMOBILIZER SHOULDER LARGE,11071760,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,22.77,12,Humana,Humana,67.31,,,,,,,Fee Schedule,67.31,67.31,
Urine Eosinophil Smear,8690390,LOCAL,85008,CPT,,,,,,Outpatient,,,22.85,4.12,Humana,Humana,3.43,,,,,,,Fee Schedule,3.43,8.21,
Urine Eosinophils,7974116,LOCAL,89051,CPT,,,,,,Outpatient,,,22.85,6.72,Humana,Humana,35.8,,,,,,,Fee Schedule,14.07,35.795,
Sodium Level Urine,4185817,LOCAL,84300,CPT,,,,,,Outpatient,,,23,6.07,Humana,Humana,9.74,,,,,,,Fee Schedule,7.16,9.74,
Almond (F20) IgE QST,13344505,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Almond (f20) IgE QSTC,8764712,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Beef (f27) IgE QSTC,8764717,LOCAL,86003,CPT,86003,HCPCS,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Brazil Nut (F18) IgE QST,13344495,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Brazil Nut (f18) IgE QSTC,8764711,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cashew Nut (F202) IgE QST,13344499,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cashew Nut (f202) IgE QSTC,8764689,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cat Dander (e1) IgE QSTC,6241002,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Catfish (f369) IgE QSTC,8764761,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Chicken Meat (f83) IgE QSTC,8761426,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Clam (f207) IgE QSTC,8764592,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cocoa (f93) IgE QSTC,8764728,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Coconut (f36) IgE QSTC,8764719,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cow'S Milk (F2) IgE w/Rflx to Panel QST,12886535,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cow'S Milk(F2) IgE W/Rfx Panel QSTC,14129187,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Crab (f23) IgE QSTC,6210507,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Crayfish (Rf320) IgE** QSTC,9039458,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
D. Pteronyssinus (d1) IgE QST,6241001,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dermatophagoides Farinae (d2) IgE QST,10217085,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dog Dander (e5) IgE QSTC,6241003,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Egg White (f1) IgE QSTC,8764699,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Egg White (F2) IgE w/Rflx to Panel QST,12886536,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Egg Yolk (f75) IgE QSTC,8764725,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Fire Ant (i70) IgE QSTC,8764698,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Gluten (f79) IgE QSTC,9039341,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Hazelnut (F17) IgE QST,13344503,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Hazelnut (f17) IgE QSTC,8764710,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Lobster (f80) IgE QSTC,6210505,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Macadamia Nut (RF345) IgE QST,13344491,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Milk Component Panel QST,10217179,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Oyster (f290) IgE QSTC,6210503,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Peanut (F13) IgE QST,13344507,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Peanut (f13) IgE QSTC,8764708,LOCAL,86003,CPT,86003,HCPCS,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
"Peanut,Tot w/rfx to Peanut Comp Pnl QSTC",8764811,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pecan Nut (F201) IgE QST,13344493,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pecan Nut (f201) IgE QSTC,8764727,LOCAL,86003,CPT,86003,HCPCS,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Perch Ocean IgE QSTC,8764760,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pistachio (F203) IgE QST,13344501,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pork (f26) IgE QSTC,8764716,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Scallop (f338) IgE QSTC,6210506,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Shrimp (f24) IgE QSTC,6241010,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Soybean (f14) IgE QSTC,8764709,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Strawberry (f44) IgE QSTC,8764722,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Tilapia IgE* QSTC,8972793,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Tomato (f25) IgE QSTC,8764715,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Walnut (F256) IgE QST,13344497,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Walnut (f256) IgE QSTC,8764747,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Wheat (f4) IgE QSTC,6241013,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
95851 ROM MEASUREMENT(EXCLUDE HANDS) CHARGE,9410226,LOCAL,95851,CPT,,,,,GP,Outpatient,,,23.49,15,Humana,Humana,6.41,,,,,,,Fee Schedule,6.41,6.41,
digoxin 250 mcg/mL (0.25 mg/mL) injectable solution 2 mL [CULL],11282125,LOCAL,J1160,CPT,,,,,,Outpatient,2,ML,23.92,,Humana,Humana,9.57,,,,,,,Fee Schedule,9.574,9.574,
sulfamethoxazole-trimethoprim 80 mg-16 mg/mL Sol [CULL],11211277,LOCAL,J2865,CPT,,,,,,Outpatient,5,ML,24.3328,,Humana,Humana,0.04,,,,,,,Fee Schedule,0.01,0.038,
Immunoglobulin G QSTC,8764569,LOCAL,82784,CPT,,,,,,Outpatient,,,24.75,11.16,Humana,Humana,34.96,,,,,,,Fee Schedule,7.16,34.958,
Sjogren's Antibody (SS-A) QSTC,8860711,LOCAL,86235,CPT,,,,,,Outpatient,,,24.75,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-A) QSTC,9039451,LOCAL,86235,CPT,,,,,,Outpatient,,,24.75,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-B) QSTC,8860712,LOCAL,86235,CPT,,,,,,Outpatient,,,24.75,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-B) QSTC,9039452,LOCAL,86235,CPT,,,,,,Outpatient,,,24.75,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
methylPREDNISolone 125 mg Pow [CULL],11247586,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,24.8064,,Humana,Humana,0.21,,,,,,,Fee Schedule,0.21,0.21,
STRAP CLAVACLE LARGE,11070713,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,24.97,12,Humana,Humana,67.31,,,,,,,Fee Schedule,67.31,67.31,
STRAP CLAVICLE MED 3IN,11098246,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,24.97,12,Humana,Humana,67.31,,,,,,,Fee Schedule,67.31,67.31,
Aerobic Bacterium ID/ Susceptibility QST,13344167,LOCAL,87077,CPT,,,,,,Outpatient,,,25,9.7,Humana,Humana,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
"Catecholamines, Fractionated, Plasma QSTC",11335672,LOCAL,82384,CPT,,,,,,Outpatient,,,25,30.3,Humana,Humana,25.25,,,,,,,Fee Schedule,18.43,25.25,
Tissue A Clinical Impression QST,10148697,LOCAL,88300,CPT,,,,,,Outpatient,,,25,,Humana,Humana,22.39,,,,,,,Fee Schedule,22.39,32.32,
Tissue A Comment QST,10148702,LOCAL,88302,CPT,,,,,,Outpatient,,,25,,Humana,Humana,35.88,,,,,,,Fee Schedule,32.32,35.88,
Tissue A Diagnosis QST,10148701,LOCAL,88304,CPT,,,,,,Outpatient,,,25,,Humana,Humana,48.85,,,,,,,Fee Schedule,32.32,48.85,
Tissue A Gross Description QST,10148699,LOCAL,88305,CPT,,,,,,Outpatient,,,25,,Humana,Humana,48.85,,,,,,,Fee Schedule,48.85,59.06,
Tissue A Micro Description QST,10148700,LOCAL,88307,CPT,,,,,,Outpatient,,,25,,Humana,Humana,328.88,,,,,,,Fee Schedule,59.06,328.88,
Tissue A Procedure QST,10148698,LOCAL,88309,CPT,,,,,,Outpatient,,,25,,Humana,Humana,746.86,,,,,,,Fee Schedule,59.06,746.86,
Childhood Allergy Profile QSTC,8972792,LOCAL,86003,CPT,,,,,,Outpatient,,,25.16,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Expanded Childhood Allergy Profile ADD ON,14019143,LOCAL,86003,CPT,,,,,,Outpatient,,,25.16,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
"Albumin, CSF QSTC",8861454,LOCAL,82042,CPT,,,,,,Outpatient,,,25.28,9.34,Humana,Humana,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Albumin, Serum QSTC",8861457,LOCAL,82040,CPT,,,,,,Outpatient,,,25.28,5.94,Humana,Humana,127.89,,,,,,,Fee Schedule,7.16,127.89,
Immunoglobulin G QSTC,8861456,LOCAL,82784,CPT,,,,,,Outpatient,,,25.28,11.16,Humana,Humana,34.96,,,,,,,Fee Schedule,7.16,34.958,
Maternal Serum AFP QST,8972825,LOCAL,82105,CPT,,,,,,Outpatient,,,25.88,20.12,Humana,Humana,26.22,,,,,,,Fee Schedule,17.73,26.22,
Maternal Serum AFP QSTC,8972825,LOCAL,82105,CPT,,,,,,Outpatient,,,25.88,20.12,Humana,Humana,26.22,,,,,,,Fee Schedule,17.73,26.22,
"G-6-PD, RBC QSTC",8764537,LOCAL,82955,CPT,,,,,,Outpatient,,,26.15,11.64,Humana,Humana,9.7,,,,,,,Fee Schedule,7.16,9.7,
ampicillin 1 g injection [CULL],11201129,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,26.256,,Humana,Humana,0.59,,,,,,,Fee Schedule,0.591,0.591,
DOBUTamine 12.5 mg/mL intravenous solution 20 mL [CULL],11201690,LOCAL,J1250,CPT,,,,,,Outpatient,20,ML,26.6144,,Humana,Humana,8.02,,,,,,,Fee Schedule,8.024,8.024,
Serotype 1 (1) QST,10243602,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 12 (12F) QST,10243608,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 14 (14) QST,10243609,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 17 (17F) QST,10242538,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 19 (19F) QST,10243610,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 2 (2) QST,10242514,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 20 (20) QST,10242544,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 22 (22F) QST,10242547,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 23 (23F) QST,10243611,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 26 (6B) QST,10243612,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 3 (3) QST,10243603,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 34 (10A) QST,10242556,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 4 (4) QST,10243604,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 43 (11A) QST,10242559,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 5 (5) QST,10243605,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 51 (7F) QST,10243613,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 54 (15B) QST,10242565,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 56 (18C) QST,10243614,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 57 (19A) QST,10242571,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 68 (9V) QST,10243615,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 70 (33F) QST,10242577,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 8 (8) QST,10243606,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 9 (9N) QST,10243607,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Humana,Humana,14.99,,,,,,,Fee Schedule,14.99,15.29,
ciprofloxacin 400 mg/200 mL-5% Sol,11201486,LOCAL,J0744,CPT,,,,,,Outpatient,200,ML,26.8416,,Humana,Humana,2,,,,,,,Fee Schedule,1.997,1.997,
Aldolase QSTC,8764531,LOCAL,82085,CPT,,,,,,Outpatient,,,26.87,11.65,Humana,Humana,18.2,,,,,,,Fee Schedule,7.16,18.195,
Glucose Fingerstick Clinic POC (RE),4192199,LOCAL,82962,CPT,,,,,,Outpatient,,,26.93,3.94,Humana,Humana,9.08,,,,,,,Fee Schedule,7.16,9.084767596,
".Smooth Muscle Ab, Titer QSTC",13864540,LOCAL,86256,CPT,,,,,,Outpatient,,,27,14.46,Humana,Humana,12.05,,,,,,,Fee Schedule,12.05,15.29,
DNA (ds) Antibody QSTC,8764566,LOCAL,86225,CPT,,,,,,Outpatient,,,27,16.49,Humana,Humana,14.72,,,,,,,Fee Schedule,14.71636364,15.29,
Hepatitis B Core Ab (IgM) QSTC,8764681,LOCAL,86705,CPT,,,,,,Outpatient,,,27,14.12,Humana,Humana,32.8,,,,,,,Fee Schedule,15.29,32.80285714,
Mumps Virus Antibody (IgG) QSTC,8764679,LOCAL,86735,CPT,,,,,,Outpatient,,,27,15.66,Humana,Humana,13.05,,,,,,,Fee Schedule,13.05,15.29,
Prolactin QSTC,8972761,LOCAL,84146,CPT,,,,,,Outpatient,,,27,23.26,Humana,Humana,19.38,,,,,,,Fee Schedule,18.43,19.38,
Smooth Muscle Ab w/refl Titer QSTC,13864539,LOCAL,83497,CPT,,,,,,Outpatient,,,27,15.48,Humana,Humana,12.9,,,,,,,Fee Schedule,12.9,19.405,
Smooth Muscle Ab w/rfx Titer QSTC,13864539,LOCAL,86015,CPT,,,,,,Outpatient,,,27,14.46,Humana,Humana,19.41,,,,,,,Fee Schedule,12.9,19.405,
"Treponema pall Ab, Particle Agg QSTC",8972906,LOCAL,86780,CPT,,,,,,Outpatient,,,27,15.89,Humana,Humana,13.24,,,,,,,Fee Schedule,13.24,15.29,
Protein Level Urine,4186691,LOCAL,84156,CPT,,,,,,Outpatient,,,27.74,4.4,Humana,Humana,11.68,,,,,,,Fee Schedule,7.16,11.68,
Lipid Panel w/ Rfx to Direct LDL QSTC,13864433,LOCAL,80061,CPT,,,,,,Outpatient,,,27.9,16.07,Humana,Humana,16.6,,,,,,,Fee Schedule,12.14,16.59934459,
cyanocobalamin 1000 mcg/mL injectable solution 1 mL [CULL],11202258,LOCAL,J3420,CPT,,,,,,Outpatient,1,ML,27.968,,Humana,Humana,3.17,,,,,,,Fee Schedule,3.167142857,3.167142857,
G0109 DM OP SMT GRP PER 30 MIN CHARGE,8709096,LOCAL,,,G0109,HCPCS,,,,Outpatient,,,27.99,18,Humana,Humana,15.04,,,,,,,Fee Schedule,15.04,67.18,
ID,8131550,LOCAL,87077,CPT,,,,,,Outpatient,,,28.15,9.7,Humana,Humana,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
ID Add On,13661571,LOCAL,87077,CPT,,,,,,Outpatient,,,28.15,9.7,Humana,Humana,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
Mitochondria M2 Ab (IgG) QSTC,8764575,LOCAL,86381,CPT,,,,,,Outpatient,,,28.26,30.54,Humana,Humana,26.61,,,,,,,Fee Schedule,15.29,26.605,
PC DOPP LOWER EXT ART/ABI,8200227,LOCAL,93922,CPT,,,,,,Outpatient,,,28.29,265,Humana,Humana,117.85,,,,,,,Fee Schedule,117.85,161.71,
clindamycin 300 mg/50 mL-NaCl 0.9% Sol [CULL],11290065,LOCAL,J0737,CPT,,,,,,Outpatient,50,ML,28.32,,Humana,Humana,2.35,,,,,,,Fee Schedule,0.819,2.346,
butorphanol 2 mg/mL Sol [CULL],11202147,LOCAL,J0595,CPT,,,,,,Outpatient,1,ML,28.7968,,Humana,Humana,5.54,,,,,,,Fee Schedule,5.544,5.544,
"Gastrin, Serum QSTC",8764526,LOCAL,82941,CPT,,,,,,Outpatient,,,28.8,21.16,Humana,Humana,17.63,,,,,,,Fee Schedule,17.63,18.43,
Hep B Core Ab (Total)w/Rfx to IgM QSTC,9039408,LOCAL,86704,CPT,,,,,,Outpatient,,,28.8,14.46,Humana,Humana,17.4,,,,,,,Fee Schedule,15.29,17.40428571,
Hepatitis A IgM QSTC,8764600,LOCAL,86709,CPT,,,,,,Outpatient,,,28.8,13.51,Humana,Humana,11.26,,,,,,,Fee Schedule,11.26,15.29,
"Hepatitis B Core Ab, Total QSTC",8764579,LOCAL,86704,CPT,,,,,,Outpatient,,,28.8,14.46,Humana,Humana,17.4,,,,,,,Fee Schedule,15.29,17.40428571,
Complement Component C3c QSTC,8972768,LOCAL,86160,CPT,,,,,,Outpatient,,,29.25,14.4,Humana,Humana,36.91,,,,,,,Fee Schedule,15.29,36.909,
Complement Component C4c QSTC,8972769,LOCAL,86160,CPT,,,,,,Outpatient,,,29.25,14.4,Humana,Humana,36.91,,,,,,,Fee Schedule,15.29,36.909,
Insulin QSTC,9039285,LOCAL,83525,CPT,,,,,,Outpatient,,,29.25,13.72,Humana,Humana,11.43,,,,,,,Fee Schedule,11.43,18.43,
Clozapine QSTC,8764629,LOCAL,80159,CPT,,,,,,Outpatient,,,29.7,24.18,Humana,Humana,20.15,,,,,,,Fee Schedule,15.38,20.15,
HSV 1 and 2 IgG Antibodies QSTC,8853241,LOCAL,86695,CPT,,,,,,Outpatient,,,29.97,15.83,Humana,Humana,13.19,,,,,,,Fee Schedule,13.19,15.29,
"HSV 1/2 IgG,Type Specific Ab QST",8389465,LOCAL,86695,CPT,,,,,,Outpatient,,,29.97,15.83,Humana,Humana,13.19,,,,,,,Fee Schedule,13.19,15.29,
97804 Medical Nutrit Group 30Min CHARGE,9323172,LOCAL,97804,CPT,,,,,,Outpatient,,,30,20,Humana,Humana,11.75,,,,,,,Fee Schedule,11.75,287.34,
Insulin Level Total,3454335,LOCAL,83525,CPT,,,,,,Outpatient,,,30,13.72,Humana,Humana,11.43,,,,,,,Fee Schedule,11.43,18.43,
budesonide 0.25 mg/2 mL inhalation suspension 2 mL [CULL],11205254,LOCAL,J7626,CPT,,,,,,Outpatient,2,ML,30.1056,,Humana,Humana,1.05,,,,,,,Fee Schedule,1.049,1.049,
cefTRIAXone 2 g injection ADDV [CULL],11282070,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,30.61632,,Humana,Humana,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
labetalol 5 mg/mL intravenous solution 20 mL [CULL],11201873,LOCAL,J1920,CPT,,,,,,Outpatient,20,ML,30.72,,Humana,Humana,5.46,,,,,,,Fee Schedule,5.464225352,5.464225352,
triamcinolone acetonide 40 mg/mL injectable suspension 1 mL [CULL],11212390,LOCAL,J3301,CPT,,,,,,Outpatient,1,ML,31.072,,Humana,Humana,3.03,,,,,,,Fee Schedule,3.025614035,3.025614035,
clindamycin 300 mg/50 mL-D5% intravenous solution 50 mL [CULL],11290065,LOCAL,J0736,CPT,,,,,,Outpatient,50,ML,31.48133333,,Humana,Humana,0.82,,,,,,,Fee Schedule,0.819,2.346,
".ANA, Titer and Pattern QSTC",8764643,LOCAL,86039,CPT,,,,,,Outpatient,,,31.5,13.39,Humana,Humana,21.22,,,,,,,Fee Schedule,15.29,21.22,
Cytomegalovirus Antibody (IgG) QSTC,13972135,LOCAL,86644,CPT,,,,,,Outpatient,,,31.5,17.27,Humana,Humana,14.39,,,,,,,Fee Schedule,14.39,15.29,
Cytomegalovirus Antibody (IgG) QSTC,8853227,LOCAL,86644,CPT,,,,,,Outpatient,,,31.5,17.27,Humana,Humana,14.39,,,,,,,Fee Schedule,14.39,15.29,
C-Reactive Protein,1628890,LOCAL,86140,CPT,,,,,,Outpatient,,,32,6.22,Humana,Humana,13.3,,,,,,,Fee Schedule,13.29690962,15.29,
Fecal WBC,4123047,LOCAL,87205,CPT,,,,,,Outpatient,,,32,5.12,Humana,Humana,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
Stool WBC,10294481,LOCAL,87205,CPT,,,,,,Outpatient,,,32,5.12,Humana,Humana,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
"Complement, Total (CH50) QSTC",8764582,LOCAL,86162,CPT,,,,,,Outpatient,,,32.4,24.38,Humana,Humana,20.32,,,,,,,Fee Schedule,15.29,20.32,
DHEA Sulfate QSTC,9696140,LOCAL,82627,CPT,,,,,,Outpatient,,,32.4,26.68,Humana,Humana,27.1,,,,,,,Fee Schedule,18.43,27.095,
Haptoglobin QSTC,8764542,LOCAL,83010,CPT,,,,,,Outpatient,,,32.4,15.1,Humana,Humana,12.58,,,,,,,Fee Schedule,12.58,17.73,
"Hepatitis A Ab, Total QSTC",8764599,LOCAL,86708,CPT,,,,,,Outpatient,,,32.4,14.87,Humana,Humana,12.39,,,,,,,Fee Schedule,12.39,15.29,
Jo-1 Antibody QSTC,8764688,LOCAL,86235,CPT,,,,,,Outpatient,,,32.4,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
"RNP Antibody, QSTC",10100359,LOCAL,86235,CPT,,,,,,Outpatient,,,32.4,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
"Sm Antibody, QSTC",10100362,LOCAL,86235,CPT,,,,,,Outpatient,,,32.4,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
"STRAP, CLAVICLE SMALL-3004-06",6010605,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,32.4,12,Humana,Humana,67.31,,,,,,,Fee Schedule,67.31,67.31,
"Albumin, CSF QSTC",13873031,LOCAL,82042,CPT,,,,,,Outpatient,,,32.46,9.34,Humana,Humana,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Albumin, Serum QSTC",13873034,LOCAL,82040,CPT,,,,,,Outpatient,,,32.46,5.94,Humana,Humana,127.89,,,,,,,Fee Schedule,7.16,127.89,
Immunoglobulin G QSTC,13873033,LOCAL,82784,CPT,,,,,,Outpatient,,,32.46,11.16,Humana,Humana,34.96,,,,,,,Fee Schedule,7.16,34.958,
"Oligoclonal Bands (IgG),CSF QSTC",13873028,LOCAL,83916,CPT,,,,,,Outpatient,,,32.46,32.87,Humana,Humana,27.39,,,,,,,Fee Schedule,17.73,27.39,
Immunoglobulin A QSTC,13904383,LOCAL,82784,CPT,,,,,,Outpatient,,,32.62,11.16,Humana,Humana,34.96,,,,,,,Fee Schedule,7.16,34.958,
tTG IgA Ab QSTC,13904382,LOCAL,86364,CPT,,,,,,Outpatient,,,32.63,13.84,Humana,Humana,61.9,,,,,,,Fee Schedule,15.29,61.9,
"Delta-Aminolevulinic Acid, Random Urine QSTC",12329984,LOCAL,82135,CPT,,,,,,Outpatient,,,32.81,19.74,Humana,Humana,16.45,,,,,,,Fee Schedule,16.45,17.73,
Bilirubin Cord Blood,10237211,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,Humana,Humana,5.02,,,,,,,Fee Schedule,5.02,7.16,
Bilirubin Neonatal (Bu/Bc),14541767,LOCAL,82248,CPT,,,,,,Outpatient,,,33.46,6.02,Humana,Humana,26.63,,,,,,,Fee Schedule,7.16,26.6275,
Bilirubin Neonatal 2,8883195,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,Humana,Humana,5.02,,,,,,,Fee Schedule,5.02,7.16,
Bilirubin Total,633672,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,Humana,Humana,5.02,,,,,,,Fee Schedule,5.02,7.16,
Bilirubin Total,7939102,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,Humana,Humana,5.02,,,,,,,Fee Schedule,5.02,7.16,
Bilirubin Total,8443661,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,Humana,Humana,5.02,,,,,,,Fee Schedule,5.02,7.16,
Cyclic Citrull Peptide (CCP) Ab IgG QSTC,8764613,LOCAL,86200,CPT,,,,,,Outpatient,,,33.75,15.54,Humana,Humana,7.49,,,,,,,Fee Schedule,7.491935484,15.29,
"Cholinesterase, Plasma QSTC",13873320,LOCAL,82482,CPT,,,,,,Outpatient,,,33.8,11.77,Humana,Humana,9.81,,,,,,,Fee Schedule,7.16,9.81,
"Cholinesterase, RBC QSTC",13873317,LOCAL,82480,CPT,,,,,,Outpatient,,,33.8,9.44,Humana,Humana,7.87,,,,,,,Fee Schedule,7.16,7.87,
STRAP CLAVICLE PED.,11071010,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,33.94,12,Humana,Humana,67.31,,,,,,,Fee Schedule,67.31,67.31,
"Calcium, 24 hour Urine QSTC",13864700,LOCAL,82340,CPT,,,,,,Outpatient,,,33.95,7.24,Humana,Humana,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
"Citric Acid, 24 Hour Urine QSTC",13864703,LOCAL,82507,CPT,,,,,,Outpatient,,,33.95,33.36,Humana,Humana,30.63,,,,,,,Fee Schedule,17.73,30.625,
"Creatinine, 24 Hour Urine QSTC",13864712,LOCAL,82570,CPT,,,,,,Outpatient,,,33.95,6.22,Humana,Humana,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Magnesium, 24 Hour Urine QSTC",13864709,LOCAL,83735,CPT,,,,,,Outpatient,,,33.95,8.04,Humana,Humana,3.66,,,,,,,Fee Schedule,3.657824427,7.16,
"Oxalate, 24 Hour Urine QSTC",13864701,LOCAL,83945,CPT,,,,,,Outpatient,,,33.95,17.34,Humana,Humana,24.09,,,,,,,Fee Schedule,17.73,24.085,
pH Urine QSTC,13864699,LOCAL,83986,CPT,,,,,,Outpatient,,,33.95,4.3,Humana,Humana,18.76,,,,,,,Fee Schedule,7.16,18.755,
"Phosphorus, 24 Hour Urine QSTC",13864707,LOCAL,84105,CPT,,,,,,Outpatient,,,33.95,6.94,Humana,Humana,19.84,,,,,,,Fee Schedule,7.16,19.835,
"Potassium, 24 Hour Urine QSTC",13864711,LOCAL,84133,CPT,,,,,,Outpatient,,,33.95,5.68,Humana,Humana,19.32,,,,,,,Fee Schedule,7.16,19.32,
"Sodium, 24 Hour Urine QSTC",13864704,LOCAL,84300,CPT,,,,,,Outpatient,,,33.95,6.07,Humana,Humana,9.74,,,,,,,Fee Schedule,7.16,9.74,
"Sulfate, 24 Hour Urine QSTC",13864705,LOCAL,84392,CPT,,,,,,Outpatient,,,33.95,6.59,Humana,Humana,19.7,,,,,,,Fee Schedule,4.02,19.695,
Uric Acid QSTC,13864716,LOCAL,84560,CPT,,,,,,Outpatient,,,33.95,6.1,Humana,Humana,19.49,,,,,,,Fee Schedule,7.16,19.49,
Ammonium Urine QSTC,8997190,LOCAL,82140,CPT,,,,,,Outpatient,,,34,17.48,Humana,Humana,22.63,,,,,,,Fee Schedule,17.73,22.62909091,
"Calcium, 24 hour Urine QSTC",8997182,LOCAL,82340,CPT,,,,,,Outpatient,,,34,7.24,Humana,Humana,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
"Citric Acid, 24 Hour Urine QSTC",8997185,LOCAL,82507,CPT,,,,,,Outpatient,,,34,33.36,Humana,Humana,30.63,,,,,,,Fee Schedule,17.73,30.625,
"Creatinine, 24 Hour Urine QSTC",8997192,LOCAL,82570,CPT,,,,,,Outpatient,,,34,6.22,Humana,Humana,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Magnesium, 24 Hour Urine QSTC",8997189,LOCAL,83735,CPT,,,,,,Outpatient,,,34,8.04,Humana,Humana,3.66,,,,,,,Fee Schedule,3.657824427,7.16,
"Oxalate, 24 Hour Urine QSTC",8997183,LOCAL,83945,CPT,,,,,,Outpatient,,,34,17.34,Humana,Humana,24.09,,,,,,,Fee Schedule,17.73,24.085,
pH Urine QSTC,8997180,LOCAL,83986,CPT,,,,,,Outpatient,,,34,4.3,Humana,Humana,18.76,,,,,,,Fee Schedule,7.16,18.755,
"Phosphorus, 24 Hour Urine QSTC",8997188,LOCAL,84105,CPT,,,,,,Outpatient,,,34,6.94,Humana,Humana,19.84,,,,,,,Fee Schedule,7.16,19.835,
"Potassium, 24 Hour Urine QSTC",8997191,LOCAL,84133,CPT,,,,,,Outpatient,,,34,5.68,Humana,Humana,19.32,,,,,,,Fee Schedule,7.16,19.32,
"Sodium, 24 Hour Urine QSTC",8997186,LOCAL,84300,CPT,,,,,,Outpatient,,,34,6.07,Humana,Humana,9.74,,,,,,,Fee Schedule,7.16,9.74,
"Sulfate, 24 Hour Urine QSTC",8997187,LOCAL,84392,CPT,,,,,,Outpatient,,,34,6.59,Humana,Humana,19.7,,,,,,,Fee Schedule,4.02,19.695,
"Uric Acid, 24 Hour Urine QSTC",8997184,LOCAL,84560,CPT,,,,,,Outpatient,,,34,6.1,Humana,Humana,19.49,,,,,,,Fee Schedule,7.16,19.49,
BINDER ABDOMINAL MALE,11070715,LOCAL,,,L0625,HCPCS,,,,Outpatient,,,34.21,86,Humana,Humana,42.8,,,,,,,Fee Schedule,42.8,42.8,
Lipase Level,633776,LOCAL,83690,CPT,,,,,,Outpatient,,,34.27,8.27,Humana,Humana,1.3,,,,,,,Fee Schedule,1.304132029,7.16,
fluconazole 200 mg/100 mL-NaCl 0.9% intravenous solution 100 mL [CULL],11220720,LOCAL,J1450,CPT,,,,,,Outpatient,100,ML,34.56,,Humana,Humana,4.48,,,,,,,Fee Schedule,4.48,4.48,
vancomycin 500 mg/100 mL intravenous solution 100 mL [CULL],11290008,LOCAL,J3375,CPT,,,,,,Outpatient,100,ML,34.56,,Humana,Humana,0.13,,,,,,,Fee Schedule,0.134,0.134,
Ceruloplasmin QSTC,8764535,LOCAL,82390,CPT,,,,,,Outpatient,,,34.88,12.89,Humana,Humana,10.74,,,,,,,Fee Schedule,10.74,17.73,
labetalol 5 mg/mL intravenous solution 4 mL [CULL],11201874,LOCAL,J1920,CPT,,,,,,Outpatient,4,ML,34.88,,Humana,Humana,5.46,,,,,,,Fee Schedule,5.464225352,5.464225352,
Amikacin Level,9034955,LOCAL,80150,CPT,,,,,,Outpatient,,,35,18.1,Humana,Humana,15.08,,,,,,,Fee Schedule,15.08,15.38,
"ANA Screen, IFA QSTC",14116751,LOCAL,86038,CPT,,,,,,Outpatient,,,35,14.51,Humana,Humana,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
Breath Alcohol,9687753,LOCAL,82075,CPT,,,,,,Outpatient,,,35,36,Humana,Humana,30,,,,,,,Fee Schedule,17.73,30,
"CCP, Antibody (IgG) QSTC",14116753,LOCAL,86200,CPT,,,,,,Outpatient,,,35,15.54,Humana,Humana,7.49,,,,,,,Fee Schedule,7.491935484,15.29,
"MCV, Antibody QSTC",14116754,LOCAL,83520,CPT,,,,,,Outpatient,,,35,20.72,Humana,Humana,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rheumatoid Factor QSTC,14116752,LOCAL,86431,CPT,,,,,,Outpatient,,,35,6.8,Humana,Humana,6.3,,,,,,,Fee Schedule,6.29875,15.29,
T4 Total,633845,LOCAL,84436,CPT,,,,,,Outpatient,,,35.09,8.24,Humana,Humana,17.54,,,,,,,Fee Schedule,17.54230769,18.43,
Rheumatoid Factor Qualitative,7906954,LOCAL,86430,CPT,,,,,,Outpatient,,,35.1,7.37,Humana,Humana,20.56,,,,,,,Fee Schedule,15.29,20.56,
Protein Tot & Protein Electrophore QSTC,8764768,LOCAL,84155,CPT,,,,,,Outpatient,,,35.23,4.4,Humana,Humana,3.67,,,,,,,Fee Schedule,3.67,7.16,
Glucose 2 Hour Post Prandial,7973897,LOCAL,82947,CPT,,,,,,Outpatient,,,35.5,4.72,Humana,Humana,10.3,,,,,,,Fee Schedule,7.16,10.29541667,
Lithium Level,2046348,LOCAL,80178,CPT,,,,,,Outpatient,,,35.5,7.93,Humana,Humana,20.99,,,,,,,Fee Schedule,15.38,20.99,
Magnesium Level,633781,LOCAL,83735,CPT,,,,,,Outpatient,,,35.5,8.04,Humana,Humana,3.66,,,,,,,Fee Schedule,3.657824427,7.16,
BINDER ABDOMINAL FEMALE,11070714,LOCAL,,,L0625,HCPCS,,,,Outpatient,,,35.59,86,Humana,Humana,42.8,,,,,,,Fee Schedule,42.8,42.8,
Crystal Analysis QSTC,9658951,LOCAL,89060,CPT,,,,,,Outpatient,,,35.87,8.8,Humana,Humana,21.53,,,,,,,Fee Schedule,14.07,21.53,
Glucose 1 Hour,7973889,LOCAL,82951,CPT,,,,,,Outpatient,,,35.9,15.44,Humana,Humana,12.87,,,,,,,Fee Schedule,12.87,17.73,
Glucose 2 Hour,7973890,LOCAL,82952,CPT,,,,,,Outpatient,,,35.9,4.7,Humana,Humana,3.92,,,,,,,Fee Schedule,3.92,7.16,
Glucose Level,633594,LOCAL,82947,CPT,,,,,,Outpatient,,,35.9,4.72,Humana,Humana,10.3,,,,,,,Fee Schedule,7.16,10.29541667,
Thyroid Peroxidase Abs QSTC,8861417,LOCAL,86376,CPT,,,,,,Outpatient,,,35.91,17.46,Humana,Humana,25.09,,,,,,,Fee Schedule,15.29,25.085,
Thyroid Peroxidase Antibodies QSTC,8764563,LOCAL,86376,CPT,,,,,,Outpatient,,,35.91,17.46,Humana,Humana,25.09,,,,,,,Fee Schedule,15.29,25.085,
"Alpha-1-Antitrypsin, Qn QSTC",9039253,LOCAL,82103,CPT,,,,,,Outpatient,,,36,16.13,Humana,Humana,60.59,,,,,,,Fee Schedule,17.73,60.59,
"Alpha-Fetoprotein, Tumor Marker QSTC",8764596,LOCAL,82105,CPT,,,,,,Outpatient,,,36,20.12,Humana,Humana,26.22,,,,,,,Fee Schedule,17.73,26.22,
"B2 Microglobulin, Serum QSTC",8764794,LOCAL,82232,CPT,,,,,,Outpatient,,,36,19.42,Humana,Humana,16.18,,,,,,,Fee Schedule,16.18,18.43,
Bill Decalcification Procedure,8489589,LOCAL,88311,CPT,,,,,,Outpatient,,,36,,Humana,Humana,7.2,,,,,,,Fee Schedule,7.2,59.06,
CA 125 QSTC,8764680,LOCAL,86304,CPT,,,,,,Outpatient,,,36,24.97,Humana,Humana,20.81,,,,,,,Fee Schedule,15.29,20.81,
CA 19-9 QSTC,8764669,LOCAL,86301,CPT,,,,,,Outpatient,,,36,24.97,Humana,Humana,20.81,,,,,,,Fee Schedule,15.29,20.81,
CA 27.29 QSTC,8764762,LOCAL,86300,CPT,,,,,,Outpatient,,,36,24.97,Humana,Humana,43.34,,,,,,,Fee Schedule,15.29,43.34448276,
Copper QSTC,8764536,LOCAL,82525,CPT,,,,,,Outpatient,,,36,14.89,Humana,Humana,24.09,,,,,,,Fee Schedule,16.07,24.085,
"Fungal Identification, Molds QSTC",8873558,LOCAL,87107,CPT,,,,,,Outpatient,,,36,12.38,Humana,Humana,10.32,,,,,,,Fee Schedule,10.32,10.57,
"Gliadin(Deamidated) Ab,IgA QSTC",9039363,LOCAL,86258,CPT,,,,,,Outpatient,,,36,14.46,Humana,Humana,12.05,,,,,,,Fee Schedule,12.05,15.29,
"Gliadin(Deamidated) Ab,IgG QSTC",9039362,LOCAL,86258,CPT,,,,,,Outpatient,,,36,14.46,Humana,Humana,12.05,,,,,,,Fee Schedule,12.05,15.29,
Lamotrigine QSTC,8853218,LOCAL,80175,CPT,,,,,,Outpatient,,,36,15.9,Humana,Humana,13.25,,,,,,,Fee Schedule,13.25,15.38,
"Protein, Total, w/Creat, Random Ur QSTC",9291011,LOCAL,84156,CPT,,,,,,Outpatient,,,36,4.4,Humana,Humana,11.68,,,,,,,Fee Schedule,7.16,11.68,
"Testosterone, Total, MS QSTC",8848606,LOCAL,84402,CPT,,,,,,Outpatient,,,36,30.56,Humana,Humana,30.49,,,,,,,Fee Schedule,18.43,30.485,
SLING PED/INFANT 5'X9,6000156,LOCAL,,,A4565,HCPCS,,,,Outpatient,,,36.19,19,Humana,Humana,10.98,,,,,,,Fee Schedule,10.98,10.98,
"Copper, 24-Hour Urine QSTC",9390117,LOCAL,82525,CPT,,,,,,Outpatient,,,36.27,14.89,Humana,Humana,24.09,,,,,,,Fee Schedule,16.07,24.085,
MALDI ID,X87077,LOCAL,87077,CPT,,,,,,Outpatient,,,36.36,9.7,Humana,Humana,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
cefTAZidime 2 g injection [CULL],11201395,LOCAL,J0713,CPT,,,,,,Outpatient,1,EA,36.67968,,Humana,Humana,1.47,,,,,,,Fee Schedule,1.468,1.468,
"ANA Screen, IFA QST",9110748,LOCAL,86038,CPT,,,,,,Outpatient,,,37,14.51,Humana,Humana,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
Complement Component C3C QST,12876950,LOCAL,86160,CPT,,,,,,Outpatient,,,37,14.4,Humana,Humana,36.91,,,,,,,Fee Schedule,15.29,36.909,
Complement Component C4C QST,12876951,LOCAL,86160,CPT,,,,,,Outpatient,,,37,14.4,Humana,Humana,36.91,,,,,,,Fee Schedule,15.29,36.909,
DNA (DS) Antibody QST,9110747,LOCAL,86225,CPT,,,,,,Outpatient,,,37,16.49,Humana,Humana,14.72,,,,,,,Fee Schedule,14.71636364,15.29,
Microalbumin Level Urine,7974117,LOCAL,82043,CPT,,,,,,Outpatient,,,37,6.94,Humana,Humana,20.16,,,,,,,Fee Schedule,4.02,20.15557971,
Rheumatoid Factor QST,9110751,LOCAL,86431,CPT,,,,,,Outpatient,,,37,6.8,Humana,Humana,6.3,,,,,,,Fee Schedule,6.29875,15.29,
Ribosomal P Antibody QST,9110754,LOCAL,83516,CPT,,,,,,Outpatient,,,37,13.84,Humana,Humana,11.53,,,,,,,Fee Schedule,11.53,17.73,
SCL-70 Antibody QST,9110757,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-A) QST,9110760,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-B) QST,9110763,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sm Antibody QST,9110766,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
SM/RNP Antibody QST,9110769,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Thyroid Peroxidase Antibodies QST,9110772,LOCAL,86376,CPT,,,,,,Outpatient,,,37,17.46,Humana,Humana,25.09,,,,,,,Fee Schedule,15.29,25.085,
EBV EBNA Ab (IgG) Interp QSTC,8849012,LOCAL,86664,CPT,,,,,,Outpatient,,,37.13,18.35,Humana,Humana,15.29,,,,,,,Fee Schedule,15.29,15.29,
EBV VCA Ab (IgM) QSTC,8849009,LOCAL,86665,CPT,,,,,,Outpatient,,,37.13,21.77,Humana,Humana,18.14,,,,,,,Fee Schedule,15.29,18.14,
".B. henselae Ab(IgG),Titer QSTC",8764830,LOCAL,86611,CPT,,,,,,Outpatient,,,37.35,12.22,Humana,Humana,10.18,,,,,,,Fee Schedule,10.18,15.29,
".B. henselae Ab(IgM),Titer QSTC",8764831,LOCAL,86611,CPT,,,,,,Outpatient,,,37.35,12.22,Humana,Humana,10.18,,,,,,,Fee Schedule,10.18,15.29,
".B. quintana Ab(IgG),Titer QSTC",10128892,LOCAL,86611,CPT,,,,,,Outpatient,,,37.35,12.22,Humana,Humana,10.18,,,,,,,Fee Schedule,10.18,15.29,
IMMOBLIZER KNEE XX-LARGE,11070340,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,37.9,158,Humana,Humana,77.23,,,,,,,Fee Schedule,77.23,77.23,
methocarbamol 100 mg/mL injectable solution 10 mL [CULL],11201939,LOCAL,J2800,CPT,,,,,,Outpatient,10,ML,38.4,,Humana,Humana,4.54,,,,,,,Fee Schedule,4.535,4.535,
calcium gluconate 100 mg/mL injectable solution 10 mL [CULL],11201252,LOCAL,J0612,CPT,,,,,,Outpatient,10,ML,38.4768,,Humana,Humana,0.03,,,,,,,Fee Schedule,0.01,0.03,
SLING & SWATHE W/SLEEVE,11071056,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,38.89,12,Humana,Humana,67.31,,,,,,,Fee Schedule,67.31,67.31,
TBG QSTC,8853216,LOCAL,84442,CPT,,,,,,Outpatient,,,39.06,17.74,Humana,Humana,14.78,,,,,,,Fee Schedule,14.78,18.43,
"Culture, Fungus, Skin, Hair, Nails QSTC",8972785,LOCAL,87101,CPT,,,,,,Outpatient,,,39.11,9.25,Humana,Humana,7.71,,,,,,,Fee Schedule,7.71,10.57,
Prostate Specific Antigen Total,7939094,LOCAL,84153,CPT,,,,,,Outpatient,,,39.17,22.07,Humana,Humana,104.84,,,,,,,Fee Schedule,17.73,104.8447059,
Prealbumin,3454341,LOCAL,84134,CPT,,,,,,Outpatient,,,39.98,17.51,Humana,Humana,4.93,,,,,,,Fee Schedule,4.934545455,17.73,
20560 DRY NEEDLING 1 OR 2 MUSCLES WO INJECTION,9650048,LOCAL,20560,CPT,,,,,,Outpatient,,,40,26,Humana,Humana,22.39,,,,,,,Fee Schedule,22.39,863,
Beef (F27) IgE Class QSTC,14129407,LOCAL,86003,CPT,,,,,,Outpatient,,,40,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Glucose Body Fluid,1628896,LOCAL,82945,CPT,,,,,,Outpatient,,,40,4.72,Humana,Humana,3.93,,,,,,,Fee Schedule,3.93,7.16,
Lamb (F88) IgE Class QSTC,14129413,LOCAL,86003,CPT,,,,,,Outpatient,,,40,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pork (F26) IgE Class QSTC,14129419,LOCAL,86003,CPT,,,,,,Outpatient,,,40,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
RESULTS_QSTC,14755730,LOCAL,86008,CPT,,,,,,Outpatient,,,40,21.52,Humana,Humana,17.93,,,,,,,Fee Schedule,15.29,17.93,
"Pyruvic Acid (Pyruvate),B QSTC",13864526,LOCAL,84210,CPT,,,,,,Outpatient,,,40.1,17.38,Humana,Humana,14.48,,,,,,,Fee Schedule,14.48,17.73,
"VDRL, CSF QSTC",8764738,LOCAL,86592,CPT,,,,,,Outpatient,,,40.41,5.12,Humana,Humana,19.99,,,,,,,Fee Schedule,15.29,19.99375,
Angiotensin Converting Enzyme QSTC,8764564,LOCAL,82164,CPT,,,,,,Outpatient,,,40.5,17.52,Humana,Humana,27.41,,,,,,,Fee Schedule,17.73,27.405,
Intrinsic Factor Blocking Antibody QSTC,8764611,LOCAL,86340,CPT,,,,,,Outpatient,,,40.5,18.1,Humana,Humana,15.08,,,,,,,Fee Schedule,15.08,15.29,
Osmolality Serum,9414322,LOCAL,83930,CPT,,,,,,Outpatient,,,40.5,7.93,Humana,Humana,6.61,,,,,,,Fee Schedule,6.61,7.16,
97018 OT PARAFFIN BATH 1+ AREAS APPLIC CHARGE,9850020,LOCAL,97018,CPT,,,,,GO,Outpatient,,,40.9,27,Humana,Humana,5.41,,,,,,,Fee Schedule,5.41,47.26,
97018 OT PARAFFIN BATH CHARGE,9860020,LOCAL,97018,CPT,,,,,GO|CO,Outpatient,,,40.9,27,Humana,Humana,5.41,,,,,,,Fee Schedule,5.41,47.26,
OT Paraffin Bath Assistant Units,7895270,LOCAL,97018,CPT,,,,,CQ,Outpatient,,,40.9,27,Humana,Humana,5.41,,,,,,,Fee Schedule,5.41,47.26,
OT Paraffin Bath Units,1373447,LOCAL,97018,CPT,,,,,GO,Outpatient,,,40.9,27,Humana,Humana,5.41,,,,,,,Fee Schedule,5.41,47.26,
Paraffin Bath Charge,7895270,LOCAL,97018,CPT,,,,,GO,Outpatient,,,40.9,27,Humana,Humana,5.41,,,,,,,Fee Schedule,5.41,47.26,
Centromere B Antibody QSTC,8764633,LOCAL,86235,CPT,,,,,,Outpatient,,,40.91,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
COLLAR LG HARD C,11070731,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,41.14,223,Humana,Humana,175.72,,,,,,,Fee Schedule,175.72,175.72,
COLLAR MED.HARD,11071039,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,41.14,223,Humana,Humana,175.72,,,,,,,Fee Schedule,175.72,175.72,
COLLAR SM HARD C,11070729,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,41.14,223,Humana,Humana,175.72,,,,,,,Fee Schedule,175.72,175.72,
M. pneumoniae Ab (IgM) QSTC,8764773,LOCAL,86738,CPT,,,,,,Outpatient,,,41.49,15.89,Humana,Humana,13.24,,,,,,,Fee Schedule,13.24,15.29,
CULL Pre-MRI Device Screening,14536295,LOCAL,76014,CPT,,,,,,Outpatient,,,41.5,19.8,Humana,Humana,22.39,,,,,,,Fee Schedule,22.39,22.39,
MRI Safety Screening,14536295,LOCAL,76014,CPT,,,,,,Outpatient,,,41.5,19.8,Humana,Humana,22.39,,,,,,,Fee Schedule,22.39,22.39,
Zinc QSTC,8764557,LOCAL,84630,CPT,,,,,,Outpatient,,,41.58,13.67,Humana,Humana,26.38,,,,,,,Fee Schedule,16.07,26.375,
Gram Stain (General Lab),8726050,LOCAL,87205,CPT,,,,,,Outpatient,,,41.62,5.12,Humana,Humana,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
Gram Stain Intraoperative,13436049,LOCAL,87205,CPT,,,,,,Outpatient,,,41.62,5.12,Humana,Humana,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
Gram Stain Report,634217,LOCAL,87205,CPT,,,,,,Outpatient,,,41.62,5.12,Humana,Humana,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
"Bile Acids, Fractionated and Total QSTC",13864500,LOCAL,82542,CPT,,,,,,Outpatient,,,41.85,28.91,Humana,Humana,24.09,,,,,,,Fee Schedule,17.73,24.09,
"Calcium, 24 hr Ur (w/o Creatinine) QSTC",9039238,LOCAL,82340,CPT,,,,,,Outpatient,,,41.99,7.24,Humana,Humana,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
Drug Panel (10),13954356,LOCAL,80306,CPT,,,,,,Outpatient,,,42.45,20.57,Humana,Humana,0.24,,,,,,,Fee Schedule,0.2416,17.73,
Bill Intraoperative Additonal,14048005,LOCAL,88332,CPT,,,,,,Outpatient,,,42.46,,Humana,Humana,21.23,,,,,,,Fee Schedule,21.23,53.82,
Toxoplasma Antibody (IgG) QSTC,8861628,LOCAL,86777,CPT,,,,,,Outpatient,,,42.48,17.27,Humana,Humana,14.39,,,,,,,Fee Schedule,14.39,15.29,
Toxoplasma Antibody (IgM) QSTC,8861629,LOCAL,86778,CPT,,,,,,Outpatient,,,42.48,17.29,Humana,Humana,14.41,,,,,,,Fee Schedule,14.41,15.29,
clindamycin 600 mg/50 mL-NaCl 0.9% Sol [CULL],11290024,LOCAL,J0737,CPT,,,,,,Outpatient,50,ML,42.72,,Humana,Humana,2.35,,,,,,,Fee Schedule,0.819,2.346,
"Cadmium, Blood, QSTC",13864925,LOCAL,82300,CPT,,,,,,Outpatient,,,42.75,28.37,Humana,Humana,29.91,,,,,,,Fee Schedule,16.07,29.91,
"Vitamin B1 (Thiamine), B QSTC",8972833,LOCAL,84425,CPT,,,,,,Outpatient,,,42.75,25.48,Humana,Humana,30.05,,,,,,,Fee Schedule,17.73,30.04654545,
"Calcium, Ionized QSTC",9039239,LOCAL,82330,CPT,,,,,,Outpatient,,,43.2,16.42,Humana,Humana,28.31,,,,,,,Fee Schedule,17.73,28.305,
"Cortisol, Free, U24 QSTC",8764823,LOCAL,82530,CPT,,,,,,Outpatient,,,43.2,20.05,Humana,Humana,29.79,,,,,,,Fee Schedule,17.73,29.79,
"Vanillylmandelic Acid, U24 QSTC",8764683,LOCAL,84585,CPT,,,,,,Outpatient,,,43.2,18.6,Humana,Humana,15.5,,,,,,,Fee Schedule,15.5,18.43,
"Aspergillus fumigatus, IgG Ab QSTC",13864492,LOCAL,86606,CPT,,,,,,Outpatient,,,43.25,18.06,Humana,Humana,15.05,,,,,,,Fee Schedule,15.05,15.29,
"Blastomyces Ab,Immunodiff QSTC",10100364,LOCAL,86612,CPT,,,,,,Outpatient,,,43.25,15.48,Humana,Humana,12.9,,,,,,,Fee Schedule,12.9,15.29,
Cryptococcal Antigen Latex QSTC,8972754,LOCAL,86403,CPT,,,,,,Outpatient,,,43.25,13.85,Humana,Humana,11.54,,,,,,,Fee Schedule,11.54,15.29,
"5HIAA, 24-Hour Urine QSTC",8764545,LOCAL,83497,CPT,,,,,,Outpatient,,,43.34,15.48,Humana,Humana,12.9,,,,,,,Fee Schedule,12.9,18.43,
betamethasone 12 mg/mL injectable suspension 2mL [CULL],11205515,LOCAL,J0702,CPT,,,,,,Outpatient,1,ML,43.4048,,Humana,Humana,22.48,,,,,,,Fee Schedule,22.47566502,22.47566502,
O2 Saturation Arterial,12487723,LOCAL,82810,CPT,,,,,,Outpatient,,,43.6,11.72,Humana,Humana,9.77,,,,,,,Fee Schedule,9.77,17.73,
O2 Saturation Venous,12487723,LOCAL,82810,CPT,,,,,,Outpatient,,,43.6,11.72,Humana,Humana,9.77,,,,,,,Fee Schedule,9.77,17.73,
"Creatinine Random Ur, QSTC",10127838,LOCAL,82570,CPT,,,,,,Outpatient,,,43.61,6.22,Humana,Humana,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Metanephrine Ur, Total QSTC",10127837,LOCAL,83835,CPT,,,,,,Outpatient,,,43.61,20.33,Humana,Humana,98.31,,,,,,,Fee Schedule,18.43,98.305,
CA 15-3 QSTC,8764684,LOCAL,86300,CPT,,,,,,Outpatient,,,44.55,24.97,Humana,Humana,43.34,,,,,,,Fee Schedule,15.29,43.34448276,
"Electrolytes, Urine",12312936,LOCAL,84166,CPT,,,,,,Outpatient,,,44.88,21.4,Humana,Humana,18.62,,,,,,,Fee Schedule,17.73,18.62,
Occult Blood Stool Screen,7909957,LOCAL,82272,CPT,,,,,,Outpatient,,,44.88,5.08,Humana,Humana,4.46,,,,,,,Fee Schedule,4.457272727,7.16,
"Carbamazepine, Total QSTC",9039320,LOCAL,80156,CPT,,,,,,Outpatient,,,44.95,17.48,Humana,Humana,16.45,,,,,,,Fee Schedule,15.38,16.45277778,
Gastric Parietal Cell AB QSTC,8764524,LOCAL,83516,CPT,,,,,,Outpatient,,,44.96,13.84,Humana,Humana,11.53,,,,,,,Fee Schedule,11.53,17.73,
"ACTH, Plasma QSTC",8764544,LOCAL,82024,CPT,,,,,,Outpatient,,,45,46.34,Humana,Humana,38.62,,,,,,,Fee Schedule,18.43,38.62,
Beta2-Glycoprotein IgA QSTC,10100357,LOCAL,86146,CPT,,,,,,Outpatient,,,45,30.54,Humana,Humana,25.45,,,,,,,Fee Schedule,15.29,25.45,
Immunoglobulin G Subclass 4 QSTC,10100372,LOCAL,82787,CPT,,,,,,Outpatient,,,45,9.62,Humana,Humana,8.02,,,,,,,Fee Schedule,7.16,8.02,
Testosterone Free & Total MS QSTC,8764632,LOCAL,84403,CPT,,,,,,Outpatient,,,45,30.97,Humana,Humana,52.38,,,,,,,Fee Schedule,18.43,52.3775,
Tissue Transglutaminase IgA Ab QSTC,8764753,LOCAL,86364,CPT,,,,,,Outpatient,,,45,13.84,Humana,Humana,61.9,,,,,,,Fee Schedule,15.29,61.9,
acetaminophen 10 mg/mL intravenous solution 100 mL [CULL],11200037,LOCAL,J0134,CPT,,,,,,Outpatient,100,ML,46.08,,Humana,Humana,3.16,,,,,,,Fee Schedule,3.159596774,3.159596774,
Scl-70 Antibody QSTC,8853206,LOCAL,86235,CPT,,,,,,Outpatient,,,46.17,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Egg Component Panel QSTC,9039428,LOCAL,86008,CPT,,,,,,Outpatient,,,46.26,21.52,Humana,Humana,17.93,,,,,,,Fee Schedule,15.29,17.93,
Total Iron Binding Capacity,7909796,LOCAL,83550,CPT,,,,,,Outpatient,,,47,10.49,Humana,Humana,8.74,,,,,,,Fee Schedule,8.74,17.73,
amikacin 250 mg/mL injectable solution 2 mL [CULL],11201051,LOCAL,J0278,CPT,,,,,,Outpatient,2,ML,47.0592,,Humana,Humana,0.62,,,,,,,Fee Schedule,0.621,0.621,
cefTRIAXone 250 mg injection [CULL],11202192,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,47.4112,,Humana,Humana,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
clindamycin 600 mg/50 mL-D5% intravenous solution 50 mL [CULL],11290024,LOCAL,J0736,CPT,,,,,,Outpatient,50,ML,47.484,,Humana,Humana,0.82,,,,,,,Fee Schedule,0.819,2.346,
Yeast Culture,7909554,LOCAL,87101,CPT,,,,,,Outpatient,,,47.7,9.25,Humana,Humana,7.71,,,,,,,Fee Schedule,7.71,10.57,
T3 Total,633833,LOCAL,84480,CPT,,,,,,Outpatient,,,48,17.02,Humana,Humana,33.01,,,,,,,Fee Schedule,18.43,33.01411765,
97035 OT ULTRASOUND,9850026,LOCAL,97035,CPT,,,,,GO,Outpatient,,,48.35,31,Humana,Humana,13.34,,,,,,,Fee Schedule,13.34,47.26,
97035 OT Ultrasound Assistant Units,9860026,LOCAL,97035,CPT,,,,,GO|CO,Outpatient,,,48.35,31,Humana,Humana,13.34,,,,,,,Fee Schedule,13.34,47.26,
97035 PT ULTRASOUND,9640026,LOCAL,97035,CPT,,,,,GP,Outpatient,,,48.35,31,Humana,Humana,13.34,,,,,,,Fee Schedule,13.34,47.26,
97035 PT Ultrasound Assistant Units,9650026,LOCAL,97035,CPT,,,,,GP|CQ,Outpatient,,,48.35,31,Humana,Humana,13.34,,,,,,,Fee Schedule,13.34,47.26,
97035 ULTRASOUND EA 15 MIN CHARGE,9410126,LOCAL,97035,CPT,,,,,GP,Outpatient,,,48.35,31,Humana,Humana,13.34,,,,,,,Fee Schedule,13.34,47.26,
OT Ultrasound Assistant Units,1366376,LOCAL,97035,CPT,,,,,CQ,Outpatient,,,48.35,31,Humana,Humana,13.34,,,,,,,Fee Schedule,13.34,47.26,
OT Ultrasound Charges,1366376,LOCAL,97035,CPT,,,,,GO,Outpatient,,,48.35,31,Humana,Humana,13.34,,,,,,,Fee Schedule,13.34,47.26,
OT Ultrasound Units,1373448,LOCAL,97035,CPT,,,,,GO,Outpatient,,,48.35,31,Humana,Humana,13.34,,,,,,,Fee Schedule,13.34,47.26,
PT Ultrasound Assistant Units,9390428,LOCAL,97035,CPT,,,,,CQ,Outpatient,,,48.35,31,Humana,Humana,13.34,,,,,,,Fee Schedule,13.34,47.26,
Ultrasound Charges,1366376,LOCAL,97035,CPT,,,,,GO,Outpatient,,,48.35,31,Humana,Humana,13.34,,,,,,,Fee Schedule,13.34,47.26,
Ultrasound Charges,7895933,LOCAL,97035,CPT,,,,,GP,Outpatient,,,48.35,31,Humana,Humana,13.34,,,,,,,Fee Schedule,13.34,47.26,
Phenobarbital QSTC,8972760,LOCAL,80184,CPT,,,,,,Outpatient,,,48.65,18.36,Humana,Humana,15.3,,,,,,,Fee Schedule,15.3,15.38,
"penicillin G potassium 5,000,000 units injection [CULL]",11211091,LOCAL,J2540,CPT,,,,,,Outpatient,1,EA,48.84864,,Humana,Humana,0.78,,,,,,,Fee Schedule,0.78,0.78,
Semen Analysis Post Vasectomy,3454457,LOCAL,89320,CPT,,,,,,Outpatient,,,48.96,14.77,Humana,Humana,12.31,,,,,,,Fee Schedule,12.31,14.07,
"HIV Ag/Ab, 4th Gen w reflexes QSTC",8764806,LOCAL,87389,CPT,,,,,,Outpatient,,,49.5,28.9,Humana,Humana,36.55,,,,,,,Fee Schedule,10.57,36.55,
"Phenytoin, Free QSTC",8764686,LOCAL,80186,CPT,,,,,,Outpatient,,,49.5,16.51,Humana,Humana,31.5,,,,,,,Fee Schedule,15.38,31.495,
"T3, Reverse, LCMSMS QSTC",8764804,LOCAL,84482,CPT,,,,,,Outpatient,,,49.5,18.91,Humana,Humana,32.48,,,,,,,Fee Schedule,18.43,32.475,
"82140 Ammonium, 24 HR, U",14789403,LOCAL,82140,CPT,,,,,,Outpatient,,,49.65,17.48,Humana,Humana,22.63,,,,,,,Fee Schedule,17.73,22.62909091,
"82340 Calcium, 24 HR, U",14797185,LOCAL,82340,CPT,,,,,,Outpatient,,,49.65,7.24,Humana,Humana,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
"82436 Chloride, 24 HR, U",14797182,LOCAL,82436,CPT,,,,,,Outpatient,,,49.65,6.9,Humana,Humana,5.75,,,,,,,Fee Schedule,5.75,7.16,
"82507 Citrate Excretion, 24 HR, U",14787436,LOCAL,82507,CPT,,,,,,Outpatient,,,49.65,33.36,Humana,Humana,30.63,,,,,,,Fee Schedule,17.73,30.625,
"82570 Creatinine, 24 HR, U",14798767,LOCAL,82570,CPT,,,,,,Outpatient,,,49.65,6.22,Humana,Humana,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"83735 Magnesium, 24 HR, U",14789401,LOCAL,83735,CPT,,,,,,Outpatient,,,49.65,8.04,Humana,Humana,3.66,,,,,,,Fee Schedule,3.657824427,7.16,
"83945 Oxalate, 24 HR, U",14797186,LOCAL,83945,CPT,,,,,,Outpatient,,,49.65,17.34,Humana,Humana,24.09,,,,,,,Fee Schedule,17.73,24.085,
"84105 Phosphorus, 24 HR, U",14787442,LOCAL,84105,CPT,,,,,,Outpatient,,,49.65,6.94,Humana,Humana,19.84,,,,,,,Fee Schedule,7.16,19.835,
"84133 Potassium, 24 HR, U",14797183,LOCAL,84133,CPT,,,,,,Outpatient,,,49.65,5.68,Humana,Humana,19.32,,,,,,,Fee Schedule,7.16,19.32,
"84300 Sodium, 24 HR, U",14797184,LOCAL,84300,CPT,,,,,,Outpatient,,,49.65,6.07,Humana,Humana,9.74,,,,,,,Fee Schedule,7.16,9.74,
"84540 Urea Nitrogen, 24 HR, U",14789404,LOCAL,84540,CPT,,,,,,Outpatient,,,49.65,6.67,Humana,Humana,5.56,,,,,,,Fee Schedule,5.56,7.16,
"84560 Uric Acid, 24 HR, U",14787441,LOCAL,84560,CPT,,,,,,Outpatient,,,49.65,6.1,Humana,Humana,19.49,,,,,,,Fee Schedule,7.16,19.49,
BUPivacaine 0.5% preservative-free injectable solution 30 mL [CULL],11282051,LOCAL,J0665,CPT,,,,,,Outpatient,30,ML,49.68576,,Humana,Humana,0.01,,,,,,,Fee Schedule,0.01,0.011,
deferoxamine 500 mg injection [CULL],11214520,LOCAL,J0895,CPT,,,,,,Outpatient,1,EA,49.728,,Humana,Humana,8.47,,,,,,,Fee Schedule,8.468,8.468,
C-Peptide,12252873,LOCAL,84681,CPT,,,,,,Outpatient,,,50,24.97,Humana,Humana,33.24,,,,,,,Fee Schedule,17.73,33.24444444,
D-Dimer,3454398,LOCAL,85380,CPT,,,,,,Outpatient,,,50,12.22,Humana,Humana,5.76,,,,,,,Fee Schedule,5.76079096,8.21,
G0447 BEHAVIORAL COUNSIL OBESITY 15 MIN CHARGE,8635988,LOCAL,,,G0447,HCPCS,,,,Outpatient,,,50,33,Humana,Humana,84.57,,,,,,,Fee Schedule,84.57,177.17,
Hepatitis B S Ab,1628908,LOCAL,86706,CPT,,,,,,Outpatient,,,50,12.89,Humana,Humana,17.79,,,,,,,Fee Schedule,15.29,17.794,
Hepatitis B Surface Antibody w/ Interp,9299896,LOCAL,86706,CPT,,,,,,Outpatient,,,50,12.89,Humana,Humana,17.79,,,,,,,Fee Schedule,15.29,17.794,
Lactate Dehydrogenase Body Fluid,3454444,LOCAL,83615,CPT,,,,,,Outpatient,,,50,7.25,Humana,Humana,21.68,,,,,,,Fee Schedule,7.16,21.675,
"Cytomegalovirus Antibodies (IgG,IgM) QSTC",8972893,LOCAL,86645,CPT,,,,,,Outpatient,,,50.4,20.22,Humana,Humana,16.85,,,,,,,Fee Schedule,15.29,16.85,
Cytomegalovirus Antibody (IgM) QSTC,8764581,LOCAL,86645,CPT,,,,,,Outpatient,,,50.4,20.22,Humana,Humana,16.85,,,,,,,Fee Schedule,15.29,16.85,
Micronutrient Vitamin E QSTC,14116320,LOCAL,84446,CPT,,,,,,Outpatient,,,50.4,17.02,Humana,Humana,14.18,,,,,,,Fee Schedule,14.18,17.73,
Vitamin A (Retinol) QSTC,8764529,LOCAL,84590,CPT,,,,,,Outpatient,,,50.4,13.93,Humana,Humana,30.89,,,,,,,Fee Schedule,17.73,30.89,
Ethosuximide QSTC,8764552,LOCAL,80168,CPT,,,,,,Outpatient,,,50.54,19.61,Humana,Humana,16.34,,,,,,,Fee Schedule,15.38,16.34,
77061 MG Diagnostic Tomo Charge: AddOn Left,13960722,LOCAL,G0279,CPT,,,,,LT,Outpatient,,,50.92,,Humana,Humana,11.11,,,,,,,Fee Schedule,11.11,74,
77061 MG Diagnostic Tomo Charge: AddOn Right,13960723,LOCAL,G0279,CPT,,,,,RT,Outpatient,,,50.92,,Humana,Humana,11.11,,,,,,,Fee Schedule,11.11,74,
77061 MG Diagnostic Tomo Charge: AddOn Right,13969683,LOCAL,G0279,CPT,,,,,RT,Outpatient,,,50.92,,Humana,Humana,11.11,,,,,,,Fee Schedule,11.11,74,
77063 MG Tomo Charge: AddOn Left,13621442,LOCAL,77063,CPT,,,,,LT,Outpatient,,,50.92,54.45,Humana,Humana,20.75,,,,,,,Fee Schedule,20.75,74,
77063 MG Tomo Charge: AddOn Right,13621441,LOCAL,77063,CPT,,,,,RT,Outpatient,,,50.92,54.45,Humana,Humana,20.75,,,,,,,Fee Schedule,20.75,74,
PC DOPP ART BIL REST,8200579,LOCAL,93923,CPT,,,,,,Outpatient,,,51.06,401,Humana,Humana,143.05,,,,,,,Fee Schedule,143.05,244.97,
acyclovir 50 mg/mL intravenous solution 10 mL [CULL],11201009,LOCAL,J0133,CPT,,,,,,Outpatient,10,ML,51.2,,Humana,Humana,0.12,,,,,,,Fee Schedule,0.119,0.119,
Chloride Level,633621,LOCAL,82435,CPT,,,,,,Outpatient,,,51.41,5.52,Humana,Humana,4.6,,,,,,,Fee Schedule,4.6,7.16,
KOH POCT,10913182,LOCAL,87220,CPT,,,,,,Outpatient,,,51.41,5.12,Humana,Humana,4.27,,,,,,,Fee Schedule,4.27,10.57,
E-Stim for Wound Other Charge,7895924,LOCAL,G0283,CPT,G0283,HCPCS,,,GP,Outpatient,,,51.51,33,Humana,Humana,11.75,,,,,,,Fee Schedule,11.75,47.26,
G0283 INTERFERENCE CHARGES,9640019,LOCAL,,,G0283,HCPCS,,,GP,Outpatient,,,51.51,33,Humana,Humana,11.81,,,,,,,Fee Schedule,11.81,47.26,
G0283 PT Elect Stim Unattended Assistant Units Charge,9650019,LOCAL,,,G0283,HCPCS,,,GP,Outpatient,,,51.51,33,Humana,Humana,11.81,,,,,,,Fee Schedule,11.81,47.26,
G0283 OT ELEC STIM MEDICARE CHARGE,9860018,LOCAL,,,G0283,HCPCS,,,GO|CO,Outpatient,,,51.52,33,Humana,Humana,11.81,,,,,,,Fee Schedule,11.81,47.26,
G0283 OT ESTIM UNATTENDED CHARGE,9850018,LOCAL,,,G0283,HCPCS,,,GO,Outpatient,,,51.52,33,Humana,Humana,11.81,,,,,,,Fee Schedule,11.81,47.26,
OT Unattended E-Stim Assistant Units,7895266,LOCAL,,,G0283,HCPCS,,,CQ,Outpatient,,,51.52,33,Humana,Humana,11.81,,,,,,,Fee Schedule,11.81,47.26,
OTElectrical Stim (Unattended) - Non-Wound,1373552,LOCAL,,,G0283,HCPCS,,,GO,Outpatient,,,51.52,33,Humana,Humana,11.81,,,,,,,Fee Schedule,11.81,47.26,
UA w Micro if Ind,1148022,LOCAL,81003,CPT,,,,,,Outpatient,,,51.6,2.7,Humana,Humana,3.8,,,,,,,Fee Schedule,3.795286195,4.02,
UA w Micro if Ind & Cult if Ind,8088555,LOCAL,81003,CPT,,,,,,Outpatient,,,51.6,2.7,Humana,Humana,3.8,,,,,,,Fee Schedule,3.795286195,4.02,
Urinalysis Macroscopic,633863,LOCAL,81003,CPT,,,,,,Outpatient,,,51.6,2.7,Humana,Humana,3.8,,,,,,,Fee Schedule,3.795286195,4.02,
"T4, Free, Direct Dialysis QSTC",13864535,LOCAL,84439,CPT,,,,,,Outpatient,,,51.98,10.82,Humana,Humana,28.58,,,,,,,Fee Schedule,18.43,28.58065455,
"Immunofixation, Serum QSTC",8764779,LOCAL,86334,CPT,,,,,,Outpatient,,,52.7,26.81,Humana,Humana,37.3,,,,,,,Fee Schedule,15.29,37.3,
77061 MG Diagnostic Tomo Charge: AddOn Left,13960724,LOCAL,G0279,CPT,,,,,LT,Outpatient,,,52.92,,Humana,Humana,11.11,,,,,,,Fee Schedule,11.11,74,
"CtrachomatisRNA, TMA, Urog QSTC",8996973,LOCAL,87491,CPT,,,,,QW,Outpatient,,,53.48,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
"NgonorrhoeaeRNA, TMA, Urog QSTC",8996974,LOCAL,87591,CPT,,,,,QW,Outpatient,,,53.48,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Chlamydia Trachomatis RNA, TMA QST",8395007,LOCAL,87491,CPT,,,,,,Outpatient,,,53.5,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",8395010,LOCAL,87591,CPT,,,,,,Outpatient,,,53.5,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
"N. Gonorrhoeae RNA, TMA, Urogenital QSTC",13864518,LOCAL,87591,CPT,,,,,QW,Outpatient,,,53.51,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
Homocysteine QSTC,8764574,LOCAL,83090,CPT,,,,,,Outpatient,,,53.55,21.5,Humana,Humana,17.92,,,,,,,Fee Schedule,17.92,18.43,
"Mycobact Culture, w Fluorochrome Sm QSTC",9039257,LOCAL,87116,CPT,,,,,,Outpatient,,,53.55,12.96,Humana,Humana,25.66,,,,,,,Fee Schedule,10.57,25.656,
"Mycobacteria, Cult, w Fluoro Smear QST",9039257,LOCAL,87116,CPT,,,,,,Outpatient,,,53.55,12.96,Humana,Humana,25.66,,,,,,,Fee Schedule,10.57,25.656,
ampicillin 2 g injection [CULL],11201144,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,53.6096,,Humana,Humana,0.59,,,,,,,Fee Schedule,0.591,0.591,
DOBUTamine 2 mg/mL-D5% intravenous solution 250 mL [CULL],11201692,LOCAL,J1250,CPT,,,,,,Outpatient,250,ML,53.68,,Humana,Humana,8.02,,,,,,,Fee Schedule,8.024,8.024,
acetylcysteine 20% inhalation solution 4 mL [CULL],11205094,LOCAL,J7608,CPT,,,,,,Outpatient,4,ML,53.7984,,Humana,Humana,8.46,,,,,,,Fee Schedule,8.455,8.455,
"Angiotensin Converting Enzyme (ACE), CSF QSTC",10170069,LOCAL,82164,CPT,,,,,,Outpatient,,,54,17.52,Humana,Humana,27.41,,,,,,,Fee Schedule,17.73,27.405,
"Endomysial Ab Screen IgA, Rfx Titer QSTC",8764677,LOCAL,86231,CPT,,,,,,Outpatient,,,54,14.51,Humana,Humana,106.94,,,,,,,Fee Schedule,15.29,106.935,
Hexagonal Phase Confirm. QSTC,9039456,LOCAL,85598,CPT,,,,,,Outpatient,,,54,21.58,Humana,Humana,17.98,,,,,,,Fee Schedule,5.42,17.98,
hs-CRP QSTC,8853237,LOCAL,86141,CPT,,,,,,Outpatient,,,54,15.54,Humana,Humana,12.95,,,,,,,Fee Schedule,12.95,15.29,
Lipoprotein (a) QSTC,8853258,LOCAL,83695,CPT,,,,,,Outpatient,,,54,17.18,Humana,Humana,14.32,,,,,,,Fee Schedule,14.32,17.73,
"Oligoclonal Bands (IgG), CSF QSTC",8764540,LOCAL,83916,CPT,,,,,,Outpatient,,,54,32.87,Humana,Humana,27.39,,,,,,,Fee Schedule,17.73,27.39,
"Plasma Renin Activity, LC/MS/MS QSTC",8764647,LOCAL,84244,CPT,,,,,,Outpatient,,,54,26.39,Humana,Humana,37.78,,,,,,,Fee Schedule,18.43,37.78,
"Vitamin D, 1,25-Dihydroxy QSTC",8764639,LOCAL,82652,CPT,,,,,,Outpatient,,,54,46.2,Humana,Humana,38.5,,,,,,,Fee Schedule,38.5,46.74,
Apolipoprotein Evaluation QSTC,13864521,LOCAL,82172,CPT,,,,,,Outpatient,,,54.36,25.31,Humana,Humana,37.52,,,,,,,Fee Schedule,17.73,37.515,
nitroglycerin 5 mg/mL intravenous solution 10 mL [CULL],11211028,LOCAL,J2305,CPT,,,,,,Outpatient,10,ML,54.7968,,Humana,Humana,1.52,,,,,,,Fee Schedule,1.523,1.523,
"C1 Esterase Inhibitor, Protein QSTC",8764554,LOCAL,86160,CPT,,,,,,Outpatient,,,54.9,14.4,Humana,Humana,36.91,,,,,,,Fee Schedule,15.29,36.909,
droNABinol 5 mg Cap [CULL],11200011,LOCAL,Q0167,CPT,,,,,,Outpatient,1,EA,54.9824,,Humana,Humana,1.35,,,,,,,Fee Schedule,1.352,1.352,
Hepatitis B Surface Antigen,633752,LOCAL,87340,CPT,,,,,,Outpatient,,,55,12.4,Humana,Humana,22.2,,,,,,,Fee Schedule,10.57,22.20058824,
Hepatitis B Surface Antigen w/ Interp,9517997,LOCAL,87340,CPT,,,,,,Outpatient,,,55,12.4,Humana,Humana,22.2,,,,,,,Fee Schedule,10.57,22.20058824,
HIV 1/2 Antibody Screen (exposure only),9609059,LOCAL,86701,CPT,,,,,,Outpatient,,,55,10.67,Humana,Humana,8.89,,,,,,,Fee Schedule,8.89,15.29,
IMMOBILIZER KNEE LARGE,11071020,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,55,158,Humana,Humana,77.23,,,,,,,Fee Schedule,77.23,77.23,
IMMOBILIZER KNEE XL 79-80028,11070735,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,55,158,Humana,Humana,77.23,,,,,,,Fee Schedule,77.23,77.23,
Potassium POCT,9616981,LOCAL,84132,CPT,,,,,,Outpatient,,,55,5.71,Humana,Humana,8.7,,,,,,,Fee Schedule,7.16,8.697880184,
IMMOBILIZER KNEE MEDIUM,11071084,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,55.06,158,Humana,Humana,77.23,,,,,,,Fee Schedule,77.23,77.23,
IMMOBILIZER KNEE SMALL,11071082,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,55.06,158,Humana,Humana,77.23,,,,,,,Fee Schedule,77.23,77.23,
Additional Testing PTT-LA QSTC,9004754,LOCAL,85730,CPT,,,,,,Outpatient,,,55.1,7.21,Humana,Humana,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
dRVVT Mix Interpretation: QSTC,9004757,LOCAL,85613,CPT,,,,,,Outpatient,,,55.1,11.5,Humana,Humana,9.58,,,,,,,Fee Schedule,5.42,9.58,
Valproic Acid Level,3170351,LOCAL,80164,CPT,,,,,,Outpatient,,,55.49,16.25,Humana,Humana,34.38,,,,,,,Fee Schedule,15.38,34.38,
.RMSF IgG Titer QSTC,8764766,LOCAL,86757,CPT,,,,,,Outpatient,,,56.25,23.22,Humana,Humana,19.35,,,,,,,Fee Schedule,15.29,19.35,
.RMSF IgM Titer QSTC,8764765,LOCAL,86757,CPT,,,,,,Outpatient,,,56.25,23.22,Humana,Humana,19.35,,,,,,,Fee Schedule,15.29,19.35,
HIV 1 Antibody QSTC,8852095,LOCAL,86701,CPT,,,,,,Outpatient,,,56.25,10.67,Humana,Humana,8.89,,,,,,,Fee Schedule,8.89,15.29,
HIV 2 Antibody QSTC,8852096,LOCAL,86702,CPT,,,,,,Outpatient,,,56.25,16.22,Humana,Humana,13.52,,,,,,,Fee Schedule,13.52,15.29,
"Aldosterone, LC/MS QSTC",8853271,LOCAL,82088,CPT,,,,,,Outpatient,,,56.93,48.9,Humana,Humana,48.44,,,,,,,Fee Schedule,18.43,48.435,
Calcium Level Total,1628887,LOCAL,82310,CPT,,,,,,Outpatient,,,57.12,6.19,Humana,Humana,5.16,,,,,,,Fee Schedule,5.16,7.16,
EPINEPHrine 1 mg/mL injectable solution 1 mL [CULL],11202413,LOCAL,J0169,CPT,,,,,,Outpatient,1,ML,57.4464,,Humana,Humana,1.38,,,,,,,Fee Schedule,1.383,1.383,
Bill UA With Microscopic,14634624,LOCAL,81001,CPT,,,,,,Outpatient,,,57.6,3.8,Humana,Humana,6.91,,,,,,,Fee Schedule,4.02,6.910081301,
PC DOPP ART BIL EXERCISE,8200578,LOCAL,93924,CPT,,,,,,Outpatient,,,57.94,302,Humana,Humana,143.05,,,,,,,Fee Schedule,143.05,161.71,
Reticulocyte Count,7909814,LOCAL,85044,CPT,,,,,,Outpatient,,,57.94,5.17,Humana,Humana,16.96,,,,,,,Fee Schedule,8.21,16.95545455,
Reticulocyte Count with Immature Reticulocyte Fraction,3454466,LOCAL,85044,CPT,,,,,,Outpatient,,,57.94,5.17,Humana,Humana,16.96,,,,,,,Fee Schedule,8.21,16.95545455,
clindamycin 900 mg/50 mL-D5% intravenous solution 50 mL [CULL],11212348,LOCAL,J0736,CPT,,,,,,Outpatient,50,ML,57.99733333,,Humana,Humana,0.82,,,,,,,Fee Schedule,0.819,0.819,
milrinone 200 mcg/mL-D5% intravenous solution 100 mL [CULL],11290134,LOCAL,J2260,CPT,,,,,,Outpatient,100,ML,58.368,,Humana,Humana,1.35,,,,,,,Fee Schedule,1.351,1.351,
"Vitamin B6, Plasma QSTC",8853234,LOCAL,84207,CPT,,,,,,Outpatient,,,58.5,33.72,Humana,Humana,40.33,,,,,,,Fee Schedule,17.73,40.33125,
Total Iron Binding Capacity,7050172,LOCAL,84466,CPT,,,,,,Outpatient,,,58.75,15.31,Humana,Humana,29.64,,,,,,,Fee Schedule,17.73,29.64248366,
Total Iron Binding Capacity,10543521,LOCAL,84466,CPT,,,,,,Outpatient,,,58.75,15.31,Humana,Humana,29.64,,,,,,,Fee Schedule,17.73,29.64248366,
"Varicella-Zoster Virus Abs(IgG,IgM) QSTC",8853253,LOCAL,86787,CPT,,,,,,Outpatient,,,59.4,15.46,Humana,Humana,12.88,,,,,,,Fee Schedule,12.88,15.29,
protamine 10 mg/mL injectable solution 5 mL [CULL],11211135,LOCAL,J2720,CPT,,,,,,Outpatient,5,ML,59.4432,,Humana,Humana,1.57,,,,,,,Fee Schedule,1.571,1.571,
Immunoglobulin E QSTC,8764571,LOCAL,82785,CPT,,,,,,Outpatient,,,59.49,19.75,Humana,Humana,203.96,,,,,,,Fee Schedule,17.73,203.9616667,
IMMOBILIZER SHOULDER XXXLARGE,4803390,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,59.62,12,Humana,Humana,67.31,,,,,,,Fee Schedule,67.31,67.31,
orphenadrine 30 mg/mL injectable solution 2 mL [CULL],11212051,LOCAL,J2360,CPT,,,,,,Outpatient,2,ML,59.904,,Humana,Humana,1.76,,,,,,,Fee Schedule,1.756666667,1.756666667,
Cortisol,3352314,LOCAL,82533,CPT,,,,,,Outpatient,,,60,19.56,Humana,Humana,15.2,,,,,,,Fee Schedule,15.196,18.43,
Cortisol 60 Min,8373789,LOCAL,82533,CPT,,,,,,Outpatient,,,60,19.56,Humana,Humana,15.2,,,,,,,Fee Schedule,15.196,18.43,
Free T4 Level,3170324,LOCAL,84439,CPT,,,,,,Outpatient,,,60,10.82,Humana,Humana,28.58,,,,,,,Fee Schedule,18.43,28.58065455,
Hepatitis A Antibody IgM,1628904,LOCAL,86709,CPT,,,,,,Outpatient,,,60,13.51,Humana,Humana,11.26,,,,,,,Fee Schedule,11.26,15.29,
HIV 1/2 Antibody and P24 Screen,633757,LOCAL,87389,CPT,,,,,,Outpatient,,,60,28.9,Humana,Humana,36.55,,,,,,,Fee Schedule,10.57,36.55,
HIV 1/2 Antibody and P24 Screen,633757,LOCAL,G0475,CPT,,,,,,Outpatient,,,60,28.9,Humana,Humana,20.9,,,,,,,Fee Schedule,10.57,36.55,
Protein Body Fluid,1634879,LOCAL,84157,CPT,,,,,,Outpatient,,,60.38,4.8,Humana,Humana,4,,,,,,,Fee Schedule,4,7.16,
IMMOBILIZER SHOULDER XXLARGE 9008-05,4803139,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,60.39,12,Humana,Humana,67.31,,,,,,,Fee Schedule,67.31,67.31,
Aspergillus fumigatus QSTC,9966204,LOCAL,86331,CPT,,,,,,Outpatient,,,60.8,14.38,Humana,Humana,11.98,,,,,,,Fee Schedule,11.98,15.29,
S. viridis QSTC,9966214,LOCAL,86609,CPT,,,,,,Outpatient,,,60.8,15.46,Humana,Humana,12.88,,,,,,,Fee Schedule,12.88,15.29,
T. candidus QSTC,9966205,LOCAL,86606,CPT,,,,,,Outpatient,,,60.8,18.06,Humana,Humana,15.05,,,,,,,Fee Schedule,15.05,15.29,
adenosine 3 mg/mL intravenous solution 2 mL [CULL],11201015,LOCAL,J0153,CPT,,,,,,Outpatient,2,ML,61.056,,Humana,Humana,0.53,,,,,,,Fee Schedule,0.529,0.529,
"Mercury, Blood QSTC",13864924,LOCAL,83825,CPT,,,,,,Outpatient,,,61.2,19.51,Humana,Humana,35.86,,,,,,,Fee Schedule,16.07,35.86038462,
Sex Hormone Binding Glob QSTC,8764670,LOCAL,84270,CPT,,,,,,Outpatient,,,61.2,26.08,Humana,Humana,21.73,,,,,,,Fee Schedule,17.73,21.73,
Stone Analysis w/ Image QSTC,9777240,LOCAL,82365,CPT,,,,,,Outpatient,,,61.2,15.48,Humana,Humana,24.62,,,,,,,Fee Schedule,17.73,24.61666667,
97012 APPLICATION OF TRACTION/MECH CHARGE,8133034,LOCAL,97012,CPT,,,,,GP,Outpatient,,,61.28,40,Humana,Humana,13.47,,,,,,,Fee Schedule,13.47,47.26,
97012 MECH TRACTION THERAPY Assistant Charge,9860050,LOCAL,97012,CPT,,,,,GO|CO,Outpatient,,,61.28,40,Humana,Humana,13.47,,,,,,,Fee Schedule,13.47,47.26,
97012 Mechanical Traction PT,9850050,LOCAL,97012,CPT,,,,,GO,Outpatient,,,61.28,40,Humana,Humana,13.47,,,,,,,Fee Schedule,13.47,47.26,
97012 TRACTION - MECHANICAL,9640018,LOCAL,97012,CPT,,,,,GP,Outpatient,,,61.28,40,Humana,Humana,13.47,,,,,,,Fee Schedule,13.47,47.26,
Mechanical Traction Charge -> Yes,13786833,LOCAL,97012,CPT,,,,,GP,Outpatient,,,61.28,40,Humana,Humana,13.47,,,,,,,Fee Schedule,13.47,47.26,
Mechanical Traction Provided,8510678,LOCAL,97012,CPT,,,,,GP,Outpatient,,,61.28,40,Humana,Humana,13.47,,,,,,,Fee Schedule,13.47,47.26,
OT Mechanical Trac Therapy Asist Units,7897758,LOCAL,97012,CPT,,,,,CQ,Outpatient,,,61.28,40,Humana,Humana,13.47,,,,,,,Fee Schedule,13.47,47.26,
OT Mechanical Traction Therapy Units,7897758,LOCAL,97012,CPT,,,,,GO,Outpatient,,,61.28,40,Humana,Humana,13.47,,,,,,,Fee Schedule,13.47,47.26,
PT Mechanical Traction Assistant Units,9390392,LOCAL,97012,CPT,,,,,CQ,Outpatient,,,61.28,40,Humana,Humana,13.47,,,,,,,Fee Schedule,13.47,47.26,
PT TRACTION MECHANICAL,9650018,LOCAL,97012,CPT,,,,,GP|CQ,Outpatient,,,61.28,40,Humana,Humana,13.47,,,,,,,Fee Schedule,13.47,47.26,
"Ethylene Glycol, Blood QSTC",8764539,LOCAL,82693,CPT,,,,,,Outpatient,,,61.34,17.88,Humana,Humana,14.9,,,,,,,Fee Schedule,14.9,16.07,
vancomycin 1 g/200 mL intravenous solution 200 mL [CULL],11291267,LOCAL,J3372,CPT,,,,,,Outpatient,200,ML,61.44,,Humana,Humana,5.49,,,,,,,Fee Schedule,5.487407407,5.487407407,
HIV 1/2 Antibody Screen,7939338,LOCAL,86703,CPT,,,,,,Outpatient,,,61.7,16.45,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.57,
"Alprazolam (Xanax), Serum QSTC",8972830,LOCAL,80299,CPT,,,,,,Outpatient,,,62.06,22.37,Humana,Humana,18.64,,,,,,,Fee Schedule,15.38,18.64,
Glucose 3 Hour,7973891,LOCAL,82952,CPT,,,,,,Outpatient,,,62.17,4.7,Humana,Humana,3.92,,,,,,,Fee Schedule,3.92,7.16,
Glucose 4 Hour,7973892,LOCAL,82952,CPT,,,,,,Outpatient,,,62.17,4.7,Humana,Humana,3.92,,,,,,,Fee Schedule,3.92,7.16,
Glucose 5 Hour,7973894,LOCAL,82952,CPT,,,,,,Outpatient,,,62.17,4.7,Humana,Humana,3.92,,,,,,,Fee Schedule,3.92,7.16,
"Cyclosporine Trough,LCMSMS QSTC",8764656,LOCAL,80158,CPT,,,,,,Outpatient,,,62.37,21.66,Humana,Humana,18.05,,,,,,,Fee Schedule,15.38,18.05,
"Ova&Parasite,Conc&Perm Smear Result QSTC",8873966,LOCAL,87177,CPT,,,,,,Outpatient,,,62.37,10.68,Humana,Humana,8.9,,,,,,,Fee Schedule,8.9,10.57,
97150  Group Therapeutic Procedure,9640074,LOCAL,97150,CPT,,,,,GP,Outpatient,,,62.69,41,Humana,Humana,16.89,,,,,,,Fee Schedule,16.89,56.44,
97150 OT Group Therapy Charge,9850058,LOCAL,97150,CPT,,,,,GO,Outpatient,,,62.69,41,Humana,Humana,16.89,,,,,,,Fee Schedule,16.89,56.44,
97150 OT Group Therapy Modifier Charge,9860058,LOCAL,97150,CPT,,,,,GO|CO,Outpatient,,,62.69,41,Humana,Humana,16.89,,,,,,,Fee Schedule,16.89,56.44,
97150 PT Group Therapy Assistant Units,9650074,LOCAL,97150,CPT,,,,,GP|CQ,Outpatient,,,62.69,41,Humana,Humana,16.89,,,,,,,Fee Schedule,16.89,56.44,
Group Therapy Charge,7895938,LOCAL,97150,CPT,,,,,GP,Outpatient,,,62.69,41,Humana,Humana,16.89,,,,,,,Fee Schedule,16.89,56.44,
Group Therapy Provided,7895280,LOCAL,97150,CPT,,,,,GO,Outpatient,,,62.69,41,Humana,Humana,16.89,,,,,,,Fee Schedule,16.89,56.44,
OT Group Therapy Assistant Units,7895280,LOCAL,97150,CPT,,,,,CQ,Outpatient,,,62.69,41,Humana,Humana,16.89,,,,,,,Fee Schedule,16.89,56.44,
OT Group Therapy Assistant Units,7897695,LOCAL,97150,CPT,,,,,CQ,Outpatient,,,62.69,41,Humana,Humana,16.89,,,,,,,Fee Schedule,16.89,56.44,
OT Group Therapy Rehab Units,7897695,LOCAL,97150,CPT,,,,,GO,Outpatient,,,62.69,41,Humana,Humana,16.89,,,,,,,Fee Schedule,16.89,56.44,
PT Group Therapy Assistant Units,9390418,LOCAL,97150,CPT,,,,,CQ,Outpatient,,,62.69,41,Humana,Humana,16.89,,,,,,,Fee Schedule,16.89,56.44,
"Giardia Antigen, EIA, Stool QSTC",8972764,LOCAL,87329,CPT,,,,,,Outpatient,,,63,14.38,Humana,Humana,11.98,,,,,,,Fee Schedule,10.57,11.98,
Methylmalonic Acid QSTC,8853212,LOCAL,83921,CPT,,,,,,Outpatient,,,63,25.45,Humana,Humana,21.21,,,,,,,Fee Schedule,17.73,21.21,
Nortriptyline QSTC,8853203,LOCAL,80299,CPT,,,,,,Outpatient,,,63.45,22.37,Humana,Humana,18.64,,,,,,,Fee Schedule,15.38,18.64,
97034 CONTRAST BATH THERAPY,9860025,LOCAL,97034,CPT,,,,,GO|CO,Outpatient,,,63.72,41,Humana,Humana,13.05,,,,,,,Fee Schedule,13.05,47.26,
97034 CONTRAST BATHS EACH 15 MIN CHARGE,9640025,LOCAL,97034,CPT,,,,,GP,Outpatient,,,63.72,41,Humana,Humana,13.05,,,,,,,Fee Schedule,13.05,47.26,
97034 OT CONTRAST BATH 15 MIN APPL CHARGE,9850025,LOCAL,97034,CPT,,,,,GO,Outpatient,,,63.72,41,Humana,Humana,13.05,,,,,,,Fee Schedule,13.05,47.26,
97034 PT CONTRAST BATH 15 MIN ASST,9650025,LOCAL,97034,CPT,,,,,GP|CQ,Outpatient,,,63.72,41,Humana,Humana,13.05,,,,,,,Fee Schedule,13.05,47.26,
OT Contrast Bath Assistant Units,7895283,LOCAL,97034,CPT,,,,,CQ,Outpatient,,,63.72,41,Humana,Humana,13.05,,,,,,,Fee Schedule,13.05,47.26,
OT Contrast Bath Assistant Units,1373567,LOCAL,97034,CPT,,,,,CQ,Outpatient,,,63.72,41,Humana,Humana,13.05,,,,,,,Fee Schedule,13.05,47.26,
OT Contrast Bath Charges,7895283,LOCAL,97034,CPT,,,,,GO,Outpatient,,,63.72,41,Humana,Humana,13.05,,,,,,,Fee Schedule,13.05,47.26,
OT Contrast Bath Units,1373567,LOCAL,97034,CPT,,,,,GO,Outpatient,,,63.72,41,Humana,Humana,13.05,,,,,,,Fee Schedule,13.05,47.26,
PT Attended E-Stim Assistant Units,9390422,LOCAL,97034,CPT,,,,,CQ,Outpatient,,,63.72,41,Humana,Humana,13.05,,,,,,,Fee Schedule,13.05,47.26,
PT Contrast Bath Charges,7895979,LOCAL,97034,CPT,,,,,GP,Outpatient,,,63.72,41,Humana,Humana,13.05,,,,,,,Fee Schedule,13.05,47.26,
BRACE ANKLE LG,9400076,LOCAL,,,L1902,HCPCS,,,,Outpatient,,,64.13,,Humana,Humana,94.39,,,,,,,Fee Schedule,94.39,94.39,
Medium Ankle Brace,9400086,LOCAL,,,L1902,HCPCS,,,,Outpatient,,,64.13,,Humana,Humana,94.39,,,,,,,Fee Schedule,94.39,94.39,
"ANA Screen, IFA QSTC",14127792,LOCAL,86038,CPT,,,,,,Outpatient,,,64.31,14.51,Humana,Humana,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
Beta2-Glycoprotein I (IgA) QSTC,14127808,LOCAL,86146,CPT,,,,,,Outpatient,,,64.31,30.54,Humana,Humana,25.45,,,,,,,Fee Schedule,15.29,25.45,
Beta2-Glycoprotein I (IgG) QSTC,14127809,LOCAL,86146,CPT,,,,,,Outpatient,,,64.31,30.54,Humana,Humana,25.45,,,,,,,Fee Schedule,15.29,25.45,
Beta2-Glycoprotein I (IgM) QSTC,14127810,LOCAL,86146,CPT,,,,,,Outpatient,,,64.31,30.54,Humana,Humana,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Ab (IgA) QSTC,14127805,LOCAL,86147,CPT,,,,,,Outpatient,,,64.31,30.54,Humana,Humana,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Ab (IgG) QSTC,14127806,LOCAL,86147,CPT,,,,,,Outpatient,,,64.31,30.54,Humana,Humana,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Ab (IgM) QSTC,14127807,LOCAL,86147,CPT,,,,,,Outpatient,,,64.31,30.54,Humana,Humana,25.45,,,,,,,Fee Schedule,15.29,25.45,
"CCP, Antibody (IgG) QSTC",14127817,LOCAL,86200,CPT,,,,,,Outpatient,,,64.31,15.54,Humana,Humana,7.49,,,,,,,Fee Schedule,7.491935484,15.29,
Centromere B Antibody QSTC,14127802,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Chromatin (Nucleosomal) Ab QSTC,14127794,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Complement Component C3c QSTC,14127803,LOCAL,86160,CPT,,,,,,Outpatient,,,64.31,14.4,Humana,Humana,36.91,,,,,,,Fee Schedule,15.29,36.909,
Complement Component C4c QSTC,14127804,LOCAL,86160,CPT,,,,,,Outpatient,,,64.31,14.4,Humana,Humana,36.91,,,,,,,Fee Schedule,15.29,36.909,
"DNA Ab (DS) Crithidia, IFA QSTC",14127793,LOCAL,86255,CPT,,,,,,Outpatient,,,64.31,14.46,Humana,Humana,12.05,,,,,,,Fee Schedule,12.05,15.29,
Jo-1 Antibody QSTC,14127801,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
"MCV, Antibody QSTC",14127818,LOCAL,83520,CPT,,,,,,Outpatient,,,64.31,20.72,Humana,Humana,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rheumatoid Factor (IgA) QSTC,14127812,LOCAL,83520,CPT,,,,,,Outpatient,,,64.31,20.72,Humana,Humana,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rheumatoid Factor (IgG) QSTC,14127814,LOCAL,83520,CPT,,,,,,Outpatient,,,64.31,20.72,Humana,Humana,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rheumatoid Factor (IgM) QSTC,14127816,LOCAL,83520,CPT,,,,,,Outpatient,,,64.31,20.72,Humana,Humana,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
RNP Antibody QSTC,14127797,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Scl-70 Antibody QSTC,14127800,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-A) QSTC,14127798,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-B) QSTC,14127799,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sm Antibody QSTC,14127795,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sm/RNP Antibody QSTC,14127796,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Thyroid Peroxidase Abs QSTC,14127819,LOCAL,86376,CPT,,,,,,Outpatient,,,64.31,17.46,Humana,Humana,25.09,,,,,,,Fee Schedule,15.29,25.085,
Calcitonin QSTC,8764739,LOCAL,82308,CPT,,,,,,Outpatient,,,64.8,32.15,Humana,Humana,26.79,,,,,,,Fee Schedule,18.43,26.79,
"DHEA, Unconjugated QSTC",8853248,LOCAL,82626,CPT,,,,,,Outpatient,,,64.8,30.32,Humana,Humana,25.27,,,,,,,Fee Schedule,17.73,25.27,
"Sjogren's Antibodies (SS-A, SS-B) QSTC",8853207,LOCAL,86235,CPT,,,,,,Outpatient,,,64.85,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Bill Special Stains Group II,8489591,LOCAL,88313,CPT,,,,,,Outpatient,,,64.93,,Humana,Humana,117.85,,,,,,,Fee Schedule,32.32,117.85,
17-Hydroxyprogesterone QSTC,8853287,LOCAL,83498,CPT,,,,,,Outpatient,,,64.94,32.6,Humana,Humana,27.17,,,,,,,Fee Schedule,18.43,27.17,
Carcinoembryonic Antigen,633697,LOCAL,82378,CPT,,,,,,Outpatient,,,65,22.75,Humana,Humana,36.03,,,,,,,Fee Schedule,17.73,36.03017241,
Hepatitis B Core Antibody IgM,1628907,LOCAL,86705,CPT,,,,,,Outpatient,,,65,14.12,Humana,Humana,32.8,,,,,,,Fee Schedule,15.29,32.80285714,
Celiac Disease Comp w/Gliadin Ab IgG QSTC,13864455,LOCAL,82784,CPT,,,,,,Outpatient,,,65.25,11.16,Humana,Humana,34.96,,,,,,,Fee Schedule,7.16,34.958,
Hep B Surface Ag w/Rflx to Confirm. QSTC,9039254,LOCAL,87340,CPT,,,,,,Outpatient,,,65.25,12.4,Humana,Humana,22.2,,,,,,,Fee Schedule,10.57,22.20058824,
Immunoglobulin Panel QSTC,8764543,LOCAL,82784,CPT,,,,,,Outpatient,,,65.25,11.16,Humana,Humana,34.96,,,,,,,Fee Schedule,7.16,34.958,
Body Fluid Cell Count w/ Diff,6213822,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,Humana,Humana,35.8,,,,,,,Fee Schedule,14.07,35.795,
Body Fluid Cell Count with Differential If Indicated,8127214,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,Humana,Humana,35.8,,,,,,,Fee Schedule,14.07,35.795,
Body Fluid Differential,4240538,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,Humana,Humana,35.8,,,,,,,Fee Schedule,14.07,35.795,
CSF Cell Count with Differential If Indicated,3454318,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,Humana,Humana,35.8,,,,,,,Fee Schedule,14.07,35.795,
CSF Differential,3454393,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,Humana,Humana,35.8,,,,,,,Fee Schedule,14.07,35.795,
Digoxin Level,1628891,LOCAL,80162,CPT,,,,,,Outpatient,,,66.1,15.94,Humana,Humana,26.44,,,,,,,Fee Schedule,15.38,26.44,
Potassium Level,633616,LOCAL,84132,CPT,,,,,,Outpatient,,,66.1,5.71,Humana,Humana,8.7,,,,,,,Fee Schedule,7.16,8.697880184,
24hr Urine Creatinine QSTC,10600648,LOCAL,82570,CPT,,,,,,Outpatient,,,66.76,6.22,Humana,Humana,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Aldosterone, 24-Hour Urine QSTC",8995528,LOCAL,82088,CPT,,,,,,Outpatient,,,66.76,48.9,Humana,Humana,48.44,,,,,,,Fee Schedule,18.43,48.435,
"Aspergillus Ab, Immunodiffusion QSTC",13864516,LOCAL,86606,CPT,,,,,,Outpatient,,,66.87,18.06,Humana,Humana,15.05,,,,,,,Fee Schedule,15.05,15.29,
T3 Free,3170323,LOCAL,84481,CPT,,,,,,Outpatient,,,67,20.33,Humana,Humana,34.46,,,,,,,Fee Schedule,18.43,34.46424242,
ANCA Screen w Reflex to ANCA Titer QSTC,8764789,LOCAL,86036,CPT,,,,,,Outpatient,,,67.5,14.46,Humana,Humana,39.66,,,,,,,Fee Schedule,15.29,39.655,
Androstenedione QSTC,8764648,LOCAL,82157,CPT,,,,,,Outpatient,,,67.5,35.14,Humana,Humana,29.28,,,,,,,Fee Schedule,18.43,29.28,
Antithrombin III Activity QSTC,8764597,LOCAL,85300,CPT,,,,,,Outpatient,,,67.5,14.22,Humana,Humana,11.85,,,,,,,Fee Schedule,5.42,11.85,
Influenza A,7909953,LOCAL,87804,CPT,,,,,,Outpatient,,,67.5,19.86,Humana,Humana,6.42,,,,,,,Fee Schedule,6.419753086,10.57,
Influenza B,7909954,LOCAL,87804,CPT,,,,,,Outpatient,,,67.5,19.86,Humana,Humana,6.42,,,,,,,Fee Schedule,6.419753086,10.57,
"Protein C, Activity QSTC",8764685,LOCAL,85303,CPT,,,,,,Outpatient,,,67.5,16.61,Humana,Humana,13.84,,,,,,,Fee Schedule,5.42,13.84,
"Protein S Antigen, Free QSTC",9777259,LOCAL,85306,CPT,,,,,,Outpatient,,,67.5,18.38,Humana,Humana,15.32,,,,,,,Fee Schedule,5.42,15.32,
"Protein S, Activity QSTC",8764774,LOCAL,85306,CPT,,,,,,Outpatient,,,67.5,18.38,Humana,Humana,15.32,,,,,,,Fee Schedule,5.42,15.32,
Shiga Toxin 1 and 2,7939191,LOCAL,87427,CPT,,,,,,Outpatient,,,67.5,14.38,Humana,Humana,29.72,,,,,,,Fee Schedule,10.57,29.71875,
Shiga Toxin 1 and 2,8875416,LOCAL,87427,CPT,,,,,,Outpatient,,,67.5,14.38,Humana,Humana,29.72,,,,,,,Fee Schedule,10.57,29.71875,
Tissue Transglutaminase IgG Ab QSTC,8764825,LOCAL,86364,CPT,,,,,,Outpatient,,,67.5,13.84,Humana,Humana,61.9,,,,,,,Fee Schedule,15.29,61.9,
Vitamin B12 QSTC,9291002,LOCAL,82607,CPT,,,,,,Outpatient,,,67.5,18.1,Humana,Humana,82.43,,,,,,,Fee Schedule,18.43,82.43266533,
Glucose CSF,1628897,LOCAL,82945,CPT,,,,,,Outpatient,,,67.73,4.72,Humana,Humana,3.93,,,,,,,Fee Schedule,3.93,7.16,
Protein CSF,1634881,LOCAL,84157,CPT,,,,,,Outpatient,,,67.73,4.8,Humana,Humana,4,,,,,,,Fee Schedule,4,7.16,
Erythropoietin (EPO) QSTC,8764551,LOCAL,82668,CPT,,,,,,Outpatient,,,68.4,22.55,Humana,Humana,43.41,,,,,,,Fee Schedule,17.73,43.41,
RT Vapotherm Subsequent CHARGE,8143879,LOCAL,94003,CPT,,,,,,Outpatient,,,68.49,613,Humana,Humana,604.42,,,,,,,Fee Schedule,604.42,941,
Hematocrit,633742,LOCAL,85014,CPT,,,,,,Outpatient,,,68.54,2.84,Humana,Humana,12.62,,,,,,,Fee Schedule,8.21,12.62068493,
Hematocrit,1635636,LOCAL,85014,CPT,,,,,,Outpatient,,,68.54,2.84,Humana,Humana,12.62,,,,,,,Fee Schedule,8.21,12.62068493,
Hemoglobin,633741,LOCAL,85018,CPT,,,,,,Outpatient,,,68.54,2.84,Humana,Humana,10.94,,,,,,,Fee Schedule,8.21,10.94316176,
Hemoglobin,1635635,LOCAL,85018,CPT,,,,,,Outpatient,,,68.54,2.84,Humana,Humana,10.94,,,,,,,Fee Schedule,8.21,10.94316176,
C1 Esterase Inhibitor QST,13870084,LOCAL,86160,CPT,,,,,,Outpatient,,,68.85,14.4,Humana,Humana,36.91,,,,,,,Fee Schedule,15.29,36.909,
"C1 Esterase Inhibitor, Functional QSTC",8853251,LOCAL,86161,CPT,,,,,,Outpatient,,,68.85,14.4,Humana,Humana,12,,,,,,,Fee Schedule,12,15.29,
Antibody Screen Gel 2,8196056,LOCAL,86850,CPT,,,,,,Outpatient,,,68.88,11.72,Humana,Humana,48.85,,,,,,,Fee Schedule,6.29,48.85,
Antibody Screen Tube.,8417431,LOCAL,86850,CPT,,,,,,Outpatient,,,68.88,11.72,Humana,Humana,48.85,,,,,,,Fee Schedule,6.29,48.85,
BB RH (D) TYPE XX,6432042,LOCAL,86901,CPT,,,,,,Outpatient,,,68.88,3.59,Humana,Humana,35.88,,,,,,,Fee Schedule,6.29,35.88,
Acid Fast Stain Report,634214,LOCAL,87206,CPT,,,,,,Outpatient,,,69.36,6.47,Humana,Humana,34.45,,,,,,,Fee Schedule,10.57,34.45384615,
Milk Component Panel QSTC,8912186,LOCAL,86008,CPT,,,,,,Outpatient,,,69.39,21.52,Humana,Humana,17.93,,,,,,,Fee Schedule,15.29,17.93,
REF TRXN Pathologist Interp,13479165,LOCAL,86078,CPT,,,,,,Outpatient,,,69.8,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.88,156.67,
BB REF RH(D) TYPING TRANSFUSION RXN,6433001,LOCAL,86901,CPT,,,,,,Outpatient,,,69.86,3.59,Humana,Humana,35.88,,,,,,,Fee Schedule,6.29,35.88,
BB REF XMATCH (IAT) TRANSFUSION RXN,6433004,LOCAL,86922,CPT,,,,,,Outpatient,,,69.86,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
REF ABO/Rh (TRXN),13479164,LOCAL,86900,CPT,,,,,,Outpatient,,,69.86,3.59,Humana,Humana,117.85,,,,,,,Fee Schedule,6.29,117.85,
REF Antibody Screen (TRXN),13479162,LOCAL,86850,CPT,,,,,,Outpatient,,,69.86,11.72,Humana,Humana,48.85,,,,,,,Fee Schedule,6.29,48.85,
REF Crossmatch (TRXN),13481255,LOCAL,86920,CPT,,,,,,Outpatient,,,69.86,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
REF DAT (TRXN),13479163,LOCAL,86880,CPT,,,,,,Outpatient,,,69.86,6.47,Humana,Humana,54.31,,,,,,,Fee Schedule,6.29,54.31,
Clostridium difficile Quik Chek Complete,10574492,LOCAL,87324,CPT,,,,,,Outpatient,,,70,14.38,Humana,Humana,20.44,,,,,,,Fee Schedule,10.57,20.4375,
Hemoglobin (POCT),4192190,LOCAL,85018,CPT,,,,,,Outpatient,,,70,2.84,Humana,Humana,10.94,,,,,,,Fee Schedule,8.21,10.94316176,
Hepatitis C Ab,1628911,LOCAL,86803,CPT,,,,,,Outpatient,,,70,17.12,Humana,Humana,32.1,,,,,,,Fee Schedule,15.29,32.10014925,
RT Education/Instruction CHARGE,90840011,LOCAL,94664,CPT,,,,,,Outpatient,,,70.15,46,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,185.95,
"RT Evaluation, Respiratory CHARGE",90840013,LOCAL,94664,CPT,,,,,,Outpatient,,,70.15,46,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,185.95,
tacrolimus 5 mg oral capsule [CULL],11205997,LOCAL,J7507,CPT,,,,,,Outpatient,1,EA,71.352,,Humana,Humana,0.2,,,,,,,Fee Schedule,0.197,0.197,
"Gliadin (Deamidated) Ab (IgG, IgA) QSTC",8764748,LOCAL,86258,CPT,,,,,,Outpatient,,,72,14.46,Humana,Humana,12.05,,,,,,,Fee Schedule,12.05,15.29,
HFO (L3929),10393294,LOCAL,,,L3929,HCPCS,,,,Outpatient,,,72,,Humana,Humana,94.67,,,,,,,Fee Schedule,94.67,94.67,
Hemoglobin A1c,1383763,LOCAL,83036,CPT,,,,,,Outpatient,,,72.22,11.65,Humana,Humana,28.6,,,,,,,Fee Schedule,7.16,28.59604426,
"Arsenic, Blood QSTC",13864922,LOCAL,82175,CPT,,,,,,Outpatient,,,72.27,22.76,Humana,Humana,42.26,,,,,,,Fee Schedule,16.07,42.25673077,
97032 ELECTRIC STIM,8478060,LOCAL,97032,CPT,,,,,GN,Outpatient,,,72.32,47,Humana,Humana,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 ELECTRIC STIM OT,9630084,LOCAL,97032,CPT,,,,,GN,Outpatient,,,72.32,47,Humana,Humana,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 OT E STIM CON - EA 15MIN CHARGE,9856105,LOCAL,97032,CPT,,,,,GO,Outpatient,,,72.32,47,Humana,Humana,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 OT Elec Stim Attended Assistant Units,9866105,LOCAL,97032,CPT,,,,,GO|CO,Outpatient,,,72.32,47,Humana,Humana,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 PT E STIM CON - EA 15MIN CHARGE,9640023,LOCAL,97032,CPT,,,,,GP,Outpatient,,,72.32,47,Humana,Humana,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 PT Elect Stim Attended Assistant Units,9650023,LOCAL,97032,CPT,,,,,GP|CQ,Outpatient,,,72.32,47,Humana,Humana,13.8,,,,,,,Fee Schedule,13.8,47.26,
Attended E-Stim Charges,1366373,LOCAL,97032,CPT,,,,,GO,Outpatient,,,72.32,47,Humana,Humana,13.8,,,,,,,Fee Schedule,13.8,47.26,
Attended E-Stim Charges,7895926,LOCAL,97032,CPT,,,,,GP,Outpatient,,,72.32,47,Humana,Humana,13.8,,,,,,,Fee Schedule,13.8,47.26,
OT Attended E-Stim Assistant Units,1366373,LOCAL,97032,CPT,,,,,CQ,Outpatient,,,72.32,47,Humana,Humana,13.8,,,,,,,Fee Schedule,13.8,47.26,
OT Attended E-Stim Assistant Units,1373442,LOCAL,97032,CPT,,,,,CQ,Outpatient,,,72.32,47,Humana,Humana,13.8,,,,,,,Fee Schedule,13.8,47.26,
OT Attended E-Stim Charges,1366373,LOCAL,97032,CPT,,,,,GO,Outpatient,,,72.32,47,Humana,Humana,13.8,,,,,,,Fee Schedule,13.8,47.26,
OT Attended E-Stim Units,1373442,LOCAL,97032,CPT,,,,,GO,Outpatient,,,72.32,47,Humana,Humana,13.8,,,,,,,Fee Schedule,13.8,47.26,
PT Attended E-Stim Assistant Units,9396343,LOCAL,97032,CPT,,,,,CQ,Outpatient,,,72.32,47,Humana,Humana,13.8,,,,,,,Fee Schedule,13.8,47.26,
Newborn Hearing Test Type -> Auditory brainstem response,8982858,LOCAL,92700,CPT,,,,,,Outpatient,,,72.72,47,Humana,Humana,22.39,,,,,,,Fee Schedule,22.39,162.41,
"IGF-1, LC/MS QSTC",8764636,LOCAL,84305,CPT,,,,,,Outpatient,,,72.9,25.51,Humana,Humana,46.87,,,,,,,Fee Schedule,18.43,46.87,
"Chlamydia Trachomatis RNA, TMA QST",10578255,LOCAL,87491,CPT,,,,,,Outpatient,,,73.16,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",10578245,LOCAL,87591,CPT,,,,,,Outpatient,,,73.16,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
Thinprep Review Cytotechnologist: QST,10590230,LOCAL,88175,CPT,,,,,,Outpatient,,,73.16,31.93,Humana,Humana,26.61,,,,,,,Fee Schedule,25.25,26.61,
pyridoxine 100 mg/mL injectable solution 1 mL [CULL],11212249,LOCAL,J3415,CPT,,,,,,Outpatient,1,ML,73.1904,,Humana,Humana,15.56,,,,,,,Fee Schedule,15.555,15.555,
97803 RE-ASSESSMENT & INTERVENTION CHARGE,8821410,LOCAL,97803,CPT,,,,,,Outpatient,,,73.41,48,Humana,Humana,21.06,,,,,,,Fee Schedule,21.06,287.34,
Amylase Level,631567,LOCAL,82150,CPT,,,,,,Outpatient,,,73.44,7.78,Humana,Humana,1.24,,,,,,,Fee Schedule,1.237209302,7.16,
Prothrombin Time,7904947,LOCAL,85610,CPT,,,,,,Outpatient,,,73.44,5.15,Humana,Humana,2.36,,,,,,,Fee Schedule,2.355196507,5.42,
Prothrombin Time and INR,633793,LOCAL,85610,CPT,,,,,,Outpatient,,,73.44,5.15,Humana,Humana,2.36,,,,,,,Fee Schedule,2.355196507,5.42,
Vancomycin Level,1634895,LOCAL,80202,CPT,,,,,,Outpatient,,,73.44,16.25,Humana,Humana,29.02,,,,,,,Fee Schedule,15.38,29.0215,
Vancomycin Level Peak,1634896,LOCAL,80202,CPT,,,,,,Outpatient,,,73.44,16.25,Humana,Humana,29.02,,,,,,,Fee Schedule,15.38,29.0215,
Vancomycin Level Trough,1634897,LOCAL,80202,CPT,,,,,,Outpatient,,,73.44,16.25,Humana,Humana,29.02,,,,,,,Fee Schedule,15.38,29.0215,
97016 OT VASOPNEUMATIC DEVICE CHARGE,9850019,LOCAL,97016,CPT,,,,,GO,Outpatient,,,73.6,48,Humana,Humana,11.17,,,,,,,Fee Schedule,11.17,47.26,
97016 PT JOBST COMPRESSION CHARGE,9640020,LOCAL,97016,CPT,,,,,GP,Outpatient,,,73.6,48,Humana,Humana,11.17,,,,,,,Fee Schedule,11.17,47.26,
97016 PT VASOPNEUMATIC DEVICE CHARGE,9650020,LOCAL,97016,CPT,,,,,GP|CQ,Outpatient,,,73.6,48,Humana,Humana,11.17,,,,,,,Fee Schedule,11.17,47.26,
OT Vasopneumatic Device Charge,7895255,LOCAL,97016,CPT,,,,,GO,Outpatient,,,73.6,48,Humana,Humana,11.17,,,,,,,Fee Schedule,11.17,47.26,
OT Vasopneumatic Devices Assistant Units,7895255,LOCAL,97016,CPT,,,,,CQ,Outpatient,,,73.6,48,Humana,Humana,11.17,,,,,,,Fee Schedule,11.17,47.26,
OT Vasopneumatic Devices Units,1373553,LOCAL,97016,CPT,,,,,GO,Outpatient,,,73.6,48,Humana,Humana,11.17,,,,,,,Fee Schedule,11.17,47.26,
PT Vasopneumatic Devices Assistant Units,9390396,LOCAL,97016,CPT,,,,,CQ,Outpatient,,,73.6,48,Humana,Humana,11.17,,,,,,,Fee Schedule,11.17,47.26,
Vasopneumatic Device Charge,7895963,LOCAL,97016,CPT,,,,,GP,Outpatient,,,73.6,48,Humana,Humana,11.17,,,,,,,Fee Schedule,11.17,47.26,
Beta hCG Quantitative,633665,LOCAL,84702,CPT,,,,,,Outpatient,,,75,18.06,Humana,Humana,15.05,,,,,,,Fee Schedule,15.05,18.43,
Flu A -Sofia,8267167,LOCAL,87804,CPT,,,,,,Outpatient,,,75,19.86,Humana,Humana,6.42,,,,,,,Fee Schedule,6.419753086,10.57,
Flu B -Sofia,8267168,LOCAL,87804,CPT,,,,,,Outpatient,,,75,19.86,Humana,Humana,6.42,,,,,,,Fee Schedule,6.419753086,10.57,
pH Venous,3454453,LOCAL,82800,CPT,,,,,,Outpatient,,,75,13.2,Humana,Humana,11,,,,,,,Fee Schedule,11,17.73,
"Protein, Total, 24 Hr Ur QSTC",8851917,LOCAL,84156,CPT,,,,,,Outpatient,,,75,4.4,Humana,Humana,11.68,,,,,,,Fee Schedule,7.16,11.68,
SARS-CoV-2 (COVID-19) IgG Ab,9706404,LOCAL,86769,CPT,,,,,,Outpatient,,,75,50.56,Humana,Humana,42.13,,,,,,,Fee Schedule,15.29,42.13,
Total hCG Quantitative,9299894,LOCAL,84702,CPT,,,,,,Outpatient,,,75,18.06,Humana,Humana,15.05,,,,,,,Fee Schedule,15.05,18.43,
pH Pleural Fluid,9631697,LOCAL,83986,CPT,,,,,,Outpatient,,,75.14,4.3,Humana,Humana,18.76,,,,,,,Fee Schedule,7.16,18.755,
terbutaline 1 mg/mL injectable solution 1 mL [CULL],11212324,LOCAL,J3105,CPT,,,,,,Outpatient,1,ML,75.648,,Humana,Humana,2.47,,,,,,,Fee Schedule,2.473,2.473,
Estradiol Lvl,3170319,LOCAL,82670,CPT,,,,,,Outpatient,,,75.89,33.53,Humana,Humana,51.64,,,,,,,Fee Schedule,18.43,51.64,
"Metanephrines, Fraction, LCMSMS,U24 QSTC",8764626,LOCAL,83835,CPT,,,,,,Outpatient,,,75.96,20.33,Humana,Humana,98.31,,,,,,,Fee Schedule,18.43,98.305,
"Mycobacteria Stain, Acid Fast, Fluorochrome QST",12126168,LOCAL,87206,CPT,,,,,,Outpatient,,,76,6.47,Humana,Humana,34.45,,,,,,,Fee Schedule,10.57,34.45384615,
C1 Esterase Inhibitor Protein QST,13870086,LOCAL,86160,CPT,,,,,,Outpatient,,,76.5,14.4,Humana,Humana,36.91,,,,,,,Fee Schedule,15.29,36.909,
Complement Component C4C QST,13870085,LOCAL,86161,CPT,,,,,,Outpatient,,,76.5,14.4,Humana,Humana,12,,,,,,,Fee Schedule,12,15.29,
"Serotonin, Serum QSTC",8853235,LOCAL,84260,CPT,,,,,,Outpatient,,,76.5,37.18,Humana,Humana,30.98,,,,,,,Fee Schedule,18.43,30.98,
.Thyroglobulin QSTC,13864485,LOCAL,84432,CPT,,,,,,Outpatient,,,76.73,19.27,Humana,Humana,46.24,,,,,,,Fee Schedule,18.43,46.235,
dexAMETHasone 4 mg/mL Sol [CULL],11202297,LOCAL,J1100,CPT,,,,,,Outpatient,1,ML,76.9408,,Humana,Humana,10.49,,,,,,,Fee Schedule,10.48743758,10.48743758,
CT PCR,12526323,LOCAL,87491,CPT,,,,,,Outpatient,,,76.95,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
NG PCR,12526324,LOCAL,87591,CPT,,,,,,Outpatient,,,76.95,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
Alkaline Phosphatase,1620878,LOCAL,84075,CPT,,,,,,Outpatient,,,77.11,6.22,Humana,Humana,5.18,,,,,,,Fee Schedule,5.18,7.16,
G0008 MC ADMIN INFLUENZA VIRUS VACCINE CHARGE,7923017,LOCAL,,,G0008,HCPCS,,,,Outpatient,,,77.13,50,Humana,Humana,42.18,,,,,,,Fee Schedule,42.18,56.18,
G0009 VACCINE ADMINISTRATION PNEUMONIA,12214659,LOCAL,,,G0009,HCPCS,,,,Outpatient,,,77.13,50,Humana,Humana,42.18,,,,,,,Fee Schedule,42.18,56.18,
64461 THORACIC PARAVERTEBRAL BLOCK,5661020,LOCAL,64461,CPT,,,,,,Outpatient,,,77.31,50,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
"Cryoglobulin (% Cryocrit), Serum QSTC",8764756,LOCAL,82595,CPT,,,,,,Outpatient,,,78.75,7.76,Humana,Humana,6.47,,,,,,,Fee Schedule,6.47,7.16,
Group B Strep Culture,7842541,LOCAL,87070,CPT,,,,,,Outpatient,,,79.56,10.34,Humana,Humana,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Partial Thromboplastin Time,633794,LOCAL,85730,CPT,,,,,,Outpatient,,,79.56,7.21,Humana,Humana,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
Partial Thromboplastin Time,7904949,LOCAL,85730,CPT,,,,,,Outpatient,,,79.56,7.21,Humana,Humana,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
Strep Confirmation,8019111,LOCAL,87081,CPT,,,,,,Outpatient,,,79.56,7.96,Humana,Humana,37.18,,,,,,,Fee Schedule,10.57,37.17627685,
99152 MOD SED SAME PHYS/QHP 5/>YRS,8653149,LOCAL,99152,CPT,,,,,,Outpatient,,,79.64,52,Humana,Humana,10.38,,,,,,,Fee Schedule,10.38,34.95,
fluconazole 400 mg/200 mL-NaCl 0.9% intravenous solution 200 mL [CULL],11220722,LOCAL,J1450,CPT,,,,,,Outpatient,200,ML,79.9168,,Humana,Humana,4.48,,,,,,,Fee Schedule,4.48,4.48,
20561 DRY NEEDLING 3+ MUSCLES WO INJECTION,9650049,LOCAL,20561,CPT,,,,,,Outpatient,,,80,52,Humana,Humana,22.39,,,,,,,Fee Schedule,22.39,863,
GC Culture,633895,LOCAL,87081,CPT,,,,,,Outpatient,,,80.78,7.96,Humana,Humana,37.18,,,,,,,Fee Schedule,10.57,37.17627685,
Lactate Dehydrogenase,633770,LOCAL,83615,CPT,,,,,,Outpatient,,,80.78,7.25,Humana,Humana,21.68,,,,,,,Fee Schedule,7.16,21.675,
MRSA Screen Culture,8244872,LOCAL,87081,CPT,,,,,,Outpatient,,,80.78,7.96,Humana,Humana,37.18,,,,,,,Fee Schedule,10.57,37.17627685,
Protein Total,633818,LOCAL,84155,CPT,,,,,,Outpatient,,,80.78,4.4,Humana,Humana,3.67,,,,,,,Fee Schedule,3.67,7.16,
"Bill Only ABID Panel, Selected Cell",8629507,LOCAL,86885,CPT,,,,,,Outpatient,,,81,6.86,Humana,Humana,156.67,,,,,,,Fee Schedule,6.29,156.67,
"Chromium, Serum QSTC",9701437,LOCAL,82495,CPT,,,,,,Outpatient,,,81,24.34,Humana,Humana,20.28,,,,,,,Fee Schedule,16.07,20.28,
Levetiracetam QSTC,8764628,LOCAL,80177,CPT,,,,,,Outpatient,,,81,15.9,Humana,Humana,9.4,,,,,,,Fee Schedule,9.399,15.38,
"Chlamydia Trachomatis RNA, TMA QST",10585658,LOCAL,87491,CPT,,,,,,Outpatient,,,82,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
HPV mRNA E6/E7 QST,10585657,LOCAL,87624,CPT,,,,,,Outpatient,,,82,42.11,Humana,Humana,67.2,,,,,,,Fee Schedule,40.19,67.195,
"Neisseria Gonorrhoeae RNA, TMA QST",10585659,LOCAL,87591,CPT,,,,,,Outpatient,,,82,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
Thinprep Review Cytotechnologist: QST,10585654,LOCAL,88175,CPT,,,,,,Outpatient,,,82,31.93,Humana,Humana,26.61,,,,,,,Fee Schedule,25.25,26.61,
Testosterone Level Total,3170320,LOCAL,84403,CPT,,,,,,Outpatient,,,82.01,30.97,Humana,Humana,52.38,,,,,,,Fee Schedule,18.43,52.3775,
methadone 10 mg/mL Injectable Sol 20 mL UD [CULL],11240064,LOCAL,J1230,CPT,,,,,,Outpatient,1,ML,82.07808,,Humana,Humana,17.7,,,,,,,Fee Schedule,17.7,17.7,
Malaria/Babesia/Other Blood Parasites QSTC,10707969,LOCAL,87207,CPT,,,,,,Outpatient,,,82.35,7.19,Humana,Humana,5.99,,,,,,,Fee Schedule,5.99,10.57,
H. Pylori CLO,9517164,LOCAL,86677,CPT,,,,,,Outpatient,,,83.23,20.22,Humana,Humana,16.85,,,,,,,Fee Schedule,15.29,16.85,
Phosphorus Level,633803,LOCAL,84100,CPT,,,,,,Outpatient,,,83.23,5.69,Humana,Humana,26.45,,,,,,,Fee Schedule,7.16,26.45123596,
"Estrogen, Total, Serum QSTC",8764701,LOCAL,82672,CPT,,,,,,Outpatient,,,83.25,26.04,Humana,Humana,21.7,,,,,,,Fee Schedule,18.43,21.7,
PHENobarbital 65 mg/mL Sol [CULL],11211087,LOCAL,J2560,CPT,,,,,,Outpatient,1,ML,83.7888,,Humana,Humana,29.08,,,,,,,Fee Schedule,29.077,29.077,
97129 ST COG/ATTEN/MEM/PROD CHARGE,9600117,LOCAL,97129,CPT,,,,,GN,Outpatient,,,84.77,114,Humana,Humana,18.94,,,,,,,Fee Schedule,18.94,56.44,
97130 ST Cognitive skills development each additional 15 minutes,9600118,LOCAL,97130,CPT,,,,,GN,Outpatient,,,84.77,114,Humana,Humana,18.08,,,,,,,Fee Schedule,18.08,56.44,
"SLP Cog Ther Intervent, Addl 15Min Units",9399379,LOCAL,97130,CPT,,,,,GN,Outpatient,,,84.77,114,Humana,Humana,18.08,,,,,,,Fee Schedule,18.08,56.44,
"SLP Cog Ther Intervent,First 15Min Units",9399375,LOCAL,97129,CPT,,,,,GN,Outpatient,,,84.77,114,Humana,Humana,18.94,,,,,,,Fee Schedule,18.94,56.44,
97802 MEDICAL NUTRITIONAL THERAPY CHARGE,13475610,LOCAL,97802,CPT,,,,,,Outpatient,,,84.82,55,Humana,Humana,25.2,,,,,,,Fee Schedule,25.2,287.34,
Minimum Inhibitory Concentration,294946,LOCAL,87186,CPT,,,,,,Outpatient,,,85,10.38,Humana,Humana,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
"HPV mRNA E6/E7, POST-$HYSTERECTOMY, VAGINAL QST",14782713,LOCAL,87624,CPT,,,,,,Outpatient,,,85.05,42.11,Humana,Humana,67.2,,,,,,,Fee Schedule,40.19,67.195,
BB REF LAB RH (D) TYPING,6413256,LOCAL,86901,CPT,,,,,,Outpatient,,,85.5,3.59,Humana,Humana,35.88,,,,,,,Fee Schedule,6.29,35.88,
"Ehrlichia chaffeensis Ab (IgG,IgM) QSTC",8853255,LOCAL,86666,CPT,,,,,,Outpatient,,,85.5,12.22,Humana,Humana,10.18,,,,,,,Fee Schedule,10.18,15.29,
REF ABO/Rh,7939266,LOCAL,86900,CPT,,,,,,Outpatient,,,85.5,3.59,Humana,Humana,117.85,,,,,,,Fee Schedule,6.29,117.85,
Uric Acid,633858,LOCAL,84550,CPT,,,,,,Outpatient,,,85.68,5.42,Humana,Humana,35.18,,,,,,,Fee Schedule,7.16,35.17852564,
cefTRIAXone 500 mg injection [CULL],11202193,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,85.9328,,Humana,Humana,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
chloroprocaine 3% preservative-free Sol [CULL],11202203,LOCAL,J2401,CPT,,,,,,Outpatient,20,ML,85.9392,,Humana,Humana,0.04,,,,,,,Fee Schedule,0.01,0.038,
Chol/HDL C QSTC,14129541,LOCAL,80061,CPT,,,,,,Outpatient,,,86,16.07,Humana,Humana,16.6,,,,,,,Fee Schedule,12.14,16.59934459,
HDL P QSTC,14129559,LOCAL,83704,CPT,,,,,,Outpatient,,,86,41.03,Humana,Humana,34.19,,,,,,,Fee Schedule,34.19,46.74,
HPV mRNA E6/E7 QST,9773934,LOCAL,87624,CPT,,,,,,Outpatient,,,86,42.11,Humana,Humana,67.2,,,,,,,Fee Schedule,40.19,67.195,
HPV mRNA E6/E7 QST,9773934,LOCAL,87624,CPT,,,,,,Outpatient,,,86,42.11,Humana,Humana,67.2,,,,,,,Fee Schedule,40.19,67.195,
HPV mRNA E6/E7 QSTC,9773934,LOCAL,87624,CPT,,,,,,Outpatient,,,86,42.11,Humana,Humana,67.2,,,,,,,Fee Schedule,40.19,67.195,
DOBUTamine 1 mg/mL-D5% Sol [CULL],11201073,LOCAL,J1250,CPT,,,,,,Outpatient,250,ML,86.208,,Humana,Humana,8.02,,,,,,,Fee Schedule,8.024,8.024,
Estrone QSTC,8853208,LOCAL,82679,CPT,,,,,,Outpatient,,,86.4,29.94,Humana,Humana,24.95,,,,,,,Fee Schedule,18.43,24.95,
fosphenytoin 500 mgPE/10 mL injectable solution 10 mL [CULL],11205071,LOCAL,Q2009,CPT,,,,,,Outpatient,10,ML,86.4,,Humana,Humana,1.47,,,,,,,Fee Schedule,1.47,1.47,
methacholine varying strength inhalation solution [CULL],11290186,LOCAL,J7674,CPT,,,,,,Outpatient,3,ML,86.4,,Humana,Humana,1.9,,,,,,,Fee Schedule,1.898,1.898,
Cyanide QSTC,13864508,LOCAL,82600,CPT,,,,,,Outpatient,,,86.45,23.28,Humana,Humana,19.4,,,,,,,Fee Schedule,16.07,19.4,
nitroglycerin 200 mcg/mL-D5% intravenous solution 250 mL [CULL],11211024,LOCAL,J2305,CPT,,,,,,Outpatient,250,ML,86.54666667,,Humana,Humana,1.52,,,,,,,Fee Schedule,1.523,1.523,
Electrolyte Panel,633610,LOCAL,80051,CPT,,,,,,Outpatient,,,86.9,8.41,Humana,Humana,7.01,,,,,,,Fee Schedule,7.01,12.14,
Sodium Level,633611,LOCAL,84295,CPT,,,,,,Outpatient,,,86.9,5.77,Humana,Humana,18.32,,,,,,,Fee Schedule,7.16,18.324,
76377 Requiring image post processing on an independent workstation,10740136,LOCAL,76377,CPT,,,,,,Outpatient,,,87,,Humana,Humana,36.62,,,,,,,Fee Schedule,36.62,36.62,
acetylcysteine 20% inhalation solution 30 mL [CULL],11203022,LOCAL,J7608,CPT,,,,,,Outpatient,30,ML,87.62688,,Humana,Humana,8.46,,,,,,,Fee Schedule,8.455,8.455,
Measles Antibody (IgM) QSTC,8853259,LOCAL,86765,CPT,,,,,,Outpatient,,,87.8,15.46,Humana,Humana,12.88,,,,,,,Fee Schedule,12.88,15.29,
Maize/Corn (F8) IgE QSTC,14116318,LOCAL,86001,CPT,,,,,,Outpatient,,,87.93,9.38,Humana,Humana,7.82,,,,,,,Fee Schedule,7.82,15.29,
97022 FLUIDOTHERAPY CHARGES,9646093,LOCAL,97022,CPT,,,,,GP,Outpatient,,,88.1,57,Humana,Humana,14.34,,,,,,,Fee Schedule,14.34,47.26,
97022 OT WHIRLPOOL - ASEPTIC,9856111,LOCAL,97022,CPT,,,,,GO,Outpatient,,,88.1,57,Humana,Humana,14.34,,,,,,,Fee Schedule,14.34,47.26,
97022 OT WHIRLPOOL 1+ AREAS APPL CHARGE,9866111,LOCAL,97022,CPT,,,,,GO|CO,Outpatient,,,88.1,57,Humana,Humana,14.34,,,,,,,Fee Schedule,14.34,47.26,
97022 PT SMALL WHIRLPOOL CHARGE,9656093,LOCAL,97022,CPT,,,,,GP|CQ,Outpatient,,,88.1,57,Humana,Humana,14.34,,,,,,,Fee Schedule,14.34,47.26,
97022 WHIRLPOOL CHARGE,9410091,LOCAL,97022,CPT,,,,,GP,Outpatient,,,88.1,57,Humana,Humana,14.34,,,,,,,Fee Schedule,14.34,47.26,
OT Whirlpool Therapy Assitant Units,9401114,LOCAL,97022,CPT,,,,,CQ,Outpatient,,,88.1,57,Humana,Humana,14.34,,,,,,,Fee Schedule,14.34,47.26,
OT Whirlpool Units,9401114,LOCAL,97022,CPT,,,,,GO,Outpatient,,,88.1,57,Humana,Humana,14.34,,,,,,,Fee Schedule,14.34,47.26,
"OT Whirlpool, Fluidotherapy Assistant Units",1373554,LOCAL,97022,CPT,,,,,CQ,Outpatient,,,88.1,57,Humana,Humana,14.34,,,,,,,Fee Schedule,14.34,47.26,
"OT Whirlpool, Fluidotherapy Units",1373554,LOCAL,97022,CPT,,,,,GO,Outpatient,,,88.1,57,Humana,Humana,14.34,,,,,,,Fee Schedule,14.34,47.26,
Whirlpool Full Body Charge,7895951,LOCAL,97022,CPT,,,,,GP,Outpatient,,,88.1,57,Humana,Humana,14.34,,,,,,,Fee Schedule,14.34,47.26,
"Whirlpool, 1+ Areas 97022",9640021,LOCAL,97022,CPT,,,,,,Outpatient,,,88.1,57,Humana,Humana,14.34,,,,,,,Fee Schedule,14.34,47.26,
"Factor XI Activity, Clotting QSTC",10358416,LOCAL,85270,CPT,,,,,,Outpatient,,,88.2,21.48,Humana,Humana,17.9,,,,,,,Fee Schedule,5.42,17.9,
99151 MOD SED SAME PHYS/QHP <5 YRS,8653147,LOCAL,99151,CPT,,,,,,Outpatient,,,88.82,58,Humana,Humana,20.19,,,,,,,Fee Schedule,20.19,34.95,
Selenium QSTC,8972757,LOCAL,84255,CPT,,,,,,Outpatient,,,89.6,30.64,Humana,Humana,57.31,,,,,,,Fee Schedule,17.73,57.31,
Theophylline Level,1634886,LOCAL,80198,CPT,,,,,,Outpatient,,,89.76,16.97,Humana,Humana,14.14,,,,,,,Fee Schedule,14.14,15.38,
97552 OT Caregiver Training Group,13649812,LOCAL,97552,CPT,,,,,,Outpatient,,,90,,Humana,Humana,9.04,,,,,,,Fee Schedule,9.04,67.18,
97552 Speech Caregiver Training Group,13767339,LOCAL,97552,CPT,,,,,,Outpatient,,,90,,Humana,Humana,9.04,,,,,,,Fee Schedule,9.04,67.18,
"Beta-2-Glycoprotein I Antibodies (IgG, IgM) QSTC",10094523,LOCAL,86146,CPT,,,,,,Outpatient,,,90,30.54,Humana,Humana,25.45,,,,,,,Fee Schedule,15.29,25.45,
Bill Only ABO,7936964,LOCAL,86900,CPT,,,,,,Outpatient,,,90,3.59,Humana,Humana,117.85,,,,,,,Fee Schedule,6.29,117.85,
Bill Only Rh,7936965,LOCAL,86901,CPT,,,,,,Outpatient,,,90,3.59,Humana,Humana,35.88,,,,,,,Fee Schedule,6.29,35.88,
B-Type Natriuretic Peptide,1383771,LOCAL,83880,CPT,,,,,,Outpatient,,,90,47.11,Humana,Humana,13.36,,,,,,,Fee Schedule,13.36379562,46.74,
"GROUP CAREGIVER TRAINING IN STRATEGIES & TECHNIQUES, FACE TO FACE, INITIAL 30 MIN 97552",13788179,LOCAL,97552,CPT,,,,,,Outpatient,,,90,,Humana,Humana,9.04,,,,,,,Fee Schedule,9.04,67.18,
"Helicobacter pylori Ag, EIA, Stool QSTC",8873559,LOCAL,87338,CPT,,,,,,Outpatient,,,90,17.26,Humana,Humana,14.38,,,,,,,Fee Schedule,10.57,14.38,
Heparin Induced Plt Ab QSTC,8995550,LOCAL,86022,CPT,,,,,,Outpatient,,,90,22.04,Humana,Humana,18.37,,,,,,,Fee Schedule,15.29,18.37,
"HPV Genotypes 16,18/45 QST",9773953,LOCAL,87625,CPT,,,,,,Outpatient,,,90,48.66,Humana,Humana,64.87,,,,,,,Fee Schedule,40.19,64.87,
"HPV GENOTYPES 16,18/45,$POST-HYST, VAGINAL QST",14782712,LOCAL,87625,CPT,,,,,,Outpatient,,,90,48.66,Humana,Humana,64.87,,,,,,,Fee Schedule,40.19,64.87,
N-Terminal Pro B-Type Natriuretic Peptide,1503769,LOCAL,83880,CPT,,,,,,Outpatient,,,90,47.11,Humana,Humana,13.36,,,,,,,Fee Schedule,13.36379562,46.74,
OT Group Caregiver Training Units,13624357,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,90,,Humana,Humana,20.25,,,,,,,Fee Schedule,20.25,67.18,
SLP Group Caregiver Training Time,14466882,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,90,,Humana,Humana,20.25,,,,,,,Fee Schedule,20.25,67.18,
"Tacrolimus, Highly Sens, LC/MS/MS QSTC",8764783,LOCAL,80197,CPT,,,,,,Outpatient,,,90,16.48,Humana,Humana,51.73,,,,,,,Fee Schedule,15.38,51.73,
Topiramate QSTC,8764585,LOCAL,80201,CPT,,,,,,Outpatient,,,90,14.3,Humana,Humana,11.92,,,,,,,Fee Schedule,11.92,15.38,
Vitamin D 25 Hydroxy Level,4240407,LOCAL,82306,CPT,,,,,,Outpatient,,,90,35.52,Humana,Humana,45.2,,,,,,,Fee Schedule,17.73,45.19775253,
NEUROPSYCHOLOGICAL TEST ADMINISTRATION,13472049,LOCAL,96146,CPT,,,,,,Outpatient,,,91.31,59,Humana,Humana,22.39,,,,,,,Fee Schedule,22.39,846.56,
Creatinine Urine,1930782,LOCAL,82570,CPT,,,,,,Outpatient,,,91.8,6.22,Humana,Humana,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
Fibrinogen Level,633728,LOCAL,85384,CPT,,,,,,Outpatient,,,92.21,11.66,Humana,Humana,9.72,,,,,,,Fee Schedule,5.42,9.72,
Rapid Plasma Reagin,633820,LOCAL,86592,CPT,,,,,,Outpatient,,,92.21,5.12,Humana,Humana,19.99,,,,,,,Fee Schedule,15.29,19.99375,
Rapid Plasma Reagin Qualitative,7948395,LOCAL,86592,CPT,,,,,,Outpatient,,,92.21,5.12,Humana,Humana,19.99,,,,,,,Fee Schedule,15.29,19.99375,
Rapid Plasma Reagin Qualitative w/ Reflex,8166073,LOCAL,86592,CPT,,,,,,Outpatient,,,92.21,5.12,Humana,Humana,19.99,,,,,,,Fee Schedule,15.29,19.99375,
Blood Type ABO/Rh Typing,634326,LOCAL,86900,CPT,,,,,,Outpatient,,,92.71,3.59,Humana,Humana,117.85,,,,,,,Fee Schedule,6.29,117.85,
Cord ABORh,8019069,LOCAL,86900,CPT,,,,,,Outpatient,,,92.71,3.59,Humana,Humana,117.85,,,,,,,Fee Schedule,6.29,117.85,
Neonatal ABORh,8070665,LOCAL,86900,CPT,,,,,,Outpatient,,,92.71,3.59,Humana,Humana,117.85,,,,,,,Fee Schedule,6.29,117.85,
Fetal Screen,634335,LOCAL,85461,CPT,,,,,,Outpatient,,,93.02,11.23,Humana,Humana,9.36,,,,,,,Fee Schedule,8.21,9.36,
methylPREDNISolone sodium succinate 500 mg injection [CULL],11201954,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,93.2352,,Humana,Humana,0.21,,,,,,,Fee Schedule,0.21,0.21,
99175 IPECAC EMESIS W/OBSERVATION TechFee,8057714,LOCAL,99175,CPT,,,,,,Outpatient,,,93.74,61,Humana,Humana,39.94,,,,,,,Fee Schedule,39.94,983.02,
RT Vapotherm Initial CHARGE,8144190,LOCAL,94002,CPT,,,,,,Outpatient,,,94.68,663,Humana,Humana,604.42,,,,,,,Fee Schedule,604.42,941,
"Coccidioides Antibody, CF & ID, S QSTC",8764815,LOCAL,86635,CPT,,,,,,Outpatient,,,95.18,13.76,Humana,Humana,11.47,,,,,,,Fee Schedule,11.47,15.29,
"Chlamydia Trachomatis RNA, TMA QST",9774353,LOCAL,87491,CPT,,,,,,Outpatient,,,96,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
DAPTOmycin 350 mg intravenous injection [CULL],11210540,LOCAL,J0878,CPT,,,,,,Outpatient,1,EA,96,480,Humana,Humana,0.03,,,,,,,Fee Schedule,0.01,122.4,
"Neisseria Gonorrhoeae RNA, TMA QST",9774354,LOCAL,87591,CPT,,,,,,Outpatient,,,96,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Trichomonas Vaginalis RNA, Ql, TMA QST",9774358,LOCAL,87661,CPT,,,,,,Outpatient,,,96,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
Creat Clear,633609,LOCAL,82575,CPT,,,,,,Outpatient,,,96.29,11.35,Humana,Humana,52.79,,,,,,,Fee Schedule,7.16,52.785,
Creat Clear (No U24),8477916,LOCAL,82575,CPT,,,,,,Outpatient,,,96.29,11.35,Humana,Humana,52.79,,,,,,,Fee Schedule,7.16,52.785,
doxycycline 100 mg injection [CULL],11201705,LOCAL,J1271,CPT,,,,,,Outpatient,1,EA,96.64,,Humana,Humana,0.1,,,,,,,Fee Schedule,0.102,0.102,
Aspartate aminotransferase,633633,LOCAL,84450,CPT,,,,,,Outpatient,,,96.7,6.22,Humana,Humana,50.89,,,,,,,Fee Schedule,7.16,50.89,
Blood Urea Nitrogen,633605,LOCAL,84520,CPT,,,,,,Outpatient,,,96.7,4.74,Humana,Humana,26.82,,,,,,,Fee Schedule,7.16,26.82133333,
Mononucleosis Screen,633785,LOCAL,86308,CPT,,,,,,Outpatient,,,96.7,6.22,Humana,Humana,5.18,,,,,,,Fee Schedule,5.18,15.29,
Monospot POCT,9038464,LOCAL,86308,CPT,,,,,,Outpatient,,,96.7,6.22,Humana,Humana,5.18,,,,,,,Fee Schedule,5.18,15.29,
Gentamicin Level,3454415,LOCAL,80170,CPT,,,,,,Outpatient,,,97.1,19.66,Humana,Humana,16.38,,,,,,,Fee Schedule,15.38,16.38,
Gentamicin Level Peak,633736,LOCAL,80170,CPT,,,,,,Outpatient,,,97.1,19.66,Humana,Humana,16.38,,,,,,,Fee Schedule,15.38,16.38,
Gentamicin Level Trough,633737,LOCAL,80170,CPT,,,,,,Outpatient,,,97.1,19.66,Humana,Humana,16.38,,,,,,,Fee Schedule,15.38,16.38,
Gamma Glutamyl Transferase,1628895,LOCAL,82977,CPT,,,,,,Outpatient,,,97.92,8.64,Humana,Humana,52.49,,,,,,,Fee Schedule,7.16,52.49,
Renal Function Panel,1634883,LOCAL,80069,CPT,,,,,,Outpatient,,,97.92,10.42,Humana,Humana,37.66,,,,,,,Fee Schedule,12.14,37.65984615,
CULL NM Therapy I131 Cap Per MCI,13644969,LOCAL,,,A9517,HCPCS,,,,Outpatient,,,98.48,64,Humana,Humana,23.13,,,,,,,Fee Schedule,23.13,662.39,
96423 CHEMO ARTRL INF EA ADDL HR CHARGE,9404493,LOCAL,96423,CPT,,,,,,Outpatient,,,98.94,64,Humana,Humana,42.18,,,,,,,Fee Schedule,42.18,749.76,
90913 - Bfb training ea addl 15 min.,9442436,LOCAL,90913,CPT,,,,,,Outpatient,,,99,64,Humana,Humana,20.19,,,,,,,Fee Schedule,20.19,233.61,
Caregiver Agreement on Discipline,7355021,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,99,,Humana,Humana,20.25,,,,,,,Fee Schedule,20.25,67.18,
Caregiver Agreement on Discipline,7355021,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,99,,Humana,Humana,20.25,,,,,,,Fee Schedule,20.25,67.18,
Cholesterol Total,633705,LOCAL,82465,CPT,,,,,,Outpatient,,,99.14,5.22,Humana,Humana,4.35,,,,,,,Fee Schedule,4.35,7.16,
Progesterone Level,3454459,LOCAL,84144,CPT,,,,,,Outpatient,,,99.14,25.03,Humana,Humana,59.8,,,,,,,Fee Schedule,18.43,59.795,
Triglyceride,633852,LOCAL,84478,CPT,,,,,,Outpatient,,,99.14,6.89,Humana,Humana,52.39,,,,,,,Fee Schedule,7.16,52.385,
"Histoplasma Antibody Panel, CF and ID, Serum QSTC",10185600,LOCAL,86698,CPT,,,,,,Outpatient,,,99.5,16.55,Humana,Humana,13.79,,,,,,,Fee Schedule,13.79,15.29,
"64420 INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVE, SINGLE ProFee",13959631,LOCAL,64420,CPT,,,,,,Outpatient,,,100,693,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
E3581 Thawed Cryo AHF,7267123,LOCAL,,,P9012,HCPCS,,,,Outpatient,,,100,65,Humana,Humana,63.57,,,,,,,Fee Schedule,63.57,217.45,
HPV mRNA E6/E7 QST,9775619,LOCAL,87624,CPT,,,,,,Outpatient,,,100,42.11,Humana,Humana,67.2,,,,,,,Fee Schedule,40.19,67.195,
HPV mRNA E6/E7 QST,10585636,LOCAL,87624,CPT,,,,,,Outpatient,,,100,42.11,Humana,Humana,67.2,,,,,,,Fee Schedule,40.19,67.195,
POC Chem8+ Panel,8920330,LOCAL,80048,CPT,,,,,,Outpatient,,,100,10.15,Humana,Humana,37.17,,,,,,,Fee Schedule,12.14,37.17170492,
Thinprep Review Cytotechnologist: QST,9775616,LOCAL,88175,CPT,,,,,,Outpatient,,,100,31.93,Humana,Humana,26.61,,,,,,,Fee Schedule,25.25,26.61,
Thinprep Review Cytotechnologist: QST,10585633,LOCAL,88175,CPT,,,,,,Outpatient,,,100,31.93,Humana,Humana,26.61,,,,,,,Fee Schedule,25.25,26.61,
97116  SB Pt Gait Train 15 mn,9640030,LOCAL,97116,CPT,,,,,GP,Outpatient,,,100.04,65,Humana,Humana,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
97116 GAIT TRAINING CHARGE,9410151,LOCAL,97116,CPT,,,,,GP,Outpatient,,,100.04,65,Humana,Humana,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
97116 PT Gait Training Assistant Units,9650030,LOCAL,97116,CPT,,,,,GP|CQ,Outpatient,,,100.04,65,Humana,Humana,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
Gait Training Charges,7895941,LOCAL,97116,CPT,,,,,GP,Outpatient,,,100.04,65,Humana,Humana,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
PT Gait Training Assistant Units,9390436,LOCAL,97116,CPT,,,,,CQ,Outpatient,,,100.04,65,Humana,Humana,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
Activated PTT,7938959,LOCAL,85730,CPT,,,,,,Outpatient,,,101.52,7.21,Humana,Humana,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
Bilirubin Direct,4240528,LOCAL,82248,CPT,,,,,,Outpatient,,,101.59,6.02,Humana,Humana,26.63,,,,,,,Fee Schedule,7.16,26.6275,
Bilirubin Direct,7939101,LOCAL,82248,CPT,,,,,,Outpatient,,,101.59,6.02,Humana,Humana,26.63,,,,,,,Fee Schedule,7.16,26.6275,
Bilirubin Direct,8443662,LOCAL,82248,CPT,,,,,,Outpatient,,,101.59,6.02,Humana,Humana,26.63,,,,,,,Fee Schedule,7.16,26.6275,
iSTAT Creatinine POCT,11673045,LOCAL,82565,CPT,,,,,,Outpatient,,,101.59,6.14,Humana,Humana,10.06,,,,,,,Fee Schedule,7.16,10.061625,
Lipid Pnl,633777,LOCAL,80061,CPT,,,,,,Outpatient,,,101.59,16.07,Humana,Humana,16.6,,,,,,,Fee Schedule,12.14,16.59934459,
77062 MG Diagnostic Tomo Charge: AddOn Bilateral,13969682,LOCAL,G0279,CPT,,,,,,Outpatient,,,101.84,,Humana,Humana,11.11,,,,,,,Fee Schedule,11.11,74,
77063 MG Tomo Charge: AddOn Bilateral,13621440,LOCAL,77063,CPT,,,,,,Outpatient,,,101.84,54.45,Humana,Humana,20.75,,,,,,,Fee Schedule,20.75,74,
CULL Mammo Tomo Add On,7867705,LOCAL,77063,CPT,,,,,,Outpatient,,,101.84,54.45,Humana,Humana,20.75,,,,,,,Fee Schedule,20.75,74,
hepatitis B pediatric vaccine 10 mcg/0.5 mL intramuscular suspension 0.5 mL [CULL],11202559,LOCAL,90744,CPT,,,,,,Outpatient,0.5,ML,102.17472,,Humana,Humana,33.2,,,,,,,Fee Schedule,33.204,39.58,
Immunoglobulin G Subclass 1 QSTC,8851875,LOCAL,82787,CPT,,,,,,Outpatient,,,102.38,9.62,Humana,Humana,8.02,,,,,,,Fee Schedule,7.16,8.02,
"Immunoglobulin G, Serum QSTC",8851879,LOCAL,82784,CPT,,,,,,Outpatient,,,102.38,11.16,Humana,Humana,34.96,,,,,,,Fee Schedule,7.16,34.958,
"HVA, 24h Urine w/o Creat QSTC",13864511,LOCAL,83150,CPT,,,,,,Outpatient,,,102.56,26.89,Humana,Humana,22.41,,,,,,,Fee Schedule,18.43,22.41,
CYSTOGRAM INJ,8210035,LOCAL,51600,CPT,,,,,,Outpatient,,,103,246,Humana,Humana,35.39,,,,,,,Fee Schedule,35.39,863,
Therapeutic Phlebotomy,8118276,LOCAL,99195,CPT,,,,,,Outpatient,,,103.04,67,Humana,Humana,117.85,,,,,,,Fee Schedule,85.79,117.85,
Strep A Xpress (GeneXpert),8642789,LOCAL,87651,CPT,,,,,,Outpatient,,,103.5,42.11,Humana,Humana,3.7,,,,,,,Fee Schedule,3.7,40.19,
Cerebrospinal Fluid Culture,4122737,LOCAL,87070,CPT,,,,,,Outpatient,,,103.63,10.34,Humana,Humana,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
pamidronate 3 mg/mL intravenous solution 10 mL [CULL],11211072,LOCAL,J2430,CPT,,,,,,Outpatient,10,ML,103.68,,Humana,Humana,11.29,,,,,,,Fee Schedule,11.29,11.29,
Coronavirus SARS Ag (Sofia),9803641,LOCAL,87426,CPT,,,,,,Outpatient,,,104,42.4,Humana,Humana,56.41,,,,,,,Fee Schedule,10.57,56.40806897,
COVID-19 Ag,11561110,LOCAL,87426,CPT,,,,,,Outpatient,,,104,42.4,Humana,Humana,56.41,,,,,,,Fee Schedule,10.57,56.40806897,
Urine Drug Screen,3454403,LOCAL,80306,CPT,,,,,,Outpatient,,,104,20.57,Humana,Humana,0.24,,,,,,,Fee Schedule,0.2416,17.73,
97533 PT SENSORY INTEGRATIVE TECH 15MIN,9866109,LOCAL,97533,CPT,,,,,GO|CO,Outpatient,,,104.14,68,Humana,Humana,55.09,,,,,,,Fee Schedule,55.09,56.44,
97533 SENSORY INTEGATIVE TECHNIQUES EACH 15 MINS,9856109,LOCAL,97533,CPT,,,,,GO,Outpatient,,,104.14,68,Humana,Humana,55.09,,,,,,,Fee Schedule,55.09,56.44,
OT Sensory Integrative Tech Assistant Units,7895276,LOCAL,97533,CPT,,,,,CQ,Outpatient,,,104.14,68,Humana,Humana,55.09,,,,,,,Fee Schedule,55.09,56.44,
OT Sensory Integrative Techniques Units,1373568,LOCAL,97533,CPT,,,,,GO,Outpatient,,,104.14,68,Humana,Humana,55.09,,,,,,,Fee Schedule,55.09,56.44,
Sensory Stimulation Charge,7895276,LOCAL,97533,CPT,,,,,GO,Outpatient,,,104.14,68,Humana,Humana,55.09,,,,,,,Fee Schedule,55.09,56.44,
L3908 Clavicle Brace,9800048,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,104.31,86,Humana,Humana,67.37,,,,,,,Fee Schedule,67.37,67.37,
L3908 Wrist/forearm Brace,9800047,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,104.31,86,Humana,Humana,67.37,,,,,,,Fee Schedule,67.37,67.37,
"Chlamydia Trachomatis RNA, TMA QST",14435138,LOCAL,87491,CPT,,,,,,Outpatient,,,105,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
HPV mRNA E6/E7 QST,14435137,LOCAL,87624,CPT,,,,,,Outpatient,,,105,42.11,Humana,Humana,67.2,,,,,,,Fee Schedule,40.19,67.195,
"Neisseria Gonorrhoeae RNA, TMA QST",14435139,LOCAL,87591,CPT,,,,,,Outpatient,,,105,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
Thinprep Review Cytotechnologist: QST,14435134,LOCAL,88175,CPT,,,,,,Outpatient,,,105,31.93,Humana,Humana,26.61,,,,,,,Fee Schedule,25.25,26.61,
Iron Level,633765,LOCAL,83540,CPT,,,,,,Outpatient,,,105.26,7.76,Humana,Humana,48.88,,,,,,,Fee Schedule,7.16,48.87820628,
Iron Level,7050169,LOCAL,83540,CPT,,,,,,Outpatient,,,105.26,7.76,Humana,Humana,48.88,,,,,,,Fee Schedule,7.16,48.87820628,
Iron Level,10543519,LOCAL,83540,CPT,,,,,,Outpatient,,,105.26,7.76,Humana,Humana,48.88,,,,,,,Fee Schedule,7.16,48.87820628,
"Vitamin B2 (Riboflavin), P QSTC",8972877,LOCAL,84252,CPT,,,,,,Outpatient,,,106.2,24.29,Humana,Humana,20.24,,,,,,,Fee Schedule,17.73,20.24,
L3908 Daytimer Wrist Support,9800046,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,106.38,86,Humana,Humana,67.37,,,,,,,Fee Schedule,67.37,67.37,
97537 COMMUNITY/WORK REINTEGRATION,9650036,LOCAL,97537,CPT,,,,,GP|CQ,Outpatient,,,107.75,70,Humana,Humana,29.96,,,,,,,Fee Schedule,29.96,56.44,
97537 Community/work reintegration training; each 15 minutes,9860034,LOCAL,97537,CPT,,,,,GO|CO,Outpatient,,,107.75,70,Humana,Humana,29.96,,,,,,,Fee Schedule,29.96,56.44,
97537 OT COMM WORK INTEGRATION CHARGE,9850034,LOCAL,97537,CPT,,,,,GO,Outpatient,,,107.75,70,Humana,Humana,29.96,,,,,,,Fee Schedule,29.96,56.44,
97537 PT ERGONOMIC TRAINING,9640036,LOCAL,97537,CPT,,,,,GP,Outpatient,,,107.75,70,Humana,Humana,29.96,,,,,,,Fee Schedule,29.96,56.44,
Community/Work Reintegration Charges,1366455,LOCAL,97537,CPT,,,,,GO,Outpatient,,,107.75,70,Humana,Humana,29.96,,,,,,,Fee Schedule,29.96,56.44,
"OT Community, Work Reintegration Assistant Units",1366455,LOCAL,97537,CPT,,,,,CQ,Outpatient,,,107.75,70,Humana,Humana,29.96,,,,,,,Fee Schedule,29.96,56.44,
"OT Community, Work Reintegration Assistant Units",1373453,LOCAL,97537,CPT,,,,,CQ,Outpatient,,,107.75,70,Humana,Humana,29.96,,,,,,,Fee Schedule,29.96,56.44,
"OT Community, Work Reintegration Units",1373453,LOCAL,97537,CPT,,,,,GO,Outpatient,,,107.75,70,Humana,Humana,29.96,,,,,,,Fee Schedule,29.96,56.44,
OT Community/Work Reintegration Charges,1366455,LOCAL,97537,CPT,,,,,GO,Outpatient,,,107.75,70,Humana,Humana,29.96,,,,,,,Fee Schedule,29.96,56.44,
"PT Community,Work Reintegration Assistant Units",9390450,LOCAL,97537,CPT,,,,,CQ,Outpatient,,,107.75,70,Humana,Humana,29.96,,,,,,,Fee Schedule,29.96,56.44,
PT Community/Work Reintegration Charge,7895991,LOCAL,97537,CPT,,,,,GP,Outpatient,,,107.75,70,Humana,Humana,29.96,,,,,,,Fee Schedule,29.96,56.44,
AChR Bind Ab w/rfx MuSK Ab QSTC,13864498,LOCAL,86041,CPT,,,,,,Outpatient,,,108,22.08,Humana,Humana,18.4,,,,,,,Fee Schedule,15.29,18.4,
Alpha-1-Antitrypsin QN QSTC,13873077,LOCAL,82103,CPT,,,,,,Outpatient,,,108,16.13,Humana,Humana,60.59,,,,,,,Fee Schedule,17.73,60.59,
Carnitine QSTC,8764784,LOCAL,82379,CPT,,,,,,Outpatient,,,108,20.24,Humana,Humana,16.87,,,,,,,Fee Schedule,16.87,17.73,
EKG Charges - RT -> Routine ECG 12 lead/15 lead tracing only,5367589,LOCAL,93041,CPT,,,,,,Outpatient,,,108.53,71,Humana,Humana,54.31,,,,,,,Fee Schedule,38.53,54.31,
97542  SB PT Wheelchair Mgt,9640037,LOCAL,97542,CPT,,,,,GP,Outpatient,,,108.91,71,Humana,Humana,29.37,,,,,,,Fee Schedule,29.37,56.44,
97542 OT WHEELCHAIR MANAGE/TRAIN 15MIN,9820201,LOCAL,97542,CPT,,,,,GO,Outpatient,,,108.91,71,Humana,Humana,29.37,,,,,,,Fee Schedule,29.37,56.44,
97542 PT WC SEATING EVAL CHARGE,9650037,LOCAL,97542,CPT,,,,,GP|CQ,Outpatient,,,108.91,71,Humana,Humana,29.37,,,,,,,Fee Schedule,29.37,56.44,
"97542 Wheelchair management (eg, assessment, fitting, training), each 15 minutes",9860201,LOCAL,97542,CPT,,,,,GO|CO,Outpatient,,,108.91,71,Humana,Humana,29.37,,,,,,,Fee Schedule,29.37,56.44,
97542 WHEELCHAIR MANAGEMENT CHARGE,9410201,LOCAL,97542,CPT,,,,,GP,Outpatient,,,108.91,71,Humana,Humana,29.37,,,,,,,Fee Schedule,29.37,56.44,
OT Wheelchair Management Assistant Units,7895273,LOCAL,97542,CPT,,,,,CQ,Outpatient,,,108.91,71,Humana,Humana,29.37,,,,,,,Fee Schedule,29.37,56.44,
OT Wheelchair Management Units,1373570,LOCAL,97542,CPT,,,,,GO,Outpatient,,,108.91,71,Humana,Humana,29.37,,,,,,,Fee Schedule,29.37,56.44,
PT Wheelchair Management Assistant Units,9390452,LOCAL,97542,CPT,,,,,CQ,Outpatient,,,108.91,71,Humana,Humana,29.37,,,,,,,Fee Schedule,29.37,56.44,
Wheelchair Charge,7895273,LOCAL,97542,CPT,,,,,GO,Outpatient,,,108.91,71,Humana,Humana,29.37,,,,,,,Fee Schedule,29.37,56.44,
Wheelchair Management Charges,7895931,LOCAL,97542,CPT,,,,,GP,Outpatient,,,108.91,71,Humana,Humana,29.37,,,,,,,Fee Schedule,29.37,56.44,
97551 OT Caregiver Training Ea Add'l 15 Mins,13647370,LOCAL,97551,CPT,,,,,,Outpatient,,,110,,Humana,Humana,20.67,,,,,,,Fee Schedule,20.67,95.93,
97551 PT Caregiver Training Ea Add'l 15 Mins,13645598,LOCAL,97551,CPT,,,,,,Outpatient,,,110,,Humana,Humana,20.67,,,,,,,Fee Schedule,20.67,95.93,
97551 ST Caregiver Training Ea  Addl 15 min,14017194,LOCAL,97551,CPT,,,,,,Outpatient,,,110,,Humana,Humana,20.67,,,,,,,Fee Schedule,20.67,95.93,
Facility Eval and Management Level 1 99211,10633491,LOCAL,99211,CPT,,,,,,Outpatient,,,110,226,Humana,Humana,7.37,,,,,,,Fee Schedule,7.37,7.37,
Medical Day Dressing Change,10633491,LOCAL,99211,CPT,,,,,,Outpatient,,,110,226,Humana,Humana,7.37,,,,,,,Fee Schedule,7.37,7.37,
"OT Caregiver Training, Addl 15 Min Asst",13623455,LOCAL,,,G0542,HCPCS,,,,Outpatient,,,110,,Humana,Humana,25.18,,,,,,,Fee Schedule,25.18,95.93,
"OT Caregiver Training, First 30 Min Asst",13623453,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,110,,Humana,Humana,50.79,,,,,,,Fee Schedule,50.79,95.93,
"SLP Caregiver Training, Addl 15 Min Time",14466886,LOCAL,,,G0542,HCPCS,,,,Outpatient,,,110,,Humana,Humana,25.18,,,,,,,Fee Schedule,25.18,95.93,
% CD19 (B Cells) QSTC,9416397,LOCAL,86355,CPT,,,,,,Outpatient,,,110.25,45.28,Humana,Humana,37.73,,,,,,,Fee Schedule,15.29,37.73,
%CD 16+CD56 (NK Cells) QSTC,9416395,LOCAL,86357,CPT,,,,,,Outpatient,,,110.25,45.28,Humana,Humana,37.73,,,,,,,Fee Schedule,15.29,37.73,
%CD3 Mature T Cells QSTC,9416288,LOCAL,86359,CPT,,,,,,Outpatient,,,110.25,45.28,Humana,Humana,37.73,,,,,,,Fee Schedule,15.29,37.73,
CD4/CD8 Ratio QSTC,8852258,LOCAL,86360,CPT,,,,,,Outpatient,,,110.25,56.38,Humana,Humana,46.98,,,,,,,Fee Schedule,44.29,46.98,
"Parvovirus B19 Antibodies(IgG, IgM) QSTC",8764577,LOCAL,86747,CPT,,,,,,Outpatient,,,110.25,18.04,Humana,Humana,15.03,,,,,,,Fee Schedule,15.03,15.29,
chlorproMAZINE 25 mg/mL injectable solution 1 mL [CULL],11202221,LOCAL,J3230,CPT,,,,,,Outpatient,1,ML,110.9376,,Humana,Humana,23.77,,,,,,,Fee Schedule,23.767,23.767,
CBC w/ Manual Differential,633682,LOCAL,85027,CPT,,,,,,Outpatient,,,111.38,7.76,Humana,Humana,27.03,,,,,,,Fee Schedule,8.21,27.02937879,
CBC without Differential,3798345,LOCAL,85027,CPT,,,,,,Outpatient,,,111.38,7.76,Humana,Humana,27.03,,,,,,,Fee Schedule,8.21,27.02937879,
gentamicin 40 mg/mL injectable solution 20 mL [CULL],11205229,LOCAL,J1580,CPT,,,,,,Outpatient,20,ML,112.2048,,Humana,Humana,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
DNase-B Antibody QSTC,8764548,LOCAL,86215,CPT,,,,,,Outpatient,,,112.5,15.9,Humana,Humana,13.25,,,,,,,Fee Schedule,13.25,15.29,
"Tissue Transglutaminase Ab(IgG,IgA) QSTC",8972930,LOCAL,86364,CPT,,,,,,Outpatient,,,112.5,13.84,Humana,Humana,61.9,,,,,,,Fee Schedule,15.29,61.9,
Cord DAT Gel,8416626,LOCAL,86880,CPT,,,,,,Outpatient,,,112.65,6.47,Humana,Humana,54.31,,,,,,,Fee Schedule,6.29,54.31,
DAT IgG Gel,7906396,LOCAL,86880,CPT,,,,,,Outpatient,,,112.65,6.47,Humana,Humana,54.31,,,,,,,Fee Schedule,6.29,54.31,
Neonatal DAT Gel,13460490,LOCAL,86880,CPT,,,,,,Outpatient,,,112.65,6.47,Humana,Humana,54.31,,,,,,,Fee Schedule,6.29,54.31,
LA Ven - Sepsis 2Hr,8485386,LOCAL,83605,CPT,,,,,,Outpatient,,,113.42,13.88,Humana,Humana,0.9,,,,,,,Fee Schedule,0.901879518,17.73,
Lactic Acid (Venous),3454442,LOCAL,83605,CPT,,,,,,Outpatient,,,113.42,13.88,Humana,Humana,0.9,,,,,,,Fee Schedule,0.901879518,17.73,
Lactic Acid (Venous) - Sepsis,8058058,LOCAL,83605,CPT,,,,,,Outpatient,,,113.42,13.88,Humana,Humana,0.9,,,,,,,Fee Schedule,0.901879518,17.73,
Unstable Hemoglobin QSTC,13864449,LOCAL,83068,CPT,,,,,,Outpatient,,,113.63,11.36,Humana,Humana,9.47,,,,,,,Fee Schedule,7.16,9.47,
97124 MASSAGE CHARGE,9640031,LOCAL,97124,CPT,,,,,GP,Outpatient,,,114.56,74,Humana,Humana,27.37,,,,,,,Fee Schedule,27.37,47.26,
97124 OT MASSAGE CHARGE,9850029,LOCAL,97124,CPT,,,,,GO,Outpatient,,,114.56,74,Humana,Humana,27.37,,,,,,,Fee Schedule,27.37,47.26,
97124 OT-MASSAGE EA 15 MIN,9860029,LOCAL,97124,CPT,,,,,GO|CO,Outpatient,,,114.56,74,Humana,Humana,27.37,,,,,,,Fee Schedule,27.37,47.26,
97124 PT Massage Assistant Units,9650031,LOCAL,97124,CPT,,,,,GP|CQ,Outpatient,,,114.56,74,Humana,Humana,27.37,,,,,,,Fee Schedule,27.37,47.26,
97140  Manual Therapy 15 min,9850047,LOCAL,97140,CPT,,,,,GO,Outpatient,,,114.56,74,Humana,Humana,65.85,,,,,,,Fee Schedule,56.44,65.845,
97140 MAN THER EA 15 MIN CHARGES,9640047,LOCAL,97140,CPT,,,,,GP,Outpatient,,,114.56,74,Humana,Humana,65.85,,,,,,,Fee Schedule,56.44,65.845,
97140 OT Manual Therapy Assistant Units,9860047,LOCAL,97140,CPT,,,,,GO|CO,Outpatient,,,114.56,74,Humana,Humana,65.85,,,,,,,Fee Schedule,56.44,65.845,
97140 PT Manual Therapy Assistant Units,9650047,LOCAL,97140,CPT,,,,,GP|CQ,Outpatient,,,114.56,74,Humana,Humana,65.85,,,,,,,Fee Schedule,56.44,65.845,
Manual Therapy Charge Units,7895928,LOCAL,97140,CPT,,,,,GP,Outpatient,,,114.56,74,Humana,Humana,65.85,,,,,,,Fee Schedule,56.44,65.845,
Manual Traction Charge,7895279,LOCAL,97140,CPT,,,,,GO,Outpatient,,,114.56,74,Humana,Humana,65.85,,,,,,,Fee Schedule,56.44,65.845,
Massage Charge Units,1041799,LOCAL,97124,CPT,,,,,GO,Outpatient,,,114.56,74,Humana,Humana,27.37,,,,,,,Fee Schedule,27.37,47.26,
Massage Charge Units,7895954,LOCAL,97124,CPT,,,,,GP,Outpatient,,,114.56,74,Humana,Humana,27.37,,,,,,,Fee Schedule,27.37,47.26,
OT Manual Therapy Assistant Units,1373444,LOCAL,97140,CPT,,,,,CQ,Outpatient,,,114.56,74,Humana,Humana,65.85,,,,,,,Fee Schedule,56.44,65.845,
OT Manual Therapy Units,1373444,LOCAL,97140,CPT,,,,,GO,Outpatient,,,114.56,74,Humana,Humana,65.85,,,,,,,Fee Schedule,56.44,65.845,
OT Massage Assistant Units,1041799,LOCAL,97124,CPT,,,,,CQ,Outpatient,,,114.56,74,Humana,Humana,27.37,,,,,,,Fee Schedule,27.37,47.26,
OT Massage Charge Units,1041799,LOCAL,97124,CPT,,,,,GO,Outpatient,,,114.56,74,Humana,Humana,27.37,,,,,,,Fee Schedule,27.37,47.26,
OT Massage Rehab Assist Units,7897698,LOCAL,97124,CPT,,,,,CQ,Outpatient,,,114.56,74,Humana,Humana,27.37,,,,,,,Fee Schedule,27.37,47.26,
OT Massage Rehab Units,7897698,LOCAL,97124,CPT,,,,,GO,Outpatient,,,114.56,74,Humana,Humana,27.37,,,,,,,Fee Schedule,27.37,47.26,
PT Manual Therapy Assistant Units,9390440,LOCAL,97140,CPT,,,,,CQ,Outpatient,,,114.56,74,Humana,Humana,65.85,,,,,,,Fee Schedule,56.44,65.845,
PT Massage Assistant Units,9390438,LOCAL,97124,CPT,,,,,CQ,Outpatient,,,114.56,74,Humana,Humana,27.37,,,,,,,Fee Schedule,27.37,47.26,
methylergonovine 0.2 mg/mL injectable solution 1 mL [CULL],11202918,LOCAL,J2210,CPT,,,,,,Outpatient,1,ML,114.8928,,Humana,Humana,21.36,,,,,,,Fee Schedule,21.363,21.363,
Thinprep TIS Pap QST,9773891,LOCAL,88175,CPT,,,,,,Outpatient,,,115,31.93,Humana,Humana,26.61,,,,,,,Fee Schedule,25.25,26.61,
Thinprep TIS Pap Rfx HPV mRNA E6/E7 QST,9773936,LOCAL,88175,CPT,,,,,,Outpatient,,,115,31.93,Humana,Humana,26.61,,,,,,,Fee Schedule,25.25,26.61,
97033 IONTOPHORESIS CHARGE,9410271,LOCAL,97033,CPT,,,,,GP,Outpatient,,,115.06,75,Humana,Humana,17.64,,,,,,,Fee Schedule,17.64,47.26,
97033 IONTOPHORESIS EA 15 MIN CHARGES,9640077,LOCAL,97033,CPT,,,,,GP,Outpatient,,,115.06,75,Humana,Humana,17.64,,,,,,,Fee Schedule,17.64,47.26,
97033 OT IONTOPHORESIS,9850073,LOCAL,97033,CPT,,,,,GO,Outpatient,,,115.06,75,Humana,Humana,17.64,,,,,,,Fee Schedule,17.64,47.26,
97033 OT IONTOPHORESIS 15 MIN APPL CHARGE,9860073,LOCAL,97033,CPT,,,,,GO|CO,Outpatient,,,115.06,75,Humana,Humana,17.64,,,,,,,Fee Schedule,17.64,47.26,
97033 PT IONTOPHORESIS,9650077,LOCAL,97033,CPT,,,,,GP|CQ,Outpatient,,,115.06,75,Humana,Humana,17.64,,,,,,,Fee Schedule,17.64,47.26,
Iontophoresis Charges,1366374,LOCAL,97033,CPT,,,,,GO,Outpatient,,,115.06,75,Humana,Humana,17.64,,,,,,,Fee Schedule,17.64,47.26,
Iontophoresis Charges,7895927,LOCAL,97033,CPT,,,,,GP,Outpatient,,,115.06,75,Humana,Humana,17.64,,,,,,,Fee Schedule,17.64,47.26,
OT Iontophoresis Assistant Units,1366374,LOCAL,97033,CPT,,,,,CQ,Outpatient,,,115.06,75,Humana,Humana,17.64,,,,,,,Fee Schedule,17.64,47.26,
OT Iontophoresis Assistant Units,1373443,LOCAL,97033,CPT,,,,,CQ,Outpatient,,,115.06,75,Humana,Humana,17.64,,,,,,,Fee Schedule,17.64,47.26,
OT Iontophoresis Charges,1366374,LOCAL,97033,CPT,,,,,GO,Outpatient,,,115.06,75,Humana,Humana,17.64,,,,,,,Fee Schedule,17.64,47.26,
OT Iontophoresis Units,1373443,LOCAL,97033,CPT,,,,,GO,Outpatient,,,115.06,75,Humana,Humana,17.64,,,,,,,Fee Schedule,17.64,47.26,
PT Iontophoresis Assistant Units,9390424,LOCAL,97033,CPT,,,,,CQ,Outpatient,,,115.06,75,Humana,Humana,17.64,,,,,,,Fee Schedule,17.64,47.26,
Allergy Panel13 Stinging Insect Grp QSTC,9063178,LOCAL,86003,CPT,,,,,,Outpatient,,,115.65,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Honey Bee (I1) IgE QST,12866524,LOCAL,86003,CPT,,,,,,Outpatient,,,115.65,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Peanut Component Panel QSTC,8764809,LOCAL,86008,CPT,,,,,,Outpatient,,,115.65,21.52,Humana,Humana,17.93,,,,,,,Fee Schedule,15.29,17.93,
RT CHARGE Chest Physiotherapy -> PEP Therapy Initial,8699752,LOCAL,94668,CPT,,,,,,Outpatient,,,115.89,75,Humana,Humana,117.85,,,,,,,Fee Schedule,76.09,117.85,
"Chlamydia Trachomatis RNA, TMA QST",12762527,LOCAL,87491,CPT,,,,,,Outpatient,,,117,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Mycoplasma Genitalium, rRNA QST",12762530,LOCAL,87563,CPT,,,,,,Outpatient,,,117,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",12762531,LOCAL,87591,CPT,,,,,,Outpatient,,,117,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
Trichomonas Vaginalis RNA QST,12762534,LOCAL,87661,CPT,,,,,,Outpatient,,,117,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
Ferritin,1628893,LOCAL,82728,CPT,,,,,,Outpatient,,,117.5,16.36,Humana,Humana,50.83,,,,,,,Fee Schedule,17.73,50.82956044,
97750 - Physical performance test or measurement,9640058,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,Humana,Humana,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 FCE-FUNCTIONAL CAPACITY EVAL 1 CHARGE,9640050,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,Humana,Humana,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 OT PERF TEST MEAS 15 MIN CHARGE,9850061,LOCAL,97750,CPT,,,,,GO,Outpatient,,,118.17,77,Humana,Humana,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 OT Strapping Shoulder Assistant Units,9860061,LOCAL,97750,CPT,,,,,GO|CO,Outpatient,,,118.17,77,Humana,Humana,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 PRE WORK SCREEN CHARGE,9650058,LOCAL,97750,CPT,,,,,GP|CQ,Outpatient,,,118.17,77,Humana,Humana,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 PT ISOKINETIC TEST 15 MIN,9640053,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,Humana,Humana,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 PT ISOKINETIC TEST 15 MIN ASST,9650053,LOCAL,97750,CPT,,,,,GP|CQ,Outpatient,,,118.17,77,Humana,Humana,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 PT PHYSICAL PERFORMANCE TEST CHARGE,9650050,LOCAL,97750,CPT,,,,,GP|CQ,Outpatient,,,118.17,77,Humana,Humana,31.29,,,,,,,Fee Schedule,31.29,56.44,
97761 (PROSTHETIC TRAINING CAWC),9650033,LOCAL,97761,CPT,,,,,GP|CQ,Outpatient,,,118.17,77,Humana,Humana,37.35,,,,,,,Fee Schedule,37.35,56.44,
97761 PROSTHETIC TRAINING 15 MINS,9640033,LOCAL,97761,CPT,,,,,GP,Outpatient,,,118.17,77,Humana,Humana,37.35,,,,,,,Fee Schedule,37.35,56.44,
97761 PT PROSTHETIC TRAINING CHARGE,9410181,LOCAL,97761,CPT,,,,,GP,Outpatient,,,118.17,77,Humana,Humana,37.35,,,,,,,Fee Schedule,37.35,56.44,
Functional Capacity Eval Charge,7895967,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,Humana,Humana,31.29,,,,,,,Fee Schedule,31.29,56.44,
OT Physical Performance Test Assistant Units,7895284,LOCAL,97750,CPT,,,,,CQ,Outpatient,,,118.17,77,Humana,Humana,31.29,,,,,,,Fee Schedule,31.29,56.44,
OT Physical Performance Test Charges,7895284,LOCAL,97750,CPT,,,,,GO,Outpatient,,,118.17,77,Humana,Humana,31.29,,,,,,,Fee Schedule,31.29,56.44,
OT Physical Performance Test Units,7897702,LOCAL,97750,CPT,,,,,GO,Outpatient,,,118.17,77,Humana,Humana,31.29,,,,,,,Fee Schedule,31.29,56.44,
Prosthetic Training Charges,7895930,LOCAL,97761,CPT,,,,,GP,Outpatient,,,118.17,77,Humana,Humana,37.35,,,,,,,Fee Schedule,37.35,56.44,
PT Physical Performance Assistant Test,9390432,LOCAL,97750,CPT,,,,,CQ,Outpatient,,,118.17,77,Humana,Humana,31.29,,,,,,,Fee Schedule,31.29,56.44,
PT Physical Performance Test Charges,7895980,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,Humana,Humana,31.29,,,,,,,Fee Schedule,31.29,56.44,
"PT Prosthetic Management, Train Assistant Units",9390460,LOCAL,97761,CPT,,,,,CQ,Outpatient,,,118.17,77,Humana,Humana,37.35,,,,,,,Fee Schedule,37.35,56.44,
"29125 Application of short arm splint (forearm to hand); static, right",8584933,LOCAL,29125,CPT,,,,,,Outpatient,,,120,129,Humana,Humana,117.85,,,,,,,Fee Schedule,63.51,863,
"Chlamydia Trachomatis RNA, TMA QST",14747186,LOCAL,87491,CPT,,,,,,Outpatient,,,120,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
Cortisol Baseline,7974014,LOCAL,80400,CPT,,,,,,Outpatient,,,120,39.14,Humana,Humana,75.99,,,,,,,Fee Schedule,18.43,75.985,
Cyt Clinical Info QST,14754292,LOCAL,88104,CPT,,,,,,Outpatient,,,120,,Humana,Humana,35.88,,,,,,,Fee Schedule,14.07,35.88,
Cyt Pathologist QST,14754294,LOCAL,88172,CPT,,,,,,Outpatient,,,120,,Humana,Humana,156.67,,,,,,,Fee Schedule,58.01,156.67,
Cyt Report Notes QST,14754295,LOCAL,88173,CPT,,,,,,Outpatient,,,120,,Humana,Humana,48.85,,,,,,,Fee Schedule,48.85,53.82,
Cyt Report Type QST,14754291,LOCAL,88121,CPT,,,,,,Outpatient,,,120,,Humana,Humana,156.67,,,,,,,Fee Schedule,58.01,156.67,
Cyt Screener QST,14754293,LOCAL,87207,CPT,,,,,,Outpatient,,,120,7.19,Humana,Humana,5.99,,,,,,,Fee Schedule,5.99,10.57,
"Mycoplasma Genitalium, rRNA QST",14747189,LOCAL,87563,CPT,,,,,,Outpatient,,,120,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",14747187,LOCAL,87591,CPT,,,,,,Outpatient,,,120,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
Tissue 1A Source QST,14754297,LOCAL,88108,CPT,,,,,,Outpatient,,,120,,Humana,Humana,35.88,,,,,,,Fee Schedule,14.07,35.88,
Tissue 1B Source QST,14754303,LOCAL,88108,CPT,,,,,,Outpatient,,,120,,Humana,Humana,35.88,,,,,,,Fee Schedule,14.07,35.88,
Tissue 1C Source QST,14754321,LOCAL,88108,CPT,,,,,,Outpatient,,,120,,Humana,Humana,35.88,,,,,,,Fee Schedule,14.07,35.88,
Tissue A Clinical Impression QST,14754296,LOCAL,88160,CPT,,,,,,Outpatient,,,120,,Humana,Humana,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue A Comment QST,14754301,LOCAL,88161,CPT,,,,,,Outpatient,,,120,,Humana,Humana,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue A Diagnosis QST,14754300,LOCAL,88162,CPT,,,,,,Outpatient,,,120,,Humana,Humana,48.85,,,,,,,Fee Schedule,48.85,58.01,
Tissue A Gross Description QST,14754299,LOCAL,88305,CPT,,,,,,Outpatient,,,120,,Humana,Humana,48.85,,,,,,,Fee Schedule,48.85,59.06,
Tissue B Comment QST,14754307,LOCAL,88161,CPT,,,,,,Outpatient,,,120,,Humana,Humana,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue B Diagnosis QST,14754306,LOCAL,88162,CPT,,,,,,Outpatient,,,120,,Humana,Humana,48.85,,,,,,,Fee Schedule,48.85,58.01,
Tissue B Gross Description QST,14754305,LOCAL,88305,CPT,,,,,,Outpatient,,,120,,Humana,Humana,48.85,,,,,,,Fee Schedule,48.85,59.06,
Tissue C Clinical Impression QST,14754320,LOCAL,88160,CPT,,,,,,Outpatient,,,120,,Humana,Humana,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue C Comment QST,14754325,LOCAL,88161,CPT,,,,,,Outpatient,,,120,,Humana,Humana,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue C Diagnosis QST,14754324,LOCAL,88162,CPT,,,,,,Outpatient,,,120,,Humana,Humana,48.85,,,,,,,Fee Schedule,48.85,58.01,
Tissue C Gross Description QST,14754323,LOCAL,88305,CPT,,,,,,Outpatient,,,120,,Humana,Humana,48.85,,,,,,,Fee Schedule,48.85,59.06,
Trichomonas Vaginalis RNA QST,14747188,LOCAL,87661,CPT,,,,,,Outpatient,,,120,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
naloxone 1 mg/mL injectable solution 2 mL [CULL],11202975,LOCAL,J2312,CPT,,,,,,Outpatient,2,ML,120.384,,Humana,Humana,0.07,,,,,,,Fee Schedule,0.065,0.065,
T. candidus QSTC,9010450,LOCAL,86606,CPT,,,,,,Outpatient,,,120.75,18.06,Humana,Humana,15.05,,,,,,,Fee Schedule,15.05,15.29,
T. vulgaris QSTC,9010456,LOCAL,86609,CPT,,,,,,Outpatient,,,120.75,15.46,Humana,Humana,12.88,,,,,,,Fee Schedule,12.88,15.29,
Trichoderma viride IgG QSTC,9010474,LOCAL,86001,CPT,,,,,,Outpatient,,,120.75,9.38,Humana,Humana,7.82,,,,,,,Fee Schedule,7.82,15.29,
L3925 Fo pip dip jnt/sprng pre ots,9856100,LOCAL,,,L3925,HCPCS,,,,Outpatient,,,121.05,79,Humana,Humana,59.39,,,,,,,Fee Schedule,59.39,59.39,
"Fecal Lipids, Total QSTC",8972795,LOCAL,82710,CPT,,,,,,Outpatient,,,121.19,20.16,Humana,Humana,16.8,,,,,,,Fee Schedule,16.8,17.73,
Oxcarbazepine Metabolite QSTC,8764758,LOCAL,80183,CPT,,,,,,Outpatient,,,121.5,15.9,Humana,Humana,13.25,,,,,,,Fee Schedule,13.25,15.38,
Lactated Ringers Injection 1000 mL [CULL],11281275,LOCAL,J7120,CPT,,,,,,Outpatient,1000,ML,121.6,,Humana,Humana,0.54,,,,,,,Fee Schedule,0.543820225,0.543820225,
97110  SB OT Thera Exer,9850027,LOCAL,97110,CPT,,,,,GO,Outpatient,,,122.28,79,Humana,Humana,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110  SB PT Thera Exer,9650027,LOCAL,97110,CPT,,,,,GP|CQ,Outpatient,,,122.28,79,Humana,Humana,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 EXERCISE 1/MORE AREAS CHARGE,9410136,LOCAL,97110,CPT,,,,,GP,Outpatient,,,122.28,79,Humana,Humana,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 OT Therapeutic Exercise Assistant Units,9860027,LOCAL,97110,CPT,,,,,GO|CO,Outpatient,,,122.28,79,Humana,Humana,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 PT THERAPEUTIC EXERCISE,9640054,LOCAL,97110,CPT,,,,,GP,Outpatient,,,122.28,79,Humana,Humana,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 PT Therapeutic Exercise Assistant Units,9650054,LOCAL,97110,CPT,,,,,GP|CQ,Outpatient,,,122.28,79,Humana,Humana,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 THERAPEUTIC EXER 15 MIN CHARGES,9640027,LOCAL,97110,CPT,,,,,GP,Outpatient,,,122.28,79,Humana,Humana,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
OT Therapeutic Exercise Assistant Units,750901,LOCAL,97110,CPT,,,,,CQ,Outpatient,,,122.28,79,Humana,Humana,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
OT Therapeutic Exercise Charges,750901,LOCAL,97110,CPT,,,,,GO,Outpatient,,,122.28,79,Humana,Humana,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
OT Therapeutic Exercise Rehab Units,7897696,LOCAL,97110,CPT,,,,,GO,Outpatient,,,122.28,79,Humana,Humana,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
PT Therapeutic Exercise Assistant Units,9390430,LOCAL,97110,CPT,,,,,CQ,Outpatient,,,122.28,79,Humana,Humana,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
Therapeutic Exercise Charges,750901,LOCAL,97110,CPT,,,,,GO,Outpatient,,,122.28,79,Humana,Humana,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
Therapeutic Exercise Charges,7895934,LOCAL,97110,CPT,,,,,GP,Outpatient,,,122.28,79,Humana,Humana,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
Creatine Kinase,633712,LOCAL,82550,CPT,,,,,,Outpatient,,,122.4,7.81,Humana,Humana,23.74,,,,,,,Fee Schedule,7.16,23.7373913,
Genital Culture,633894,LOCAL,87070,CPT,,,,,,Outpatient,,,122.4,10.34,Humana,Humana,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Respiratory Culture,4123062,LOCAL,87070,CPT,,,,,,Outpatient,,,122.4,10.34,Humana,Humana,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Sputum Culture,7909553,LOCAL,87070,CPT,,,,,,Outpatient,,,122.4,10.34,Humana,Humana,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Blood Culture,4122800,LOCAL,87040,CPT,,,,,,Outpatient,,,123.22,12.38,Humana,Humana,19.45,,,,,,,Fee Schedule,10.57,19.45393258,
Blood Unit Culture,7967813,LOCAL,87040,CPT,,,,,,Outpatient,,,123.22,12.38,Humana,Humana,19.45,,,,,,,Fee Schedule,10.57,19.45393258,
Folate Level,1628894,LOCAL,82746,CPT,,,,,,Outpatient,,,123.62,17.64,Humana,Humana,48.81,,,,,,,Fee Schedule,17.73,48.81056075,
Troponin-I,1634892,LOCAL,84484,CPT,,,,,,Outpatient,,,124.52,14.96,Humana,Humana,0.89,,,,,,,Fee Schedule,0.887987013,17.73,
influenza vaccine (Flucelvax PF) vaccine 2025-2026 [CULL],11292050,LOCAL,90661,CPT,,,,,,Outpatient,0.5,ML,124.60032,,Humana,Humana,52.02,,,,,,,Fee Schedule,39.58,52.0225,
methylPREDNISolone 1 g Pow,11201957,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,124.8,,Humana,Humana,0.21,,,,,,,Fee Schedule,0.21,0.21,
29584 PT APPLICATION OF MULTI-LAYER COMPRESSION SYSTEM,9109668,LOCAL,29584,CPT,,,,,GP,Outpatient,,,125,81,Humana,Humana,144.26,,,,,,,Fee Schedule,63.51,863,
PT MultiLayer Compress Below Knee Charge,7896004,LOCAL,29584,CPT,,,,,GP,Outpatient,,,125,81,Humana,Humana,144.26,,,,,,,Fee Schedule,63.51,863,
XR TMJ Open and Closed Left,9514710,LOCAL,70328,CPT,,,,,LT,Outpatient,,,125,66.83,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR TMJ Open and Closed Right,9514712,LOCAL,70328,CPT,,,,,RT,Outpatient,,,125,66.83,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
Liver Kidney Microsomal LKM1 Ab IgG QSTC,8764790,LOCAL,86376,CPT,,,,,,Outpatient,,,125.19,17.46,Humana,Humana,25.09,,,,,,,Fee Schedule,15.29,25.085,
Medium Cam Walking Boot,9400074,LOCAL,,,L4387,HCPCS,,,,Outpatient,,,125.35,67,Humana,Humana,195.89,,,,,,,Fee Schedule,195.89,195.89,
PTH-Related Protein (PTH-RP) QSTC,8764743,LOCAL,83519,CPT,,,,,,Outpatient,,,126,22.08,Humana,Humana,72.02,,,,,,,Fee Schedule,17.73,72.02,
REF DAT IgG,7939268,LOCAL,86880,CPT,,,,,,Outpatient,,,126,6.47,Humana,Humana,54.31,,,,,,,Fee Schedule,6.29,54.31,
Computer Crossmatch Interp -> Computer XM OK,8142426,LOCAL,86923,CPT,,,,,,Outpatient,,,126.02,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
Serological Immediate Spin -> Compatible,8014366,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
Serological Immediate Spin -> Corrected,10125801,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
Serological Immediate Spin -> Incompatible,9527535,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Gel Interp -> Compatible,8013754,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Gel Interp -> Incompatible,8013753,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Gel Interp -> Least Incompatible,8013752,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Tube Interp -> Compatible,8014220,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Tube Interp -> Incompatible,8014219,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Tube Interp -> Least Incompatible,8014218,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
Alanine aminotransferase,633632,LOCAL,84460,CPT,,,,,,Outpatient,,,126.07,6.36,Humana,Humana,5.3,,,,,,,Fee Schedule,5.3,7.16,
Erythrocyte Sedimentation Rate (ESR),7909828,LOCAL,85652,CPT,,,,,,Outpatient,,,126.07,3.24,Humana,Humana,43.68,,,,,,,Fee Schedule,8.21,43.67975976,
97112 BAL ACT EA 15 MIN CHARGES,9640028,LOCAL,97112,CPT,,,,,GP,Outpatient,,,127.2,83,Humana,Humana,30.63,,,,,,,Fee Schedule,30.63,56.44,
97112 NEUROMUSCULAR RE-EDUCATION CHARGE,9410141,LOCAL,97112,CPT,,,,,GP,Outpatient,,,127.2,83,Humana,Humana,30.63,,,,,,,Fee Schedule,30.63,56.44,
97112 OT NEURO MUSCULAR RE ED EA 15 MIN,9850028,LOCAL,97112,CPT,,,,,GO,Outpatient,,,127.2,83,Humana,Humana,30.63,,,,,,,Fee Schedule,30.63,56.44,
97112 OT Neuromusc Re-education Assistant Units,9860028,LOCAL,97112,CPT,,,,,GO|CO,Outpatient,,,127.2,83,Humana,Humana,30.63,,,,,,,Fee Schedule,30.63,56.44,
97112 PT Neuromuscular Re-Ed Assistant Units,9650028,LOCAL,97112,CPT,,,,,GP|CQ,Outpatient,,,127.2,83,Humana,Humana,30.63,,,,,,,Fee Schedule,30.63,56.44,
Neuromuscular Reeducation Charges,750905,LOCAL,97112,CPT,,,,,GO,Outpatient,,,127.2,83,Humana,Humana,30.63,,,,,,,Fee Schedule,30.63,56.44,
Neuromuscular Reeducation Charges,7895932,LOCAL,97112,CPT,,,,,GP,Outpatient,,,127.2,83,Humana,Humana,30.63,,,,,,,Fee Schedule,30.63,56.44,
OT Neuromuscular Reeducation Assistant Units,750905,LOCAL,97112,CPT,,,,,CQ,Outpatient,,,127.2,83,Humana,Humana,30.63,,,,,,,Fee Schedule,30.63,56.44,
OT Neuromuscular Reeducation Charges,750905,LOCAL,97112,CPT,,,,,GO,Outpatient,,,127.2,83,Humana,Humana,30.63,,,,,,,Fee Schedule,30.63,56.44,
OT Neuromuscular Reeducation Rehab Units,7897697,LOCAL,97112,CPT,,,,,GO,Outpatient,,,127.2,83,Humana,Humana,30.63,,,,,,,Fee Schedule,30.63,56.44,
PT Neuromuscular Reeducation Assistant Units,9390444,LOCAL,97112,CPT,,,,,CQ,Outpatient,,,127.2,83,Humana,Humana,30.63,,,,,,,Fee Schedule,30.63,56.44,
Culture Fungus Smear not Hr Skn Bld QST,10217136,LOCAL,87102,CPT,,,,,,Outpatient,,,127.3,10.09,Humana,Humana,53.14,,,,,,,Fee Schedule,10.57,53.14428571,
Alcohol Level,1503765,LOCAL,,,G0480,HCPCS,,,,Outpatient,,,129.74,84,Humana,Humana,114.43,,,,,,,Fee Schedule,46.74,114.43,
CBC w/ Differential,633683,LOCAL,85025,CPT,,,,,,Outpatient,,,129.74,9.32,Humana,Humana,31.46,,,,,,,Fee Schedule,8.21,31.45666667,
Na Citrate Platelet Count,9472554,LOCAL,85049,CPT,,,,,,Outpatient,,,129.74,5.38,Humana,Humana,33.54,,,,,,,Fee Schedule,8.21,33.535,
Platelet Count,2182297,LOCAL,85049,CPT,,,,,,Outpatient,,,129.74,5.38,Humana,Humana,33.54,,,,,,,Fee Schedule,8.21,33.535,
Platelet Count Manual,7974157,LOCAL,85049,CPT,,,,,,Outpatient,,,129.74,5.38,Humana,Humana,33.54,,,,,,,Fee Schedule,8.21,33.535,
iron dextran 50 mg/mL injectable solution 2 mL [CULL],11205256,LOCAL,J1750,CPT,,,,,,Outpatient,2,ML,129.85728,,Humana,Humana,18.11,,,,,,,Fee Schedule,18.11,122.4,
70030 X-RAY EYE FOR FOREIGN BODY,8658473,LOCAL,70030,CPT,,,,,,Outpatient,,,130,72.6,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Foreign Body Localization Eye,8658473,LOCAL,70030,CPT,,,,,,Outpatient,,,130,72.6,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
TSI(Thyroid Stimulating Immunoglob) QSTC,8764795,LOCAL,84445,CPT,,,,,,Outpatient,,,130.05,61.03,Humana,Humana,89.95,,,,,,,Fee Schedule,47.35,89.95,
Glucose Fasting GTT,8238854,LOCAL,82951,CPT,,,,,,Outpatient,,,130.97,15.44,Humana,Humana,12.87,,,,,,,Fee Schedule,12.87,17.73,
Small Cam Walking Boot,9400073,LOCAL,,,L4387,HCPCS,,,,Outpatient,,,131.56,67,Humana,Humana,195.89,,,,,,,Fee Schedule,195.89,195.89,
L3908 Comfort cool thumb/wrist CMC orthosis,9800210,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,131.58,86,Humana,Humana,67.37,,,,,,,Fee Schedule,67.37,67.37,
L3908 OT WRIST HAND ORTHOSIS,9800211,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,131.58,86,Humana,Humana,67.37,,,,,,,Fee Schedule,67.37,67.37,
Large Cam Walking Boot,9400070,LOCAL,,,L4387,HCPCS,,,,Outpatient,,,131.67,67,Humana,Humana,195.89,,,,,,,Fee Schedule,195.89,195.89,
97535  SB PT Act of Liv 15 m,9640035,LOCAL,97535,CPT,,,,,GP,Outpatient,,,132.09,86,Humana,Humana,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97535 OT HOME MAKING ACTIVITY CHARGE,9820191,LOCAL,97535,CPT,,,,,GO,Outpatient,,,132.09,86,Humana,Humana,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97535 OT SELF CARE/HOME MGMT/ADL 15 MIN,9860191,LOCAL,97535,CPT,,,,,GO|CO,Outpatient,,,132.09,86,Humana,Humana,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97535 PT ADL Training/Self Care Assistant Units,9650035,LOCAL,97535,CPT,,,,,GP|CQ,Outpatient,,,132.09,86,Humana,Humana,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97535 SELF CARE/HOME MGMT-ADL'S CHARGE,9410191,LOCAL,97535,CPT,,,,,GP,Outpatient,,,132.09,86,Humana,Humana,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
ADL Training Charge,7895959,LOCAL,97535,CPT,,,,,GP,Outpatient,,,132.09,86,Humana,Humana,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
ADL Training Charges,1366372,LOCAL,97535,CPT,,,,,GO,Outpatient,,,132.09,86,Humana,Humana,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
OT ADL Training Charges,1366372,LOCAL,97535,CPT,,,,,GO,Outpatient,,,132.09,86,Humana,Humana,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
"OT Self Care, Home Management Units",1373569,LOCAL,97535,CPT,,,,,GO,Outpatient,,,132.09,86,Humana,Humana,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
"OT Self Care, Home Mgmt Assistant Units",1373569,LOCAL,97535,CPT,,,,,CQ,Outpatient,,,132.09,86,Humana,Humana,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97530  SB OT Thera Act 15,9850032,LOCAL,97530,CPT,,,,,GO,Outpatient,,,133.15,87,Humana,Humana,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
97530 ACTIVITIES EACH 15 MIN CHARGE,9410270,LOCAL,97530,CPT,,,,,GP,Outpatient,,,133.15,87,Humana,Humana,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
97530 OT Therapeutic Activities Assistant Units,9860032,LOCAL,97530,CPT,,,,,GO|CO,Outpatient,,,133.15,87,Humana,Humana,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
97530 PT MAT\BED ACTIVITIES CHARGE,9640034,LOCAL,97530,CPT,,,,,GP,Outpatient,,,133.15,87,Humana,Humana,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
97530 PT Theraputic Activities Assistant Units,9650034,LOCAL,97530,CPT,,,,,GP|CQ,Outpatient,,,133.15,87,Humana,Humana,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
OT Therapeutic Activities Assistant Units,750903,LOCAL,97530,CPT,,,,,CQ,Outpatient,,,133.15,87,Humana,Humana,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
OT Therapeutic Activities Charges,750903,LOCAL,97530,CPT,,,,,GO,Outpatient,,,133.15,87,Humana,Humana,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
OT Therapeutic Activities Rehab Units,7897699,LOCAL,97530,CPT,,,,,GO,Outpatient,,,133.15,87,Humana,Humana,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
PT Therapeutic Activity Assistant Units,9390442,LOCAL,97530,CPT,,,,,CQ,Outpatient,,,133.15,87,Humana,Humana,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
Therapeutic Activities Charge,7895929,LOCAL,97530,CPT,,,,,GP,Outpatient,,,133.15,87,Humana,Humana,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
Therapeutic Activities Charges,750903,LOCAL,97530,CPT,,,,,GO,Outpatient,,,133.15,87,Humana,Humana,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
amiodarone 150 mg/100 mL-D5% intravenous solution 100 mL [CULL],11200044,LOCAL,J0283,CPT,,,,,,Outpatient,100,ML,133.2106667,,Humana,Humana,2.53,,,,,,,Fee Schedule,2.529,2.529,
BB CROSSMATCH (AHG),6413027,LOCAL,86922,CPT,,,,,,Outpatient,,,133.82,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
BB CROSSMATCH (XMG INSTRUMENT),6413070,LOCAL,86922,CPT,,,,,,Outpatient,,,133.82,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
Urine Culture,4126493,LOCAL,87086,CPT,,,,,,Outpatient,,,134.64,9.68,Humana,Humana,31.43,,,,,,,Fee Schedule,10.57,31.43235995,
.dRVVT 1:1 Mix QSTC,6230328,LOCAL,85613,CPT,,,,,,Outpatient,,,135,11.5,Humana,Humana,9.58,,,,,,,Fee Schedule,5.42,9.58,
Glomerular Basement Memb. Ab (IgG) QSTC,8853257,LOCAL,83520,CPT,,,,,,Outpatient,,,135,20.72,Humana,Humana,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Glutamic Acid Decarboxylase-65 Ab QSTC,8764746,LOCAL,86341,CPT,,,,,,Outpatient,,,135,28.28,Humana,Humana,23.57,,,,,,,Fee Schedule,15.29,23.57,
Quad Screen QSTC,8972927,LOCAL,81511,CPT,,,,,,Outpatient,,,135,184.2,Humana,Humana,153.5,,,,,,,Fee Schedule,153.5,173.68,
Ribosomal P Antibody QSTC,8853260,LOCAL,83516,CPT,,,,,,Outpatient,,,135,13.84,Humana,Humana,11.53,,,,,,,Fee Schedule,11.53,17.73,
"Rickettsia RMSF IgG,IgM w rfx Titer QSTC",8764764,LOCAL,86757,CPT,,,,,,Outpatient,,,135,23.22,Humana,Humana,19.35,,,,,,,Fee Schedule,15.29,19.35,
Tryptase QSTC,8764744,LOCAL,83520,CPT,,,,,,Outpatient,,,135,20.72,Humana,Humana,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
96523 Port Flush,14892040,LOCAL,96523,CPT,,,,,59,Outpatient,,,136,153,Humana,Humana,54.31,,,,,,,Fee Schedule,54.31,64.56,
OLANZapine 10 mg VL [CULL],11240752,LOCAL,J2358,CPT,,,,,,Outpatient,1,EA,136.096,,Humana,Humana,2.92,,,,,,,Fee Schedule,2.92,2.92,
.Endomysial Ab Titer QSTC,8853243,LOCAL,86231,CPT,,,,,,Outpatient,,,136.17,14.51,Humana,Humana,106.94,,,,,,,Fee Schedule,15.29,106.935,
Endomysial (IgG) Antibody Screen and Titer QSTC,10146198,LOCAL,86231,CPT,,,,,,Outpatient,,,136.17,14.51,Humana,Humana,106.94,,,,,,,Fee Schedule,15.29,106.935,
L3808 OT SPLINT - DORSAL HAND SPLINT CHARGE,9856068,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,137.3,89,Humana,Humana,375.59,,,,,,,Fee Schedule,375.59,375.59,
"L3808 WHFO, RIGID W/O JOINTS CHARGE",9856097,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,137.3,89,Humana,Humana,375.59,,,,,,,Fee Schedule,375.59,375.59,
"96361- Hydration, each additional hour",1928298,LOCAL,96361,CPT,,,,,,Outpatient,,,137.66,89,Humana,Humana,42.18,,,,,,,Fee Schedule,42.18,749.76,
96361 IV INFUSION HYDRATION ADDL HR Charge,8049102,LOCAL,96361,CPT,,,,,,Outpatient,,,137.66,89,Humana,Humana,42.18,,,,,,,Fee Schedule,42.18,749.76,
90472 PO IMMUNIZATION ADM EA ADDTL VAC CHARGE,9279753,LOCAL,90472,CPT,,,,,,Outpatient,,,137.77,90,Humana,Humana,14.55,,,,,,,Fee Schedule,14.55,56.18,
Phenytoin Lvl Total,7973985,LOCAL,80185,CPT,,,,,,Outpatient,,,138,15.9,Humana,Humana,75.5,,,,,,,Fee Schedule,15.38,75.495,
aztreonam 1 g injection [CULL],11201222,LOCAL,J0457,CPT,,,,,,Outpatient,1,EA,138.5472,,Humana,Humana,2.23,,,,,,,Fee Schedule,2.233,2.233,
"Allergy Panel 19, Seafood QSTC",13864480,LOCAL,86003,CPT,,,,,,Outpatient,,,138.78,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Crystal Examination Body Fluid,3454316,LOCAL,89060,CPT,,,,,,Outpatient,,,139,8.8,Humana,Humana,21.53,,,,,,,Fee Schedule,14.07,21.53,
Bill Cyto Path Cell Enhance Tech,8489561,LOCAL,88112,CPT,,,,,,Outpatient,,,139.94,,Humana,Humana,48.85,,,,,,,Fee Schedule,42.2,48.85,
Bill FNA Eval Interp & Rpt,8489566,LOCAL,88173,CPT,,,,,,Outpatient,,,139.94,,Humana,Humana,48.85,,,,,,,Fee Schedule,48.85,53.82,
Bill IHC Antibody Additional,14048006,LOCAL,88341,CPT,,,,,,Outpatient,,,139.94,,Humana,Humana,59.04,,,,,,,Fee Schedule,59.04,59.06,
Bill Tissue Exam Level 3,14047998,LOCAL,88304,CPT,,,,,,Outpatient,,,139.94,,Humana,Humana,48.85,,,,,,,Fee Schedule,32.32,48.85,
Bill Tissue Exam Level 4,14036169,LOCAL,88305,CPT,,,,,,Outpatient,,,139.94,,Humana,Humana,48.85,,,,,,,Fee Schedule,48.85,59.06,
70250 X-RAY EXAM OF SKULL,8658523,LOCAL,70250,CPT,,,,,,Outpatient,,,140,286.28,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
hepatitis A pediatric vaccine 25 units/0.5 mL intramuscular suspension 0.5 mL [CULL],11202555,LOCAL,90632,CPT,,,,,,Outpatient,0.5,ML,140.288,,Humana,Humana,73.54,,,,,,,Fee Schedule,39.58,73.542,
medroxyPROGESTERone 150 mg/mL intramuscular suspension 1 mL [CULL],11204480,LOCAL,J1050,CPT,,,,,,Outpatient,1,ML,140.704,,Humana,Humana,50.14,,,,,,,Fee Schedule,50.14,50.14,
"West Nile Ab IgG, CSF QSTC",13872975,LOCAL,86789,CPT,,,,,,Outpatient,,,141.3,17.27,Humana,Humana,14.39,,,,,,,Fee Schedule,14.39,15.29,
"West Nile Ab IgG, Serum QSTC",9010233,LOCAL,86789,CPT,,,,,,Outpatient,,,141.3,17.27,Humana,Humana,14.39,,,,,,,Fee Schedule,14.39,15.29,
"West Nile Ab IgM, CSF QSTC",13872978,LOCAL,86788,CPT,,,,,,Outpatient,,,141.3,20.22,Humana,Humana,16.85,,,,,,,Fee Schedule,15.29,16.85,
"West Nile Ab IgM, Serum QSTC",9010236,LOCAL,86788,CPT,,,,,,Outpatient,,,141.3,20.22,Humana,Humana,16.85,,,,,,,Fee Schedule,15.29,16.85,
"Chlamydia Trachomatis RNA, TMA QST",14718353,LOCAL,87491,CPT,,,,,,Outpatient,,,142,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
HPV MRNA E6/E7 QSTA,14718356,LOCAL,87624,CPT,,,,,,Outpatient,,,142,42.11,Humana,Humana,67.2,,,,,,,Fee Schedule,40.19,67.195,
Thinprep Review Cytotechnologist: QST,14718368,LOCAL,88175,CPT,,,,,,Outpatient,,,142,31.93,Humana,Humana,26.61,,,,,,,Fee Schedule,25.25,26.61,
"Trichomonas vaginalis, Ql TMA, Pap QST",14718355,LOCAL,87661,CPT,,,,,,Outpatient,,,142,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Cardio IQ(R) Lipoprotein Fraction, Ion Mobility QSTC",9039426,LOCAL,83704,CPT,,,,,,Outpatient,,,142.38,41.03,Humana,Humana,34.19,,,,,,,Fee Schedule,34.19,46.74,
Parathyroid Hormone Intact,3455483,LOCAL,83970,CPT,,,,,,Outpatient,,,143,49.54,Humana,Humana,92.84,,,,,,,Fee Schedule,47.35,92.84111111,
"Factor VIII Activity, Clotting QSTC",9039263,LOCAL,85240,CPT,,,,,,Outpatient,,,144,21.48,Humana,Humana,17.9,,,,,,,Fee Schedule,5.42,17.9,
"Sirolimus, LC/MS/MS QSTC",8764819,LOCAL,80195,CPT,,,,,,Outpatient,,,144,16.48,Humana,Humana,13.73,,,,,,,Fee Schedule,13.73,15.38,
97760 ORTHOTICS FIT/TRAIN EA 15MN CHARGE,9410176,LOCAL,97760,CPT,,,,,GP,Outpatient,,,144.44,94,Humana,Humana,42.32,,,,,,,Fee Schedule,42.32,56.44,
97760 ORTHOTICS FITTING & TRAINING CHARGE,9850030,LOCAL,97760,CPT,,,,,GO,Outpatient,,,144.44,94,Humana,Humana,42.32,,,,,,,Fee Schedule,42.32,56.44,
97760 OT Orthotic Mgmt/Train Initial Charge Assistant Units,9860030,LOCAL,97760,CPT,,,,,GO|CO,Outpatient,,,144.44,94,Humana,Humana,42.32,,,,,,,Fee Schedule,42.32,56.44,
97760 PO ORTHOTIC EVALUATION CHARGE,9640032,LOCAL,97760,CPT,,,,,GP,Outpatient,,,144.44,94,Humana,Humana,42.32,,,,,,,Fee Schedule,42.32,56.44,
97760 PO ORTHOTIC FOLLOW UP CHARGE,9650032,LOCAL,97760,CPT,,,,,GP|CQ,Outpatient,,,144.44,94,Humana,Humana,42.32,,,,,,,Fee Schedule,42.32,56.44,
Orthotic Mgmt and Training Charges,7895275,LOCAL,97760,CPT,,,,,GO,Outpatient,,,144.44,94,Humana,Humana,42.32,,,,,,,Fee Schedule,42.32,56.44,
Orthotic Mgmt and Training Charges,7895953,LOCAL,97760,CPT,,,,,GP,Outpatient,,,144.44,94,Humana,Humana,42.32,,,,,,,Fee Schedule,42.32,56.44,
"OT Orthotic Management, Train Assistant Units",1373573,LOCAL,97760,CPT,,,,,CQ,Outpatient,,,144.44,94,Humana,Humana,42.32,,,,,,,Fee Schedule,42.32,56.44,
"OT Orthotic Management, Train Units",1373573,LOCAL,97760,CPT,,,,,GO,Outpatient,,,144.44,94,Humana,Humana,42.32,,,,,,,Fee Schedule,42.32,56.44,
"PT Orthotic Management, Train Assistant Units",9390458,LOCAL,97760,CPT,,,,,CQ,Outpatient,,,144.44,94,Humana,Humana,42.32,,,,,,,Fee Schedule,42.32,56.44,
Urinary Catheter Type:; -> Straight/Intermittent,4610954,LOCAL,51701,CPT,,,,,,Outpatient,,,144.74,94,Humana,Humana,117.85,,,,,,,Fee Schedule,105.27,863,
EVENT MONITOR RECORDING ONLY,8200120,LOCAL,93270,CPT,,,,,,Outpatient,,,145.04,94,Humana,Humana,34.09,,,,,,,Fee Schedule,34.09,99.86,
desmopressin 4 mcg/mL injectable solution 1 mL [CULL],11201582,LOCAL,J2597,CPT,,,,,,Outpatient,1,ML,145.92,,Humana,Humana,3.52,,,,,,,Fee Schedule,3.52,233.26,
% CD3 (Mature T Cells) QSTC,13873423,LOCAL,86359,CPT,,,,,,Outpatient,,,146.25,45.28,Humana,Humana,37.73,,,,,,,Fee Schedule,15.29,37.73,
CD4/CD8 Ratio QSTC,13873439,LOCAL,86360,CPT,,,,,,Outpatient,,,146.25,56.38,Humana,Humana,46.98,,,,,,,Fee Schedule,44.29,46.98,
Beta hCG Qualitative,633663,LOCAL,84703,CPT,,,,,,Outpatient,,,146.88,9.02,Humana,Humana,7.52,,,,,,,Fee Schedule,7.16,7.52,
Serum Pregnancy Qual POCT,10461706,LOCAL,84703,CPT,,,,,,Outpatient,,,146.88,9.02,Humana,Humana,7.52,,,,,,,Fee Schedule,7.16,7.52,
Serum Pregnancy Test Qualitative,7909775,LOCAL,84703,CPT,,,,,,Outpatient,,,146.88,9.02,Humana,Humana,7.52,,,,,,,Fee Schedule,7.16,7.52,
Serum Pregnancy Test Qualitative w/ Reflex,9384303,LOCAL,84703,CPT,,,,,,Outpatient,,,146.88,9.02,Humana,Humana,7.52,,,,,,,Fee Schedule,7.16,7.52,
Urine Pregnancy POCT,8373784,LOCAL,81025,CPT,,,,,,Outpatient,,,146.88,10.33,Humana,Humana,13.38,,,,,,,Fee Schedule,4.02,13.375,
Urine Pregnancy Test Qualitative,7909798,LOCAL,81025,CPT,,,,,,Outpatient,,,146.88,10.33,Humana,Humana,13.38,,,,,,,Fee Schedule,4.02,13.375,
cefTRIAXone 1 g injection [CULL],11201426,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,147.0368,,Humana,Humana,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
"IgA, Serum QSTC",13873298,LOCAL,82787,CPT,,,,,,Outpatient,,,147.38,9.62,Humana,Humana,8.02,,,,,,,Fee Schedule,7.16,8.02,
IgA1 QSTC,13873292,LOCAL,82784,CPT,,,,,,Outpatient,,,147.38,11.16,Humana,Humana,34.96,,,,,,,Fee Schedule,7.16,34.958,
Tobramycin Level,1634888,LOCAL,80200,CPT,,,,,,Outpatient,,,148.1,19.36,Humana,Humana,16.13,,,,,,,Fee Schedule,15.38,16.13,
Blood Gas Arterial RT,8172944,LOCAL,36600,CPT,,,,,,Outpatient,,,148.2,96,Humana,Humana,117.85,,,,,,,Fee Schedule,85.79,863,
Blood Gas Draw Type -> Arterial (Puncture),5230102,LOCAL,36600,CPT,,,,,,Outpatient,,,148.2,96,Humana,Humana,117.85,,,,,,,Fee Schedule,85.79,863,
RT Arterial Puncture CHARGE,8143881,LOCAL,36600,CPT,,,,,,Outpatient,,,148.2,96,Humana,Humana,117.85,,,,,,,Fee Schedule,85.79,863,
"RT CHARGE PFT -> Maximum breathing capacity, Maximal voluntary ventilation (M",5267133,LOCAL,94200,CPT,,,,,,Outpatient,,,148.2,96,Humana,Humana,54.31,,,,,,,Fee Schedule,54.31,76.09,
XR TMJ Open and Closed Bilateral,1170502,LOCAL,70330,CPT,,,,,,Outpatient,,,150,80.85,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
Diphtheria Antitoxoid QSTC,14129477,LOCAL,86648,CPT,,,,,,Outpatient,,,151,18.25,Humana,Humana,15.21,,,,,,,Fee Schedule,15.21,15.29,
Tetanus Antitoxoid QSTC,14129478,LOCAL,86774,CPT,,,,,,Outpatient,,,151,17.76,Humana,Humana,14.8,,,,,,,Fee Schedule,14.8,15.29,
Hepatic Function Panel,633744,LOCAL,80076,CPT,,,,,,Outpatient,,,151.78,9.8,Humana,Humana,58.59,,,,,,,Fee Schedule,12.14,58.58814815,
Hepatic Panel,633744,LOCAL,80076,CPT,,,,,,Outpatient,,,151.78,9.8,Humana,Humana,58.59,,,,,,,Fee Schedule,12.14,58.58814815,
Dihydrotestosterone QSTC,8853275,LOCAL,82642,CPT,,,,,,Outpatient,,,151.88,35.14,Humana,Humana,29.28,,,,,,,Fee Schedule,18.43,29.28,
36430 BLOOD TRANSFUSION CHARGE,9284603,LOCAL,36430,CPT,,,,,,Outpatient,,,151.98,99,Humana,Humana,399.7,,,,,,,Fee Schedule,399.7,863,
BLOOD ADMINISTRATION Charge,5240125,LOCAL,36430,CPT,,,,,,Outpatient,,,151.98,99,Humana,Humana,399.7,,,,,,,Fee Schedule,399.7,863,
92608 ST EX FOR SPEECH DEVICE RX EACH 30 MIN ADDL TIM,9636007,LOCAL,92608,CPT,,,,,GN,Outpatient,,,152.72,99,Humana,Humana,44.72,,,,,,,Fee Schedule,44.72,337.75,
SLP Speech AAC Eval Addl Half Hour Units,1373854,LOCAL,92608,CPT,,,,,GN,Outpatient,,,152.72,99,Humana,Humana,44.72,,,,,,,Fee Schedule,44.72,337.75,
Speech Generating Device Eval Additional 30 Min,1373854,LOCAL,92608,CPT,,,,,GN,Outpatient,,,152.72,99,Humana,Humana,44.72,,,,,,,Fee Schedule,44.72,337.75,
Bill Only REF Splitting,13514968,LOCAL,86985,CPT,,,,,,Outpatient,,,153,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.88,156.67,
"Quantiferon(R)-TB Gold Plus, 1 Tube QST",9384402,LOCAL,86480,CPT,,,,,,Outpatient,,,153,74.38,Humana,Humana,65.24,,,,,,,Fee Schedule,44.29,65.24390244,
"Quantiferon(R)-TB Gold Plus, 1 Tube QSTC",8983765,LOCAL,86480,CPT,,,,,,Outpatient,,,153,74.38,Humana,Humana,65.24,,,,,,,Fee Schedule,44.29,65.24390244,
97113 AQUATIC THERAPY 15 MINS,9650029,LOCAL,97113,CPT,,,,,GP|CQ,Outpatient,,,153.55,100,Humana,Humana,34.34,,,,,,,Fee Schedule,34.34,56.44,
97113 AQUATIC THERAPY 15 MINS OT,9860051,LOCAL,97113,CPT,,,,,GO|CO,Outpatient,,,153.55,100,Humana,Humana,34.34,,,,,,,Fee Schedule,34.34,56.44,
97113 Occupational Therapy Aquatic charge,9850051,LOCAL,97113,CPT,,,,,GO,Outpatient,,,153.55,100,Humana,Humana,34.34,,,,,,,Fee Schedule,34.34,56.44,
97113 OT AQUATIC THERAPY CHARGE,9640029,LOCAL,97113,CPT,,,,,GP,Outpatient,,,153.55,100,Humana,Humana,34.34,,,,,,,Fee Schedule,34.34,56.44,
Aquatic Charge,7895272,LOCAL,97113,CPT,,,,,GO,Outpatient,,,153.55,100,Humana,Humana,34.34,,,,,,,Fee Schedule,34.34,56.44,
Aquatic Therapy Charges,7895958,LOCAL,97113,CPT,,,,,GP,Outpatient,,,153.55,100,Humana,Humana,34.34,,,,,,,Fee Schedule,34.34,56.44,
OT Aquatic Exercise Assistant Units,7895272,LOCAL,97113,CPT,,,,,CQ,Outpatient,,,153.55,100,Humana,Humana,34.34,,,,,,,Fee Schedule,34.34,56.44,
OT Aquatic Exercise Assistant Units,7898597,LOCAL,97113,CPT,,,,,CQ,Outpatient,,,153.55,100,Humana,Humana,34.34,,,,,,,Fee Schedule,34.34,56.44,
OT Aquatic Exercise Units,7897709,LOCAL,97113,CPT,,,,,GO,Outpatient,,,153.55,100,Humana,Humana,34.34,,,,,,,Fee Schedule,34.34,56.44,
OT Aquatic Exercise Units,7898597,LOCAL,97113,CPT,,,,,GO,Outpatient,,,153.55,100,Humana,Humana,34.34,,,,,,,Fee Schedule,34.34,56.44,
PT Aquatic Assistant Units,9390434,LOCAL,97113,CPT,,,,,CQ,Outpatient,,,153.55,100,Humana,Humana,34.34,,,,,,,Fee Schedule,34.34,56.44,
G0237 PULM REHAB EA 15 MIN,10470027,LOCAL,,,G0237,HCPCS,,,59,Outpatient,,,154.78,101,Humana,Humana,22.39,,,,,,,Fee Schedule,22.39,51.98,
G0239 PULMONARY EXERCISE,10470025,LOCAL,,,G0239,HCPCS,,,,Outpatient,,,154.78,101,Humana,Humana,35.88,,,,,,,Fee Schedule,35.88,51.98,
Calcium Oxalate QSTC,8997193,LOCAL,82340,CPT,,,,,,Outpatient,,,155,7.24,Humana,Humana,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
Sodium Urate QSTC,8997195,LOCAL,84300,CPT,,,,,,Outpatient,,,155,6.07,Humana,Humana,9.74,,,,,,,Fee Schedule,7.16,9.74,
Uric Acid QSTC,8997197,LOCAL,84560,CPT,,,,,,Outpatient,,,155,6.1,Humana,Humana,19.49,,,,,,,Fee Schedule,7.16,19.49,
"LD, Pericardial Fluid QSTC",13864442,LOCAL,83615,CPT,,,,,,Outpatient,,,155.39,7.25,Humana,Humana,21.68,,,,,,,Fee Schedule,7.16,21.675,
"16000 Initial treatment, first degree burn, when no more than local treatment required",9400038,LOCAL,16000,CPT,,,,,,Outpatient,,,155.91,101,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
Diphtheria Antitoxoid QST,13824476,LOCAL,86648,CPT,,,,,,Outpatient,,,156,18.25,Humana,Humana,15.21,,,,,,,Fee Schedule,15.21,15.29,
Tetanus Antitoxoid QST,13824477,LOCAL,86774,CPT,,,,,,Outpatient,,,156,17.76,Humana,Humana,14.8,,,,,,,Fee Schedule,14.8,15.29,
Transferrin,633851,LOCAL,84466,CPT,,,,,,Outpatient,,,156.67,15.31,Humana,Humana,29.64,,,,,,,Fee Schedule,17.73,29.64248366,
CANDIDA GLABRATA QST,12439000,LOCAL,87481,CPT,,,,,,Outpatient,,,157,42.11,Humana,Humana,478.17,,,,,,,Fee Schedule,40.19,478.165,
CANDIDA SPECIES QST,12438999,LOCAL,87481,CPT,,,,,,Outpatient,,,157,42.11,Humana,Humana,478.17,,,,,,,Fee Schedule,40.19,478.165,
"Chlamydia Trachomatis RNA, TMA QST",12439002,LOCAL,87591,CPT,,,,,,Outpatient,,,157,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",12439003,LOCAL,87491,CPT,,,,,,Outpatient,,,157,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
SURESWAB(R) ADV BV QST,12438998,LOCAL,81513,CPT,,,,,,Outpatient,,,157,171.16,Humana,Humana,142.63,,,,,,,Fee Schedule,63.34,142.63,
"TRICHOMONAS VAGINALIS (TV), TMA QST",12439001,LOCAL,87661,CPT,,,,,,Outpatient,,,157,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
CANDIDA GLABRATA QST,12433969,LOCAL,87481,CPT,,,,,,Outpatient,,,157.5,42.11,Humana,Humana,478.17,,,,,,,Fee Schedule,40.19,478.165,
CANDIDA SPECIES QST,12433968,LOCAL,87481,CPT,,,,,,Outpatient,,,157.5,42.11,Humana,Humana,478.17,,,,,,,Fee Schedule,40.19,478.165,
"CRYPTOSPORIDIUM ANTIGEN, EIA QSTC",12500635,LOCAL,87328,CPT,,,,,,Outpatient,,,157.5,16.58,Humana,Humana,13.82,,,,,,,Fee Schedule,10.57,13.82,
"Kappa/LambdaLt Chains,Freew/Ratio,S QSTC",8853285,LOCAL,83521,CPT,,,,,,Outpatient,,,157.5,20.72,Humana,Humana,87.22,,,,,,,Fee Schedule,17.73,87.215,
XR Bone Age Studies,1170014,LOCAL,77072,CPT,,,,,,Outpatient,,,157.72,84.98,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
BB REF ABO DISCREP (RH),6432002,LOCAL,86901,CPT,,,,,,Outpatient,,,159.75,3.59,Humana,Humana,35.88,,,,,,,Fee Schedule,6.29,35.88,
REF ABO/Rh Discrep,13484121,LOCAL,86900,CPT,,,,,,Outpatient,,,159.75,3.59,Humana,Humana,117.85,,,,,,,Fee Schedule,6.29,117.85,
"Ammonia, Plasma",7974187,LOCAL,82140,CPT,,,,,,Outpatient,,,160.34,17.48,Humana,Humana,22.63,,,,,,,Fee Schedule,17.73,22.62909091,
97164 CIS Prgm PT Re-Evaluation 20 min,9650016,LOCAL,97164,CPT,,,,,GP|CQ,Outpatient,,,160.46,104,Humana,Humana,62.94,,,,,,,Fee Schedule,62.94,349.89,
97164 RE-EVALUATION CHARGE,9410061,LOCAL,97164,CPT,,,,,GP,Outpatient,,,160.46,104,Humana,Humana,62.94,,,,,,,Fee Schedule,62.94,349.89,
97164 RE-EVALUATION PT CHARGES,9640016,LOCAL,97164,CPT,,,,,GP,Outpatient,,,160.46,104,Humana,Humana,62.94,,,,,,,Fee Schedule,62.94,349.89,
PT ReEval Time,7896016,LOCAL,97164,CPT,,,,,GP,Outpatient,,,160.46,104,Humana,Humana,62.94,,,,,,,Fee Schedule,62.94,349.89,
Tobramycin Level Peak,1634889,LOCAL,80200,CPT,,,,,,Outpatient,,,163.2,19.36,Humana,Humana,16.13,,,,,,,Fee Schedule,15.38,16.13,
Tobramycin Level Trough,1634890,LOCAL,80200,CPT,,,,,,Outpatient,,,163.2,19.36,Humana,Humana,16.13,,,,,,,Fee Schedule,15.38,16.13,
11719 TRIM NAIL(S) ANY NUMBER WC CHARGE,8726774,LOCAL,11719,CPT,,,,,,Outpatient,,,163.39,106,Humana,Humana,54.31,,,,,,,Fee Schedule,54.31,863,
.C-ANCA Titer QSTC,8764786,LOCAL,86037,CPT,,,,,,Outpatient,,,163.67,14.46,Humana,Humana,12.05,,,,,,,Fee Schedule,12.05,15.29,
.P-ANCA Titer QSTC,6225794,LOCAL,86037,CPT,,,,,,Outpatient,,,163.67,14.46,Humana,Humana,12.05,,,,,,,Fee Schedule,12.05,15.29,
"Methicillin Resistant Staphylococcus aureus,PCR QSTC",9630594,LOCAL,87641,CPT,,,,,,Outpatient,,,164.16,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
phytonadione 10 mg/mL injectable solution 1 mL [CULL],11212150,LOCAL,J3430,CPT,,,,,,Outpatient,1,ML,164.224,,Humana,Humana,2.81,,,,,,,Fee Schedule,2.808,2.808,
Bill Manual Tumor IM Histochem,14049347,LOCAL,88360,CPT,,,,,,Outpatient,,,164.92,,Humana,Humana,156.67,,,,,,,Fee Schedule,59.06,156.67,
Bill SB Consult 1st TB w FS SGL SP,14048002,LOCAL,88331,CPT,,,,,,Outpatient,,,164.92,,Humana,Humana,156.67,,,,,,,Fee Schedule,53.82,156.67,
Bill IHC Initial Antibody,14049345,LOCAL,88342,CPT,,,,,,Outpatient,,,164.98,,Humana,Humana,156.67,,,,,,,Fee Schedule,59.06,156.67,
29105 - Long Arm Splint,9322359,LOCAL,29105,CPT,,,,,,Outpatient,,,165,158,Humana,Humana,144.26,,,,,,,Fee Schedule,63.51,863,
Toxocara Ab (IgG) QSTC,13864452,LOCAL,86682,CPT,,,,,,Outpatient,,,165.38,15.61,Humana,Humana,13.01,,,,,,,Fee Schedule,13.01,15.29,
Tissue Culture,633906,LOCAL,87070,CPT,,,,,,Outpatient,,,166.46,10.34,Humana,Humana,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
acetaZOLAMIDE 500 mg intravenous injection [CULL],11200001,LOCAL,J1120,CPT,,,,,,Outpatient,1,EA,168.8,,Humana,Humana,25.59,,,,,,,Fee Schedule,25.594,25.594,
97763 OT Orthotic Mgmt/Train Establish Charge,9650038,LOCAL,97763,CPT,,,,,GP|CQ,Outpatient,,,168.9,110,Humana,Humana,45.74,,,,,,,Fee Schedule,45.74,56.44,
97763 OT Orthotic Mgmt/Train Established Assistant Units,9820206,LOCAL,97763,CPT,,,,,GO,Outpatient,,,168.9,110,Humana,Humana,45.74,,,,,,,Fee Schedule,45.74,56.44,
97763 OT Orthotic/Prosthetic Mgmt/Training - each 15 min,9860206,LOCAL,97763,CPT,,,,,GO|CO,Outpatient,,,168.9,110,Humana,Humana,45.74,,,,,,,Fee Schedule,45.74,56.44,
97763 PT ORTHO/PROST MNG/TRAIN EA 15,9410206,LOCAL,97763,CPT,,,,,GP,Outpatient,,,168.9,110,Humana,Humana,45.74,,,,,,,Fee Schedule,45.74,56.44,
97763 PT Orthotic Mgmt/Train Establish Charge,9640038,LOCAL,97763,CPT,,,,,GP,Outpatient,,,168.9,110,Humana,Humana,45.74,,,,,,,Fee Schedule,45.74,56.44,
OT Orthotic Mgmt/Train Est. Assit Units,7965332,LOCAL,97763,CPT,,,,,CQ,Outpatient,,,168.9,110,Humana,Humana,45.74,,,,,,,Fee Schedule,45.74,56.44,
OT Orthotic Mgmt/Train Establish Charge,7965332,LOCAL,97763,CPT,,,,,GO,Outpatient,,,168.9,110,Humana,Humana,45.74,,,,,,,Fee Schedule,45.74,56.44,
OT Orthotic Mgmt/Train Establish Rehab Units,7964942,LOCAL,97763,CPT,,,,,GO,Outpatient,,,168.9,110,Humana,Humana,45.74,,,,,,,Fee Schedule,45.74,56.44,
PT Orthotic Mgmt/Train Establish Charge,7965252,LOCAL,97763,CPT,,,,,GP,Outpatient,,,168.9,110,Humana,Humana,45.74,,,,,,,Fee Schedule,45.74,56.44,
"PT Orthotic/Prosthetic Manage,Train Assistant Units",9390462,LOCAL,97763,CPT,,,,,CQ,Outpatient,,,168.9,110,Humana,Humana,45.74,,,,,,,Fee Schedule,45.74,56.44,
Total Glutathione QST,14799054,LOCAL,82978,CPT,,,,,,Outpatient,,,169,18.54,Humana,Humana,15.45,,,,,,,Fee Schedule,15.45,17.73,
epoetin alfa-epbx 4000 units/mL preservative-free injectable solution 1 mL [CULL],11202396,LOCAL,Q5106,CPT,,,,,,Outpatient,1,ML,169.4208,,Humana,Humana,7.85,,,,,,,Fee Schedule,7.85,525.49,
CT Heart Calcium Scoring,2424782,LOCAL,75571,CPT,,,,,,Outpatient,,,170,90.75,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,170.53,
"Cortisol, LC/MS, Saliva QSTC",8853249,LOCAL,82530,CPT,,,,,,Outpatient,,,171,20.05,Humana,Humana,29.79,,,,,,,Fee Schedule,17.73,29.79,
Factor V (Leiden) Mutation Analysis QSTC,8764652,LOCAL,81241,CPT,,,,,,Outpatient,,,171,88.04,Humana,Humana,73.37,,,,,,,Fee Schedule,63.34,73.37,
"Lyme Disease Ab (IgM), Blot QSTC",8849718,LOCAL,86617,CPT,,,,,,Outpatient,,,171,18.59,Humana,Humana,15.49,,,,,,,Fee Schedule,15.29,15.49,
"Lyme Disease Ab(IgG),Blot QSTC",8849707,LOCAL,86617,CPT,,,,,,Outpatient,,,171,18.59,Humana,Humana,15.49,,,,,,,Fee Schedule,15.29,15.49,
Prothrombin Gene Analysis QSTC,8764653,LOCAL,81240,CPT,,,,,,Outpatient,,,171,78.83,Humana,Humana,65.69,,,,,,,Fee Schedule,63.34,65.69,
Cholesterol HDL,3170344,LOCAL,83718,CPT,,,,,,Outpatient,,,172,9.83,Humana,Humana,8.19,,,,,,,Fee Schedule,7.16,8.19,
Glucagon QSTC,13864528,LOCAL,82943,CPT,,,,,,Outpatient,,,173.7,17.15,Humana,Humana,14.29,,,,,,,Fee Schedule,14.29,18.43,
fondaparinux 2.5 mg/0.5 mL subcutaneous solution 0.5 mL [CULL],11260583,LOCAL,J1652,CPT,,,,,,Outpatient,0.5,ML,174.8864,,Humana,Humana,0.88,,,,,,,Fee Schedule,0.877,0.877,
CULL MG Wire Loc Needle,13721990,LOCAL,10035,CPT,A4648,HCPCS,,,,Outpatient,,,174.99,114,Humana,Humana,643.26,,,,,,,Fee Schedule,643.26,1291,
90912 - Bfb training 1st 15 min.,9442435,LOCAL,90912,CPT,,,,,,Outpatient,,,175,114,Humana,Humana,35.97,,,,,,,Fee Schedule,35.97,233.61,
97129 Cognition Ther Intervent First 15 min,9850048,LOCAL,97129,CPT,,,,,GO,Outpatient,,,175,114,Humana,Humana,18.94,,,,,,,Fee Schedule,18.94,56.44,
97129 Cognition Ther Intervent First 15 min Assistant Units,9860048,LOCAL,97129,CPT,,,,,GO|CO,Outpatient,,,175,114,Humana,Humana,18.94,,,,,,,Fee Schedule,18.94,56.44,
97130 Cognition Ther Intervent Addlt 15 min,9850049,LOCAL,97130,CPT,,,,,GO,Outpatient,,,175,114,Humana,Humana,18.08,,,,,,,Fee Schedule,18.08,56.44,
97130 Cognition Ther Intervent Addlt 15 min Assistant Units,9860049,LOCAL,97130,CPT,,,,,GO|CO,Outpatient,,,175,114,Humana,Humana,18.08,,,,,,,Fee Schedule,18.08,56.44,
"OT Cog Ther Intervent, Addl 15 Min Asst",9401146,LOCAL,97130,CPT,,,,,CQ,Outpatient,,,175,114,Humana,Humana,18.08,,,,,,,Fee Schedule,18.08,56.44,
"OT Cog Ther Intervent, Addl 15 Min Units",9401146,LOCAL,97130,CPT,,,,,GO,Outpatient,,,175,114,Humana,Humana,18.08,,,,,,,Fee Schedule,18.08,56.44,
"OT Cog Ther Intervent, First 15 Min Asst",9401140,LOCAL,97129,CPT,,,,,CQ,Outpatient,,,175,114,Humana,Humana,18.94,,,,,,,Fee Schedule,18.94,56.44,
"OT Cog Ther Intervent,First 15 Min Units",9401140,LOCAL,97129,CPT,,,,,GO,Outpatient,,,175,114,Humana,Humana,18.94,,,,,,,Fee Schedule,18.94,56.44,
Bill Only Pheno Non-Rh EA/Ag,13517193,LOCAL,86905,CPT,,,,,,Outpatient,,,175.5,4.6,Humana,Humana,328.88,,,,,,,Fee Schedule,6.29,328.88,
Bill Only REF Thawing,13514966,LOCAL,86927,CPT,,,,,,Outpatient,,,175.5,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.88,156.67,
Ref Hgb S,9527497,LOCAL,85660,CPT,,,,,,Outpatient,,,175.5,6.61,Humana,Humana,5.51,,,,,,,Fee Schedule,5.51,8.21,
Basic Metabolic Panel,633628,LOCAL,80048,CPT,,,,,,Outpatient,,,176.26,10.15,Humana,Humana,37.17,,,,,,,Fee Schedule,12.14,37.17170492,
gemcitabine 1 g injection [CULL],11292094,LOCAL,J9201,CPT,,,,,,Outpatient,1,EA,176.384,,Humana,Humana,3.59,,,,,,,Fee Schedule,3.59,3.59,
RT CHARGE PFT -> Diffusion (DLCO),5267130,LOCAL,94729,CPT,,,,,,Outpatient,,,176.44,115,Humana,Humana,47.24,,,,,,,Fee Schedule,47.24,76.09,
E0773 Thawed FFP CPD,7267127,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Humana,Humana,84.29,,,,,,,Fee Schedule,84.29,217.45,
E1237 Thawed Aph FFP ACDA,7267133,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Humana,Humana,84.29,,,,,,,Fee Schedule,84.29,217.45,
E2701 Thawed Plasma CPD <24h,7267161,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Humana,Humana,84.29,,,,,,,Fee Schedule,84.29,217.45,
E2737 Thawed Plasma CP2D <24h,7267171,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Humana,Humana,84.29,,,,,,,Fee Schedule,84.29,217.45,
E4713 Thawed Aph FFP ACDA 1,7267173,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Humana,Humana,84.29,,,,,,,Fee Schedule,84.29,217.45,
E4717 Thawed Aph FFP ACDA 2,7267174,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Humana,Humana,84.29,,,,,,,Fee Schedule,84.29,217.45,
E4721 Thawed Aph FFP ACDA 3,7267175,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Humana,Humana,84.29,,,,,,,Fee Schedule,84.29,217.45,
amiodarone 360 mg/200 mL-D5% intravenous solution 200 mL [CULL],11200046,LOCAL,J0283,CPT,,,,,,Outpatient,200,ML,177.1776,,Humana,Humana,2.53,,,,,,,Fee Schedule,2.529,2.529,
protamine 10 mg/mL injectable solution 25 mL [CULL],11211130,LOCAL,J2720,CPT,,,,,,Outpatient,25,ML,178.208,,Humana,Humana,1.57,,,,,,,Fee Schedule,1.571,1.571,
Anti-Mullerian Hormone (AMH) Female QSTC,8972886,LOCAL,82166,CPT,,,,,,Outpatient,,,180,46.34,Humana,Humana,38.62,,,,,,,Fee Schedule,17.73,38.62,
"Chlamydia Trachomatis RNA, TMA QST",14718336,LOCAL,87491,CPT,,,,,,Outpatient,,,180,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Chromogranin A, LC/MS/MS QSTC",10319690,LOCAL,86316,CPT,,,,,,Outpatient,,,180,24.97,Humana,Humana,100.2,,,,,,,Fee Schedule,15.29,100.2,
"Estriol, Serum QSTC",9039351,LOCAL,82677,CPT,,,,,,Outpatient,,,180,29.02,Humana,Humana,24.18,,,,,,,Fee Schedule,18.43,24.18,
H. pylori Urea Breath Test QSTC,8764622,LOCAL,83013,CPT,,,,,,Outpatient,,,180,80.83,Humana,Humana,123.01,,,,,,,Fee Schedule,46.74,123.01,
"Metanephrines, Fract Free LCMSMS, P QSTC",8764672,LOCAL,83835,CPT,,,,,,Outpatient,,,180,20.33,Humana,Humana,98.31,,,,,,,Fee Schedule,18.43,98.305,
Mycophenolic Acid QSTC,9039269,LOCAL,80180,CPT,,,,,,Outpatient,,,180,21.66,Humana,Humana,98.85,,,,,,,Fee Schedule,15.38,98.845,
"Neisseria Gonorrhoeae RNA, TMA QST",14718337,LOCAL,87591,CPT,,,,,,Outpatient,,,180,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
Thinprep Review Cytotechnologist: QST,14718350,LOCAL,88175,CPT,,,,,,Outpatient,,,180,31.93,Humana,Humana,26.61,,,,,,,Fee Schedule,25.25,26.61,
"Trichomonas vaginalis, Ql TMA, Pap QST",14718338,LOCAL,87661,CPT,,,,,,Outpatient,,,180,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Galactose-Alpha-1,3-Galactose IgE QSTC",8764840,LOCAL,86008,CPT,,,,,,Outpatient,,,180.09,21.52,Humana,Humana,17.93,,,,,,,Fee Schedule,15.29,17.93,
HOLTER MONITOR  24H,8200090,LOCAL,93225,CPT,,,,,,Outpatient,,,182,198,Humana,Humana,117.85,,,,,,,Fee Schedule,99.86,117.85,
DRAIN TRU-CLOSE 500CC (BUY BY EACH-10/CS,6800045,LOCAL,,,A7048,HCPCS,,,,Outpatient,,,183.26,88,Humana,Humana,60.63,,,,,,,Fee Schedule,60.63,60.63,
FLUORO CENTRAL LINE PLACEMENT,8201221,LOCAL,77001,CPT,,,,,,Outpatient,,,184.82,177.38,Humana,Humana,70.92,,,,,,,Fee Schedule,70.92,262.79,
Vitamin B12 Level,633871,LOCAL,82607,CPT,,,,,,Outpatient,,,184.82,18.1,Humana,Humana,82.43,,,,,,,Fee Schedule,18.43,82.43266533,
XR Port Placement,10460170,LOCAL,77001,CPT,,,,,,Outpatient,,,184.82,177.38,Humana,Humana,70.92,,,,,,,Fee Schedule,70.92,262.79,
RT CHARGE Chest Physiotherapy -> PEP Therapy Subsequent,8699751,LOCAL,94667,CPT,,,,,,Outpatient,,,184.89,120,Humana,Humana,117.85,,,,,,,Fee Schedule,76.09,117.85,
RT CHARGE Mechanical Oscillation -> Yes,10417130,LOCAL,94667,CPT,,,,,,Outpatient,,,184.89,120,Humana,Humana,117.85,,,,,,,Fee Schedule,76.09,117.85,
"Streptococcus pneumoniae Ag, Ur QSTC",13864418,LOCAL,87899,CPT,,,,,,Outpatient,,,185.22,19.28,Humana,Humana,16.07,,,,,,,Fee Schedule,10.57,16.07,
"FVIII Act, Clotting QSTC",13873492,LOCAL,85240,CPT,,,,,,Outpatient,,,186.96,21.48,Humana,Humana,17.9,,,,,,,Fee Schedule,5.42,17.9,
"PTT, Activated QSTC",13873491,LOCAL,85730,CPT,,,,,,Outpatient,,,186.96,7.21,Humana,Humana,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
Ristocetin Cofactor QSTC,13873494,LOCAL,85245,CPT,,,,,,Outpatient,,,186.96,27.53,Humana,Humana,22.94,,,,,,,Fee Schedule,5.42,22.94,
von Willebrand Factor Ag QSTC,13873493,LOCAL,85246,CPT,,,,,,Outpatient,,,186.96,27.53,Humana,Humana,22.94,,,,,,,Fee Schedule,5.42,22.94,
"vWf Ag, Multimeric QSTC",13873495,LOCAL,85247,CPT,,,,,,Outpatient,,,186.96,27.53,Humana,Humana,22.94,,,,,,,Fee Schedule,5.42,22.94,
benztropine 1 mg/mL injectable solution 2 mL [CULL],11202065,LOCAL,J0515,CPT,,,,,,Outpatient,2,ML,188,,Humana,Humana,13.82,,,,,,,Fee Schedule,13.815,13.815,
.T. pallidum Ab QSTC,13864522,LOCAL,86780,CPT,,,,,,Outpatient,,,189,15.89,Humana,Humana,13.24,,,,,,,Fee Schedule,13.24,15.29,
Syphilis Antibody Cascading Reflex QSTC,8972904,LOCAL,86780,CPT,,,,,,Outpatient,,,189,15.89,Humana,Humana,13.24,,,,,,,Fee Schedule,13.24,15.29,
L3923 HFO W/O JOINTS PRE CST CHARGE,9646078,LOCAL,,,L3923,HCPCS,,,,Outpatient,,,191.03,124,Humana,Humana,97.81,,,,,,,Fee Schedule,97.81,97.81,
"MAG-SGPG Ab IgM, EIA QSTC",13864465,LOCAL,83520,CPT,,,,,,Outpatient,,,191.75,20.72,Humana,Humana,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
amphotericin B 50 mg Pow [CULL],J0285,CPT,,,,,,,,Outpatient,50,ML,192,,Humana,Humana,43.29,,,,,,,Fee Schedule,43.29,43.29,
"96366 IV INFUSION, MEDICATIONS, ADDITIONAL",7904532,LOCAL,96366,CPT,,,,,,Outpatient,,,193,125,Humana,Humana,42.18,,,,,,,Fee Schedule,42.18,749.76,
"96366- IV tx, each additional hour",1928300,LOCAL,96366,CPT,,,,,,Outpatient,,,193,125,Humana,Humana,42.18,,,,,,,Fee Schedule,42.18,749.76,
"96367 IV INFUSION, SEQUENTIAL, NEW OR DIFF",7904533,LOCAL,96367,CPT,,,,,,Outpatient,,,193,125,Humana,Humana,65.07,,,,,,,Fee Schedule,65.07,442.94,
"96367- IV tx, sequential infusion",1928301,LOCAL,96367,CPT,,,,,,Outpatient,,,193,125,Humana,Humana,65.07,,,,,,,Fee Schedule,65.07,442.94,
"96374- IV Injection, single/initial",1928305,LOCAL,96374,CPT,,,,,59,Outpatient,,,193,125,Humana,Humana,192.63,,,,,,,Fee Schedule,64.56,192.63,
96374 IV PUSH MEDS INIT INJ 15 MIN OR LESS,7904536,LOCAL,96374,CPT,,,,,59,Outpatient,,,193,125,Humana,Humana,192.63,,,,,,,Fee Schedule,64.56,192.63,
"96375- IV Injection, add new drug",1928306,LOCAL,96375,CPT,,,,,59,Outpatient,,,193,125,Humana,Humana,42.18,,,,,,,Fee Schedule,42.18,64.56,
"96375 IV PUSH INJECTION ADD, NEW OR DIFF",7904537,LOCAL,96375,CPT,,,,,59,Outpatient,,,193,125,Humana,Humana,42.18,,,,,,,Fee Schedule,42.18,64.56,
INJ IV PUSH THER/PROPH SUBSTANCE INTIAL,8210021,LOCAL,96374,CPT,,,,,59,Outpatient,,,193,125,Humana,Humana,192.63,,,,,,,Fee Schedule,64.56,192.63,
"Beryllium, Serum/Plasma QSTC",10704808,LOCAL,83018,CPT,,,,,,Outpatient,,,194.5,26.35,Humana,Humana,21.96,,,,,,,Fee Schedule,16.07,21.96,
9581626 EEG AWAKE/DROWSY PRO FEE CHARGES,8795941,LOCAL,95816,CPT,,,,,26,Outpatient,,,195,533,Humana,Humana,284.7,,,,,,,Fee Schedule,284.7,466.96,
95819 EEG AWAKE AND ASLEEP PRO-FEE CHARGE,13508139,LOCAL,95819,CPT,,,,,26,Outpatient,,,195,599,Humana,Humana,284.7,,,,,,,Fee Schedule,284.7,466.96,
95822 EEG COMA or SLEEP ONLY PRO,10049176,LOCAL,95822,CPT,,,,,26,Outpatient,,,195,499,Humana,Humana,284.7,,,,,,,Fee Schedule,284.7,466.96,
Vitamin B3 QSTC,8972908,LOCAL,84591,CPT,,,,,,Outpatient,,,195.75,20.47,Humana,Humana,17.06,,,,,,,Fee Schedule,17.06,17.73,
Thyroid Stimulating Hormone,633844,LOCAL,84443,CPT,,,,,,Outpatient,,,195.84,20.16,Humana,Humana,87.64,,,,,,,Fee Schedule,18.43,87.63697303,
TSH with Reflex to FT4,7948309,LOCAL,84439,CPT,,,,,,Outpatient,,,195.84,10.82,Humana,Humana,28.58,,,,,,,Fee Schedule,18.43,28.58065455,
"Mumps Virus Ab IgG, IgM, Diagnostic QSTC",13864479,LOCAL,86735,CPT,,,,,,Outpatient,,,196.07,15.66,Humana,Humana,13.05,,,,,,,Fee Schedule,13.05,15.29,
Deoxycorticosterone QSTC,13864487,LOCAL,82633,CPT,,,,,,Outpatient,,,196.2,37.18,Humana,Humana,30.98,,,,,,,Fee Schedule,18.43,30.98,
Q Fever Ab IgG IgM w/rfx Titers QSTC,13864460,LOCAL,86638,CPT,,,,,,Outpatient,,,196.56,14.54,Humana,Humana,12.12,,,,,,,Fee Schedule,12.12,15.29,
G0108 Diabetes Management Treatment 30 Minutes CHARGE,10255367,LOCAL,,,G0108,HCPCS,,,,Outpatient,,,196.8,128,Humana,Humana,52.41,,,,,,,Fee Schedule,52.41,95.93,
94799 Pulm Function Screen Charge,10440012,LOCAL,94799,CPT,,,,,,Outpatient,,,198.38,129,Humana,Humana,143.05,,,,,,,Fee Schedule,76.09,143.05,
97168 CIS Prgm OT Re-Evaluation 30 min,9850016,LOCAL,97168,CPT,,,,,GO,Outpatient,,,200.91,131,Humana,Humana,63.82,,,,,,,Fee Schedule,63.82,269.95,
97168 RE-EVALUATION CHARGE,9860016,LOCAL,97168,CPT,,,,,GO|CO,Outpatient,,,200.91,131,Humana,Humana,63.82,,,,,,,Fee Schedule,63.82,269.95,
OT ReEval Units,7895298,LOCAL,97168,CPT,,,,,GO,Outpatient,,,200.91,131,Humana,Humana,63.82,,,,,,,Fee Schedule,63.82,269.95,
OT ReEvaluation Units,7897819,LOCAL,97168,CPT,,,,,GO,Outpatient,,,200.91,131,Humana,Humana,63.82,,,,,,,Fee Schedule,63.82,269.95,
Gabapentin QSTC,8764562,LOCAL,80171,CPT,,,,,,Outpatient,,,202.5,26,Humana,Humana,111.87,,,,,,,Fee Schedule,15.38,111.87,
TRAb (TSH Receptor Binding Ab) QSTC,8764674,LOCAL,83520,CPT,,,,,,Outpatient,,,202.5,20.72,Humana,Humana,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
"Coccidioides Ab, CF w/ ID, CSF QSTC",13864531,LOCAL,86635,CPT,,,,,,Outpatient,,,203.04,13.76,Humana,Humana,11.47,,,,,,,Fee Schedule,11.47,15.29,
Body Fluid Culture,4122803,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Humana,Humana,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Ear Culture,633890,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Humana,Humana,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Eye Culture,633892,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Humana,Humana,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Medical Device Culture,633898,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Humana,Humana,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Nasal Culture,633900,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Humana,Humana,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
"Porphyrins, Fract, Quant, Random Ur QSTC",13864457,LOCAL,84120,CPT,,,,,,Outpatient,,,203.18,17.65,Humana,Humana,14.71,,,,,,,Fee Schedule,14.71,17.73,
Stool Culture,633904,LOCAL,87045,CPT,,,,,,Outpatient,,,203.18,11.33,Humana,Humana,79.67,,,,,,,Fee Schedule,10.57,79.665,
Throat Culture,633905,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Humana,Humana,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Wound Culture,633908,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Humana,Humana,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Wound Culture Deep,8395521,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Humana,Humana,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
micafungin 100 mg intravenous injection [CULL],11220353,LOCAL,J2248,CPT,,,,,,Outpatient,1,EA,203.7888,,Humana,Humana,0.25,,,,,,,Fee Schedule,0.249,122.4,
Vitamin K QSTC,8972880,LOCAL,84597,CPT,,,,,,Outpatient,,,203.9,16.46,Humana,Humana,13.72,,,,,,,Fee Schedule,13.72,17.73,
PSA Diagnostic,1634882,LOCAL,84153,CPT,,,,,,Outpatient,,,206.86,22.07,Humana,Humana,104.84,,,,,,,Fee Schedule,17.73,104.8447059,
PSA Screening,4123035,LOCAL,,,G0103,HCPCS,,,,Outpatient,,,206.86,134,Humana,Humana,19.31,,,,,,,Fee Schedule,15.29,19.31,
Chromatin (Nucleosomal) Antibody QSTC,10148609,LOCAL,86235,CPT,,,,,,Outpatient,,,206.91,21.52,Humana,Humana,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
94640 UDN SPECIAL MED 2 CHARGE,13515633,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,185.95,
94640 UDN SPECIAL MED CHARGE,13522003,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE Aerosol Therapy -> Subsequent,5397112,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE EZPAP -> Initial,9429159,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE EZPAP -> Subsequent,9429160,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE MDI -> Initial,12111660,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE MDI -> Subsequent,12111659,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE Suction -> BBG/Nasopharyngeal,6690655,LOCAL,31720,CPT,,,,,,Outpatient,,,208.54,136,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,863,
RT Continuous Neb Subsequent CHARGE,8144096,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT IPV Subsequent CHARGE,8144062,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> Cough,13657418,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> ET tube,13657417,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> Medication aerosol,8846461,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> Nasal aspirate,13650046,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> Nasal wash,13650044,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,185.95,
L3912 HFO FLEXION,9856101,LOCAL,,,L3912,HCPCS,,,,Outpatient,,,211.05,137,Humana,Humana,108.07,,,,,,,Fee Schedule,108.07,108.07,
"penicillin G potassium 20,000,000 units injection [CULL]",11211080,LOCAL,J2540,CPT,,,,,,Outpatient,1,EA,211.2,,Humana,Humana,0.78,,,,,,,Fee Schedule,0.78,0.78,
REF Antibody Screen,7939320,LOCAL,86850,CPT,,,,,,Outpatient,,,211.5,11.72,Humana,Humana,48.85,,,,,,,Fee Schedule,6.29,48.85,
US Unlisted Procedure,8733482,LOCAL,76999,CPT,,,,,,Outpatient,,,212.54,113.85,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,161.71,
%CDT QSTC,13864781,LOCAL,82373,CPT,,,,,,Outpatient,,,213.75,21.67,Humana,Humana,18.06,,,,,,,Fee Schedule,17.73,18.06,
Transferrin - QSTC,13864778,LOCAL,84466,CPT,,,,,,Outpatient,,,213.75,15.31,Humana,Humana,29.64,,,,,,,Fee Schedule,17.73,29.64248366,
hyaluronidase 150 units/mL injectable solution 1 mL [CULL],11282257,LOCAL,J3470,CPT,,,,,,Outpatient,1,ML,214.272,,Humana,Humana,31.81,,,,,,,Fee Schedule,31.807,122.4,
"96372 INJECTIONS (IM, SC) OP",7904535,LOCAL,96372,CPT,,,,,59,Outpatient,,,214.42,139,Humana,Humana,65.07,,,,,,,Fee Schedule,64.56,65.07,
96372- Subq/IM Injection,1928303,LOCAL,96372,CPT,,,,,59,Outpatient,,,214.42,139,Humana,Humana,65.07,,,,,,,Fee Schedule,64.56,65.07,
RT CHARGE PFT -> Lung Volume,9004829,LOCAL,94727,CPT,,,,,,Outpatient,,,215.73,140,Humana,Humana,143.05,,,,,,,Fee Schedule,76.09,143.05,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,90471,CPT,G0010,HCPCS,,,,Outpatient,,,216.15,140,Humana,Humana,42.18,,,,,,,Fee Schedule,42.18,65.07,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,G0010,CPT,,,,,,Outpatient,,,216.15,,Humana,Humana,42.18,,,,,,,Fee Schedule,42.18,65.07,
CATH LAB US INTRAOPERATIVE,8200550,LOCAL,76998,CPT,,,,,,Outpatient,,,216.65,116.33,Humana,Humana,36.73,,,,,,,Fee Schedule,36.73,165.47,
Bladder Scan,649589,LOCAL,51798,CPT,,,,,,Outpatient,,,216.87,59,Humana,Humana,54.31,,,,,,,Fee Schedule,54.31,863,
DOPP LOWER EXT ARTERIAL/ABI,8200450,LOCAL,93922,CPT,,,,,,Outpatient,,,218,265,Humana,Humana,117.85,,,,,,,Fee Schedule,117.85,161.71,
69209 REM IMPACT CERUMEN REQ IRRIGAT CHARGE,8020086,LOCAL,69209,CPT,,,,,,Outpatient,,,219.69,143,Humana,Humana,54.31,,,,,,,Fee Schedule,54.31,863,
97550 CAREGIVER TRAINING 1ST 30 MIN,14015178,LOCAL,97550,CPT,,,,,,Outpatient,,,220,,Humana,Humana,38.85,,,,,,,Fee Schedule,38.85,95.93,
97550 OT Caregiver Training Init 30 Mins,13649811,LOCAL,97550,CPT,,,,,,Outpatient,,,220,,Humana,Humana,38.85,,,,,,,Fee Schedule,38.85,95.93,
97550 ST Caregiver Training 1st 30 min,14013233,LOCAL,97550,CPT,,,,,,Outpatient,,,220,,Humana,Humana,38.85,,,,,,,Fee Schedule,38.85,95.93,
"SLP Caregiver Training, First 30 Min Time",14466884,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,220,,Humana,Humana,50.79,,,,,,,Fee Schedule,50.79,95.93,
Bill Only ABSC,7936968,LOCAL,86850,CPT,,,,,,Outpatient,,,220.5,11.72,Humana,Humana,48.85,,,,,,,Fee Schedule,6.29,48.85,
"Platelet Antibody Screen, Serum QSTC",10736090,LOCAL,86022,CPT,,,,,,Outpatient,,,220.5,22.04,Humana,Humana,18.37,,,,,,,Fee Schedule,15.29,18.37,
92524 BEHAVIORAL AND QUALITATIVE ANALYSIS OF VOICE AND RESONANCE,9630059,LOCAL,92524,CPT,,,,,GN,Outpatient,,,222.2,144,Humana,Humana,103.27,,,,,,,Fee Schedule,103.27,337.75,
Behav/Qual Analysis of Voice and Resonance Charge,7897211,LOCAL,92524,CPT,,,,,GN,Outpatient,,,222.2,144,Humana,Humana,103.27,,,,,,,Fee Schedule,103.27,337.75,
SLP Analysis of Voice & Resonance Units,7897212,LOCAL,92524,CPT,,,,,GN,Outpatient,,,222.2,144,Humana,Humana,103.27,,,,,,,Fee Schedule,103.27,337.75,
92597 EVAL FOR USE AND/OR FITTING OF VOICE PROSTHETIC TO SUPPLEMENT ORAL SPEECH,9630068,LOCAL,92597,CPT,,,,,GN,Outpatient,,,223.9,146,Humana,Humana,67.18,,,,,,,Fee Schedule,67.18,337.75,
Eval for Use/Fitting of Voice Prosthetic Dvc Chg,1373846,LOCAL,92597,CPT,,,,,GN,Outpatient,,,223.9,146,Humana,Humana,67.18,,,,,,,Fee Schedule,67.18,337.75,
"SLP Use,Fit Speech Prosthetic Eval Units",1373846,LOCAL,92597,CPT,,,,,GN,Outpatient,,,223.9,146,Humana,Humana,67.18,,,,,,,Fee Schedule,67.18,337.75,
64418- Suprascapular nerve block,10452404,LOCAL,64418,CPT,,,,,,Outpatient,,,225,693,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
75809 SHUNTOGRAM PREV PLCMNT INDWELLING NONVASC SHUNT,13650394,LOCAL,75809,CPT,,,,,,Outpatient,,,225,87.45,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,176.48,
"Hantavirus Antibody IgG,IgM QSTC",13864534,LOCAL,86790,CPT,,,,,,Outpatient,,,225,15.46,Humana,Humana,12.88,,,,,,,Fee Schedule,12.88,15.29,
"Histoplasma Quantitative Antigen, EIA QSTC",9752803,LOCAL,87385,CPT,,,,,,Outpatient,,,225,15.9,Humana,Humana,13.25,,,,,,,Fee Schedule,10.57,13.25,
"Potassium w/o Creatinine, Random Ur QSTC",9039260,LOCAL,84133,CPT,,,,,,Outpatient,,,225,5.68,Humana,Humana,19.32,,,,,,,Fee Schedule,7.16,19.32,
Soluble Transferrin Receptor QSTC,9777250,LOCAL,84238,CPT,,,,,,Outpatient,,,225,43.88,Humana,Humana,36.57,,,,,,,Fee Schedule,36.57,46.74,
XR Shunt Series,13650394,LOCAL,75809,CPT,,,,,,Outpatient,,,225,87.45,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,176.48,
Dengue Fever Ab (IgG) QSTC,13873177,LOCAL,86790,CPT,,,,,,Outpatient,,,228,15.46,Humana,Humana,12.88,,,,,,,Fee Schedule,12.88,15.29,
Dengue Fever Ab (IgM) QSTC,13873183,LOCAL,86790,CPT,,,,,,Outpatient,,,228,15.46,Humana,Humana,12.88,,,,,,,Fee Schedule,12.88,15.29,
"Mycoplasma pneumoniae Ab (IgG, IgM) QSTC",8972832,LOCAL,86738,CPT,,,,,,Outpatient,,,228.83,15.89,Humana,Humana,13.24,,,,,,,Fee Schedule,13.24,15.29,
REF DAT Polyspecific,7939270,LOCAL,86880,CPT,,,,,,Outpatient,,,229.5,6.47,Humana,Humana,54.31,,,,,,,Fee Schedule,6.29,54.31,
voriconazole 200 mg intravenous injection [CULL],11211371,LOCAL,J3465,CPT,,,,,,Outpatient,1,EA,230.4,,Humana,Humana,0.75,,,,,,,Fee Schedule,0.751,0.751,
92610  Bedside Swallowing Eval,9630082,LOCAL,92610,CPT,,,,,GN,Outpatient,,,231.76,151,Humana,Humana,55.89,,,,,,,Fee Schedule,55.89,337.75,
Eval of Oral and Pharyngeal Swallowing Fx Chg  nd Pharyngeal Swallowing Fx Chg,7896918,LOCAL,92610,CPT,,,,,GN,Outpatient,,,231.76,151,Humana,Humana,55.89,,,,,,,Fee Schedule,55.89,337.75,
Eval of Oral and Pharyngeal Swallowing Fx Chg  nd Pharyngeal Swallowing Fx Chg -> Yes,7896918,LOCAL,92610,CPT,,,,,GN,Outpatient,,,231.76,151,Humana,Humana,55.89,,,,,,,Fee Schedule,55.89,337.75,
SLP Pharyngeal Swallow Eval Units,1373843,LOCAL,92610,CPT,,,,,GN,Outpatient,,,231.76,151,Humana,Humana,55.89,,,,,,,Fee Schedule,55.89,337.75,
"Caregiver / patient demonstrates understanding of substance abuse, triggers, treatment",4517330,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,235,,Humana,Humana,50.79,,,,,,,Fee Schedule,50.79,95.93,
"Caregiver / patient demonstrates understanding of substance abuse, triggers, treatment",4517330,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,235,,Humana,Humana,50.79,,,,,,,Fee Schedule,50.79,95.93,
PT CAREGIVER TRAINING INT 30 MIN,4517330,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,235,,Humana,Humana,50.79,,,,,,,Fee Schedule,50.79,95.93,
96523 FLUSH VAD CHARGE,8213318,LOCAL,96523,CPT,,,,,,Outpatient,,,235.66,153,Humana,Humana,54.31,,,,,,,Fee Schedule,54.31,64.56,
Follicle Stimulating Hormone Level,3170314,LOCAL,83001,CPT,,,,,,Outpatient,,,238.68,22.3,Humana,Humana,98.8,,,,,,,Fee Schedule,18.43,98.80384615,
Antibody ID,634330,LOCAL,86870,CPT,,,,,,Outpatient,,,238.76,,Humana,Humana,328.88,,,,,,,Fee Schedule,38.27,328.88,
BB THAW FFP,6413062,LOCAL,86931,CPT,,,,,,Outpatient,,,238.76,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.88,156.67,
Bill IHC Multiplex Antibody,14048007,LOCAL,88344,CPT,,,,,,Outpatient,,,238.76,,Humana,Humana,328.88,,,,,,,Fee Schedule,59.06,328.88,
"Bill Only Antigen Type, Patient",8872565,LOCAL,86905,CPT,,,,,,Outpatient,,,238.76,4.6,Humana,Humana,328.88,,,,,,,Fee Schedule,6.29,328.88,
"Bill Only Antigen Type, Product",8872566,LOCAL,86902,CPT,,,,,,Outpatient,,,238.76,7.62,Humana,Humana,328.88,,,,,,,Fee Schedule,6.29,328.88,
Bill Tissue Exam Level 5,14049344,LOCAL,88307,CPT,,,,,,Outpatient,,,238.76,,Humana,Humana,328.88,,,,,,,Fee Schedule,59.06,328.88,
11732 AVULSION OF EACH ADDITIONAL NAIL PLATE,13029593,LOCAL,11732,CPT,,,,,,Outpatient,,,239.9,156,Humana,Humana,14.39,,,,,,,Fee Schedule,14.39,863,
93463 Pharmacologic Agent Administration,8230065,LOCAL,93463,CPT,,,,,,Outpatient,,,240,156,Humana,Humana,79.18,,,,,,,Fee Schedule,64.56,863,
36591 COLLECT BLOOD FROM IMPL VEN DEVICE CHARGE,10451346,LOCAL,36591,CPT,,,,,,Outpatient,,,241.46,157,Humana,Humana,117.85,,,,,,,Fee Schedule,85.79,863,
Central Line Activity. -> Blood drawn,12856467,LOCAL,36592,CPT,,,,,,Outpatient,,,241.46,157,Humana,Humana,117.85,,,,,,,Fee Schedule,85.79,863,
Anaerobic Culture,4122782,LOCAL,87075,CPT,,,,,,Outpatient,,,242.35,11.36,Humana,Humana,50.33,,,,,,,Fee Schedule,10.57,50.328,
Bill Only ABID Panel,7936969,LOCAL,86870,CPT,,,,,,Outpatient,,,243,,Humana,Humana,328.88,,,,,,,Fee Schedule,38.27,328.88,
US OB Greater Than 14 Weeks,1169850,LOCAL,76805,CPT,,,,,,Outpatient,,,243,130.35,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,148.61,
US OB Greater Than 14 Weeks,1169851,LOCAL,76805,CPT,,,,,,Outpatient,,,243,130.35,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,148.61,
FLUOROSCOPY <1 HOUR,8210790,LOCAL,76000,CPT,,,,,,Outpatient,,,246.02,380.33,Humana,Humana,220.99,,,,,,,Fee Schedule,176.48,220.99,
.Hep C Viral RNA Quant RealTime PCR QSTC,8764584,LOCAL,87522,CPT,,,,,,Outpatient,,,247.5,51.41,Humana,Humana,144.75,,,,,,,Fee Schedule,40.19,144.745,
HCV RNA Quan Progress to Genotyping QSTC,9039270,LOCAL,87522,CPT,,,,,,Outpatient,,,247.5,51.41,Humana,Humana,144.75,,,,,,,Fee Schedule,40.19,144.745,
"Hepatitis C, RNA, Quantitative, PCR QSTC",8764755,LOCAL,87522,CPT,,,,,,Outpatient,,,247.5,51.41,Humana,Humana,144.75,,,,,,,Fee Schedule,40.19,144.745,
"HSV Type 1&2 DNA, Qual RT PCR QSTC",8873562,LOCAL,87529,CPT,,,,,,Outpatient,,,247.5,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
Pancreatic Elastase-1 QSTC,8764835,LOCAL,82653,CPT,,,,,,Outpatient,,,247.5,27.56,Humana,Humana,22.97,,,,,,,Fee Schedule,17.73,22.97,
REF PLT Screening,13475613,LOCAL,86022,CPT,,,,,,Outpatient,,,247.5,22.04,Humana,Humana,18.37,,,,,,,Fee Schedule,15.29,18.37,
RT CHARGE Aerosol Therapy -> Initial,12502774,LOCAL,94640,CPT,,,,,,Outpatient,,,247.86,136,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT Continuous Neb Initial CHARGE,8144200,LOCAL,94640,CPT,,,,,,Outpatient,,,247.86,136,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT IPV Initial CHARGE,8144187,LOCAL,94640,CPT,,,,,,Outpatient,,,247.86,136,Humana,Humana,185.95,,,,,,,Fee Schedule,76.09,185.95,
96415 CHEMO IV INFUSION EA ADDL HR INF CHARGE,9665726,LOCAL,96415,CPT,,,,,,Outpatient,,,248.22,161,Humana,Humana,65.07,,,,,,,Fee Schedule,65.07,749.76,
aztreonam 2 g injection [CULL],11201229,LOCAL,J0457,CPT,,,,,,Outpatient,1,EA,249.6,,Humana,Humana,2.23,,,,,,,Fee Schedule,2.233,2.233,
"Clobazam and Metabolite, Serum/Plasma QSTC",8764736,LOCAL,80299,CPT,,,,,,Outpatient,,,249.75,22.37,Humana,Humana,18.64,,,,,,,Fee Schedule,15.38,18.64,
95977 - device analysis and complex programming,14685299,LOCAL,95977,CPT,,,,,,Outpatient,,,250,92,Humana,Humana,83.92,,,,,,,Fee Schedule,83.92,214.22,
Hep Acute Pnl,633756,LOCAL,80074,CPT,,,,,,Outpatient,,,250,57.16,Humana,Humana,59.34,,,,,,,Fee Schedule,12.14,59.336,
Hep Acute Pnl Post Exposure,9517262,LOCAL,80074,CPT,,,,,,Outpatient,,,250,57.16,Humana,Humana,59.34,,,,,,,Fee Schedule,12.14,59.336,
COLLAR HARD PED 8 -11,6000015,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,250.75,223,Humana,Humana,175.72,,,,,,,Fee Schedule,175.72,175.72,
Albumin Level,1620877,LOCAL,82040,CPT,,,,,,Outpatient,,,250.92,5.94,Humana,Humana,127.89,,,,,,,Fee Schedule,7.16,127.89,
Luteinizing Hormone,4240834,LOCAL,83002,CPT,,,,,,Outpatient,,,250.92,22.22,Humana,Humana,18.52,,,,,,,Fee Schedule,18.43,18.52,
Rufinamide QSTC,13864436,LOCAL,80210,CPT,,,,,,Outpatient,,,251.6,32.53,Humana,Humana,27.11,,,,,,,Fee Schedule,15.38,27.11,
XR Hand 2 Views Left,1170215,LOCAL,73120,CPT,,,,,LT,Outpatient,,,253.04,135.3,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Hand 2 Views Right,1170217,LOCAL,73120,CPT,,,,,RT,Outpatient,,,253.04,135.3,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Lower Extremity Infant 2 Views Bilat,8455866,LOCAL,73592,CPT,,,,,,Outpatient,,,253.13,136.13,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Lower Extremity Infant 2 Views Left,8455869,LOCAL,73592,CPT,,,,,LT,Outpatient,,,253.13,136.13,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Lower Extremity Infant 2 Views Right,8455872,LOCAL,73592,CPT,,,,,RT,Outpatient,,,253.13,136.13,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
hepatitis B adult vaccine 20 mcg/mL intramuscular suspension 1 mL [CULL],11202558,LOCAL,90746,CPT,,,,,,Outpatient,1,ML,253.80864,,Humana,Humana,75.15,,,,,,,Fee Schedule,39.58,75.145,
XR Chest 1 View,8132832,LOCAL,71045,CPT,,,,,,Outpatient,,,253.82,136.13,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Elbow 1 View Left,13554981,LOCAL,73070,CPT,,,,,52|LT,Outpatient,,,254.32,136.13,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Elbow 1 View Right,13554984,LOCAL,73070,CPT,,,,,52|RT,Outpatient,,,254.32,136.13,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
69210 REM IMPACT CERUMEN REQ INSTRU CHARGE,8020194,LOCAL,69210,CPT,,,,,,Outpatient,,,255.9,166,Humana,Humana,54.31,,,,,,,Fee Schedule,54.31,863,
Bill Only Computer Search EA/Ag,13517192,LOCAL,86902,CPT,,,,,,Outpatient,,,256.5,7.62,Humana,Humana,328.88,,,,,,,Fee Schedule,6.29,328.88,
Bill Only Fresh Unit (<5 Days Old),13517198,LOCAL,86999,CPT,,,,,,Outpatient,,,256.5,,Humana,Humana,22.39,,,,,,,Fee Schedule,6.29,22.39,
US Pelvic Ltd,8206967,LOCAL,76857,CPT,,,,,,Outpatient,,,257.05,137.78,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
RT CHARGE PFT -> Spirometry,5274349,LOCAL,94010,CPT,,,,,,Outpatient,,,258.58,168,Humana,Humana,143.05,,,,,,,Fee Schedule,76.09,143.05,
97161  SB PT Eval Low Comp,9640014,LOCAL,97161,CPT,,,,,GP,Outpatient,,,262.16,170,Humana,Humana,46.04,,,,,,,Fee Schedule,46.04162662,349.89,
97161 EVAL - LOW COMPLEXITY CHARGE,9410054,LOCAL,97161,CPT,,,,,GP,Outpatient,,,262.16,170,Humana,Humana,46.04,,,,,,,Fee Schedule,46.04162662,349.89,
97161 PHYSICAL THERAPY EVALUATION CHARGE,9650014,LOCAL,97161,CPT,,,,,GP|CQ,Outpatient,,,262.16,170,Humana,Humana,46.04,,,,,,,Fee Schedule,46.04162662,349.89,
PT Low Complex Units,7896010,LOCAL,97161,CPT,,,,,GP,Outpatient,,,262.16,170,Humana,Humana,46.04,,,,,,,Fee Schedule,46.04162662,349.89,
"Lactoferrin, QL, Stool QSTC",9039266,LOCAL,83630,CPT,,,,,,Outpatient,,,263.25,23.64,Humana,Humana,19.7,,,,,,,Fee Schedule,17.73,19.7,
"92521 EVALUATION OF SPEECH FLUENCY (STUTTERING, CLUTTERING)",9630056,LOCAL,92521,CPT,,,,,GN,Outpatient,,,263.99,172,Humana,Humana,125.86,,,,,,,Fee Schedule,125.86,337.75,
SLP Speech Fluency Eval Units,7897205,LOCAL,92521,CPT,,,,,GN,Outpatient,,,263.99,172,Humana,Humana,125.86,,,,,,,Fee Schedule,125.86,337.75,
Speech Fluency Eval Charge,7897205,LOCAL,92521,CPT,,,,,GN,Outpatient,,,263.99,172,Humana,Humana,125.86,,,,,,,Fee Schedule,125.86,337.75,
methylPREDNISolone 1 g preservative-free Pow,11287452,LOCAL,J2919,CPT,,,,,,Outpatient,1,UN,264.6528,,Humana,Humana,0.21,,,,,,,Fee Schedule,0.21,5685.74,
92526  Treatment of Swallow,9630083,LOCAL,92526,CPT,,,,,GN,Outpatient,,,265.2,172,Humana,Humana,85.25,,,,,,,Fee Schedule,56.44,85.2525,
dihydroergotamine 1 mg/mL injectable solution 1 mL [CULL],11202330,LOCAL,J1110,CPT,,,,,,Outpatient,1,ML,265.2,,Humana,Humana,57.08,,,,,,,Fee Schedule,57.082,57.082,
SLP Swallow Dysfunction Oral Feed Units,1373842,LOCAL,92526,CPT,,,,,GN,Outpatient,,,265.2,172,Humana,Humana,85.25,,,,,,,Fee Schedule,56.44,85.2525,
Treatment of Swallowing Dysfunction Charge,7896917,LOCAL,92526,CPT,,,,,GN,Outpatient,,,265.2,172,Humana,Humana,85.25,,,,,,,Fee Schedule,56.44,85.2525,
Treatment of Swallowing Dysfunction Charge -> Yes,7896917,LOCAL,92526,CPT,,,,,GN,Outpatient,,,265.2,172,Humana,Humana,85.25,,,,,,,Fee Schedule,56.44,85.2525,
RNA Polymerase III Antibody QSTC,10067478,LOCAL,83516,CPT,,,,,,Outpatient,,,265.5,13.84,Humana,Humana,11.53,,,,,,,Fee Schedule,11.53,17.73,
XR Sinuses Paranasal < 3 Views,1170432,LOCAL,70210,CPT,,,,,,Outpatient,,,266.27,142.73,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Pelvis 1 or 2 Views,1170351,LOCAL,72170,CPT,,,,,,Outpatient,,,266.62,142.73,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
Zonisamide QSTC,8764609,LOCAL,80203,CPT,,,,,,Outpatient,,,267.53,15.9,Humana,Humana,13.25,,,,,,,Fee Schedule,13.25,15.38,
"Iodine, U24 QSTC",13864440,LOCAL,82542,CPT,,,,,,Outpatient,,,267.8,28.91,Humana,Humana,24.09,,,,,,,Fee Schedule,17.73,24.09,
.Atypical P-ANCA Titer QSTC,8764788,LOCAL,86037,CPT,,,,,,Outpatient,,,270,14.46,Humana,Humana,12.05,,,,,,,Fee Schedule,12.05,15.29,
"Acylcarnitine, Plasma QSTC",9215425,LOCAL,82017,CPT,,,,,,Outpatient,,,270,20.24,Humana,Humana,16.87,,,,,,,Fee Schedule,16.87,17.73,
C. difficile Toxin B Qual PCR QSTC,13864437,LOCAL,87493,CPT,,,,,,Outpatient,,,270,44.72,Humana,Humana,37.27,,,,,,,Fee Schedule,37.27,40.19,
"Cytomegalovirus DNA, QN, Real-T PCR QSTC",8764608,LOCAL,87497,CPT,,,,,,Outpatient,,,270,51.41,Humana,Humana,42.84,,,,,,,Fee Schedule,40.19,42.84,
"Kappa/Lambda Lght Chn, Free w Rat U QSTC",9039383,LOCAL,83883,CPT,,,,,,Outpatient,,,270,16.32,Humana,Humana,13.6,,,,,,,Fee Schedule,13.6,15.29,
"Kappa/Lambda Light Chains, Tot Ur QSTC",9039383,LOCAL,83883,CPT,,,,,,Outpatient,,,270,16.32,Humana,Humana,13.6,,,,,,,Fee Schedule,13.6,15.29,
"Mycoplasma Genitalium,R-T PCR QST",9773947,LOCAL,87624,CPT,,,,,,Outpatient,,,270,42.11,Humana,Humana,67.2,,,,,,,Fee Schedule,40.19,67.195,
Reference Lab Crossmatch -> Compatible,8185614,LOCAL,86920,CPT,,,,,,Outpatient,,,270,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
Reference Lab Crossmatch -> Incompatible,8185613,LOCAL,86920,CPT,,,,,,Outpatient,,,270,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
Reference Lab Crossmatch -> Least Incompatible,8185612,LOCAL,86920,CPT,,,,,,Outpatient,,,270,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
von Willebrand Factor Ag QSTC,8764731,LOCAL,85246,CPT,,,,,,Outpatient,,,270,27.53,Humana,Humana,22.94,,,,,,,Fee Schedule,5.42,22.94,
99281 Emergency Department Visit. Level 1,2644297,LOCAL,99281,CPT,,,,,25,Outpatient,,,272.36,177,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,80.5,
XR Finger(s) 1 View Left,13554987,LOCAL,73140,CPT,,,,,52|LT,Outpatient,,,272.62,146.03,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Finger(s) 1 View Right,13554990,LOCAL,73140,CPT,,,,,52|RT,Outpatient,,,272.62,146.03,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
Electrocardiogram 12 Lead.,9696149,LOCAL,93005,CPT,,,,,,Outpatient,,,273.98,178,Humana,Humana,54.31,,,,,,,Fee Schedule,38.53,54.31,
93242 Holter 3 to 7 Days Recording,90820010,LOCAL,93242,CPT,,,,,,Outpatient,,,275,179,Humana,Humana,35.88,,,,,,,Fee Schedule,35.88,99.86,
Prolactin Level,3170316,LOCAL,84146,CPT,,,,,,Outpatient,,,275.4,23.26,Humana,Humana,19.38,,,,,,,Fee Schedule,18.43,19.38,
XR Elbow 2 Views Left,1170121,LOCAL,73070,CPT,,,,,LT,Outpatient,,,275.53,136.13,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Elbow 2 Views Right,1170123,LOCAL,73070,CPT,,,,,RT,Outpatient,,,275.53,136.13,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
.TR Interpretation,1173781,LOCAL,86078,CPT,,,,,,Outpatient,,,277.85,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.88,156.67,
BB REF LAB PHYSICIAN INTERP,6413086,LOCAL,86077,CPT,,,,,,Outpatient,,,279,,Humana,Humana,22.39,,,,,,,Fee Schedule,22.39,38.88,
Bill Only Crossmatch IS,8419033,LOCAL,86920,CPT,,,,,,Outpatient,,,279,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
hepatitis B immune globulin intramuscular solution 0.5 mL [CULL],11202561,LOCAL,J1571,CPT,,,,,,Outpatient,0.5,ML,280.064,,Humana,Humana,66.64,,,,,,,Fee Schedule,66.64,771.25,
XR Spine 1 View Specify Level,8058789,LOCAL,72020,CPT,,,,,,Outpatient,,,281.44,150.98,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Knee 1 View Standing AP Bilateral,1170291,LOCAL,73565,CPT,,,,,,Outpatient,,,283.03,151.8,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
Iodine QSTC,13864439,LOCAL,82542,CPT,,,,,,Outpatient,,,283.32,28.91,Humana,Humana,24.09,,,,,,,Fee Schedule,17.73,24.09,
XR Neck Soft Tissue,1170331,LOCAL,70360,CPT,,,,,,Outpatient,,,284.4,152.63,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
97162  SB PT Eval Mod Comp,9640015,LOCAL,97162,CPT,,,,,GP,Outpatient,,,287.16,187,Humana,Humana,42.69,,,,,,,Fee Schedule,42.68861429,349.89,
97162 EVAL - MODERATE COMPLEXITY CHARGE,9410055,LOCAL,97162,CPT,,,,,GP,Outpatient,,,287.16,187,Humana,Humana,42.69,,,,,,,Fee Schedule,42.68861429,349.89,
97162 PT EVAL MOD COMPLEX CHARGES,9650015,LOCAL,97162,CPT,,,,,GP|CQ,Outpatient,,,287.16,187,Humana,Humana,42.69,,,,,,,Fee Schedule,42.68861429,349.89,
PT Moderate Complex Units,7896012,LOCAL,97162,CPT,,,,,GP,Outpatient,,,287.16,187,Humana,Humana,42.69,,,,,,,Fee Schedule,42.68861429,349.89,
Soluble Liver Antigen (SLA) Autoantibody QSTC,10148492,LOCAL,83520,CPT,,,,,,Outpatient,,,288,20.72,Humana,Humana,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
XR Shoulder 1 View Left,1170409,LOCAL,73020,CPT,,,,,LT,Outpatient,,,289.86,155.1,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Shoulder 1 View Right,1170411,LOCAL,73020,CPT,,,,,RT,Outpatient,,,289.86,155.1,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR AC Joints Bilateral,1169922,LOCAL,73050,CPT,,,,,,Outpatient,,,289.94,155.1,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Calcaneus Limited Left,13554972,LOCAL,73650,CPT,,,,,52|LT,Outpatient,,,290.55,174.9,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Calcaneus Limited Right,13554975,LOCAL,73650,CPT,,,,,52|RT,Outpatient,,,290.55,174.9,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
BD Bone Density DEXA Vert Fracture Assmt,8206345,LOCAL,77086,CPT,,,,,,Outpatient,,,291.16,155.93,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,116.02,
XR Foreign Body Localization Child 1 Vw,1170207,LOCAL,76010,CPT,,,,,,Outpatient,,,291.16,155.93,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
cefTRIAXone 2 g injection [CULL],11202189,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,292.1824,,Humana,Humana,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
"Cytomegalovirus DNA, QL R-T PCR QSTC",9777223,LOCAL,87496,CPT,,,,,,Outpatient,,,292.5,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Factor IX Activity,Clotting [352X]  QSTC",12534660,LOCAL,85250,CPT,,,,,,Outpatient,,,292.5,22.85,Humana,Humana,19.04,,,,,,,Fee Schedule,5.42,19.04,
"HIV-1 RNA, QN, Real-Time PCR QSTC",8764763,LOCAL,87536,CPT,,,,,,Outpatient,,,292.5,102.12,Humana,Humana,85.1,,,,,,,Fee Schedule,85.1,158.39,
XR Chest Decubitus,1170049,LOCAL,71046,CPT,,,,,,Outpatient,,,292.6,212.85,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
"Factor VIII Inhibitor, EIA QSTC",13873092,LOCAL,85335,CPT,,,,,,Outpatient,,,294.75,15.44,Humana,Humana,12.87,,,,,,,Fee Schedule,5.42,12.87,
"FVIII Act, Clotting QSTC",13873093,LOCAL,85240,CPT,,,,,,Outpatient,,,294.75,21.48,Humana,Humana,17.9,,,,,,,Fee Schedule,5.42,17.9,
XR Upper Extremity Infant 2 Views Left,8455878,LOCAL,73092,CPT,,,,,LT,Outpatient,,,296.99,159.23,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Upper Extremity Infant 2 Views Right,8455881,LOCAL,73092,CPT,,,,,RT,Outpatient,,,296.99,159.23,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
Ref Rh Phenotyping,9527485,LOCAL,86906,CPT,,,,,,Outpatient,,,297,9.3,Humana,Humana,35.88,,,,,,,Fee Schedule,6.29,35.88,
92611 ST VIDEOFLUOR SWALLOW CHARGE,9630067,LOCAL,92611,CPT,,,,,GN,Outpatient,,,297.49,193,Humana,Humana,189.99,,,,,,,Fee Schedule,176.48,189.9866667,
Fluoroscopic Evaluation of Swallow Function Charge,7896919,LOCAL,92611,CPT,,,,,GN,Outpatient,,,297.49,193,Humana,Humana,189.99,,,,,,,Fee Schedule,176.48,189.9866667,
SLP Fluoroscopic Evaluation Units,1373839,LOCAL,92611,CPT,,,,,GN,Outpatient,,,297.49,193,Humana,Humana,189.99,,,,,,,Fee Schedule,176.48,189.9866667,
97165 EVAL -  LOW COMPLEXITY CHARGE,9850014,LOCAL,97165,CPT,,,,,GO,Outpatient,,,297.74,194,Humana,Humana,94.3,,,,,,,Fee Schedule,94.3,269.95,
97165 OT Evaluation Low Complexity 30 min,9860014,LOCAL,97165,CPT,,,,,GO|CO,Outpatient,,,297.74,194,Humana,Humana,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Evaluation Low Complexity Units,7897807,LOCAL,97165,CPT,,,,,GO,Outpatient,,,297.74,194,Humana,Humana,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Low Complex Units,7895291,LOCAL,97165,CPT,,,,,GO,Outpatient,,,297.74,194,Humana,Humana,94.3,,,,,,,Fee Schedule,94.3,269.95,
"Aspergillus Antigen, EIA, Serum QSTC",9777227,LOCAL,87305,CPT,,,,,,Outpatient,,,298,14.38,Humana,Humana,11.98,,,,,,,Fee Schedule,10.57,11.98,
29581 PT Lower Extremity Application of Strapping,9640079,LOCAL,29581,CPT,,,,,GP,Outpatient,,,300,195,Humana,Humana,144.26,,,,,,,Fee Schedule,144.26,863,
PT Lymphedema Wrap below Knee Charge,7895901,LOCAL,29581,CPT,,,,,GP,Outpatient,,,300,195,Humana,Humana,144.26,,,,,,,Fee Schedule,144.26,863,
Lacosamide QSTC,8764635,LOCAL,80235,CPT,,,,,,Outpatient,,,301.5,32.53,Humana,Humana,27.11,,,,,,,Fee Schedule,15.38,27.11,
tetanus/diphth/pertussis (Tdap) adult/adol 5 units-2 units-15.5 mcg/0.5 mL intramuscular suspension 0.5 mL [CULL],11202346,LOCAL,90714,CPT,,,,,,Outpatient,0.5,ML,301.632,,Humana,Humana,14.45,,,,,,,Fee Schedule,14.45070423,39.58,
XR Toe(s) 2 PLUS Views Right,1170522,LOCAL,73660,CPT,,,,,RT,Outpatient,,,301.78,161.7,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Toe(s) 2+ Views Left,1170520,LOCAL,73660,CPT,,,,,LT,Outpatient,,,301.78,161.7,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
influenza vaccine (Fluzone HD) vaccine 2025-2026 [CULL],11292055,LOCAL,90662,CPT,,,,,,Outpatient,0.5,ML,303.5392,,Humana,Humana,86.13,,,,,,,Fee Schedule,39.58,86.13,
Large Humeral Fracture Brace,9400080,LOCAL,,,L3982,HCPCS,,,,Outpatient,,,303.88,,Humana,Humana,429.48,,,,,,,Fee Schedule,429.48,429.48,
Medium Humeral Fracture Brace,9400079,LOCAL,,,L3982,HCPCS,,,,Outpatient,,,303.88,,Humana,Humana,429.48,,,,,,,Fee Schedule,429.48,429.48,
CV Holter Monitor Recording up to 48 Hrs,8230053,LOCAL,93225,CPT,,,,,,Outpatient,,,304,198,Humana,Humana,117.85,,,,,,,Fee Schedule,99.86,117.85,
Holter Monitor 48 Hr,8230053,LOCAL,93225,CPT,,,,,,Outpatient,,,304,198,Humana,Humana,117.85,,,,,,,Fee Schedule,99.86,117.85,
Bill Only Rh Phenotyping,7936966,LOCAL,86906,CPT,,,,,,Outpatient,,,306,9.3,Humana,Humana,35.88,,,,,,,Fee Schedule,6.29,35.88,
COV19/Flu/RSV (GeneXpert Plus),10791321,LOCAL,87637,CPT,,,,,,Outpatient,,,306,171.16,Humana,Humana,69.48,,,,,,,Fee Schedule,40.19,69.4761107,
US OB Less Than 14 Weeks,8206952,LOCAL,76801,CPT,,,,,,Outpatient,,,307,165,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,148.61,
Chlamydia/Chlamydophila Ab 2 IgM QSTC,13864537,LOCAL,86632,CPT,,,,,,Outpatient,,,307.13,15.22,Humana,Humana,12.68,,,,,,,Fee Schedule,12.68,15.29,
EPINEPHrine 8 mg/250 mL-NaCl 0.9% Sol [CULL],11200040,LOCAL,J0165,CPT,,,,,,Outpatient,250,ML,307.2,,Humana,Humana,0.43,,,,,,,Fee Schedule,0.433,0.433,
Comprehensive Metabolic Panel,633709,LOCAL,80053,CPT,,,,,,Outpatient,,,307.22,12.67,Humana,Humana,82.76,,,,,,,Fee Schedule,12.14,82.75523053,
XR Ankle 1 View Left,13554963,LOCAL,73600,CPT,,,,,52|LT,Outpatient,,,307.85,165,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ankle 1 View Right,13554966,LOCAL,73600,CPT,,,,,52|RT,Outpatient,,,307.85,165,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Foot 2 Views Left,1170185,LOCAL,73620,CPT,,,,,LT,Outpatient,,,309.19,165.83,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Foot 2 Views Right,1170187,LOCAL,73620,CPT,,,,,RT,Outpatient,,,309.19,165.83,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
"Bill Only ABID Panel, Enzyme (Ab)",13517190,LOCAL,86870,CPT,,,,,,Outpatient,,,310.5,,Humana,Humana,328.88,,,,,,,Fee Schedule,38.27,328.88,
"Bill Only ABID Panel, Enzyme (Ezym)",13517194,LOCAL,86971,CPT,,,,,,Outpatient,,,310.5,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.88,156.67,
Insulin Autoantibody QSTC,8764818,LOCAL,86337,CPT,,,,,,Outpatient,,,310.5,25.69,Humana,Humana,21.41,,,,,,,Fee Schedule,15.29,21.41,
XR Finger(s) 2 Plus Views Left,1170151,LOCAL,73140,CPT,,,,,LT,Outpatient,,,311.14,146.03,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Finger(s) 2 Plus Views Right,1170153,LOCAL,73140,CPT,,,,,RT,Outpatient,,,311.14,146.03,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
97163  SB PT Eval High Comp,9640017,LOCAL,97163,CPT,,,,,GP,Outpatient,,,312.16,203,Humana,Humana,92.25,,,,,,,Fee Schedule,92.25,349.89,
97163 EVAL - HIGH COMPLEXITY CHARGE,9410062,LOCAL,97163,CPT,,,,,GP,Outpatient,,,312.16,203,Humana,Humana,92.25,,,,,,,Fee Schedule,92.25,349.89,
97163 IND EDUCATION EVAL CHARGE,9650017,LOCAL,97163,CPT,,,,,GP|CQ,Outpatient,,,312.16,203,Humana,Humana,92.25,,,,,,,Fee Schedule,92.25,349.89,
PT High Complex Units,7896014,LOCAL,97163,CPT,,,,,GP,Outpatient,,,312.16,203,Humana,Humana,92.25,,,,,,,Fee Schedule,92.25,349.89,
Factor II Activity QSTC,8972859,LOCAL,85210,CPT,,,,,,Outpatient,,,312.8,15.58,Humana,Humana,12.98,,,,,,,Fee Schedule,5.42,12.98,
MG Mammo Implant Screening Lt w/ Tomo.,8146654,LOCAL,77067,CPT,,,,,LT,Outpatient,,,313.11,363,Humana,Humana,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Implant Screening Rt w/ Tomo.,8146657,LOCAL,77067,CPT,,,,,RT,Outpatient,,,313.11,363,Humana,Humana,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Screening Left w/ Tomo.,8146660,LOCAL,77067,CPT,,,,,LT,Outpatient,,,313.11,363,Humana,Humana,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Screening Right w/ Tomo.,8146663,LOCAL,77067,CPT,,,,,RT,Outpatient,,,313.11,363,Humana,Humana,79.68,,,,,,,Fee Schedule,74,79.68,
92609 ST USE OF SPEECH DEVICE SERVICES,9636008,LOCAL,92609,CPT,,,,,GN,Outpatient,,,314.48,204,Humana,Humana,95.88,,,,,,,Fee Schedule,56.44,95.88,
SLP Speech-Gen Dev Prog and Mod,7896913,LOCAL,92609,CPT,,,,,GN,Outpatient,,,314.48,204,Humana,Humana,95.88,,,,,,,Fee Schedule,56.44,95.88,
SLP Speech-Gen Dev Prog and Mod Time,1373849,LOCAL,92609,CPT,,,,,GN,Outpatient,,,314.48,204,Humana,Humana,95.88,,,,,,,Fee Schedule,56.44,95.88,
SLP Tx Generating Device Units,1373849,LOCAL,92609,CPT,,,,,GN,Outpatient,,,314.48,204,Humana,Humana,95.88,,,,,,,Fee Schedule,56.44,95.88,
"Factor V Activity, Clotting QSTC",9777239,LOCAL,85220,CPT,,,,,,Outpatient,,,315,21.18,Humana,Humana,17.65,,,,,,,Fee Schedule,5.42,17.65,
Hepatitis B Virus DNA Qnt RT PCR QSTC,8764549,LOCAL,87517,CPT,,,,,,Outpatient,,,315,51.41,Humana,Humana,178.5,,,,,,,Fee Schedule,40.19,178.495,
Inhibin A QSTC,8972775,LOCAL,86336,CPT,,,,,,Outpatient,,,315,18.71,Humana,Humana,15.59,,,,,,,Fee Schedule,15.29,15.59,
"Viral Respiratory, Rapid Culture with Reflex QST",12126195,LOCAL,87140,CPT,,,,,,Outpatient,,,315,6.68,Humana,Humana,5.57,,,,,,,Fee Schedule,5.57,10.57,
"Porphyrins, Total QSTC",13864419,LOCAL,82542,CPT,,,,,,Outpatient,,,315.9,28.91,Humana,Humana,24.09,,,,,,,Fee Schedule,17.73,24.09,
"73040 Radiologic examination, shoulder, arthrography: AddOn",14917589,LOCAL,73040,CPT,,,,,,Outpatient,,,316.12,777.98,Humana,Humana,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Forearm 1 View Left,13554993,LOCAL,73090,CPT,,,,,52|LT,Outpatient,,,318.62,170.78,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Forearm 1 View Right,13554996,LOCAL,73090,CPT,,,,,52|RT,Outpatient,,,318.62,170.78,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ankle 2 Views Left,1169936,LOCAL,73600,CPT,,,,,LT,Outpatient,,,318.65,165,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ankle 2 Views Right,1169938,LOCAL,73600,CPT,,,,,RT,Outpatient,,,318.65,165,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
tobramycin 1.2 g injection [CULL],11211303,LOCAL,J3260,CPT,,,,,,Outpatient,1,EA,320,,Humana,Humana,2.07,,,,,,,Fee Schedule,2.071,2.071,
Complement Component C1q QSTC,8972752,LOCAL,86160,CPT,,,,,,Outpatient,,,322.65,14.4,Humana,Humana,36.91,,,,,,,Fee Schedule,15.29,36.909,
97166  SB OT Eval Mod Comp,9860015,LOCAL,97166,CPT,,,,,GO|CO,Outpatient,,,322.74,210,Humana,Humana,94.3,,,,,,,Fee Schedule,94.3,269.95,
97166 EVAL -  MODERATE COMPLEXITY CHARGE,9850015,LOCAL,97166,CPT,,,,,GO,Outpatient,,,322.74,210,Humana,Humana,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Evaluation Moderate Complexity Units,7897808,LOCAL,97166,CPT,,,,,GO,Outpatient,,,322.74,210,Humana,Humana,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Moderate Complex Units,7895293,LOCAL,97166,CPT,,,,,GO,Outpatient,,,322.74,210,Humana,Humana,94.3,,,,,,,Fee Schedule,94.3,269.95,
XR Calcaneus Left,1170032,LOCAL,73650,CPT,,,,,LT,Outpatient,,,325.42,174.9,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Calcaneus Right,1170034,LOCAL,73650,CPT,,,,,RT,Outpatient,,,325.42,174.9,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
94618 PULM STRESS TEST - 6 MIN WALK CHARGE,10470023,LOCAL,94618,CPT,,,,,59,Outpatient,,,326.86,212,Humana,Humana,117.85,,,,,,,Fee Schedule,76.09,117.85,
94618 PULMONARY STRESS TEST CHARGE,10470022,LOCAL,94618,CPT,,,,,,Outpatient,,,326.86,212,Humana,Humana,117.85,,,,,,,Fee Schedule,76.09,117.85,
XR Hips 2 Views w/AP Pelvis Bilat,7520609,LOCAL,73521,CPT,,,,,,Outpatient,,,327.27,175.73,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
"Neutrophil Funct, Oxidative Burst QSTC",13864519,LOCAL,82657,CPT,,,,,,Outpatient,,,327.6,26.6,Humana,Humana,22.17,,,,,,,Fee Schedule,17.73,22.17,
XR Clavicle Limited Left,13554978,LOCAL,73000,CPT,,,,,52|LT,Outpatient,,,330.84,198.83,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Clavicle Limited Right,13575896,LOCAL,73000,CPT,,,,,52|RT,Outpatient,,,330.84,198.83,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR CV Line Injection,10153535,LOCAL,77001,CPT,,,,,,Outpatient,,,330.88,177.38,Humana,Humana,70.92,,,,,,,Fee Schedule,70.92,262.79,
XR Portogram,8602535,LOCAL,36598,CPT,,,,,,Outpatient,,,330.88,587,Humana,Humana,192.63,,,,,,,Fee Schedule,192.63,863,
"Neuron Specific Enolase, CSF QSTC",13864472,LOCAL,86316,CPT,,,,,,Outpatient,,,335.25,24.97,Humana,Humana,100.2,,,,,,,Fee Schedule,15.29,100.2,
XR Sternum 2+ Views,1170496,LOCAL,71120,CPT,,,,,,Outpatient,,,335.51,179.85,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
"Borrelia species DNA, QL RT PCR QSTC",13864432,LOCAL,87801,CPT,,,,,,Outpatient,,,337.5,84.24,Humana,Humana,70.2,,,,,,,Fee Schedule,40.19,70.2,
"Calprotectin, Stool QSTC",8764641,LOCAL,83993,CPT,,,,,,Outpatient,,,337.5,23.56,Humana,Humana,19.63,,,,,,,Fee Schedule,17.73,19.63,
"Factor VII Activity, Clotting QSTC",12530023,LOCAL,85230,CPT,,,,,,Outpatient,,,337.5,21.48,Humana,Humana,17.9,,,,,,,Fee Schedule,5.42,17.9,
"Rheumatoid Factor (IgA, IgG, IgM) QSTC",9743436,LOCAL,83520,CPT,,,,,,Outpatient,,,337.5,20.72,Humana,Humana,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
SURESWAB(R) ADV BV QST,12432150,LOCAL,81513,CPT,,,,,,Outpatient,,,338,171.16,Humana,Humana,142.63,,,,,,,Fee Schedule,63.34,142.63,
"Estrogens, Fractionated, LC/MS QSTC",8972883,LOCAL,82671,CPT,,,,,,Outpatient,,,340.29,38.76,Humana,Humana,185.98,,,,,,,Fee Schedule,18.43,185.975,
"86617-Lyme Disease Abs (IgG, IgM) IBL CSF QSTC",14825580,LOCAL,86617,CPT,,,,,,Outpatient,,,342,18.59,Humana,Humana,15.49,,,,,,,Fee Schedule,15.29,15.49,
"BK Virus DNA, Quant, RT PCR QSTC",8853280,LOCAL,87799,CPT,,,,,,Outpatient,,,342,51.41,Humana,Humana,42.84,,,,,,,Fee Schedule,40.19,42.84,
"Lyme Disease Ab Rfx Blot IgG, IgM QSTC",8764732,LOCAL,86618,CPT,,,,,,Outpatient,,,342,20.44,Humana,Humana,17.03,,,,,,,Fee Schedule,15.29,17.03,
"Lyme Disease Abs (IgG, IgM) IBL CSF QSTC",14114578,LOCAL,86617,CPT,,,,,,Outpatient,,,342,18.59,Humana,Humana,15.49,,,,,,,Fee Schedule,15.29,15.49,
"Lyme Disease Antibodies (IgG, IgM), Immunoblot, CSF QST",6232109,LOCAL,86617,CPT,,,,,,Outpatient,,,342,18.59,Humana,Humana,15.49,,,,,,,Fee Schedule,15.29,15.49,
sodium thiosulfate 25% intravenous solution 50 mL [CULL],11260081,LOCAL,J0208,CPT,,,,,,Outpatient,50,ML,342.4,,Humana,Humana,95.11,,,,,,,Fee Schedule,95.11,7537.07,
Chlamydia/Chlamydophila Ab 1 IgG QSTC,13864536,LOCAL,86631,CPT,,,,,,Outpatient,,,342.9,14.18,Humana,Humana,11.82,,,,,,,Fee Schedule,11.82,15.29,
"TRICHOMONAS VAGINALIS (TV), TMA QST",12432301,LOCAL,87661,CPT,,,,,,Outpatient,,,343.11,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
CANDIDA GLABRATA QST,12432300,LOCAL,87481,CPT,,,,,,Outpatient,,,343.13,42.11,Humana,Humana,478.17,,,,,,,Fee Schedule,40.19,478.165,
CANDIDA SPECIES QST,12432293,LOCAL,87481,CPT,,,,,,Outpatient,,,343.13,42.11,Humana,Humana,478.17,,,,,,,Fee Schedule,40.19,478.165,
CANDIDA SPECIES QST,12432299,LOCAL,87481,CPT,,,,,,Outpatient,,,343.13,42.11,Humana,Humana,478.17,,,,,,,Fee Schedule,40.19,478.165,
SURESWAB(R) ADV BV QST,12432298,LOCAL,81513,CPT,,,,,,Outpatient,,,343.13,171.16,Humana,Humana,142.63,,,,,,,Fee Schedule,63.34,142.63,
"EBV DNA, QN PCR QSTC",8764620,LOCAL,87799,CPT,,,,,,Outpatient,,,344.25,51.41,Humana,Humana,42.84,,,,,,,Fee Schedule,40.19,42.84,
XR Wrist 2 Views Left,1170606,LOCAL,73100,CPT,,,,,LT,Outpatient,,,344.56,184.8,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Wrist 2 Views Right,1170608,LOCAL,73100,CPT,,,,,RT,Outpatient,,,344.56,184.8,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
REF LAB IAT CROSSMATCH,13797753,LOCAL,86922,CPT,,,,,,Outpatient,,,347,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
XR Forearm 2 Views Left,1170197,LOCAL,73090,CPT,,,,,LT,Outpatient,,,347.3,170.78,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Forearm 2 Views Right,1170199,LOCAL,73090,CPT,,,,,RT,Outpatient,,,347.3,170.78,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
97167 EVAL -  HIGH COMPLEXITY CHARGE,9850017,LOCAL,97167,CPT,,,,,GO,Outpatient,,,347.74,226,Humana,Humana,94.3,,,,,,,Fee Schedule,94.3,269.95,
97167 IND EDUCATION EVAL CHARGE,9860017,LOCAL,97167,CPT,,,,,GO|CO,Outpatient,,,347.74,226,Humana,Humana,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Evaluation High Complexity Units,7897809,LOCAL,97167,CPT,,,,,GO,Outpatient,,,347.74,226,Humana,Humana,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT High Complex Units,7895295,LOCAL,97167,CPT,,,,,GO,Outpatient,,,347.74,226,Humana,Humana,94.3,,,,,,,Fee Schedule,94.3,269.95,
99211 LEVEL I VISIT CHARGE,9319019,LOCAL,99211,CPT,,,,,,Outpatient,,,348.41,226,Humana,Humana,7.37,,,,,,,Fee Schedule,7.37,7.37,
99211 Office Visit Established Pt. Level 1,10168485,LOCAL,99211,CPT,,,,,,Outpatient,,,348.41,226,Humana,Humana,7.37,,,,,,,Fee Schedule,7.37,7.37,
XR Scapula Left,1170401,LOCAL,73010,CPT,,,,,LT,Outpatient,,,348.57,187.28,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Scapula Right,1170403,LOCAL,73010,CPT,,,,,RT,Outpatient,,,348.57,187.28,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
Mycobacterium Slow Grower MIC QST,13864520,LOCAL,87186,CPT,,,,,,Outpatient,,,348.75,10.38,Humana,Humana,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
Mycobacterium Slow Grower MIC QSTC,13864520,LOCAL,87186,CPT,,,,,,Outpatient,,,348.75,10.38,Humana,Humana,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
CPAP Charge -> Subsequent,8365858,LOCAL,94660,CPT,,,,,,Outpatient,,,348.84,279,Humana,Humana,185.95,,,,,,,Fee Schedule,181.37,185.95,
17110 CRYOSURGERY REMOVAL OF LESIONS CHARGE,9038957,LOCAL,17110,CPT,,,,,,Outpatient,,,350,228,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
94625 PHY/QHP OP PULM RHB W/O MNTR,10470028,LOCAL,94625,CPT,,,,,,Outpatient,,,350,407,Humana,Humana,54.31,,,,,,,Fee Schedule,51.98,54.31,
11730 AVULSION OF NAIL PLATE SINGLE,8715870,LOCAL,11730,CPT,,,,,,Outpatient,,,350.01,228,Humana,Humana,181.66,,,,,,,Fee Schedule,95.93,863,
94618 PULMONARY STRESS TEST 6 MINUTE WALK,10440014,LOCAL,94618,CPT,,,,,,Outpatient,,,351.07,212,Humana,Humana,117.85,,,,,,,Fee Schedule,76.09,117.85,
linezolid 2 mg/mL-D5% intravenous solution 300 mL [CULL],11201931,LOCAL,J2020,CPT,,,,,,Outpatient,300,ML,352,,Humana,Humana,2.74,,,,,,,Fee Schedule,2.742,2.742,
RT CHARGE PFT -> Bedside Spirometry,8860673,LOCAL,94060,CPT,,,,,,Outpatient,,,353.43,230,Humana,Humana,284.7,,,,,,,Fee Schedule,149.57,284.7,
RT CHARGE PFT -> Spirometry before & after,5267139,LOCAL,94060,CPT,,,,,,Outpatient,,,353.43,230,Humana,Humana,284.7,,,,,,,Fee Schedule,149.57,284.7,
Alpha Subunit QSTC,9849271,LOCAL,83520,CPT,,,,,,Outpatient,,,354.33,20.72,Humana,Humana,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
XR Spine Thoracic 2 Views,1170484,LOCAL,72070,CPT,,,,,,Outpatient,,,358.33,192.23,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
micafungin 50 mg intravenous injection [CULL],11220352,LOCAL,J2248,CPT,,,,,,Outpatient,1,EA,359.232,,Humana,Humana,0.25,,,,,,,Fee Schedule,0.249,122.4,
Acetylcholine Recept. Modulating Ab QSTC,13864533,LOCAL,86043,CPT,,,,,,Outpatient,,,360,14.46,Humana,Humana,12.05,,,,,,,Fee Schedule,12.05,15.29,
Adenovirus DNA Qual RT PCR QSTC,10100374,LOCAL,87798,CPT,,,,,,Outpatient,,,360,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
"B.pertussis/para DNA,Ql Rl-Time PCR QSTC",8873570,LOCAL,87798,CPT,,,,,,Outpatient,,,360,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Bartonella Sp Ab IgG,IgM w/rf Titer QSTC",9777261,LOCAL,86611,CPT,,,,,,Outpatient,,,360,12.22,Humana,Humana,10.18,,,,,,,Fee Schedule,10.18,15.29,
Copeptin QSTC,9039409,LOCAL,86255,CPT,,,,,,Outpatient,,,360,14.46,Humana,Humana,12.05,,,,,,,Fee Schedule,12.05,15.29,
Hepatitis C Viral RNA Genotype LiPA QSTC,8764578,LOCAL,87902,CPT,,,,,,Outpatient,,,360,308.94,Humana,Humana,257.45,,,,,,,Fee Schedule,158.39,257.45,
Histamine QSTC,13864456,LOCAL,83088,CPT,,,,,,Outpatient,,,360,35.44,Humana,Humana,29.53,,,,,,,Fee Schedule,17.73,29.53,
HSV 1 QST,9775428,LOCAL,87529,CPT,,,,,,Outpatient,,,360,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
HSV 2 QST,9775429,LOCAL,87529,CPT,,,,,,Outpatient,,,360,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
Mycobacterium Avium Complex MIC QST,13344174,LOCAL,87186,CPT,,,,,,Outpatient,,,360,10.38,Humana,Humana,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
methylPREDNISolone sodium succinate 2 g injection [CULL],11201958,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,361.92,,Humana,Humana,0.21,,,,,,,Fee Schedule,0.21,0.21,
XR Mandible Less Than 4 Views,1170303,LOCAL,70100,CPT,,,,,,Outpatient,,,362.58,194.7,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
Babesia microti Ab (IgG) QSTC,13872991,LOCAL,86753,CPT,,,,,,Outpatient,,,367.5,14.87,Humana,Humana,12.39,,,,,,,Fee Schedule,12.39,15.29,
Ehrlichia chaffeensis Ab IgG QSTC,13872999,LOCAL,86753,CPT,,,,,,Outpatient,,,367.5,14.87,Humana,Humana,12.39,,,,,,,Fee Schedule,12.39,15.29,
Lyme Ab Screen QSTC,13872998,LOCAL,86618,CPT,,,,,,Outpatient,,,367.5,20.44,Humana,Humana,17.03,,,,,,,Fee Schedule,15.29,17.03,
XR Clavicle Left,1170075,LOCAL,73000,CPT,,,,,LT,Outpatient,,,370.53,198.83,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Clavicle Right,1170077,LOCAL,73000,CPT,,,,,RT,Outpatient,,,370.53,198.83,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Humerus Limited Left,13554999,LOCAL,73060,CPT,,,,,52|LT,Outpatient,,,372.34,223.58,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Humerus Limited Right,13555002,LOCAL,73060,CPT,,,,,52|RT,Outpatient,,,372.34,223.58,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
Reptilase Clotting Time QSTC,13864513,LOCAL,85635,CPT,,,,,,Outpatient,,,372.42,11.82,Humana,Humana,9.85,,,,,,,Fee Schedule,8.21,9.85,
XR Tibia/Fibula Left,1170516,LOCAL,73590,CPT,,,,,LT,Outpatient,,,373.27,200.48,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Tibia/Fibula Right,1170518,LOCAL,73590,CPT,,,,,RT,Outpatient,,,373.27,200.48,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
27095 INJ PROC FOR HIP ARTHROGRAPHY W/ ANESTH,5661071,LOCAL,27095,CPT,,,,,,Outpatient,,,373.99,,Humana,Humana,64.91,,,,,,,Fee Schedule,64.91,863,
"64454 - Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imagin",12897048,LOCAL,64454,CPT,,,,,,Outpatient,,,375,244,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
"64454 Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging",9520502,LOCAL,64454,CPT,,,,,,Outpatient,,,375,244,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
caspofungin 50 mg intravenous injection [CULL],11201273,LOCAL,J0637,CPT,,,,,,Outpatient,1,EA,376,,Humana,Humana,3.82,,,,,,,Fee Schedule,3.818,3.818,
"Bill Only Adsorption (Pheno, Rest, Wrm)",13517195,LOCAL,86978,CPT,,,,,,Outpatient,,,378,,Humana,Humana,54.31,,,,,,,Fee Schedule,38.88,54.31,
"Bill Only Rare Unit, Outside Search",13517199,LOCAL,86999,CPT,,,,,,Outpatient,,,378,,Humana,Humana,22.39,,,,,,,Fee Schedule,6.29,22.39,
tuberculin purified protein derivative 5 tuberculin units/0.1 mL intradermal solution 1 mL [CULL],11200764,LOCAL,86580,CPT,,,,,,Outpatient,1,ML,379.84,,Humana,Humana,22.39,,,,,,,Fee Schedule,15.29,22.39,
"SureSwab(R) Trich. Vag. RNA,QL TMA QSTC",8853247,LOCAL,87661,CPT,,,,,,Outpatient,,,382.5,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Trichomonas Vaginalis RNA, Ql, TMA QST",8853247,LOCAL,87661,CPT,,,,,,Outpatient,,,382.5,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
XR Femur 1 View Left,7520564,LOCAL,73551,CPT,,,,,LT,Outpatient,,,382.59,205.43,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Femur 1 View Right,7520567,LOCAL,73551,CPT,,,,,RT,Outpatient,,,382.59,205.43,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
Hereditary Hemochroma DNA Mut Analy QSTC,8764601,LOCAL,81256,CPT,,,,,,Outpatient,,,387,78.43,Humana,Humana,65.36,,,,,,,Fee Schedule,63.34,65.36,
Bill Only Absorption,7967780,LOCAL,86978,CPT,,,,,,Outpatient,,,391.5,,Humana,Humana,54.31,,,,,,,Fee Schedule,38.88,54.31,
Food and Tree Nut Allergy Panel QSTC,14884175,LOCAL,86003,CPT,,,,,,Outpatient,,,393.21,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
99282 - Level 2,2644298,LOCAL,99282,CPT,,,,,25,Outpatient,,,393.64,256,Humana,Humana,144.78,,,,,,,Fee Schedule,144.78,144.78,
BRACE COOL X-ACT DON-JOY (USE),4852073,LOCAL,,,L1833,HCPCS,,,,Outpatient,,,394.02,994,Humana,Humana,556.31,,,,,,,Fee Schedule,556.31,556.31,
93797 Cardiac Rehab without ECG monitoring,10411210,LOCAL,93797,CPT,,,,,,Outpatient,,,394.32,256,Humana,Humana,115.11,,,,,,,Fee Schedule,115.11,219.28,
93798 Cardiac Rehab Phase II,10411000,LOCAL,93798,CPT,,,,,,Outpatient,,,394.32,256,Humana,Humana,115.11,,,,,,,Fee Schedule,115.11,219.28,
DUP ARTERIAL & VENOUS MAPPING UNI,8200502,LOCAL,93986,CPT,,,,,,Outpatient,,,395.6,257,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Vein Mapping Lower Extremity Left,12175098,LOCAL,93986,CPT,,,,,LT,Outpatient,,,395.6,257,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Vein Mapping Lower Extremity Right,12175101,LOCAL,93986,CPT,,,,,RT,Outpatient,,,395.6,257,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Vein Mapping Upper Extremity Left,12175107,LOCAL,93986,CPT,,,,,LT,Outpatient,,,395.6,257,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Vein Mapping Upper Extremity Right,12175110,LOCAL,93986,CPT,,,,,RT,Outpatient,,,395.6,257,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
caspofungin 70 mg intravenous injection [CULL],11201274,LOCAL,J0637,CPT,,,,,,Outpatient,1,EA,396,,Humana,Humana,3.82,,,,,,,Fee Schedule,3.818,3.818,
71046 XR Chest 2 Views: AddOn,13632841,LOCAL,71046,CPT,,,,,,Outpatient,,,397.38,212.85,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Chest 2 Views,689607,LOCAL,71046,CPT,,,,,,Outpatient,,,397.38,212.85,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
Heparin Anti-Xa QSTC,8972922,LOCAL,85520,CPT,,,,,,Outpatient,,,400.5,15.71,Humana,Humana,13.09,,,,,,,Fee Schedule,5.42,13.09,
XR Abdomen KUB 1 View,1169926,LOCAL,74018,CPT,,,,,,Outpatient,,,401.12,215.33,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Knee 1 or 2 Views Left,1170263,LOCAL,73560,CPT,,,,,LT,Outpatient,,,401.12,215.33,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Knee 1 or 2 Views Right,1170265,LOCAL,73560,CPT,,,,,RT,Outpatient,,,401.12,215.33,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
21- Hydroxylase Antibody QSTC,9708927,LOCAL,83516,CPT,,,,,,Outpatient,,,402.53,13.84,Humana,Humana,11.53,,,,,,,Fee Schedule,11.53,17.73,
"96360 - Hydration, first hour",1928297,LOCAL,96360,CPT,,,,,,Outpatient,,,403.29,262,Humana,Humana,192.63,,,,,,,Fee Schedule,192.63,442.94,
"96360 IV HYDRATION, INITIAL 31-90 MINS",7904529,LOCAL,96360,CPT,,,,,,Outpatient,,,403.29,262,Humana,Humana,192.63,,,,,,,Fee Schedule,192.63,442.94,
Inhibin B QSTC,6210082,LOCAL,83520,CPT,,,,,,Outpatient,,,405,20.72,Humana,Humana,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rituxan Sensitivity (CD20) QSTC,13864421,LOCAL,86356,CPT,,,,,,Outpatient,,,405,32.14,Humana,Humana,26.78,,,,,,,Fee Schedule,15.29,26.78,
XR Hip 1 View Left,1170225,LOCAL,73501,CPT,,,,,LT,Outpatient,,,407.12,218.63,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 1 View Right,1170227,LOCAL,73501,CPT,,,,,RT,Outpatient,,,407.12,218.63,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
A. phagocytophilum Ab IgG IgM QSTC,13864527,LOCAL,86666,CPT,,,,,,Outpatient,,,407.25,12.22,Humana,Humana,10.18,,,,,,,Fee Schedule,10.18,15.29,
XR Bone Length Studies Scanograms,1170016,LOCAL,77073,CPT,,,,,,Outpatient,,,407.59,218.63,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
DOP ABI-ANKLE BRACHIAL INDEX,8230017,LOCAL,93922,CPT,,,,,,Outpatient,,,408.25,265,Humana,Humana,117.85,,,,,,,Fee Schedule,117.85,161.71,
US ABI,8206802,LOCAL,93922,CPT,,,,,,Outpatient,,,408.25,265,Humana,Humana,117.85,,,,,,,Fee Schedule,117.85,161.71,
US Segmental Pressures LE 1-2 Lvls Bilat,1169757,LOCAL,93922,CPT,,,,,,Outpatient,,,408.25,265,Humana,Humana,117.85,,,,,,,Fee Schedule,117.85,161.71,
XR Sacrum/Coccyx 2+ Views,1170391,LOCAL,72220,CPT,,,,,,Outpatient,,,408.83,219.45,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Sniff Test,8602547,LOCAL,71046,CPT,,,,,,Outpatient,,,409.11,212.85,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Sternoclavicular Joint(s),1170494,LOCAL,71130,CPT,,,,,,Outpatient,,,411.41,220.28,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
Bill Only Antigen Type Group 1,13517191,LOCAL,86902,CPT,,,,,,Outpatient,,,414,7.62,Humana,Humana,328.88,,,,,,,Fee Schedule,6.29,328.88,
Proinsulin QSTC,8972777,LOCAL,84206,CPT,,,,,,Outpatient,,,414,32.03,Humana,Humana,26.69,,,,,,,Fee Schedule,18.43,26.69,
XR Elbow Complete 3+ Views Left,1170127,LOCAL,73080,CPT,,,,,LT,Outpatient,,,414.29,221.93,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Elbow Complete 3+ Views Right,1170129,LOCAL,73080,CPT,,,,,RT,Outpatient,,,414.29,221.93,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
DOPP ART EXT BIL MULTIPLE,8200300,LOCAL,93923,CPT,,,,,,Outpatient,,,414.94,401,Humana,Humana,143.05,,,,,,,Fee Schedule,143.05,244.97,
DOPP ART EXT BIL W/EXERCISE,8200310,LOCAL,93924,CPT,,,,,,Outpatient,,,414.94,302,Humana,Humana,143.05,,,,,,,Fee Schedule,143.05,161.71,
XR Shoulder Complete 2 Plus Views Left,1170415,LOCAL,73030,CPT,,,,,LT,Outpatient,,,416.12,222.75,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Shoulder Complete 2 Plus Views Right,1170417,LOCAL,73030,CPT,,,,,RT,Outpatient,,,416.12,222.75,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Femur 2 Views Left,7520570,LOCAL,73552,CPT,,,,,LT,Outpatient,,,417.02,223.58,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Femur 2 Views Right,7520573,LOCAL,73552,CPT,,,,,RT,Outpatient,,,417.02,223.58,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Humerus Left,1170245,LOCAL,73060,CPT,,,,,LT,Outpatient,,,417.02,223.58,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Humerus Right,1170247,LOCAL,73060,CPT,,,,,RT,Outpatient,,,417.02,223.58,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 1 View w/ AP Pelvis Left,7520576,LOCAL,73501,CPT,,,,,LT,Outpatient,,,418.32,218.63,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 1 View w/ AP Pelvis Right,7520579,LOCAL,73501,CPT,,,,,RT,Outpatient,,,418.32,218.63,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
15272 APP SKN SUB GRFT TAL 100 SQ CM ADDT FAC CHARGE,12831013,LOCAL,15272,CPT,,,,,,Outpatient,,,419.53,273,Humana,Humana,13.68,,,,,,,Fee Schedule,13.68,2862.92,
"epoetin alfa-epbx 10,000 units/mL preservative-free injectable solution 1 mL [CULL]",11202387,LOCAL,Q5105,CPT,,,,,,Outpatient,1,ML,423.552,,Humana,Humana,0.79,,,,,,,Fee Schedule,0.79,233.26,
"11055 BENIGN LESION PARING/CUTTING, SINGLE",13043366,LOCAL,11055,CPT,,,,,,Outpatient,,,426.97,278,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
"Enterovirus RNA, QL Real-Time PCR QSTC",8873564,LOCAL,87498,CPT,,,,,,Outpatient,,,427.5,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
CULL US Echo Dop w/ Spectr Ltd,13734793,LOCAL,93321,CPT,,,,,,Outpatient,,,428.24,278,Humana,Humana,15.78,,,,,,,Fee Schedule,15.78,678.38,
ECHO DOP W/SPECTR LTD,8200175,LOCAL,93321,CPT,,,,,,Outpatient,,,428.24,278,Humana,Humana,15.78,,,,,,,Fee Schedule,15.78,678.38,
CPAP Charge -> Initial,8365859,LOCAL,94660,CPT,,,,,,Outpatient,,,429.93,279,Humana,Humana,185.95,,,,,,,Fee Schedule,181.37,185.95,
"S. pneumoniae Ab (IgG), MAID QSTC",13864418,LOCAL,87899,CPT,,,,,,Outpatient,,,431.1,19.28,Humana,Humana,16.07,,,,,,,Fee Schedule,10.57,16.07,
XR Foot Complete 3 Plus Views Left,1170191,LOCAL,73630,CPT,,,,,LT,Outpatient,,,431.43,231,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Foot Complete 3 plus Views Right,1170193,LOCAL,73630,CPT,,,,,RT,Outpatient,,,431.43,231,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
ER US VASCULAR ACCESS GUIDANCE,8200565,LOCAL,76937,CPT,,,,,,Outpatient,,,431.69,231.83,Humana,Humana,23.28,,,,,,,Fee Schedule,23.28,165.47,
US VASCULAR ACCESS GUIDANCE,8200560,LOCAL,76937,CPT,,,,,,Outpatient,,,431.69,231.83,Humana,Humana,23.28,,,,,,,Fee Schedule,23.28,165.47,
E0181 RBC CPD 500 LR,7266548,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Humana,Humana,182,,,,,,,Fee Schedule,182,217.45,
E0226 RBC CPDA1 500 LR,7266556,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Humana,Humana,182,,,,,,,Fee Schedule,182,217.45,
E0366 RBC CP2D AS3 500,7266579,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Humana,Humana,182,,,,,,,Fee Schedule,182,217.45,
E0382 RBC CP2D AS3 500 LR,7266659,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Humana,Humana,182,,,,,,,Fee Schedule,182,217.45,
E0424 RBC CPD AS5 500 LR,7266667,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Humana,Humana,182,,,,,,,Fee Schedule,182,217.45,
E4531 Aph RBC ACDA AS1 LR,7266601,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Humana,Humana,182,,,,,,,Fee Schedule,182,217.45,
E4532 Aph RBC ACDA AS1 LR 1,7266602,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Humana,Humana,182,,,,,,,Fee Schedule,182,217.45,
E4533 Aph RBC ACDA AS1 LR 2,7266603,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Humana,Humana,182,,,,,,,Fee Schedule,182,217.45,
E4543 Aph RBC ACDA AS3 LR,7266613,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Humana,Humana,182,,,,,,,Fee Schedule,182,217.45,
E4544 Aph RBC ACDA AS3 LR 1,7266614,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Humana,Humana,182,,,,,,,Fee Schedule,182,217.45,
E4545 Aph RBC ACDA AS3 LR 2,7266615,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Humana,Humana,182,,,,,,,Fee Schedule,182,217.45,
E5157 RBC CPD AS1 LR LV,8069011,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Humana,Humana,182,,,,,,,Fee Schedule,182,217.45,
XR Hip 2-3 Views Left,7520582,LOCAL,73502,CPT,,,,,LT,Outpatient,,,434.37,232.65,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 2-3 Views Right,7520585,LOCAL,73502,CPT,,,,,RT,Outpatient,,,434.37,232.65,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
fondaparinux 7.5 mg/0.6 mL subcutaneous solution 0.6 mL [CULL],11260585,LOCAL,J1652,CPT,,,,,,Outpatient,0.6,ML,434.56,,Humana,Humana,0.88,,,,,,,Fee Schedule,0.877,0.877,
XR Ankle Complete 3 Plus Views Left,1169942,LOCAL,73610,CPT,,,,,LT,Outpatient,,,434.8,233.48,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ankle Complete 3 Plus Views Right,1169944,LOCAL,73610,CPT,,,,,RT,Outpatient,,,434.8,233.48,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hand Complete 3 Plus Views Right,1170223,LOCAL,73130,CPT,,,,,RT,Outpatient,,,438.91,235.13,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hand Complete 3 Views Left,1170221,LOCAL,73130,CPT,,,,,LT,Outpatient,,,438.91,235.13,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
E0336 RBC CPD AS1 500 LR,7266574,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,439,282,Humana,Humana,182,,,,,,,Fee Schedule,182,217.45,
11056 BENIGN LESION PARING(2-4),13029575,LOCAL,11056,CPT,,,,,,Outpatient,,,439.05,285,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
11103 TANGENTIAL BIOP EA ADDT CHARGE,9322081,LOCAL,11103,CPT,,,,,,Outpatient,,,439.05,285,Humana,Humana,16.62,,,,,,,Fee Schedule,16.62,863,
11721 DEBRIDE NAIL 6 OR MORE WC CHARGE,8726776,LOCAL,11721,CPT,,,,,,Outpatient,,,439.05,285,Humana,Humana,54.31,,,,,,,Fee Schedule,54.31,863,
97602 DEBRIDE MAGGOT THERAPY NON-EXC,11633062,LOCAL,97602,CPT,,,,,,Outpatient,,,439.05,285,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,549.61,
97605 Wound VAC <=50 sq cm,10015643,LOCAL,97605,CPT,,,,,,Outpatient,,,439.05,285,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,273.27,
XR Sacroiliac Joints 3+ Views,1170387,LOCAL,72202,CPT,,,,,,Outpatient,,,440.26,235.95,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
BD Bone Density DEXA Axial w/Frac Assess,5017920,LOCAL,77085,CPT,,,,,,Outpatient,,,442.63,237.6,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,116.02,
US PSEUDOANEURYSM COMPRESSION,8200520,LOCAL,76936,CPT,,,,,,Outpatient,,,443.14,237.6,Humana,Humana,284.7,,,,,,,Fee Schedule,262.79,284.7,
US Pseudoaneurysm Compression Repair,7936316,LOCAL,76936,CPT,,,,,,Outpatient,,,443.14,237.6,Humana,Humana,284.7,,,,,,,Fee Schedule,262.79,284.7,
XR Sinuses Paranasal Complete,1170434,LOCAL,70220,CPT,,,,,,Outpatient,,,445.06,238.43,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
92523 SPEECH SOUND LANGUAGE COMPREHENS CHARGE,9630058,LOCAL,92523,CPT,,,,,GN,Outpatient,,,445.57,290,Humana,Humana,214.08,,,,,,,Fee Schedule,214.08,337.75,
SLP Analysis of Voice & Resonance Minutes,7897211,LOCAL,92523,CPT,,,,,GN,Outpatient,,,445.57,290,Humana,Humana,214.08,,,,,,,Fee Schedule,103.27,337.75,
SLP Sound Prod w/ Lang Comp Eval Units,7897209,LOCAL,92523,CPT,,,,,GN,Outpatient,,,445.57,290,Humana,Humana,214.08,,,,,,,Fee Schedule,214.08,337.75,
Speech Sound Prod w/ Language Charge,7896929,LOCAL,92523,CPT,,,,,GN,Outpatient,,,445.57,290,Humana,Humana,214.08,,,,,,,Fee Schedule,214.08,337.75,
XR Hip 2-3 Views w/AP Pelvis Left,7520588,LOCAL,73502,CPT,,,,,LT,Outpatient,,,446.32,232.65,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 2-3 Views w/AP Pelvis Right,7520591,LOCAL,73502,CPT,,,,,RT,Outpatient,,,446.32,232.65,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
L3931 Forearm based radial nerve orthosis,9646083,LOCAL,,,L3931,HCPCS,,,GP,Outpatient,,,447.23,291,Humana,Humana,229.01,,,,,,,Fee Schedule,229.01,229.01,
L3931 OT WRIST HAND FINGER ORTHOSIS,9856104,LOCAL,,,L3931,HCPCS,,,,Outpatient,,,447.23,291,Humana,Humana,229.01,,,,,,,Fee Schedule,229.01,229.01,
L3931 Wrst/thmb Spic Spnt,9800062,LOCAL,,,L3931,HCPCS,,,,Outpatient,,,447.23,291,Humana,Humana,229.01,,,,,,,Fee Schedule,229.01,229.01,
US Breast Limited Left.,8068444,LOCAL,76642,CPT,,,,,LT,Outpatient,,,449.55,240.9,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,161.71,
US Breast Limited Right.,8068447,LOCAL,76642,CPT,,,,,RT,Outpatient,,,449.55,240.9,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,161.71,
pneumococcal 23-polyvalent vaccine injectable solution 0.5 mL [CULL],11212160,LOCAL,90732,CPT,,,,,,Outpatient,0.5,ML,449.59104,,Humana,Humana,133.47,,,,,,,Fee Schedule,39.58,133.472,
Adalimumab Level for IBD QSTC,13864453,LOCAL,80145,CPT,,,,,,Outpatient,,,450,46.28,Humana,Humana,38.57,,,,,,,Fee Schedule,15.38,38.57,
"Amino Acid Analysis, Plasma QSTC",9039235,LOCAL,82139,CPT,,,,,,Outpatient,,,450,20.24,Humana,Humana,16.87,,,,,,,Fee Schedule,16.87,17.73,
"BK Virus DNA, Quant, RT PCR, Ur QSTC",8764640,LOCAL,87799,CPT,,,,,,Outpatient,,,450,51.41,Humana,Humana,42.84,,,,,,,Fee Schedule,40.19,42.84,
CULL CV Nurse MRI Monitoring,14671862,LOCAL,76018,CPT,,,,,,Outpatient,,,450,75.9,Humana,Humana,83.92,,,,,,,Fee Schedule,83.92,83.92,
Histamine Release Chronic Urticaria QSTC,8764646,LOCAL,86343,CPT,,,,,,Outpatient,,,450,14.95,Humana,Humana,12.46,,,,,,,Fee Schedule,12.46,15.29,
Infliximab Anti-drug Antibody for IBD QSTC,12552286,LOCAL,83520,CPT,,,,,,Outpatient,,,450,20.72,Humana,Humana,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Infliximab Level for IBD QSTC,13864454,LOCAL,80230,CPT,,,,,,Outpatient,,,450,46.28,Humana,Humana,38.57,,,,,,,Fee Schedule,15.38,38.57,
"Interleukin-6 (IL-6), Serum QSTC",9708918,LOCAL,83529,CPT,,,,,,Outpatient,,,450,20.72,Humana,Humana,17.27,,,,,,,Fee Schedule,17.27,17.73,
SJMC 76018 MR Safety Implant Electronics Preparation,14671862,LOCAL,76018,CPT,,,,,,Outpatient,,,450,75.9,Humana,Humana,83.92,,,,,,,Fee Schedule,83.92,83.92,
"VZV DNA, QL RT PCR QSTC",9777241,LOCAL,87798,CPT,,,,,,Outpatient,,,450,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
"99202 LEVEL II INITIAL VISIT, FAC CHARGE",12832515,LOCAL,99202,CPT,,,,,,Outpatient,,,452.19,294,Humana,Humana,39.11,,,,,,,Fee Schedule,39.11,39.11,
99202 Office Visit New Pt. Level 2,10168481,LOCAL,99202,CPT,,,,,,Outpatient,,,452.19,294,Humana,Humana,39.11,,,,,,,Fee Schedule,39.11,39.11,
99212 LEVEL II VISIT CHARGE,9319021,LOCAL,99212,CPT,,,,,,Outpatient,,,452.19,294,Humana,Humana,29.48,,,,,,,Fee Schedule,29.48,29.48,
99212 Office Visit Established Pt. Level 2,10168486,LOCAL,99212,CPT,,,,,,Outpatient,,,452.19,294,Humana,Humana,29.48,,,,,,,Fee Schedule,29.48,29.48,
12001 SIMPLE REPAIR OF WOUND TRUNK,13029607,LOCAL,12001,CPT,,,,,,Outpatient,,,454.38,295,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
FIRST HOUR DIRECT OBSERVATION CHARGE,8566355,LOCAL,,,G0379,HCPCS,,,25,Outpatient,,,457.38,297,Humana,Humana,560.53,,,,,,,Fee Schedule,560.53,560.53,
CHOLANGIO W EXIST CATH S&I,8210339,LOCAL,47531,CPT,,,,,,Outpatient,,,458,298,Humana,Humana,3226.48,,,,,,,Fee Schedule,2599,3226.48,
esmolol 10 mg/mL-sterile water Sol 250 mL [CULL],11201727,LOCAL,J1806,CPT,,,,,,Outpatient,250,ML,458.88,,Humana,Humana,0.41,,,,,,,Fee Schedule,0.41,0.41,
Pregabalin QSTC,8853245,LOCAL,80299,CPT,,,,,,Outpatient,,,459,22.37,Humana,Humana,18.64,,,,,,,Fee Schedule,15.38,18.64,
29580 Application of a Paste Boot (Bilateral),12642335,LOCAL,29580,CPT,,,,,,Outpatient,,,462.53,301,Humana,Humana,144.26,,,,,,,Fee Schedule,144.26,863,
29580 PT UNNA BOOT APPL,9410275,LOCAL,29580,CPT,,,,,GP,Outpatient,,,462.53,301,Humana,Humana,144.26,,,,,,,Fee Schedule,144.26,863,
US EXT NONVASC COMPLETE,8230013,LOCAL,76881,CPT,,,,,,Outpatient,,,462.67,248.33,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US EXT NONVASC LIMITED ANATOMIC SPEC,8230014,LOCAL,76882,CPT,,,,,,Outpatient,,,462.67,248.33,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
Bill Only Elution,7967778,LOCAL,86860,CPT,,,,,,Outpatient,,,463.5,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.27,156.67,
XR Pelvis Complete 3+ Views,1170353,LOCAL,72190,CPT,,,,,,Outpatient,,,463.51,248.33,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
DOP ART - LEA W/ TREADMILL,8230021,LOCAL,93924,CPT,,,,,,Outpatient,,,465.08,302,Humana,Humana,143.05,,,,,,,Fee Schedule,143.05,161.71,
US Lower Ext Doppler w/ Stress Test,1169765,LOCAL,93924,CPT,,,,,,Outpatient,,,465.08,302,Humana,Humana,143.05,,,,,,,Fee Schedule,143.05,161.71,
XR Osseous Survey Infant,1170020,LOCAL,77076,CPT,,,,,,Outpatient,,,466.03,249.98,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Facial Bones < 3 Views,1170139,LOCAL,70140,CPT,,,,,,Outpatient,,,471.62,253.28,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Orbits Limited,13555005,LOCAL,70140,CPT,,,,,,Outpatient,,,471.62,253.28,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
US Hips Infant Limited/Static,8206871,LOCAL,76886,CPT,,,,,,Outpatient,,,472.34,253.28,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,161.71,
US Spinal Canal,1169879,LOCAL,76800,CPT,,,,,,Outpatient,,,472.34,253.28,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
Bill Only Rare Donor Fee,13517197,LOCAL,86999,CPT,,,,,,Outpatient,,,472.5,,Humana,Humana,22.39,,,,,,,Fee Schedule,6.29,22.39,
96373- Intra-Arterial Injection,1928304,LOCAL,96373,CPT,,,,,59,Outpatient,,,473.98,308,Humana,Humana,192.63,,,,,,,Fee Schedule,64.56,192.63,
96373 S-INJ NON CHEMO IA CHARGE,8049127,LOCAL,96373,CPT,,,,,59,Outpatient,,,473.98,308,Humana,Humana,192.63,,,,,,,Fee Schedule,64.56,192.63,
DOP VENOUS LOWER EXT UNILATERAL,8200430,LOCAL,93971,CPT,,,,,,Outpatient,,,476.32,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
DOP VENOUS UPPER EXT UNI OR LTD,8200431,LOCAL,93971,CPT,,,,,,Outpatient,,,476.32,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUP AO IVC ILIAC LIMITED,8200531,LOCAL,93979,CPT,,,,,,Outpatient,,,476.32,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Aorta IVC Iliac Duplex Limited,1169579,LOCAL,93979,CPT,,,,,,Outpatient,,,476.32,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Venous Duplex Left,1169771,LOCAL,93971,CPT,,,,,LT,Outpatient,,,476.32,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Venous Duplex Right,1169773,LOCAL,93971,CPT,,,,,RT,Outpatient,,,476.32,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Upper Ext Venous Duplex Left,1169903,LOCAL,93971,CPT,,,,,LT,Outpatient,,,476.32,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Upper Ext Venous Duplex Right,1169905,LOCAL,93971,CPT,,,,,RT,Outpatient,,,476.32,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUP AV FISTULA OR DIALYSIS GRAFT,8200500,LOCAL,93990,CPT,,,,,,Outpatient,,,476.33,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUPLEX ARTERAL UPPER EXT UNI OR LTD,8200490,LOCAL,93931,CPT,,,,,,Outpatient,,,476.33,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUPLEX ARTERIAL LOWER EXT UNI OR LTD,8200470,LOCAL,93926,CPT,,,,,,Outpatient,,,476.33,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Hemodialysis Duplex Access Lt,8206865,LOCAL,93990,CPT,,,,,,Outpatient,,,476.33,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Hemodialysis Duplex Access Rt,8206868,LOCAL,93990,CPT,,,,,RT,Outpatient,,,476.33,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Arterial Duplex Left,1169761,LOCAL,93926,CPT,,,,,LT,Outpatient,,,476.33,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Arterial Duplex Right,1169763,LOCAL,93926,CPT,,,,,RT,Outpatient,,,476.33,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Upper Ext Arterial Duplex Left,1169897,LOCAL,93931,CPT,,,,,LT,Outpatient,,,476.33,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Upper Ext Arterial Duplex Right,1169899,LOCAL,93931,CPT,,,,,RT,Outpatient,,,476.33,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
DAPTOmycin 500 mg intravenous injection [CULL],11210536,LOCAL,J0878,CPT,,,,,,Outpatient,1,EA,480,480,Humana,Humana,0.03,,,,,,,Fee Schedule,0.01,122.4,
CULL MG Needle/Wire Loc Breast,13720943,LOCAL,19281,CPT,,,,,,Outpatient,,,481.51,313,Humana,Humana,1481.32,,,,,,,Fee Schedule,1200.99,1496,
MG Mammo Guided Needle Loc Left,8206592,LOCAL,19281,CPT,,,,,LT,Outpatient,,,481.51,313,Humana,Humana,1481.32,,,,,,,Fee Schedule,1200.99,1496,
MG Mammo Guided Needle Loc Right,8206595,LOCAL,19281,CPT,,,,,RT,Outpatient,,,481.51,313,Humana,Humana,1481.32,,,,,,,Fee Schedule,1200.99,1496,
Bill Tissue Exam Level 6,14048000,LOCAL,88309,CPT,,,,,,Outpatient,,,485.96,,Humana,Humana,746.86,,,,,,,Fee Schedule,59.06,746.86,
IA-2 Antibody QSTC,9039410,LOCAL,86341,CPT,,,,,,Outpatient,,,486,28.28,Humana,Humana,23.57,,,,,,,Fee Schedule,15.29,23.57,
Low LSO,9400072,LOCAL,,,L0642,HCPCS,,,,Outpatient,,,486.86,,Humana,Humana,319.33,,,,,,,Fee Schedule,319.33,319.33,
96422 CHEMO ARTERIAL INFUS UP TO 1HR CHARGE,9404492,LOCAL,96422,CPT,,,,,,Outpatient,,,488.94,318,Humana,Humana,303.25,,,,,,,Fee Schedule,303.25,442.94,
L3933 OT FINGER ORTHOSIS,9856060,LOCAL,,,L3933,HCPCS,,,,Outpatient,,,488.97,318,Humana,Humana,239.92,,,,,,,Fee Schedule,239.92,239.92,
Bill Only Reticulocyte Separation,8629513,LOCAL,86972,CPT,,,,,,Outpatient,,,490.5,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.88,156.67,
"11105 Punch Biopsy of Skin, Ea Separate/Additional CRRH_GA",13243078,LOCAL,11105,CPT,,,,,,Outpatient,,,491.38,319,Humana,Humana,19.82,,,,,,,Fee Schedule,19.82,863,
A. phagocytophilum/E chaffeensis Ab QSTC,13864420,LOCAL,86666,CPT,,,,,,Outpatient,,,492.75,12.22,Humana,Humana,10.18,,,,,,,Fee Schedule,10.18,15.29,
XR Spine Cervical 2 or 3 Views,1170452,LOCAL,72040,CPT,,,,,,Outpatient,,,496.68,266.48,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
96125 ST-COGNITIVE TEST PER 1HR,9630086,LOCAL,96125,CPT,,,,,GN,Outpatient,,,497.34,323,Humana,Humana,96.7,,,,,,,Fee Schedule,96.7,846.56,
SLP Cognitive Test Units,7897180,LOCAL,96125,CPT,,,,,GN,Outpatient,,,497.34,323,Humana,Humana,96.7,,,,,,,Fee Schedule,96.7,846.56,
Standardized Cognitive Eval Charge,7897180,LOCAL,96125,CPT,,,,,GN,Outpatient,,,497.34,323,Humana,Humana,96.7,,,,,,,Fee Schedule,96.7,846.56,
"45300 PROCTOSIGMOIDOSCOPY, RIGID, DIAGNOSTIC, W OR W/O COLLECTION BY BRUSHING OR WASHING",8934255,LOCAL,45300,CPT,,,,,,Outpatient,,,498,129,Humana,Humana,833.54,,,,,,,Fee Schedule,833.54,1419.32,
BD Bone Density DEXA Axial Skeleton,1167839,LOCAL,77080,CPT,,,,,,Outpatient,,,499.09,267.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,116.02,
OASIS MATRIX WOUND 3X3.5,13962593,LOCAL,,,Q4102,HCPCS,,,,Outpatient,,,501.86,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
G0463 CR REHAB ASSESSMENT CHARGE,10470016,LOCAL,,,G0463,HCPCS,,,,Outpatient,,,502.12,326,Humana,Humana,117.82,,,,,,,Fee Schedule,117.82,117.82,
G0463 HOSPITAL OP CLINIC VISIT W PROC MCR ONLY,13436347,LOCAL,,,G0463,HCPCS,,,25,Outpatient,,,502.12,326,Humana,Humana,117.82,,,,,,,Fee Schedule,117.82,117.82,
G0463 HOSPITAL OUTPATIENT VISIT CHARGE,10470015,LOCAL,,,G0463,HCPCS,,,25,Outpatient,,,502.12,326,Humana,Humana,117.82,,,,,,,Fee Schedule,117.82,117.82,
G0463 OUTPATIENT CLINIC VISIT,13043743,LOCAL,,,G0463,HCPCS,,,25,Outpatient,,,502.12,326,Humana,Humana,117.82,,,,,,,Fee Schedule,117.82,117.82,
IVUS ADDL VESSEL,8230049,LOCAL,92979,CPT,,,,,,Outpatient,,,506,329,Humana,Humana,130.59,,,,,,,Fee Schedule,130.59,863,
"Susceptibility Aerobic Bacteria,MIC QSTC",9039459,LOCAL,87186,CPT,,,,,,Outpatient,,,506.25,10.38,Humana,Humana,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
"Susceptibility, Aerobic Bacterium QST",8389539,LOCAL,87186,CPT,,,,,,Outpatient,,,506.25,10.38,Humana,Humana,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
Administration of Blood (Bridge),8019084,LOCAL,36430,CPT,,,,,,Outpatient,,,509,99,Humana,Humana,399.7,,,,,,,Fee Schedule,399.7,863,
TRANSFUSE Fresh Frozen Plasma (Bridge),8482691,LOCAL,36430,CPT,,,,,,Outpatient,,,509,99,Humana,Humana,399.7,,,,,,,Fee Schedule,399.7,863,
TRANSFUSE Platelet Product (Bridge),8482692,LOCAL,36430,CPT,,,,,,Outpatient,,,509,99,Humana,Humana,399.7,,,,,,,Fee Schedule,399.7,863,
TRANSFUSE Red Blood Cells Leukoreduced (Bridge),8482690,LOCAL,36430,CPT,,,,,,Outpatient,,,509,99,Humana,Humana,399.7,,,,,,,Fee Schedule,399.7,863,
XR Nasal Bones 3+ Views,1170329,LOCAL,70160,CPT,,,,,,Outpatient,,,510.81,273.9,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
"Bill Only RBC Pretreatment, Chemicals",8629511,LOCAL,86970,CPT,,,,,,Outpatient,,,513,,Humana,Humana,54.31,,,,,,,Fee Schedule,38.88,54.31,
"Bill Only RBC Pretreatment, Enyzme",8629512,LOCAL,86971,CPT,,,,,,Outpatient,,,513,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.88,156.67,
XR Arthrogram Injection Ankle Left,1169950,LOCAL,20605,CPT,,,,,LT,Outpatient,,,517.48,336,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrogram Injection Ankle Right,1169952,LOCAL,20605,CPT,,,,,RT,Outpatient,,,517.48,336,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrogram Injection Elbow Right,1169958,LOCAL,20605,CPT,,,,,RT,Outpatient,,,517.48,336,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrogram Injection Wrist Left,1169996,LOCAL,20605,CPT,,,,,LT,Outpatient,,,517.48,336,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrogram Injection Wrist Right,1169998,LOCAL,20605,CPT,,,,,RT,Outpatient,,,517.48,336,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
IMPLANT ALLODERM 1/2,13962573,LOCAL,,,Q4116,HCPCS,,,,Outpatient,,,517.5,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
ECHO DOP COLOR FLOW MAPPING,8200220,LOCAL,93325,CPT,,,,,,Outpatient,,,517.63,336,Humana,Humana,17.83,,,,,,,Fee Schedule,17.83,161.71,
XR Spine Lumbosacral 2 or 3 Views,1170470,LOCAL,72100,CPT,,,,,,Outpatient,,,520.24,278.85,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
"G0399 HOME SLEEP STUDY, CHARGE",8303751,LOCAL,,,G0399,HCPCS,,,,Outpatient,,,523.26,340,Humana,Humana,143.05,,,,,,,Fee Schedule,143.05,206.62,
11057 BENIGN LESION PARING(4+),13029576,LOCAL,11057,CPT,,,,,,Outpatient,,,523.3,340,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
16030 Dressing/Debridement Large More than one ext or >10% total body,9400041,LOCAL,16030,CPT,,,,,,Outpatient,,,523.3,863,Humana,Humana,365.27,,,,,,,Fee Schedule,365.27,863,
15276 APPL-HC SKSB GRT F/N/H/G-AD 25CM CHARGE,9709030,LOCAL,15276,CPT,,,,,,Outpatient,,,526.26,342,Humana,Humana,20.61,,,,,,,Fee Schedule,20.61,2862.92,
XR Knee 3 Views Left,1170269,LOCAL,73562,CPT,,,,,LT,Outpatient,,,527.77,282.98,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Knee 3 Views Right,1170271,LOCAL,73562,CPT,,,,,RT,Outpatient,,,527.77,282.98,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Barium Swallow,9756897,LOCAL,74220,CPT,,,,,,Outpatient,,,527.78,282.98,Humana,Humana,162.76,,,,,,,Fee Schedule,83.69,162.76,
XR Swallowing Function w/ Speech,1170500,LOCAL,74230,CPT,,,,,,Outpatient,,,527.78,282.98,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,176.48,
RT CHARGE PFT -> Bronchoprovocation,5267129,LOCAL,94070,CPT,,,,,,Outpatient,,,530,345,Humana,Humana,284.7,,,,,,,Fee Schedule,149.57,284.7,
Ertapenem Sodium 1 gram intravenous injection [CULL],11201820,LOCAL,J1335,CPT,,,,,,Outpatient,1,EA,532.992,,Humana,Humana,9.16,,,,,,,Fee Schedule,9.16,9.16,
XR Mandible Complete 4+ Views,1170301,LOCAL,70110,CPT,,,,,,Outpatient,,,533.23,286.28,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Facial Bones 3+ Views,1170141,LOCAL,70150,CPT,,,,,,Outpatient,,,533.25,286.28,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Skull < 4 Views,1170436,LOCAL,70250,CPT,,,,,,Outpatient,,,533.25,286.28,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Hips 3-4 Views Bilat,7520612,LOCAL,73522,CPT,,,,,,Outpatient,,,534.2,286.28,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Hips 3-4 Views w/AP Pelvis Bilat,7520615,LOCAL,73522,CPT,,,,,,Outpatient,,,534.2,286.28,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
93799 INPATIENT TEACH CARDIAC REHAB CHARGE,8230066,LOCAL,93799,CPT,,,,,,Outpatient,,,535.14,348,Humana,Humana,143.05,,,,,,,Fee Schedule,38.53,863,
XR Wrist Complete 3 Plus Views Right,1170614,LOCAL,73110,CPT,,,,,RT,Outpatient,,,538.7,288.75,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Wrist Complete 3+ Views Left,1170612,LOCAL,73110,CPT,,,,,LT,Outpatient,,,538.7,288.75,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
"COVID-19, Respiratory Panel 2.1(Biofire)",9624028,LOCAL,0202U,CPT,,,,,,Outpatient,,,540,500.14,Humana,Humana,443.38,,,,,,,Fee Schedule,173.68,443.38,
Bill Only Antigen Type Group 2,10312940,LOCAL,86902,CPT,,,,,,Outpatient,,,544.5,7.62,Humana,Humana,328.88,,,,,,,Fee Schedule,6.29,328.88,
XR Abdomen 2 Views,8132826,LOCAL,74019,CPT,,,,,,Outpatient,,,546.49,292.88,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
L3807 Tko Splint,9646038,LOCAL,,,L3807,HCPCS,,,,Outpatient,,,549.15,357,Humana,Humana,281.19,,,,,,,Fee Schedule,281.19,281.19,
96132 NEUROPSYCH TESTING EVAL; FIRST HOUR CHARGE,9496220,LOCAL,96132,CPT,,,,,,Outpatient,,,549.45,357,Humana,Humana,485.11,,,,,,,Fee Schedule,485.11,846.56,
XR Spine Cervical 4 or 5 Views,1170454,LOCAL,72050,CPT,,,,,,Outpatient,,,552.95,296.18,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
albumin human 25% intravenous solution 100 mL [CULL],11281015,LOCAL,P9047,CPT,,,,,,Outpatient,100,ML,552.96,,Humana,Humana,53.08,,,,,,,Fee Schedule,53.077,217.45,
G0277 HBO Full Body 30 Min Interval,10015694,LOCAL,,,G0277,HCPCS,,,,Outpatient,,,553.52,360,Humana,Humana,126.08,,,,,,,Fee Schedule,126.08,549.61,
XR Knee Complete 4 Plus Views Left,1170287,LOCAL,73564,CPT,,,,,LT,Outpatient,,,554.16,297,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Knee Complete 4 Plus Views Right,1170289,LOCAL,73564,CPT,,,,,RT,Outpatient,,,554.16,297,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
"penicillin G benzathine 600,000 units/mL intramuscular suspension 1 mL [CULL]",11202082,LOCAL,J0561,CPT,,,,,,Outpatient,1,ML,558.848,,Humana,Humana,30.01,,,,,,,Fee Schedule,30.01,122.4,
ADAMTS13 Activity w/Rfx Inhibitor QSTC,9777262,LOCAL,85397,CPT,,,,,,Outpatient,,,562.5,37.03,Humana,Humana,30.86,,,,,,,Fee Schedule,26.47,30.86,
"Chromosome Analysis, Blood QSTC",8848485,LOCAL,88262,CPT,,,,,,Outpatient,,,562.5,150.59,Humana,Humana,125.49,,,,,,,Fee Schedule,63.34,125.49,
Clinical Indication: QSTC,8848484,LOCAL,88230,CPT,,,,,,Outpatient,,,562.5,139.79,Humana,Humana,116.49,,,,,,,Fee Schedule,58.01,116.49,
Kleihauer-Betke Stain QSTC,9956031,LOCAL,85460,CPT,,,,,,Outpatient,,,562.5,9.28,Humana,Humana,7.73,,,,,,,Fee Schedule,7.73,8.21,
Respirat. Allergy Profile Region VI QSTC,9039268,LOCAL,86003,CPT,,,,,,Outpatient,,,564.39,6.26,Humana,Humana,5.22,,,,,,,Fee Schedule,5.22,15.29,
Respirat. Allergy Profile Region VI QSTC,9041102,LOCAL,82785,CPT,,,,,,Outpatient,,,564.39,19.75,Humana,Humana,203.96,,,,,,,Fee Schedule,17.73,203.9616667,
Respiratory Allergy Panel Region VI with Reflexes QSTC,14884176,LOCAL,82785,CPT,,,,,,Outpatient,,,564.39,19.75,Humana,Humana,203.96,,,,,,,Fee Schedule,17.73,203.9616667,
XR Spine Thoracic 3 Views,1170486,LOCAL,72072,CPT,,,,,,Outpatient,,,567.43,304.43,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Ribs 2 Views Left,1170371,LOCAL,71100,CPT,,,,,LT,Outpatient,,,567.44,304.43,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ribs 2 Views Right,1170373,LOCAL,71100,CPT,,,,,RT,Outpatient,,,567.44,304.43,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
US Breast ABUS Left,8746657,LOCAL,76641,CPT,,,,,LT,Outpatient,,,571.63,306.9,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Breast ABUS Left.,8567804,LOCAL,76641,CPT,,,,,LT,Outpatient,,,571.63,306.9,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Breast ABUS Right.,8567807,LOCAL,76641,CPT,,,,,RT,Outpatient,,,571.63,306.9,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Breast Complete Left.,8068438,LOCAL,76641,CPT,,,,,LT,Outpatient,,,571.63,306.9,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Breast Complete Right.,8068441,LOCAL,76641,CPT,,,,,RT,Outpatient,,,571.63,306.9,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
Electrocardiogram 12 Lead,2322786,LOCAL,93005,CPT,,,,,,Outpatient,,,573,178,Humana,Humana,54.31,,,,,,,Fee Schedule,38.53,54.31,
99283 - Level 3,2644299,LOCAL,99283,CPT,,,,,25,Outpatient,,,578.6,376,Humana,Humana,253.15,,,,,,,Fee Schedule,253.15,253.15,
pneumococcal 21-valent conjugate vaccine (cvx 327) - Sus [CULL],11200021,LOCAL,90684,CPT,,,,,,Outpatient,0.5,ML,579.792,,Humana,Humana,344.25,,,,,,,Fee Schedule,160.4,344.252,
29581 APPL MULTLAY COMPRS LWR LEG,9739188,LOCAL,29581,CPT,,,,,,Outpatient,,,580.2,195,Humana,Humana,144.26,,,,,,,Fee Schedule,144.26,863,
XR Ribs 3 Views Bilateral,1170375,LOCAL,71110,CPT,,,,,,Outpatient,,,580.49,311.03,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Spine Thoracic 4+ Views,1170488,LOCAL,72074,CPT,,,,,,Outpatient,,,581.11,311.85,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Sinus Tract SI,2425614,LOCAL,76080,CPT,,,,,,Outpatient,,,583.56,312.68,Humana,Humana,501.29,,,,,,,Fee Schedule,176.48,501.29,
Bill Only Rare Unit,8196052,LOCAL,86999,CPT,,,,,,Outpatient,,,585,,Humana,Humana,22.39,,,,,,,Fee Schedule,6.29,22.39,
Oviduct chromotubation 58350,9093091,LOCAL,58350,CPT,,,,,,Outpatient,,,585,4936,Humana,Humana,4513.2,,,,,,,Fee Schedule,2599,4513.2,
ER ECHOCARDIOGRAM 2D LIMITED,8200203,LOCAL,93308,CPT,,,,,,Outpatient,,,586,564,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,678.38,
TRANSPAC REUSABLE CABLE 42661-03,8200204,LOCAL,93308,CPT,,,,,,Outpatient,,,586,564,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,678.38,
64445 NERV BLOCK SCIATIC,5661029,LOCAL,64445,CPT,,,,,,Outpatient,,,587.24,382,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
"FISH, Chromosome Specific 1 Pr QSTC",13864683,LOCAL,88271,CPT,,,,,,Outpatient,,,587.34,25.7,Humana,Humana,21.42,,,,,,,Fee Schedule,21.42,63.34,
Specimen Source: FISH Chrom Pr x1 QSTC,13864676,LOCAL,88273,CPT,,,,,,Outpatient,,,587.34,41.77,Humana,Humana,34.81,,,,,,,Fee Schedule,34.81,63.34,
rifAMPin 600 mg intravenous injection [CULL],11211144,LOCAL,J2804,CPT,,,,,,Outpatient,1,EA,587.52,,Humana,Humana,0.15,,,,,,,Fee Schedule,0.153,0.153,
REF Antibody ID,7032173,LOCAL,86870,CPT,,,,,,Outpatient,,,589.5,,Humana,Humana,328.88,,,,,,,Fee Schedule,38.27,328.88,
US Head Newborn,8206862,LOCAL,76506,CPT,,,,,,Outpatient,,,590.44,316.8,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
Very Long Chain Fatty Acids QSTC,8764801,LOCAL,82726,CPT,,,,,,Outpatient,,,590.63,23.7,Humana,Humana,19.75,,,,,,,Fee Schedule,17.73,19.75,
US Fetal Biophysical Profile w/ Non-Str,1169687,LOCAL,76818,CPT,,,,,,Outpatient,,,591.07,316.8,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,148.61,
99203  New Patient-Detailed,12642291,LOCAL,99203,CPT,,,,,,Outpatient,,,595.04,387,Humana,Humana,67.57,,,,,,,Fee Schedule,67.57,67.57,
99203 Office Visit New Pt. Level 3,10168482,LOCAL,99203,CPT,,,,,,Outpatient,,,595.04,387,Humana,Humana,67.57,,,,,,,Fee Schedule,67.57,67.57,
99203 Office Visit New Pt. Level 3,10168482,LOCAL,99203,CPT,,,,,,Outpatient,,,595.04,387,Humana,Humana,67.57,,,,,,,Fee Schedule,67.57,67.57,
99213 Established patient visit- level 3,7947777,LOCAL,99213,CPT,,,,,,Outpatient,,,595.04,387,Humana,Humana,54.77,,,,,,,Fee Schedule,54.77,54.77,
99213 Established patient visit- level 3,7947777,LOCAL,99213,CPT,,,,,,Outpatient,,,595.04,387,Humana,Humana,54.77,,,,,,,Fee Schedule,54.77,54.77,
99213 LEVEL III VISIT CHARGE,9319022,LOCAL,99213,CPT,,,,,,Outpatient,,,595.04,387,Humana,Humana,54.77,,,,,,,Fee Schedule,54.77,54.77,
99213 Office Visit Established Pt. Level 3,10168487,LOCAL,99213,CPT,,,,,,Outpatient,,,595.04,387,Humana,Humana,54.77,,,,,,,Fee Schedule,54.77,54.77,
LENS #SA60AT,4832535,LOCAL,,,V2632,HCPCS,,,,Outpatient,,,599.5,392,Humana,Humana,145.73,,,,,,,Fee Schedule,145.73,145.73,
"Creatinine, Random, Ur QSTC",13873086,LOCAL,82570,CPT,,,,,,Outpatient,,,599.63,6.22,Humana,Humana,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"N-Methylhistamine, Random, Ur QSTC",13873083,LOCAL,82542,CPT,,,,,,Outpatient,,,599.63,28.91,Humana,Humana,24.09,,,,,,,Fee Schedule,17.73,24.09,
XR Ribs w/ PA Chest Bilateral,1170377,LOCAL,71111,CPT,,,,,,Outpatient,,,601.59,322.58,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
36010 INTRO CATH SUP/INF VENA CAVA,8266890,LOCAL,36010,CPT,,,,,,Outpatient,,,604.59,393,Humana,Humana,87.95,,,,,,,Fee Schedule,87.95,929.12,
INTRO CATH VENA CAVA,8267101,LOCAL,36010,CPT,,,,,,Outpatient,,,604.59,393,Humana,Humana,87.95,,,,,,,Fee Schedule,87.95,929.12,
Antenatal Testing Type -> Contraction stress test,10446024,LOCAL,59020,CPT,,,,,,Outpatient,,,607.55,94,Humana,Humana,183.92,,,,,,,Fee Schedule,183.92,863,
97597 ACTIVE WOUND CARE MANAGEMENT FIRST 20 CM,13048047,LOCAL,97597,CPT,,,,,59,Outpatient,,,608.25,395,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
97597 DEBRIDE SCISSOR/SCAPEL 20SQ CM,9410251,LOCAL,97597,CPT,,,,,GP,Outpatient,,,608.25,395,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
97597 DEBRIDEMENT,9866113,LOCAL,97597,CPT,,,,,GO|CO,Outpatient,,,608.25,395,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
97597 OT SELECT DEBRIDE ME CHARGE,9856113,LOCAL,97597,CPT,,,,,GO,Outpatient,,,608.25,395,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
97598 Debrid Open wound > 20 sq cm charge,12511973,LOCAL,97598,CPT,,,,,,Outpatient,,,608.25,395,Humana,Humana,20.42,,,,,,,Fee Schedule,20.42,1466.58,
OT Removal Devitalized Tissue < 20 cm Units,7897756,LOCAL,97597,CPT,,,,,GO,Outpatient,,,608.25,395,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
OT Removal Tissue <20 Assist Units,7897756,LOCAL,97597,CPT,,,,,CQ,Outpatient,,,608.25,395,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
OT Selective Debridement Charge,7895252,LOCAL,97597,CPT,,,,,GO,Outpatient,,,608.25,395,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
Selective Debridement Charge,7895942,LOCAL,97597,CPT,,,,,GP,Outpatient,,,608.25,395,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
"Selective Debridement Charge -> Yes, total wound surface area, first 20 sq cm or less",8968080,LOCAL,97597,CPT,,,,,GP,Outpatient,,,608.25,395,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
XR Cystogram Limited,13703435,LOCAL,74430,CPT,,,,,52,Outpatient,,,612.55,554.4,Humana,Humana,326.51,,,,,,,Fee Schedule,176.48,326.51,
US Chest,1169635,LOCAL,76604,CPT,,,,,,Outpatient,,,612.93,328.35,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
XR Ribs w/ PA Chest Left,1170379,LOCAL,71101,CPT,,,,,LT,Outpatient,,,615.08,330,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Ribs w/ PA Chest Right,1170381,LOCAL,71101,CPT,,,,,RT,Outpatient,,,615.08,330,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
Strep Pneumoniae Ab IgG 23 Serotypes QST,10217037,LOCAL,86581,CPT,,,,,,Outpatient,,,615.83,,Humana,Humana,92.03,,,,,,,Fee Schedule,44.29,92.03,
"Strep pneumoniae IgG Abs, 23 Serotypes QST",14006318,LOCAL,86581,CPT,,,,,,Outpatient,,,615.83,,Humana,Humana,92.03,,,,,,,Fee Schedule,44.29,92.03,
DUP ARTERIAL & VENOUS MAPPING BIL,8200501,LOCAL,93985,CPT,,,,,,Outpatient,,,616.92,401,Humana,Humana,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Vein Mapping Lower Extremity Bilat,12175095,LOCAL,93985,CPT,,,,,,Outpatient,,,616.92,401,Humana,Humana,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Vein Mapping Upper Extremity Bilat,12175104,LOCAL,93985,CPT,,,,,,Outpatient,,,616.92,401,Humana,Humana,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Vessel Mapping for Hemo Access Bilat,10216429,LOCAL,93985,CPT,,,,,,Outpatient,,,616.92,401,Humana,Humana,220.99,,,,,,,Fee Schedule,161.71,220.99,
DOP ART-LEA WITH ABI SEG PRESSURES,8230018,LOCAL,93923,CPT,,,,,,Outpatient,,,617.64,401,Humana,Humana,143.05,,,,,,,Fee Schedule,143.05,244.97,
DOP ART-UEA W/ PRESSURES UPPER,8230064,LOCAL,93923,CPT,,,,,,Outpatient,,,617.64,401,Humana,Humana,143.05,,,,,,,Fee Schedule,143.05,244.97,
US Segmental Pressures LE 3+ Lvls Bilat,1169755,LOCAL,93923,CPT,,,,,,Outpatient,,,617.64,401,Humana,Humana,143.05,,,,,,,Fee Schedule,143.05,244.97,
US Segmental Pressures UE 3+ Lvls Bilat,9759154,LOCAL,93923,CPT,,,,,,Outpatient,,,617.64,401,Humana,Humana,143.05,,,,,,,Fee Schedule,143.05,244.97,
L3913 Hand finger orthosis (HFO) without joints may include soft interface straps custom fabricated,9856095,LOCAL,,,L3913,HCPCS,,,,Outpatient,,,620.7,403,Humana,Humana,304.58,,,,,,,Fee Schedule,304.58,304.58,
L3913 HFO W/O JOINTS CF CHARGE,9856102,LOCAL,,,L3913,HCPCS,,,,Outpatient,,,620.7,403,Humana,Humana,304.58,,,,,,,Fee Schedule,304.58,304.58,
MG Mammo Diagnostic Left w/ Tomo.,8058649,LOCAL,77065,CPT,,,,,LT,Outpatient,,,623.77,334.13,Humana,Humana,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Diagnostic Right w/ Tomo.,8058652,LOCAL,77065,CPT,,,,,RT,Outpatient,,,623.77,334.13,Humana,Humana,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Digital Diagnostic Left.,7918560,LOCAL,77065,CPT,,,,,LT,Outpatient,,,623.77,334.13,Humana,Humana,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Digital Diagnostic Right.,7918563,LOCAL,77065,CPT,,,,,RT,Outpatient,,,623.77,334.13,Humana,Humana,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Implant Diag Left w/ Tomo.,8058658,LOCAL,77065,CPT,,,,,LT,Outpatient,,,623.77,334.13,Humana,Humana,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Implant Diag Right w/ Tomo.,8058661,LOCAL,77065,CPT,,,,,RT,Outpatient,,,623.77,334.13,Humana,Humana,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Implant Digital Diag Left.,8058667,LOCAL,77065,CPT,,,,,LT,Outpatient,,,623.77,334.13,Humana,Humana,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Implant Digital Diag Right.,8058670,LOCAL,77065,CPT,,,,,RT,Outpatient,,,623.77,334.13,Humana,Humana,75.3,,,,,,,Fee Schedule,74,75.3,
XR Osseous Survey Limited,1170022,LOCAL,77074,CPT,,,,,,Outpatient,,,626.27,335.78,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
94625 OUTPATIENT PULMONARY REHAB W/O CONTINIOUS MONITORING,10470029,LOCAL,94625,CPT,,,,,,Outpatient,,,626.86,407,Humana,Humana,54.31,,,,,,,Fee Schedule,51.98,54.31,
Newborn Screen,8165282,LOCAL,84035,CPT,,,,,,Outpatient,,,629.03,4.78,Humana,Humana,3.98,,,,,,,Fee Schedule,3.98,7.16,
"Phenylketonuria, Blood SO",9565050,LOCAL,84030,CPT,,,,,,Outpatient,,,629.03,6.6,Humana,Humana,5.5,,,,,,,Fee Schedule,5.5,7.16,
"Susceptibility, Yeast, Comp. Panel QSTC",6250013,LOCAL,87186,CPT,,,,,,Outpatient,,,630,10.38,Humana,Humana,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
US OB Limited,1169856,LOCAL,76815,CPT,,,,,,Outpatient,,,632.6,339.08,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,148.61,
"L3702 Elbow orthosis, without joints, may include soft interface, straps, custom fabricated",9646073,LOCAL,,,L3702,HCPCS,,,,Outpatient,,,634.13,412,Humana,Humana,324.72,,,,,,,Fee Schedule,324.72,324.72,
L3702 ELBOW SPLINT,9856096,LOCAL,,,L3702,HCPCS,,,,Outpatient,,,634.13,412,Humana,Humana,324.72,,,,,,,Fee Schedule,324.72,324.72,
CULL US Echo Dop w/ Spectral Complete,13736513,LOCAL,93320,CPT,,,,,,Outpatient,,,636.3,414,Humana,Humana,29.71,,,,,,,Fee Schedule,29.71,678.38,
ECHO DOP W/SPECTRAL COMPLETE,8200180,LOCAL,93320,CPT,,,,,,Outpatient,,,636.3,414,Humana,Humana,29.71,,,,,,,Fee Schedule,29.71,678.38,
"epoetin alfa 10,000 units/mL preservative-free Sol 1 mL [CULL]",11202387,LOCAL,J0885,CPT,,,,,,Outpatient,1,ML,636.672,,Humana,Humana,8.54,,,,,,,Fee Schedule,0.79,233.26,
74248 XR Small Bowel Follow Thru: AddOn,13626886,LOCAL,74248,CPT,,,,,,Outpatient,,,636.99,341.55,Humana,Humana,41.4,,,,,,,Fee Schedule,41.4,176.48,
CULL XR Small Bowel Follow Thru,13626886,LOCAL,74248,CPT,,,,,,Outpatient,,,636.99,341.55,Humana,Humana,41.4,,,,,,,Fee Schedule,41.4,176.48,
64486 TAP BLOCK UNILATERAL BY INJECTION(S),5661023,LOCAL,64486,CPT,,,,,,Outpatient,,,637.75,415,Humana,Humana,46.33,,,,,,,Fee Schedule,46.33,863,
INTRO CATH RT HEART PA,8267102,LOCAL,36013,CPT,,,,,,Outpatient,,,638.52,415,Humana,Humana,104.34,,,,,,,Fee Schedule,104.34,929.12,
alteplase 2 mg injection [CULL],11201047,LOCAL,J2997,CPT,,,,,,Outpatient,1,EA,644.928,,Humana,Humana,94.45,,,,,,,Fee Schedule,94.45,122.4,
"Supersaturation, U24 SO",13938669,LOCAL,83945,CPT,,,,,,Outpatient,,,645.39,17.34,Humana,Humana,24.09,,,,,,,Fee Schedule,17.73,24.085,
10060 DRAINAGE OF SKIN ABSCESS CHARGE,9704026,LOCAL,10060,CPT,,,,,,Outpatient,,,646.72,420,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
10061 I & D COMPLEX,13048116,LOCAL,10061,CPT,,,,,,Outpatient,,,646.72,420,Humana,Humana,365.27,,,,,,,Fee Schedule,239.03,863,
Bill Prostate Biopsy,14048008,LOCAL,,,G0416,HCPCS,,,,Outpatient,,,646.83,,Humana,Humana,328.88,,,,,,,Fee Schedule,59.06,328.88,
XR Spine Thoracolumbar 2 Views,1170490,LOCAL,72080,CPT,,,,,,Outpatient,,,651.93,349.8,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
High LSO,9400071,LOCAL,,,L0648,HCPCS,,,,Outpatient,,,655.66,,Humana,Humana,797.49,,,,,,,Fee Schedule,797.49,797.49,
"11102 Tangential Biopsy of Skin, 1 lesion",9620037,LOCAL,11102,CPT,,,,,,Outpatient,,,656.43,427,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
16020 BURN DEBRIDEMENT/DRESSING INITIAL OR SUB,13043448,LOCAL,16020,CPT,,,,,,Outpatient,,,656.43,427,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
16020 Chemical Canterizaiton,9400039,LOCAL,16020,CPT,,,,,,Outpatient,,,656.43,427,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
17250 CAUTERY OF WOUND (ELECTRICAL),13033473,LOCAL,17250,CPT,,,,,,Outpatient,,,656.43,427,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
97606 Wound VAC >50 sq cm HBO,10015644,LOCAL,97606,CPT,,,,,,Outpatient,,,656.43,427,Humana,Humana,365.27,,,,,,,Fee Schedule,365.27,549.61,
REF ABO Discrep (ABSC),13481254,LOCAL,86850,CPT,,,,,,Outpatient,,,657,11.72,Humana,Humana,48.85,,,,,,,Fee Schedule,6.29,48.85,
TELEMETRY DAILY CHARGE,9341351,LOCAL,93229,CPT,,,,,,Outpatient,,,659,311,Humana,Humana,284.7,,,,,,,Fee Schedule,99.86,284.7,
13133 >  Each additional 5 cm or less (List separately in addition to primary procedure),12788295,LOCAL,13133,CPT,,,,,,Outpatient,,,660,,Humana,Humana,95.58,,,,,,,Fee Schedule,95.58,863,
"13133-Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; e",14746903,LOCAL,13133,CPT,,,,,,Outpatient,,,660,,Humana,Humana,95.58,,,,,,,Fee Schedule,95.58,863,
82570 QST,14798876,LOCAL,82570,CPT,,,,,,Outpatient,,,662,6.22,Humana,Humana,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Leukotriene E4, Random, Urine QST",14798876,LOCAL,82542,CPT,,,,,,Outpatient,,,662.05,28.91,Humana,Humana,24.09,,,,,,,Fee Schedule,7.16,40.97514925,
Bill Only Antigen Type Group 3,10312933,LOCAL,86902,CPT,,,,,,Outpatient,,,666,7.62,Humana,Humana,328.88,,,,,,,Fee Schedule,6.29,328.88,
"JC Polyoma Virus DNA, Qual PCR CSF QSTC",10170129,LOCAL,87798,CPT,,,,,,Outpatient,,,666,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
XR Skull Complete,1170438,LOCAL,70260,CPT,,,,,,Outpatient,,,672.73,360.53,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
Bill Only REF Washing,13514969,LOCAL,86999,CPT,,,,,,Outpatient,,,675,,Humana,Humana,22.39,,,,,,,Fee Schedule,6.29,22.39,
US AAA Screening,8058767,LOCAL,76706,CPT,,,,,,Outpatient,,,675.12,362.18,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Abdomen Limited,1169569,LOCAL,76705,CPT,,,,,,Outpatient,,,675.12,362.18,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Renal,7936319,LOCAL,76770,CPT,,,,,,Outpatient,,,675.12,362.18,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,245.49,
US Retroperitoneal Complete,1169867,LOCAL,76770,CPT,,,,,,Outpatient,,,675.12,362.18,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,245.49,
MG Mammo Digital Screening Bilateral.,7918566,LOCAL,77067,CPT,,,,,,Outpatient,,,676.43,363,Humana,Humana,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Digital Screening Left.,7949062,LOCAL,77067,CPT,,,,,52|LT,Outpatient,,,676.43,363,Humana,Humana,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Digital Screening Right.,7949065,LOCAL,77067,CPT,,,,,52|RT,Outpatient,,,676.43,363,Humana,Humana,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Implant Digital Screening Bil.,8058673,LOCAL,77067,CPT,,,,,,Outpatient,,,676.43,363,Humana,Humana,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Implant Screening Bil w/ Tomo.,8058682,LOCAL,77067,CPT,,,,,,Outpatient,,,676.43,363,Humana,Humana,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Screening Bilateral w/ Tomo.,8058685,LOCAL,77067,CPT,,,,,,Outpatient,,,676.43,363,Humana,Humana,79.68,,,,,,,Fee Schedule,74,79.68,
64450 INJECTION PERIPHERAL NERVE OR BRANCH,5661030,LOCAL,64450,CPT,,,,,,Outpatient,,,680,1613,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
57105 - BIOPSY VAGINAL MUCOSA EXTENSIVE,14749499,LOCAL,57105,CPT,,,,,,Outpatient,,,685,3180,Humana,Humana,2906.92,,,,,,,Fee Schedule,2315,3558.77,
adenosine 3 mg/mL intravenous solution 30 mL [CULL],11201017,LOCAL,J0153,CPT,,,,,,Outpatient,30,ML,686.4,,Humana,Humana,0.53,,,,,,,Fee Schedule,0.529,0.529,
"Immunoglobulins Panel, CSF QSTC",13864507,LOCAL,82784,CPT,,,,,,Outpatient,,,687.2,11.16,Humana,Humana,34.96,,,,,,,Fee Schedule,7.16,34.958,
LENS PRELOADED #PCB00,4851541,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,687.5,410,Humana,Humana,145.73,,,,,,,Fee Schedule,145.73,145.73,
LENS PRELOADED DCB00,4855985,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,687.5,410,Humana,Humana,145.73,,,,,,,Fee Schedule,145.73,145.73,
US Fetal Biophysical Profile w/o N-Str,1169689,LOCAL,76819,CPT,,,,,,Outpatient,,,688.53,369.6,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,148.61,
"FISH, Prenatal Scr Interp QSTC",13864670,LOCAL,88274,CPT,,,,,,Outpatient,,,690.75,50.86,Humana,Humana,42.38,,,,,,,Fee Schedule,42.38,63.34,
"FISH, Prenatal Screen QSTC",13864673,LOCAL,88271,CPT,,,,,,Outpatient,,,690.75,25.7,Humana,Humana,21.42,,,,,,,Fee Schedule,21.42,63.34,
zoledronic acid 4 mg/100 mL intravenous solution 100 mL [CULL],11211397,LOCAL,J3489,CPT,,,,,,Outpatient,100,ML,691.2,,Humana,Humana,5.08,,,,,,,Fee Schedule,5.082,5.082,
11104 Punch Biopsy,10017193,LOCAL,11104,CPT,,,,,,Outpatient,,,691.38,449,Humana,Humana,365.27,,,,,,,Fee Schedule,365.27,863,
XR Abdomen Series Chest 1 View,1169932,LOCAL,74022,CPT,,,,,,Outpatient,,,691.86,53.63,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Osseous Survey Complete,1170018,LOCAL,77075,CPT,,,,,,Outpatient,,,694.85,372.9,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,176.48,
XR Spine Cervical 6+ Views,1170461,LOCAL,72052,CPT,,,,,,Outpatient,,,701.96,376.2,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
"96365 IV INFUSION, MEDS, INITIAL 16-90 MINS",7904531,LOCAL,96365,CPT,,,,,,Outpatient,,,702.66,457,Humana,Humana,192.63,,,,,,,Fee Schedule,192.63,442.94,
"96365- IV tx, first hour",1928299,LOCAL,96365,CPT,,,,,,Outpatient,,,702.66,457,Humana,Humana,192.63,,,,,,,Fee Schedule,192.63,442.94,
US Aorta,7936256,LOCAL,76775,CPT,,,,,,Outpatient,,,702.79,377.03,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Retroperitoneal Limited,1169869,LOCAL,76775,CPT,,,,,,Outpatient,,,702.79,377.03,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
F/U EMBOLIZATION/INFUSION,8210730,LOCAL,75898,CPT,,,,,,Outpatient,,,707.78,379.5,Humana,Humana,2877.63,,,,,,,Fee Schedule,1231.66,2877.63,
US Extremity Nonvascular Limited Left,2425338,LOCAL,76882,CPT,,,,,LT,Outpatient,,,708.51,248.33,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Extremity Nonvascular Limited Right,2425341,LOCAL,76882,CPT,,,,,RT,Outpatient,,,708.51,248.33,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Head/Neck Soft Tissue,1169729,LOCAL,76536,CPT,,,,,,Outpatient,,,708.51,380.33,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
76000 XR Fluoroscopy Under 1 Hour: AddOn,13658083,LOCAL,76000,CPT,,,,,,Outpatient,,,709.31,380.33,Humana,Humana,220.99,,,,,,,Fee Schedule,176.48,220.99,
64495 - INJ PARAVERT F JNT L/S 3 LEV,5661079,LOCAL,64495,CPT,,,,,,Outpatient,,,710.23,462,Humana,Humana,42.72,,,,,,,Fee Schedule,42.72,1250.53,
INTRO CAROTID VERTEBRAL ARTERY,8267188,LOCAL,36100,CPT,,,,,,Outpatient,,,710.94,462,Humana,Humana,122.25,,,,,,,Fee Schedule,122.25,929.12,
XR Urography Retrograde,10454609,LOCAL,74420,CPT,,,,,,Outpatient,,,714.75,383.63,Humana,Humana,326.51,,,,,,,Fee Schedule,176.48,326.51,
97607 Disp NP Wound Tx <=50 Sq Cm.,10017200,LOCAL,97607,CPT,,,,,,Outpatient,,,716.42,466,Humana,Humana,365.27,,,,,,,Fee Schedule,365.27,549.61,
".Thyroglobulin, LC/MS/MS QSTC",13864486,LOCAL,84432,CPT,,,,,,Outpatient,,,720,19.27,Humana,Humana,46.24,,,,,,,Fee Schedule,18.43,46.235,
93017 CARDIAC STRESS TEST CHARGE,7938407,LOCAL,93017,CPT,,,,,,Outpatient,,,721.43,469,Humana,Humana,284.7,,,,,,,Fee Schedule,244.97,284.7,
CARDIAC STRESS W/TRACING,8200041,LOCAL,93017,CPT,,,,,,Outpatient,,,721.43,469,Humana,Humana,284.7,,,,,,,Fee Schedule,244.97,284.7,
NM Stress Test Trace,2426005,LOCAL,93017,CPT,,,,,,Outpatient,,,721.43,469,Humana,Humana,284.7,,,,,,,Fee Schedule,244.97,284.7,
64405 Occipital Nerve Block Unilateral,5661077,LOCAL,64405,CPT,,,,,,Outpatient,,,724.33,879,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
MRI 3D Reconstruction w/o Workstation,8108472,LOCAL,76376,CPT,,,,,,Outpatient,,,730.14,391.88,Humana,Humana,13.93,,,,,,,Fee Schedule,13.93,13.93,
Bill Only REF Thawing & Washing RBC,13514967,LOCAL,86931,CPT,,,,,,Outpatient,,,733.5,,Humana,Humana,156.67,,,,,,,Fee Schedule,38.88,156.67,
L3808 Forearm based orthosis w/o dynamic,9856093,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,733.5,89,Humana,Humana,375.59,,,,,,,Fee Schedule,375.59,375.59,
OT CARPAL TUNNEL SPLINTS,9646074,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,733.5,89,Humana,Humana,375.59,,,,,,,Fee Schedule,375.59,375.59,
REF HLA ABSC,13484120,LOCAL,86829,CPT,,,,,,Outpatient,,,733.5,77.03,Humana,Humana,64.19,,,,,,,Fee Schedule,6.29,64.19,
REF HPA-1 Typing,13481256,LOCAL,81105,CPT,,,,,,Outpatient,,,733.5,146.66,Humana,Humana,122.22,,,,,,,Fee Schedule,63.34,122.22,
93571 Cor Flow Wire 1st Measure,8230055,LOCAL,93571,CPT,,,,,,Outpatient,,,734.27,477,Humana,Humana,143.66,,,,,,,Fee Schedule,143.66,2669.67,
LENS #ACU0T0,4853561,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,737,410,Humana,Humana,145.73,,,,,,,Fee Schedule,145.73,145.73,
LENS #SN60WF,4891100,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,737,410,Humana,Humana,145.73,,,,,,,Fee Schedule,145.73,145.73,
XR Arthrocentesis Asp/Inj Intmed Jt Lt,14807134,LOCAL,20605,CPT,,,,,LT,Outpatient,,,740,336,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Intmed Jt Rt,14807137,LOCAL,20605,CPT,,,,,RT,Outpatient,,,740,336,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Major Jt Bilat,14807140,LOCAL,20610,CPT,,,,,50,Outpatient,,,740,650,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Major Jt Lt,14807143,LOCAL,20610,CPT,,,,,LT,Outpatient,,,740,650,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Major Jt Rt,14807146,LOCAL,20610,CPT,,,,,RT,Outpatient,,,740,650,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Small Jt Lt,14807149,LOCAL,20600,CPT,,,,,LT,Outpatient,,,740,295,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Small Jt Rt,14807152,LOCAL,20600,CPT,,,,,RT,Outpatient,,,740,295,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
XR Colon Barium Enema,9427624,LOCAL,74270,CPT,,,,,,Outpatient,,,740.46,396.83,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,176.48,
DOP VENOUS LOWER EXT BILATERAL,8200420,LOCAL,93970,CPT,,,,,,Outpatient,,,742.12,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
DOP VENOUS UPPER EXT BIL,8200421,LOCAL,93970,CPT,,,,,,Outpatient,,,742.12,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP AO IVC ILIAC COMPLETE,8200530,LOCAL,93978,CPT,,,,,,Outpatient,,,742.12,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP CAROTID BILATERAL,8200370,LOCAL,93880,CPT,,,,,,Outpatient,,,742.12,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP CAROTID UNI,8200380,LOCAL,93882,CPT,,,,,,Outpatient,,,742.12,482,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUP HEPATOPORTAL INFLOW/OUTFLOW COMP,8200434,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP MESENTERIC/CELIAC ARTERY IN/OUT COMP,8200433,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP RENAL ARTERIES INFLOW/OUTFLOW COMP,8200432,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUPLEX ARTERIAL LOWER EXT BIL,8200460,LOCAL,93925,CPT,,,,,,Outpatient,,,742.12,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUPLEX ARTERIAL UPPER EXT BIL,8200480,LOCAL,93930,CPT,,,,,,Outpatient,,,742.12,482,Humana,Humana,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Abdomen Vascular Limited,8206811,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Aorta IVC Iliac Duplex Complete,1169577,LOCAL,93978,CPT,,,,,,Outpatient,,,742.12,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Art/Vein Abd/Pelvis/Scrotal Complete,1169581,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Carotid Duplex Bilateral,1169631,LOCAL,93880,CPT,,,,,,Outpatient,,,742.12,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Carotid Duplex Left,8814383,LOCAL,93882,CPT,,,,,LT,Outpatient,,,742.12,482,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Carotid Duplex Right,8814386,LOCAL,93882,CPT,,,,,RT,Outpatient,,,742.12,482,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Arterial Duplex Bilateral,1169759,LOCAL,93925,CPT,,,,,,Outpatient,,,742.12,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Lower Ext Venous Duplex Bilateral,1169769,LOCAL,93970,CPT,,,,,,Outpatient,,,742.12,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Renal Artery Duplex Bilateral,4246822,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Upper Ext Arterial Duplex Bilateral,1169895,LOCAL,93930,CPT,,,,,,Outpatient,,,742.12,482,Humana,Humana,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Upper Ext Venous Duplex Bilateral,1169901,LOCAL,93970,CPT,,,,,,Outpatient,,,742.12,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP RENAL ARTERIES UNI,8200585,LOCAL,93976,CPT,,,,,,Outpatient,,,742.13,482,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,245.49,
US Renal Artery Duplex Left,4246828,LOCAL,93976,CPT,,,,,LT,Outpatient,,,742.13,482,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,245.49,
US Renal Artery Duplex Right,4246843,LOCAL,93976,CPT,,,,,RT,Outpatient,,,742.13,482,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,245.49,
Acetylcholine Receptor Binding Ab QSTC,8853232,LOCAL,86041,CPT,,,,,,Outpatient,,,743,22.08,Humana,Humana,18.4,,,,,,,Fee Schedule,15.29,18.4,
XR Small Bowel Series,12908279,LOCAL,74250,CPT,,,,,,Outpatient,,,748.74,401.78,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,176.48,
Chlamydophila pneumoniae QSTC,9727429,LOCAL,87486,CPT,,,,,,Outpatient,,,750,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
Human RSV A QSTC,9727398,LOCAL,87633,CPT,,,,,,Outpatient,,,750,500.14,Humana,Humana,610.31,,,,,,,Fee Schedule,158.39,610.305625,
Mycoplasma pneumoniae QSTC,9727431,LOCAL,87581,CPT,,,,,,Outpatient,,,750,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
REF Antibody Titer,7943112,LOCAL,86886,CPT,,,,,,Outpatient,,,756,6.22,Humana,Humana,156.67,,,,,,,Fee Schedule,6.29,156.67,
64494 - INJ PARAVERT F JNT L/S 2 LEV,5661036,LOCAL,64494,CPT,,,,,,Outpatient,,,761,495,Humana,Humana,41.55,,,,,,,Fee Schedule,41.55,1250.53,
REF HLA PLT ABSC,13479160,LOCAL,86829,CPT,,,,,,Outpatient,,,767.25,77.03,Humana,Humana,64.19,,,,,,,Fee Schedule,6.29,64.19,
REF PLT ABSC,13484122,LOCAL,86022,CPT,,,,,,Outpatient,,,767.25,22.04,Humana,Humana,18.37,,,,,,,Fee Schedule,15.29,18.37,
95822 EEG COMA OR SLEEP ONLY CHARGE,8687098,LOCAL,95822,CPT,,,,,,Outpatient,,,768.44,499,Humana,Humana,284.7,,,,,,,Fee Schedule,284.7,466.96,
EEG EXTENDED 41-60 MINUTES CHARGE,13515636,LOCAL,95812,CPT,,,,,,Outpatient,,,768.44,499,Humana,Humana,284.7,,,,,,,Fee Schedule,284.7,740.58,
MG Mammo Diagnostic Bilateral w/ Tomo.,8058646,LOCAL,77066,CPT,,,,,,Outpatient,,,770.81,413.33,Humana,Humana,96.53,,,,,,,Fee Schedule,74,96.53,
MG Mammo Digital Diagnostic Bilat.,7918557,LOCAL,77066,CPT,,,,,,Outpatient,,,770.81,413.33,Humana,Humana,96.53,,,,,,,Fee Schedule,74,96.53,
MG Mammo Implant Diag Bilateral w/ Tomo.,8058655,LOCAL,77066,CPT,,,,,,Outpatient,,,770.81,413.33,Humana,Humana,96.53,,,,,,,Fee Schedule,11.11,96.53,
MG Mammo Implant Diag Bilateral w/ Tomo.,8058655,LOCAL,G0279,CPT,,,,,,Outpatient,,,770.81,,Humana,Humana,11.11,,,,,,,Fee Schedule,11.11,96.53,
MG Mammo Implant Digital Diag Bilateral.,8058664,LOCAL,77066,CPT,,,,,,Outpatient,,,770.81,413.33,Humana,Humana,96.53,,,,,,,Fee Schedule,74,96.53,
Pen G Benz/Proc (Bicillin CR) [CULL],11202075,LOCAL,J0558,CPT,,,,,,Outpatient,2,ML,771.5488,,Humana,Humana,19.52,,,,,,,Fee Schedule,19.52,122.4,
97608 Disp NP Wound Tx >50 Sq Cm.,10017187,LOCAL,97608,CPT,,,,,,Outpatient,,,777.46,505,Humana,Humana,365.27,,,,,,,Fee Schedule,365.27,549.61,
Bill Only Antigen Type Group 4,10312939,LOCAL,86902,CPT,,,,,,Outpatient,,,778.5,7.62,Humana,Humana,328.88,,,,,,,Fee Schedule,6.29,328.88,
64491 INJ PARAVER CERV/THOR 2ND LEVEL,5661064,LOCAL,64491,CPT,,,,,,Outpatient,,,782.44,509,Humana,Humana,48.01,,,,,,,Fee Schedule,48.01,1250.53,
64492 FACET CERV/THOR 3RD ADDTL LEVEL CHARGE,5661080,LOCAL,64492,CPT,,,,,,Outpatient,,,782.44,509,Humana,Humana,48.5,,,,,,,Fee Schedule,48.5,1250.53,
"FISH, Locus Specific X2 100 QSTC",13864693,LOCAL,88271,CPT,,,,,,Outpatient,,,787.5,25.7,Humana,Humana,21.42,,,,,,,Fee Schedule,21.42,63.34,
KERECIS OMEGA 3 - DISK 14MM 2,13962583,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,787.5,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
"Liver Fibrosis, Fibro-ActiTest Pnl QSTC",8764813,LOCAL,81596,CPT,,,,,,Outpatient,,,787.5,86.63,Humana,Humana,429.13,,,,,,,Fee Schedule,63.34,429.125,
Specimen Source: FISH Locus Pr x2 QSTC,13864687,LOCAL,88275,CPT,,,,,,Outpatient,,,787.5,61.43,Humana,Humana,51.19,,,,,,,Fee Schedule,51.19,63.34,
ICD DFT TESTING,8231015,LOCAL,93641,CPT,,,,,,Outpatient,,,788,512,Humana,Humana,205.74,,,,,,,Fee Schedule,205.74,9059.73,
99204 New patient-level 4 specialty clinic,13538609,LOCAL,,,G0463,HCPCS,,,,Outpatient,,,788.5,326,Humana,Humana,117.82,,,,,,,Fee Schedule,117.82,117.82,
99204 Office Visit New Pt. Level 4,10168483,LOCAL,99204,CPT,,,,,,Outpatient,,,788.5,513,Humana,Humana,110.67,,,,,,,Fee Schedule,110.67,110.67,
99204 Office Visit New Pt. Level 4,10168483,LOCAL,99204,CPT,,,,,,Outpatient,,,788.5,513,Humana,Humana,110.67,,,,,,,Fee Schedule,110.67,110.67,
99214 LEVEL IV VISIT CHARGE,9319023,LOCAL,99214,CPT,,,,,,Outpatient,,,788.5,513,Humana,Humana,80.51,,,,,,,Fee Schedule,80.51,80.51,
99214 Office Visit Established Pt. Level 4,10168488,LOCAL,99214,CPT,,,,,,Outpatient,,,788.5,513,Humana,Humana,80.51,,,,,,,Fee Schedule,80.51,80.51,
New Patient Level 4,13436278,LOCAL,99204,CPT,,,,,25,Outpatient,,,788.5,513,Humana,Humana,110.67,,,,,,,Fee Schedule,110.67,117.82,
New Patient Level 4,13436278,LOCAL,G0463,CPT,,,,,25,Outpatient,,,788.5,326,Humana,Humana,117.82,,,,,,,Fee Schedule,110.67,117.82,
36593 DECLOT IMPLANT DEVICE/CATHETER CHARGE,8700839,LOCAL,36593,CPT,,,,,,Outpatient,,,794.92,517,Humana,Humana,303.25,,,,,,,Fee Schedule,303.25,863,
64590  Insertion or replacement of peripheral or gastric neurostimulator pulse generator,8529396,LOCAL,64590,CPT,,,,,,Outpatient,,,798,519,Humana,Humana,19605.75,,,,,,,Fee Schedule,9233,30196.67,
US Transvaginal Non-OB,1169889,LOCAL,76830,CPT,,,,,,Outpatient,,,798,428.18,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
JAK2 V617F Mutation Analysis QSTC,9039438,LOCAL,81270,CPT,,,,,,Outpatient,,,810,109.99,Humana,Humana,449.92,,,,,,,Fee Schedule,63.34,449.915,
TPMT Genotype QSTC,10168397,LOCAL,81335,CPT,,,,,,Outpatient,,,810,209.77,Humana,Humana,174.81,,,,,,,Fee Schedule,173.68,174.81,
LENS CLAREON CCA0T0,4802028,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,819.5,410,Humana,Humana,145.73,,,,,,,Fee Schedule,145.73,145.73,
LENS CLAREON CNA0T0,4890000,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,819.5,410,Humana,Humana,145.73,,,,,,,Fee Schedule,145.73,145.73,
95816 EEG AWAKE AND DROWSY CHARGE,8303772,LOCAL,95816,CPT,,,,,,Outpatient,,,820.05,533,Humana,Humana,284.7,,,,,,,Fee Schedule,284.7,466.96,
ADD'L ART 2ND/3RD ABD,8267115,LOCAL,36248,CPT,,,,,,Outpatient,,,820.1,533,Humana,Humana,39.09,,,,,,,Fee Schedule,39.09,929.12,
XR Spine Lumbosacral 4 Plus Views,1170476,LOCAL,72110,CPT,,,,,,Outpatient,,,823.1,441.38,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
"GAD65, IA-2 and Insulin Autoantibody QSTC",14105691,LOCAL,86337,CPT,,,,,,Outpatient,,,823.5,25.69,Humana,Humana,21.41,,,,,,,Fee Schedule,15.29,21.41,
"GAD65, IA-2 and Insulin Autoantibody QSTC.",14621959,LOCAL,86337,CPT,,,,,,Outpatient,,,823.5,25.69,Humana,Humana,21.41,,,,,,,Fee Schedule,15.29,21.41,
LENS #DIB00,4803761,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,825,410,Humana,Humana,145.73,,,,,,,Fee Schedule,145.73,145.73,
92978 Cath IVUS First Vessel,8230048,LOCAL,92978,CPT,,,,,,Outpatient,,,828.2,538,Humana,Humana,164.22,,,,,,,Fee Schedule,164.22,863,
"Rho D Immune Globulin, Human, full dose, 300 micrograms, INJ",90620010,LOCAL,J2790,CPT,,,,,,Outpatient,,,829.08,,Humana,Humana,80.53,,,,,,,Fee Schedule,80.532,122.4,
XR Arthrogram Knee SI Left,2425410,LOCAL,73580,CPT,,,,,LT,Outpatient,,,834.05,447.15,Humana,Humana,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Arthrogram Knee SI Right,2425413,LOCAL,73580,CPT,,,,,RT,Outpatient,,,834.05,447.15,Humana,Humana,326.51,,,,,,,Fee Schedule,176.48,326.51,
Abeta 40 - QST,13874686,LOCAL,82233,CPT,,,,,,Outpatient,,,844,,Humana,Humana,128.92,,,,,,,Fee Schedule,128.92,173.68,
Abeta 42 - QST,13874685,LOCAL,82234,CPT,,,,,,Outpatient,,,844,,Humana,Humana,128.92,,,,,,,Fee Schedule,128.92,173.68,
PASSY-MUIR PMV2001- 703-2001,8800100,LOCAL,,,L8501,HCPCS,,,,Outpatient,,,846.95,,Humana,Humana,179.42,,,,,,,Fee Schedule,179.42,179.42,
"epoetin alfa-epbx 20,000 units/mL injectable solution 1 mL [CULL]",11202388,LOCAL,Q5106,CPT,,,,,,Outpatient,1,ML,847.104,,Humana,Humana,7.85,,,,,,,Fee Schedule,7.85,525.49,
36005 Venogram Injection,8212037,LOCAL,36005,CPT,,,,,,Outpatient,,,847.39,551,Humana,Humana,38.76,,,,,,,Fee Schedule,38.76,929.12,
levothyroxine 40 mcg (0.04 mg)/mL intravenous solution 5 mL [CULL],11202740,LOCAL,J0650,CPT,,,,,,Outpatient,5,ML,851.392,,Humana,Humana,5.98,,,,,,,Fee Schedule,5.983,122.4,
XR Upper GI w/ Air Contrast,1170566,LOCAL,74246,CPT,,,,,,Outpatient,,,862.77,492.53,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,176.48,
XR Upper GI w/ Air w/ Small Bowel,1170570,LOCAL,74246,CPT,,,,,,Outpatient,,,862.77,492.53,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,176.48,
EPINEPHrine 1 mg/mL injectable solution 30 mL [CULL],11202381,LOCAL,J0165,CPT,,,,,,Outpatient,30,ML,864,,Humana,Humana,0.43,,,,,,,Fee Schedule,0.433,0.433,
US Scrotum (Contents),8206982,LOCAL,76870,CPT,,,,,,Outpatient,,,864.82,463.65,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
US OB Transvaginal,1169861,LOCAL,76817,CPT,,,,,,Outpatient,,,865.47,464.48,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,148.61,
93308 LMTD STUDENT ECHOCARDIOGRAM CHARGE,6011002,LOCAL,93308,CPT,,,,,,Outpatient,,,867.64,564,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,678.38,
ECHO 2D LTD,8200150,LOCAL,93308,CPT,,,,,,Outpatient,,,867.64,564,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,678.38,
US Echo 2D Limited,8071400,LOCAL,93308,CPT,,,,,,Outpatient,,,867.64,564,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,678.38,
Pneumonia Panel (Biofire),9594219,LOCAL,87633,CPT,,,,,,Outpatient,,,868.73,500.14,Humana,Humana,610.31,,,,,,,Fee Schedule,158.39,610.305625,
tbo-filgrastim 300 mcg/0.5 mL subcutaneous solution 0.5 mL [CULL],11202449,LOCAL,J1447,CPT,,,,,,Outpatient,0.5,ML,872.2368,,Humana,Humana,0.28,,,,,,,Fee Schedule,0.28,525.49,
XR Colon Barium Enema w/ Air Contrast,9427627,LOCAL,74280,CPT,,,,,,Outpatient,,,872.33,467.78,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,176.48,
CARDIAC THROMBOLYTICS IV,8267127,LOCAL,92977,CPT,,,,,,Outpatient,,,874.14,568,Humana,Humana,303.25,,,,,,,Fee Schedule,303.25,863,
NM Thyroid Imaging,2426008,LOCAL,78013,CPT,A9512,HCPCS,,,,Outpatient,,,879.12,471.08,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,560.96,
92612 - ENDOSCOPY SWALLOW TST (FEES),9636010,LOCAL,92612,CPT,,,,,GN,Outpatient,,,884,575,Humana,Humana,52.01,,,,,,,Fee Schedule,52.01,162.41,
92612 Fiber Endo Eval Swallow Video Charge,9410192,LOCAL,92612,CPT,,,,,GN,Outpatient,,,884,575,Humana,Humana,52.01,,,,,,,Fee Schedule,52.01,162.41,
SLP Fiberoptic Swallow Eval Units,1373844,LOCAL,92612,CPT,,,,,GN,Outpatient,,,884,575,Humana,Humana,52.01,,,,,,,Fee Schedule,52.01,162.41,
Speech Fiberoptic Swallow Eval Charge,1373844,LOCAL,92612,CPT,,,,,GN,Outpatient,,,884,575,Humana,Humana,52.01,,,,,,,Fee Schedule,52.01,162.41,
99284 - Level 4,2644300,LOCAL,99284,CPT,,,,,25,Outpatient,,,886.65,576,Humana,Humana,389.31,,,,,,,Fee Schedule,389.31,389.31,
3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase (HMGCR) Antibody (IgG) QSTC,13864471,LOCAL,83520,CPT,,,,,,Outpatient,,,888.75,20.72,Humana,Humana,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
XR Hips 5+ Views Bilat,7520618,LOCAL,73523,CPT,,,,,,Outpatient,,,890.34,477.68,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Hips 5+ Views w/AP Pelvis Bilat,7520621,LOCAL,73523,CPT,,,,,,Outpatient,,,890.34,477.68,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Barium Swallow w/ Upper GI + KUB,8912828,LOCAL,74240,CPT,,,,,,Outpatient,,,891.48,477.68,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,176.48,
XR Upper GI,1170562,LOCAL,74240,CPT,,,,,,Outpatient,,,891.48,477.68,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,176.48,
XR Upper GI w/ Small Bowel,1170574,LOCAL,74240,CPT,,,,,,Outpatient,,,891.48,477.68,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,176.48,
ceftaroline 600 mg intravenous injection [CULL],11201425,LOCAL,J0712,CPT,,,,,,Outpatient,1,EA,896.73216,,Humana,Humana,4.23,,,,,,,Fee Schedule,4.23,233.26,
"ANNA3 Ab, IFA, CSF QSTC",13873554,LOCAL,86255,CPT,,,,,,Outpatient,,,900,14.46,Humana,Humana,12.05,,,,,,,Fee Schedule,12.05,15.29,
"GAD65 Ab, IFA, CSF QSTC",13873575,LOCAL,86341,CPT,,,,,,Outpatient,,,900,28.28,Humana,Humana,23.57,,,,,,,Fee Schedule,15.29,23.57,
TPMT Activity QSTC,8764663,LOCAL,84433,CPT,,,,,,Outpatient,,,900,26.6,Humana,Humana,22.17,,,,,,,Fee Schedule,17.73,22.17,
CATH PL 1ST ORDER VENOUS,8267186,LOCAL,36011,CPT,,,,,,Outpatient,,,908.34,590,Humana,Humana,126.74,,,,,,,Fee Schedule,126.74,929.12,
VENOGRAM INJ BILATERAL,8267755,LOCAL,36005,CPT,,,,,,Outpatient,,,914.51,551,Humana,Humana,38.76,,,,,,,Fee Schedule,38.76,929.12,
XR Barium Swallow w/ Upper GI w/ Air,13554969,LOCAL,74246,CPT,,,,,,Outpatient,,,918.22,492.53,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,176.48,
95819 EEG AWAKE & ASLEEP CHARGE,8704890,LOCAL,95819,CPT,,,,,,Outpatient,,,922.13,599,Humana,Humana,284.7,,,,,,,Fee Schedule,284.7,466.96,
US Biopsy Abdomen/Retroperitoneal Mass,8565247,LOCAL,76942,CPT,,,,,,Outpatient,,,927.16,497.48,Humana,Humana,28.54,,,,,,,Fee Schedule,28.54,165.47,
US Biopsy Liver,1169599,LOCAL,76942,CPT,,,,,,Outpatient,,,927.16,497.48,Humana,Humana,28.54,,,,,,,Fee Schedule,28.54,165.47,
US Breast Needle Loc Left,7936259,LOCAL,19285,CPT,,,,,LT,Outpatient,,,927.16,603,Humana,Humana,643.26,,,,,,,Fee Schedule,643.26,1291,
US Breast Needle Loc Right,7936262,LOCAL,19285,CPT,,,,,RT,Outpatient,,,927.16,603,Humana,Humana,643.26,,,,,,,Fee Schedule,643.26,1291,
US NEEDLE PLACEMENT CVS,8200510,LOCAL,76942,CPT,,,,,,Outpatient,,,927.16,497.48,Humana,Humana,28.54,,,,,,,Fee Schedule,28.54,165.47,
XR Cholangiogram T-Tube Check,8207012,LOCAL,47531,CPT,,,,,,Outpatient,,,927.38,298,Humana,Humana,3226.48,,,,,,,Fee Schedule,2599,3226.48,
KERECIS OMEGA 3 - DISK 16MM 2,13962585,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,929.25,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
XR Arthrogram Elbow SI Left,2425398,LOCAL,73085,CPT,,,,,LT,Outpatient,,,934.13,500.78,Humana,Humana,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Arthrogram Elbow SI Right,2425401,LOCAL,73085,CPT,,,,,RT,Outpatient,,,934.13,500.78,Humana,Humana,326.51,,,,,,,Fee Schedule,176.48,326.51,
"Bartonella DNA, Qual, RT PCR QSTC",13864512,LOCAL,87471,CPT,,,,,,Outpatient,,,940.5,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
BiPAP Charge -> Subsequent,2678299,LOCAL,94003,CPT,,,,,,Outpatient,,,943.5,613,Humana,Humana,604.42,,,,,,,Fee Schedule,604.42,941,
NM Lung Perfusion Imaging,1169328,LOCAL,78580,CPT,A9540,HCPCS,,,,Outpatient,,,948.45,508.2,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,1409.71,
64999 PERI-INFILTRATION HARDWARE,5661083,LOCAL,64999,CPT,,,,,,Outpatient,,,953.35,620,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
L3806 OT WRIST HAND FINGER ORTHOSIS,9856094,LOCAL,,,L3806,HCPCS,,,,Outpatient,,,966.78,628,Humana,Humana,510.8,,,,,,,Fee Schedule,510.8,510.8,
"penicillin G benzathine 1,200,000 units/2 mL intramuscular suspension 2 mL [CULL]",11202076,LOCAL,J0561,CPT,,,,,,Outpatient,2,ML,967.8944,,Humana,Humana,30.01,,,,,,,Fee Schedule,30.01,122.4,
ADD'L ART 2ND/3RD THORAC,8267111,LOCAL,36218,CPT,,,,,,Outpatient,,,970.36,631,Humana,Humana,42.55,,,,,,,Fee Schedule,42.55,929.12,
CATH PLACE SEG SUBSEG PA,8267104,LOCAL,36015,CPT,,,,,,Outpatient,,,980.22,637,Humana,Humana,139.57,,,,,,,Fee Schedule,139.57,929.12,
US Abdomen Complete,1169567,LOCAL,76700,CPT,,,,,,Outpatient,,,984.47,528,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,245.49,
BiPAP Charge -> Initial,2678300,LOCAL,94002,CPT,,,,,,Outpatient,,,990,663,Humana,Humana,604.42,,,,,,,Fee Schedule,604.42,941,
BiPAP/CPAP Mode -> NIMV,2678300,LOCAL,94002,CPT,,,,,,Outpatient,,,990,663,Humana,Humana,604.42,,,,,,,Fee Schedule,604.42,941,
ECHOCARDIOGRAM 2D W/STRESS,8200440,LOCAL,93350,CPT,,,,,,Outpatient,,,990,644,Humana,Humana,501.29,,,,,,,Fee Schedule,501.29,678.38,
16025 DRESS AN/OR DEBMT BURN INI MED CHARGE,8020080,LOCAL,16025,CPT,,,,,,Outpatient,,,991.5,644,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
CT Angio Heart/Coronary Arteries,9515210,LOCAL,75574,CPT,,,,,,Outpatient,,,992.21,532.13,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,565.59,
20610 INJECT MAJOR JOINT,5661087,LOCAL,20610,CPT,,,,,,Outpatient,,,1000,650,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
methylene blue 5 mg/mL intravenous solution 10 mL [CULL],11202913,LOCAL,Q9968,CPT,,,,,,Outpatient,10,ML,1000.0512,,Humana,Humana,8.73,,,,,,,Fee Schedule,8.73,8.73,
OASIS MATRIX WOUND 3 X 7 CM,13962592,LOCAL,,,Q4102,HCPCS,,,,Outpatient,,,1003.01,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
NM Parathyroid Imaging w/ Spect Inj/Scan,2425984,LOCAL,78071,CPT,A9500,HCPCS,,,,Outpatient,,,1004.58,331.65,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,560.96,
XR Arthrogram Hip SI Left,2425404,LOCAL,73525,CPT,,,,,LT,Outpatient,,,1004.84,538.73,Humana,Humana,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Arthrogram Hip SI Right,2425407,LOCAL,73525,CPT,,,,,RT,Outpatient,,,1004.84,538.73,Humana,Humana,326.51,,,,,,,Fee Schedule,176.48,326.51,
INTRO EXTREMITY ARTERY,8267105,LOCAL,36140,CPT,,,,,,Outpatient,,,1022.12,664,Humana,Humana,72.34,,,,,,,Fee Schedule,72.34,929.12,
PERC CHANGE TUBE OR DRAINAGE CATH S&I,8210742,LOCAL,75984,CPT,,,,,,Outpatient,,,1029.19,551.93,Humana,Humana,49.58,,,,,,,Fee Schedule,49.58,262.79,
XR Drainage Perc Cath Replace,9343679,LOCAL,75984,CPT,,,,,,Outpatient,,,1029.19,551.93,Humana,Humana,49.58,,,,,,,Fee Schedule,49.58,262.79,
11107 INCAL BX SKN EA SEP/ADDL CHARGE,9704096,LOCAL,11107,CPT,,,,,,Outpatient,,,1030.62,670,Humana,Humana,23.51,,,,,,,Fee Schedule,23.51,863,
CYSTOGRAM S&I,8211185,LOCAL,74430,CPT,,,,,,Outpatient,,,1033.41,554.4,Humana,Humana,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Cystogram,4126362,LOCAL,74430,CPT,,,,,,Outpatient,,,1033.41,554.4,Humana,Humana,326.51,,,,,,,Fee Schedule,176.48,326.51,
US Joint/Bursa Lw Int Arth/Asp/Inj Left,3148332,LOCAL,20606,CPT,,,,,LT,Outpatient,,,1035.43,673,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
US Joint/Bursa Lw Int Arth/Asp/Inj Right,3148335,LOCAL,20606,CPT,,,,,RT,Outpatient,,,1035.43,673,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
US Joint/Bursa Lw Maj Arth/Asp/Inj Left,3148338,LOCAL,20611,CPT,,,,,LT,Outpatient,,,1035.43,673,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Lw Maj Arth/Asp/Inj Right,3148341,LOCAL,20611,CPT,,,,,RT,Outpatient,,,1035.43,673,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Lw Sm Arth/Asp/Inj Left,6130396,LOCAL,20604,CPT,,,,,LT,Outpatient,,,1035.43,673,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Lw Sm Arth/Asp/Inj Right,6130399,LOCAL,20604,CPT,,,,,RT,Outpatient,,,1035.43,673,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Up Int Arth/Asp/Inj Left,2425353,LOCAL,20606,CPT,,,,,LT,Outpatient,,,1035.43,673,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
US Joint/Bursa Up Int Arth/Asp/Inj Right,2425356,LOCAL,20606,CPT,,,,,RT,Outpatient,,,1035.43,673,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
US Joint/Bursa Up Maj Arth/Asp/Inj Left,2425359,LOCAL,20611,CPT,,,,,LT,Outpatient,,,1035.43,673,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Up Maj Arth/Asp/Inj Right,2425362,LOCAL,20611,CPT,,,,,RT,Outpatient,,,1035.43,673,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Up Sm Arth/Asp/Inj Left,6130402,LOCAL,20604,CPT,,,,,LT,Outpatient,,,1035.43,673,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Up Sm Arth/Asp/Inj Right,6130405,LOCAL,20604,CPT,,,,,RT,Outpatient,,,1035.43,673,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
GASTRO-JEJUNOSTOMY TUBE REPLACEMENT,8200254,LOCAL,49452,CPT,,,,,,Outpatient,,,1040.53,676,Humana,Humana,857.17,,,,,,,Fee Schedule,857.17,1496,
"Chikungunya Virus RNA, Qual RT PCR QSTC",13864475,LOCAL,87798,CPT,,,,,,Outpatient,,,1050.75,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
ARTERIAL LINE PLACEMENT,8210320,LOCAL,36620,CPT,,,,,,Outpatient,,,1052.64,684,Humana,Humana,38.92,,,,,,,Fee Schedule,38.92,929.12,
NM Hepatobiliary Imaging,2425957,LOCAL,78226,CPT,,,,,,Outpatient,,,1059,567.6,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,560.96,
DART FIRE EDGE SCREW,4810328,LOCAL,,,C1716,HCPCS,,,,Outpatient,,,1062.93,,Humana,Humana,868.33,,,,,,,Fee Schedule,612.6,868.33,
NEPHROSTOGRAM S&I,8212039,LOCAL,74425,CPT,,,,,,Outpatient,,,1072.47,575.03,Humana,Humana,326.51,,,,,,,Fee Schedule,176.48,326.51,
glucagon 1 mg injection [CULL],11282210,LOCAL,J1610,CPT,,,,,,Outpatient,1,EA,1075.2,,Humana,Humana,182.45,,,,,,,Fee Schedule,182.45,233.26,
99205 LEVEL V INITIAL VISIT FAC CHARGE,12832503,LOCAL,99205,CPT,,,,,,Outpatient,,,1078.84,701,Humana,Humana,151.18,,,,,,,Fee Schedule,151.18,151.18,
99205 New patient-level 5 specialty clinic,13538610,LOCAL,,,G0463,HCPCS,,,,Outpatient,,,1078.84,326,Humana,Humana,117.82,,,,,,,Fee Schedule,117.82,117.82,
99205 Office Visit New Pt. Level 5,10168484,LOCAL,99205,CPT,,,,,,Outpatient,,,1078.84,701,Humana,Humana,151.18,,,,,,,Fee Schedule,151.18,151.18,
99205 Office Visit New Pt. Level 5,10168484,LOCAL,99205,CPT,,,,,,Outpatient,,,1078.84,701,Humana,Humana,151.18,,,,,,,Fee Schedule,151.18,151.18,
99215 LEVEL V VISIT CHARGE,9322144,LOCAL,99215,CPT,,,,,,Outpatient,,,1078.84,701,Humana,Humana,119.41,,,,,,,Fee Schedule,119.41,119.41,
99215 Office Visit Established Pt. Level 5,10168489,LOCAL,99215,CPT,,,,,,Outpatient,,,1078.84,701,Humana,Humana,119.41,,,,,,,Fee Schedule,119.41,119.41,
"Leptospira DNA, Qual RT PCR QSTC",13864445,LOCAL,87798,CPT,,,,,,Outpatient,,,1096.88,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Fungal Sequencing, ITS Region QSTC",13864438,LOCAL,87153,CPT,,,,,,Outpatient,,,1102.5,138.43,Humana,Humana,115.36,,,,,,,Fee Schedule,115.36,158.39,
"Cortisol, Free, LC/MS, Serum QSTC",8972878,LOCAL,82530,CPT,,,,,,Outpatient,,,1104.43,20.05,Humana,Humana,29.79,,,,,,,Fee Schedule,17.73,29.79,
acetylcysteine 20% intravenous solution 30 mL [CULL],11200013,LOCAL,J0132,CPT,,,,,,Outpatient,30,ML,1120.00032,,Humana,Humana,0.37,,,,,,,Fee Schedule,0.367,0.367,
"Pneumocystis jirovecii,Qual Real-Time PCR QSTC",9215420,LOCAL,87798,CPT,,,,,,Outpatient,,,1120.91,42.11,Humana,Humana,35.09,,,,,,,Fee Schedule,35.09,40.19,
CATH PL 2ND ORDER VENOUS,8267187,LOCAL,36012,CPT,,,,,,Outpatient,,,1122.44,730,Humana,Humana,142.32,,,,,,,Fee Schedule,142.32,929.12,
NM Gastrointestinal Blood Loss Imaging,1169242,LOCAL,78278,CPT,A9512,HCPCS,,,,Outpatient,,,1123.93,603.08,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,1409.71,
Bird Fancier's Precipitin Panel I QSTC,13864443,LOCAL,86331,CPT,,,,,,Outpatient,,,1133.1,14.38,Humana,Humana,11.98,,,,,,,Fee Schedule,11.98,15.29,
99285 - Level 5,2644301,LOCAL,99285,CPT,,,,,25,Outpatient,,,1135.13,738,Humana,Humana,560.53,,,,,,,Fee Schedule,560.53,560.53,
chlorothiazide 0.5 g intravenous injection [CULL],11240810,LOCAL,J1205,CPT,,,,,,Outpatient,1,EA,1143.168,,Humana,Humana,58.13,,,,,,,Fee Schedule,58.126,58.126,
US Breast ABUS Bilateral.,13939856,LOCAL,76641,CPT,,,,,50,Outpatient,,,1143.26,306.9,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
XR ERCP Biliary,8649296,LOCAL,74328,CPT,,,,,,Outpatient,,,1143.36,612.98,Humana,Humana,121.3,,,,,,,Fee Schedule,121.3,262.79,
XR ERCP Pancreatic,8649299,LOCAL,74329,CPT,,,,,,Outpatient,,,1143.36,612.98,Humana,Humana,23.05,,,,,,,Fee Schedule,23.05,262.79,
amphotericin B liposomal 50 mg intravenous injection [CULL],11202015,LOCAL,J0289,CPT,,,,,,Outpatient,1,EA,1152.16,,Humana,Humana,21.48,,,,,,,Fee Schedule,21.48,1293.51,
GUIDED PERC DRAIN W CATH S&I,8210333,LOCAL,75989,CPT,,,,,,Outpatient,,,1153.62,618.75,Humana,Humana,50.75,,,,,,,Fee Schedule,50.75,262.79,
US Pelvic Comp,8206964,LOCAL,76856,CPT,,,,,,Outpatient,,,1159.45,622.05,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,245.49,
29445 APPL RIGID LEG CAST,9739196,LOCAL,29445,CPT,,,,,,Outpatient,,,1160.76,266,Humana,Humana,242.81,,,,,,,Fee Schedule,242.81,863,
NM Hyperthyroid Therapy,8567789,LOCAL,79005,CPT,A9517,HCPCS,,,,Outpatient,,,1161.71,622.88,Humana,Humana,23.13,,,,,,,Fee Schedule,23.13,456.65,
XR Spine Scoliosis 1 View,7520627,LOCAL,72081,CPT,,,,,,Outpatient,,,1170.74,627.83,Humana,Humana,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Arthrogram Wrist SI Left,2425422,LOCAL,73115,CPT,,,,,LT,Outpatient,,,1176.56,631.13,Humana,Humana,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Arthrogram Wrist SI Right,2425425,LOCAL,73115,CPT,,,,,RT,Outpatient,,,1176.56,631.13,Humana,Humana,326.51,,,,,,,Fee Schedule,176.48,326.51,
E3077 Aph Plt ACDA LR,7266775,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Humana,Humana,487.1,,,,,,,Fee Schedule,487.1,546.55,
E3087 Aph Plt ACDA LR 1,7266780,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Humana,Humana,487.1,,,,,,,Fee Schedule,487.1,546.55,
E3088 Aph Plt ACDA LR 2,7266781,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Humana,Humana,487.1,,,,,,,Fee Schedule,487.1,546.55,
E3089 Aph Plt ACDA LR 3,7266782,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Humana,Humana,487.1,,,,,,,Fee Schedule,487.1,546.55,
E4643 Aph Plt ACDA LR <3E11,7266909,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Humana,Humana,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5030 Aph Plt ACDA LR BM,8058823,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Humana,Humana,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5032 Aph Plt ACDA LR BM 2,8029134,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Humana,Humana,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5033 Aph Plt ACDA LR BM 3,8058812,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Humana,Humana,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5036 Aph Plt ACDA LR Irr BM 2,8029108,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Humana,Humana,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5075 Aph Plt ACDA LR <3E11 BM,8058809,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Humana,Humana,487.1,,,,,,,Fee Schedule,487.1,546.55,
E9232 Aph Plt ACDA LR BT6,10074919,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Humana,Humana,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5031  Aph Plt ACDA LR BM 1,8029138,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1188,768,Humana,Humana,487.1,,,,,,,Fee Schedule,487.1,546.55,
64480 CERVICAL THORACIC TRANSFORAMINAL EACH AD,5661052,LOCAL,64480,CPT,,,,,,Outpatient,,,1193.14,776,Humana,Humana,50.22,,,,,,,Fee Schedule,50.22,1250.53,
95824 EEG CEREBRAL DEATH EVALUATION ONLY CHARGE,9646722,LOCAL,95824,CPT,,,,,,Outpatient,,,1194.07,776,Humana,Humana,485.11,,,,,,,Fee Schedule,466.96,485.11,
BREAST SIZER SMOOTH ROUND HIGH 565CC,4850931,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,1210,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE 505HP,4840154,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,1210,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
"RT CHARGE Ventilator Restart, Ongoing -> Yes",12109384,LOCAL,94003,CPT,,,,,,Outpatient,,,1224,613,Humana,Humana,604.42,,,,,,,Fee Schedule,604.42,941,
KERECIS OMEGA 3 - 1.75 X 1.75CM,13962575,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,1228.5,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
"Prostaglandin D2 (Pg D2), Urine QST",12667576,LOCAL,84150,CPT,,,,,,Outpatient,,,1230,50.12,Humana,Humana,41.77,,,,,,,Fee Schedule,41.77,47.35,
15274 App Skin Sub Graft (TWSA>100cm2) t/s/l ; add 100 cm 2,12642329,LOCAL,15274,CPT,,,,,,Outpatient,,,1230.36,800,Humana,Humana,35.4,,,,,,,Fee Schedule,35.4,2862.92,
15278 APPL-HC SKSB GRT F/N/H/G-KD A100 CHARGE,9709036,LOCAL,15278,CPT,,,,,,Outpatient,,,1230.36,800,Humana,Humana,44.7,,,,,,,Fee Schedule,44.7,2862.92,
11106 INCAL BX SKN SINGLE LES CHARGE,9704095,LOCAL,11106,CPT,,,,,,Outpatient,,,1230.62,800,Humana,Humana,559.65,,,,,,,Fee Schedule,559.65,1291,
"Aquaporin-4 (AQP4) (NMO-IgG) Antibody with Reflex to Titer, Serum QSTC",10041610,LOCAL,86052,CPT,,,,,,Outpatient,,,1237.5,14.46,Humana,Humana,12.05,,,,,,,Fee Schedule,12.05,15.29,
"JC Polyoma Virus DNA, Qnt PCR, Serum QSTC",10274092,LOCAL,87799,CPT,,,,,,Outpatient,,,1237.5,51.41,Humana,Humana,42.84,,,,,,,Fee Schedule,40.19,42.84,
"NMO Spectrum Eval (AQP4 w/Rflx toMOG), Serum QSTC",10274088,LOCAL,86052,CPT,,,,,,Outpatient,,,1237.5,14.46,Humana,Humana,12.05,,,,,,,Fee Schedule,12.05,15.29,
"64520 Injection Lumbar or Thoracic, Paravertebral Sympathetic",5661043,LOCAL,64520,CPT,,,,,,Outpatient,,,1239.7,806,Humana,Humana,813.96,,,,,,,Fee Schedule,813.96,1291,
96413 CHEMO IV INFUSION 1ST HR INF CHARGE,9665725,LOCAL,96413,CPT,,,,,,Outpatient,,,1244.66,809,Humana,Humana,303.25,,,,,,,Fee Schedule,303.25,442.94,
REF Genetic RBC Phenotyping,13481257,LOCAL,81403,CPT,,,,,,Outpatient,,,1246.5,222.24,Humana,Humana,185.2,,,,,,,Fee Schedule,173.68,185.2,
NM Liver/Spleen Imaging Injection/Scan,1169286,LOCAL,78215,CPT,A9541,HCPCS,,,,Outpatient,,,1248.36,669.08,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,1409.71,
"CBFB/MYH11 inv(16), Quant RT PCR QSTC",13864502,LOCAL,81401,CPT,,,,,,Outpatient,,,1260,164.4,Humana,Humana,137,,,,,,,Fee Schedule,63.34,137,
REF PLT Crossmatch,13481259,LOCAL,86022,CPT,,,,,,Outpatient,,,1269,22.04,Humana,Humana,18.37,,,,,,,Fee Schedule,15.29,18.37,
epoetin alfa 20000 units/mL Sol 1 mL [CULL],11202388,LOCAL,J0885,CPT,,,,,,Outpatient,1,ML,1273.344,,Humana,Humana,8.54,,,,,,,Fee Schedule,7.85,525.49,
Admark Phospho Tau/Ttl Ab42 Comments QST,13877904,LOCAL,83520,CPT,,,,,,Outpatient,,,1277.25,20.72,Humana,Humana,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Admark Phospho Tau/Ttl Ab42 Interp QST,13877902,LOCAL,83520,CPT,,,,,,Outpatient,,,1277.25,20.72,Humana,Humana,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Admark Phospho Tau/Ttl Ab42 Methods QST,13877905,LOCAL,83520,CPT,,,,,,Outpatient,,,1277.25,20.72,Humana,Humana,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
62320 Cervical/Thoracic Epidural without Fluor,5661014,LOCAL,62320,CPT,,,,,,Outpatient,,,1284.42,835,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
11042 DEB SQ TISSUE-1ST 20SQCM/< CHARGE,9704056,LOCAL,11042,CPT,,,,,,Outpatient,,,1286.64,836,Humana,Humana,365.27,,,,,,,Fee Schedule,365.27,863,
11043 DEB MUS/FASCIA-1ST 20SQCM/< CHARGE,9704059,LOCAL,11043,CPT,,,,,,Outpatient,,,1286.64,836,Humana,Humana,559.65,,,,,,,Fee Schedule,549.61,863,
11045 Debrid bone 1st 20 sq cm charge,12510099,LOCAL,11045,CPT,,,,,,Outpatient,,,1286.64,836,Humana,Humana,20.61,,,,,,,Fee Schedule,20.61,1466.58,
11045 Debrid Sub Tissue > 20 sq cm charge,12511974,LOCAL,11045,CPT,,,,,,Outpatient,,,1286.64,836,Humana,Humana,20.61,,,,,,,Fee Schedule,20.61,1466.58,
11046 DEB MUS/FASCIA-EA ADDL 20SQCM CHARGE,9704068,LOCAL,11046,CPT,,,,,,Outpatient,,,1286.64,836,Humana,Humana,44.01,,,,,,,Fee Schedule,44.01,1466.58,
XR Urethrocystography Retrograde,1170578,LOCAL,74450,CPT,,,,,,Outpatient,,,1300.84,697.95,Humana,Humana,220.99,,,,,,,Fee Schedule,176.48,220.99,
MTB Complex Rifampin Resist PCR Sput QSTC,8873578,LOCAL,87801,CPT,,,,,,Outpatient,,,1316.25,84.24,Humana,Humana,70.2,,,,,,,Fee Schedule,40.19,70.2,
US OB Greater Than 14 Weeks Single,8583651,LOCAL,76805,CPT,,,,,,Outpatient,,,1319.46,130.35,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,148.61,
NM Parathyroid Imaging Injection/Scan,1169316,LOCAL,78070,CPT,A9500,HCPCS,,,,Outpatient,,,1324.92,710.33,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,1409.71,
NM Bone Marrow Imaging Whole Body,1169186,LOCAL,78104,CPT,A9541,HCPCS,,,,Outpatient,,,1327.01,711.98,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,560.96,
16030 DRESS AN/OR DEBMT BURN INI LG CHARGE,8020081,LOCAL,16030,CPT,,,,,,Outpatient,,,1328,863,Humana,Humana,365.27,,,,,,,Fee Schedule,365.27,863,
93660 STRESS TILT TABLE CHARGE,8200435,LOCAL,93660,CPT,,,,,,Outpatient,,,1338.01,870,Humana,Humana,485.11,,,,,,,Fee Schedule,244.97,863,
JEJUNOSTOMY PERC,8200251,LOCAL,49441,CPT,,,,,,Outpatient,,,1339,870,Humana,Humana,1734.34,,,,,,,Fee Schedule,983.02,1734.34,
Bacterial 16S rDNA Sequencing QSTC,8873571,LOCAL,87153,CPT,,,,,,Outpatient,,,1344.6,138.43,Humana,Humana,115.36,,,,,,,Fee Schedule,115.36,158.39,
64620 DESTR INTERCOSTAL NERVE,5661066,LOCAL,64620,CPT,,,,,,Outpatient,,,1345.12,874,Humana,Humana,813.96,,,,,,,Fee Schedule,813.96,1695.82,
64634 DESTR FACET CRV/THR EA ADL LVL,5661058,LOCAL,64634,CPT,,,,,,Outpatient,,,1345.12,874,Humana,Humana,54.71,,,,,,,Fee Schedule,54.71,1250.53,
15002 SITE PREP -100 SQCM(TAL),12625535,LOCAL,15002,CPT,,,,,,Outpatient,,,1348.68,877,Humana,Humana,1672.39,,,,,,,Fee Schedule,1466.58,1672.39,
64405 OCCIPITAL - BILATERAL CHARGE,5661078,LOCAL,64405,CPT,,,,,,Outpatient,,,1352.9,879,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
conjugated estrogens 25 mg injection [CULL],11201516,LOCAL,J1410,CPT,,,,,,Outpatient,1,EA,1372.1472,,Humana,Humana,392.06,,,,,,,Fee Schedule,233.26,392.06,
10120 Incision & removal of Foreign Body Simple,9620024,LOCAL,10120,CPT,,,,,,Outpatient,,,1373.45,893,Humana,Humana,365.27,,,,,,,Fee Schedule,239.03,863,
62321 CERVICAL THORACIC EPIDURAL,5661016,LOCAL,62321,CPT,,,,,,Outpatient,,,1375.34,894,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
64520 LUMBAR OR THORACIC Sympathetic Charge,5661033,LOCAL,64520,CPT,,,,,,Outpatient,,,1375.34,806,Humana,Humana,813.96,,,,,,,Fee Schedule,813.96,1291,
64490 INJ PARAVER CERV/THOR 1ST LEVEL,5661063,LOCAL,64490,CPT,,,,,,Outpatient,,,1376.78,895,Humana,Humana,813.96,,,,,,,Fee Schedule,813.96,1291,
INTRO CATH AORTA,8267107,LOCAL,36200,CPT,,,,,,Outpatient,,,1379.82,897,Humana,Humana,112.42,,,,,,,Fee Schedule,112.42,929.12,
tbo-filgrastim 480 mcg/0.8 mL subcutaneous solution 0.8 mL [CULL],11202451,LOCAL,J1447,CPT,,,,,,Outpatient,0.8,ML,1395.9776,,Humana,Humana,0.28,,,,,,,Fee Schedule,0.28,525.49,
64479 CERVICAL THORACIC TRANSFORAMINAL EPIDRL,5661051,LOCAL,64479,CPT,,,,,,Outpatient,,,1397.93,909,Humana,Humana,813.96,,,,,,,Fee Schedule,813.96,1291,
BUPivacaine liposome 1.3% (13.3 mg/mL) injectable suspension 20 mL [CULL],11202119,LOCAL,J0666,CPT,,,,,,Outpatient,20,ML,1402.224,,Humana,Humana,1.34,,,,,,,Fee Schedule,1.34,1.34,
62323 LUMBAR OR CAUDAL EPIDURAL,5661015,LOCAL,62323,CPT,,,,,,Outpatient,,,1408.03,915,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
PERC ASPIRATION DISC,8230054,LOCAL,62267,CPT,,,,,,Outpatient,,,1409.73,916,Humana,Humana,643.26,,,,,,,Fee Schedule,643.26,1291,
EPIFIX SKIN SUBSTITUTE 14MM,13962560,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,1410.75,1755,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
64510 NERV BLK STELLATE GANGLION,5661032,LOCAL,64510,CPT,,,,,,Outpatient,,,1418.86,922,Humana,Humana,813.96,,,,,,,Fee Schedule,813.96,1695.82,
"64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when per",9520503,LOCAL,64624,CPT,,,,,,Outpatient,,,1425,926,Humana,Humana,1785.34,,,,,,,Fee Schedule,1695.82,2315,
64640 DESTR OTH PERIPHERAL NERVE/BRCH,5661065,LOCAL,64640,CPT,,,,,,Outpatient,,,1425.83,927,Humana,Humana,813.96,,,,,,,Fee Schedule,813.96,1695.82,
62290 INJ DISKOGRAPH LUMBAR EA LVL,5661062,LOCAL,62290,CPT,,,,,,Outpatient,,,1432.9,931,Humana,Humana,134.34,,,,,,,Fee Schedule,134.34,863,
11400 EXC BENIGN LES-T/A/L 0.5CM OR < CHARGE FACILITY,9704107,LOCAL,11400,CPT,,,,,,Outpatient,,,1438,935,Humana,Humana,643.26,,,,,,,Fee Schedule,643.26,1291,
PLACE ART 2ND ABD & BELOW,8267113,LOCAL,36246,CPT,,,,,,Outpatient,,,1441.95,937,Humana,Humana,203.35,,,,,,,Fee Schedule,203.35,929.12,
NM Kidney Imaging Single w/ Pharm,1169262,LOCAL,78708,CPT,A9562,HCPCS,,,,Outpatient,,,1446.62,775.5,Humana,Humana,492.12,,,,,,,Fee Schedule,492.12,560.96,
"92950 Cardiopulmonary resuscitation (eg, in cardiac arrest)",7968980,LOCAL,92950,CPT,,,,,,Outpatient,,,1448.28,941,Humana,Humana,284.7,,,,,,,Fee Schedule,284.7,1328.28,
92950 Cardiopulmonary Resuscitation Cath Lab,8212013,LOCAL,92950,CPT,,,,,,Outpatient,,,1448.28,941,Humana,Humana,284.7,,,,,,,Fee Schedule,284.7,1328.28,
92950 CARDIOPULMONARY RESUSCITATION CHARGE,8207219,LOCAL,92950,CPT,,,,,,Outpatient,,,1448.28,941,Humana,Humana,284.7,,,,,,,Fee Schedule,284.7,1328.28,
RT CHARGE Ventilator Initiate -> Yes,12109383,LOCAL,94002,CPT,,,,,,Outpatient,,,1453.5,663,Humana,Humana,604.42,,,,,,,Fee Schedule,604.42,941,
NM Inflammation Loc Limited,1226092,LOCAL,78800,CPT,,,,,,Outpatient,,,1461.78,783.75,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,1409.71,
NM Inflammation Loc Limited - Ceretec,1169144,LOCAL,78800,CPT,A9521,HCPCS,,,,Outpatient,,,1461.78,783.75,Humana,Humana,802.34,,,,,,,Fee Schedule,802.34,1409.71,
11402 EXC BENIGN LES-T/A/L 1.1-2.0 CM CHARGE,9704151,LOCAL,11402,CPT,,,,,,Outpatient,,,1481.17,963,Humana,Humana,643.26,,,,,,,Fee Schedule,643.26,1291,
62273 BLOOD PATCH,5661017,LOCAL,62273,CPT,,,,,,Outpatient,,,1494.18,971,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
"13131-Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1",14749500,LOCAL,13131,CPT,,,,,,Outpatient,,,1505,400,Humana,Humana,365.27,,,,,,,Fee Schedule,365.27,863,
MRI Fingers w/ Contrast Left,9343664,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Fingers w/ Contrast Right,9343667,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Forearm w/ Contrast Left,8206725,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Forearm w/ Contrast Right,8206727,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hand w/ Contrast Left,1168924,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hand w/ Contrast Right,1168926,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Humerus w/ Contrast Left,8206756,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Humerus w/ Contrast Right,8206758,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Scapula w/ Contrast Left,12912778,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Scapula w/ Contrast Right,12912781,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
NM Intestine Imaging Meckels,1169254,LOCAL,78290,CPT,A9512,HCPCS,,,,Outpatient,,,1535.86,823.35,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,560.96,
XR Spine Scoliosis 2-3 Views,7520630,LOCAL,72082,CPT,,,,,,Outpatient,,,1542.91,827.48,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR ERCP Biliary and Pancreatic,8207021,LOCAL,74330,CPT,,,,,,Outpatient,,,1543.36,827.48,Humana,Humana,151.62,,,,,,,Fee Schedule,151.62,262.79,
XR IVP,1170251,LOCAL,74400,CPT,,,,,,Outpatient,,,1550,831.6,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,176.48,
64493 - INJ PARAVERT F JNT L/S 1 LEV,5661035,LOCAL,64493,CPT,,,,,,Outpatient,,,1563.68,1016,Humana,Humana,813.96,,,,,,,Fee Schedule,813.96,1291,
G0260 INJ SACRO JNT ARTHR ANEST/STER,8132863,LOCAL,G0260,CPT,,,,,,Outpatient,,,1564.95,1017,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
NM Bone Imaging Limited Injection,1169176,LOCAL,78300,CPT,,,,,,Outpatient,,,1566.92,839.85,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,560.96,
"62272 SPINAL PUNC, THERAP",5661019,LOCAL,62272,CPT,,,,,,Outpatient,,,1587.32,693,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
64425 NERV BLK ILIOINGUINAL,5661024,LOCAL,64425,CPT,,,,,,Outpatient,,,1587.32,1032,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
64483 TRANS INJ LUMB/SACR-UNILATERAL CHARGE,5661053,LOCAL,64483,CPT,,,,,,Outpatient,,,1587.72,1812,Humana,Humana,813.96,,,,,,,Fee Schedule,813.96,1291,
64484 TRANS INJ LUMB/SACR EA ADD UIL CHARGE,5661054,LOCAL,64484,CPT,,,,,,Outpatient,,,1587.72,1812,Humana,Humana,41.55,,,,,,,Fee Schedule,41.55,1250.53,
ECHO COMPLETE W/ DOPPLER,8200137,LOCAL,93306,CPT,,,,,,Outpatient,,,1593.2,1036,Humana,Humana,501.29,,,,,,,Fee Schedule,501.29,678.38,
ECHOCARDIOGRAM 2D COMPLETE,8200140,LOCAL,93307,CPT,,,,,,Outpatient,,,1593.2,1036,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,678.38,
US Echo Doppler Complete,7936277,LOCAL,93306,CPT,,,,,,Outpatient,,,1593.2,1036,Humana,Humana,501.29,,,,,,,Fee Schedule,501.29,678.38,
XR Spine Scoliosis 4-5 Views,7520624,LOCAL,72083,CPT,,,,,,Outpatient,,,1597.41,856.35,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
phentolamine 5 mg injection [CULL],11211090,LOCAL,J2760,CPT,,,,,,Outpatient,1,EA,1605.12,,Humana,Humana,432.02,,,,,,,Fee Schedule,122.4,432.02,
TLSO,9400067,LOCAL,,,L0648,HCPCS,,,,Outpatient,,,1611.78,,Humana,Humana,797.49,,,,,,,Fee Schedule,797.49,797.49,
64636 DESTR FACET LUM/SAC EA ADL LVL,5661056,LOCAL,64636,CPT,,,,,,Outpatient,,,1614.14,1049,Humana,Humana,48.01,,,,,,,Fee Schedule,48.01,1250.53,
"12020 SIMP CLOSURE, SUPERF WOUND CHARGE",9303466,LOCAL,12020,CPT,,,,,,Outpatient,,,1615.12,1050,Humana,Humana,559.65,,,,,,,Fee Schedule,549.61,863,
"rabies vaccine, human diploid cell 2.5 intl units intramuscular injection [CULL]",11212261,LOCAL,90675,CPT,,,,,,Outpatient,1,EA,1633.664,328,Humana,Humana,313.68,,,,,,,Fee Schedule,160.4,313.68,
BAL Fluid Count with Differential,12449847,LOCAL,0202U,CPT,,,,,,Outpatient,,,1642.5,500.14,Humana,Humana,443.38,,,,,,,Fee Schedule,173.68,443.38,
XR Spine Scoliosis 6+ Views,7520633,LOCAL,72084,CPT,,,,,,Outpatient,,,1651.91,886.05,Humana,Humana,97.22,,,,,,,Fee Schedule,83.69,97.22,
NM Non-Cardiac Vascular Flow Imaging,1169314,LOCAL,78445,CPT,,,,,,Outpatient,,,1652.88,886.05,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,560.96,
63650 IMPLANT NEURSTIM ELEC EPIDURAL,10283945,LOCAL,63650,CPT,,,,,,Outpatient,,,1660,6563,Humana,Humana,6000.2,,,,,,,Fee Schedule,5787,8672.71,
63650 IMPLANT NEURSTIM ELEC EPIDURAL,8132877,LOCAL,63650,CPT,,,,,,Outpatient,,,1660,6563,Humana,Humana,6000.2,,,,,,,Fee Schedule,5787,8672.71,
63650-IMPLANT NEURSTIM ELEC EPIDURAL,8132877,LOCAL,63650,CPT,,,,,,Outpatient,,,1660,6563,Humana,Humana,6000.2,,,,,,,Fee Schedule,5787,8672.71,
"rabies vaccine, human diploid cell 2.5 intl units Pow [CULL]",11212261,LOCAL,90675,CPT,,,,,,Outpatient,1,EA,1665.824,328,Humana,Humana,313.68,,,,,,,Fee Schedule,160.4,313.68,
XR Nephrostogram,8115644,LOCAL,50430,CPT,,,,,,Outpatient,,,1670,1389,Humana,Humana,610.24,,,,,,,Fee Schedule,555.55,1291,
XR Nephrostogram Existing Access,10454588,LOCAL,50431,CPT,,,,,,Outpatient,,,1670,1389,Humana,Humana,610.24,,,,,,,Fee Schedule,555.55,1291,
36568 INTRO CATH VENA CAVA PICC CHARGE,13709100,LOCAL,36568,CPT,,,,,,Outpatient,,,1678,1091,Humana,Humana,1420.25,,,,,,,Fee Schedule,1291,1644.1,
REPOSITION CVL UNDER FLUORO,8210300,LOCAL,36597,CPT,,,,,,Outpatient,,,1678,1091,Humana,Humana,1420.25,,,,,,,Fee Schedule,1068.64,1420.25,
omadacycline 100 mg injection [CULL],11290183,LOCAL,J0121,CPT,,,,,,Outpatient,1,EA,1678.2144,,Humana,Humana,4.02,,,,,,,Fee Schedule,4.02,2110.36,
15271 APP SKN SUB GRFT T/A/L 100 SQ CM FAC CHARGE,12831012,LOCAL,15271,CPT,,,,,,Outpatient,,,1680.09,1092,Humana,Humana,1672.39,,,,,,,Fee Schedule,1496,2862.92,
"15275 App Skin Sub Graft (TWSA<100cm2) f/a/h-ft/aig; 1""25 sp cm",12641291,LOCAL,15275,CPT,,,,,,Outpatient,,,1680.09,1092,Humana,Humana,1672.39,,,,,,,Fee Schedule,1496,2862.92,
"Zika Virus RNA, Qual TMA QSTC",13864496,LOCAL,87662,CPT,,,,,,Outpatient,,,1687.5,61.57,Humana,Humana,51.31,,,,,,,Fee Schedule,40.19,51.31,
CATH LAB STRESS ECHO,8200161,LOCAL,93351,CPT,,,,,,Outpatient,,,1697.74,1104,Humana,Humana,501.29,,,,,,,Fee Schedule,501.29,678.38,
US Stress Echo,7936322,LOCAL,93351,CPT,,,,,,Outpatient,,,1697.74,1104,Humana,Humana,501.29,,,,,,,Fee Schedule,501.29,678.38,
64581 Incision for implantation of neurostimulator electrode array; sacral nerve,8603595,LOCAL,64581,CPT,,,,,,Outpatient,,,1704,1108,Humana,Humana,6000.2,,,,,,,Fee Schedule,6000.2,8672.71,
CASPR2 Ab QSTC,13864490,LOCAL,86255,CPT,,,,,,Outpatient,,,1704.38,14.46,Humana,Humana,12.05,,,,,,,Fee Schedule,12.05,15.29,
IMPLANT 625CC 350-1695,4802349,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,1710.5,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
"KIT D816, Mutation Analysis  QSTC",13864489,LOCAL,81273,CPT,,,,,,Outpatient,,,1721.25,149.84,Humana,Humana,124.87,,,,,,,Fee Schedule,63.34,124.87,
Ganglioside Ab Panel 6 QSTC,13864481,LOCAL,83520,CPT,,,,,,Outpatient,,,1734.26,20.72,Humana,Humana,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
64418 - suprascapular nerve block,10452404,LOCAL,64418,CPT,,,,,,Outpatient,,,1735,693,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
64420 NERV BLK INTERCSTL NERV SNGL,5661025,LOCAL,64420,CPT,,,,,,Outpatient,,,1735,693,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
64454 Genicular block,13776911,LOCAL,64454,CPT,,,,,,Outpatient,,,1735,244,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
64461 THORACIC PARAVERTEBRAL BLOCK,13786726,LOCAL,64461,CPT,,,,,,Outpatient,,,1735,50,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
Injection Blood Patch Epidural,7633812,LOCAL,62273,CPT,,,,,,Outpatient,,,1735,971,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
LGI1 Ab QSTC,13864491,LOCAL,86255,CPT,,,,,,Outpatient,,,1738.13,14.46,Humana,Humana,12.05,,,,,,,Fee Schedule,12.05,15.29,
PULM ANGIO DURING CORONARIES,8230012,LOCAL,93568,CPT,,,,,,Outpatient,,,1744,1134,Humana,Humana,37.1,,,,,,,Fee Schedule,37.1,863,
92960 ELEC CARDIOVERSION/DEFIBRILATION OP Tech Fee,7969852,LOCAL,92960,CPT,,,,,,Outpatient,,,1759.91,1144,Humana,Humana,598.27,,,,,,,Fee Schedule,598.27,1291,
Perc Cor Stent-Drug Eluding LD,4221012,LOCAL,92960,CPT,,,,,,Outpatient,,,1759.91,1144,Humana,Humana,598.27,,,,,,,Fee Schedule,598.27,1291,
10030 FLUID DRAIN SOFT TIS PERC GUID,8266849,LOCAL,10030,CPT,,,,,,Outpatient,,,1760,704,Humana,Humana,643.26,,,,,,,Fee Schedule,643.26,1605.05,
NM Thyroid Uptake Single/Multi,2426011,LOCAL,78014,CPT,,,,,,Outpatient,,,1775.09,952.05,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,560.96,
NM Thyroid w/ Uptake Single,12109219,LOCAL,78014,CPT,A9516,HCPCS,,,,Outpatient,,,1775.09,952.05,Humana,Humana,482.33,,,,,,,Fee Schedule,482.3325,560.96,
NUSHIELD 1.6CM DISC,13962586,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,1777.5,1155,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
MG Surgical Specimen,9437784,LOCAL,76098,CPT,,,,,,Outpatient,,,1778.77,953.7,Humana,Humana,501.29,,,,,,,Fee Schedule,176.48,501.29,
GASTROSTOMY TUBE REPLACEMENT,8200253,LOCAL,49450,CPT,,,,,,Outpatient,,,1793.73,1166,Humana,Humana,857.17,,,,,,,Fee Schedule,857.17,1496,
JEJUNOSTOMY REPLACEMENT PERC,8200252,LOCAL,49451,CPT,,,,,,Outpatient,,,1793.73,1166,Humana,Humana,857.17,,,,,,,Fee Schedule,857.17,1496,
Critical Care Ill/Injured Patient Init 30-74 Min 99291,2389455,LOCAL,99291,CPT,,,,,25,Outpatient,,,1816.43,1181,Humana,Humana,770.36,,,,,,,Fee Schedule,770.36,770.36,
"13132 -Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet;",14751269,LOCAL,13132,CPT,,,,,,Outpatient,,,1830,612,Humana,Humana,559.65,,,,,,,Fee Schedule,559.65,863,
NM Myocardial Planar Single Study,2425978,LOCAL,78481,CPT,A9500,HCPCS,,,,Outpatient,,,1832.02,982.58,Humana,Humana,492.12,,,,,,,Fee Schedule,492.12,560.96,
MRI Breast w/o Contrast Left.,9386272,LOCAL,77046,CPT,,,,,LT,Outpatient,,,1833.89,983.4,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Breast w/o Contrast Right.,9386275,LOCAL,77046,CPT,,,,,RT,Outpatient,,,1833.89,983.4,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
CULL US OB Greater Than 14 Wks Add'l Gest,13579115,LOCAL,76810,CPT,,,,,,Outpatient,,,1847.31,990.83,Humana,Humana,36.14,,,,,,,Fee Schedule,36.14,148.61,
US OB Greater Than 14 Weeks Multi,8108499,LOCAL,76810,CPT,,,,,,Outpatient,,,1847.31,990.83,Humana,Humana,36.14,,,,,,,Fee Schedule,36.14,148.61,
NM Tumor Loc Limited,1169410,LOCAL,78800,CPT,,,,,,Outpatient,,,1850.54,783.75,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,1409.71,
NM Tumor Loc Multiple Areas,1169412,LOCAL,78801,CPT,,,,,,Outpatient,,,1850.54,2895.75,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,1409.71,
PARACENTESIS ABDOMINAL WITH IMAGING,8267134,LOCAL,49083,CPT,,,,,,Outpatient,,,1857.81,1208,Humana,Humana,857.17,,,,,,,Fee Schedule,857.17,1496,
NM Cardiac MUGA,1169208,LOCAL,78472,CPT,A9512,HCPCS,,,,Outpatient,,,1861.6,998.25,Humana,Humana,1118.05,,,,,,,Fee Schedule,560.96,1118.045,
Meningitis Panel (BioFire),7909558,LOCAL,87483,CPT,,,,,,Outpatient,,,1875.71,500.14,Humana,Humana,416.78,,,,,,,Fee Schedule,158.39,416.78,
PLACE ART 1ST ABD & BELOW,8267112,LOCAL,36245,CPT,,,,,,Outpatient,,,1882.73,1224,Humana,Humana,191.24,,,,,,,Fee Schedule,191.24,929.12,
GRAFIX PRIME 16MM,13962570,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,1883.25,3671,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
PLACE ART 1ST THORAC/BRAC,8267108,LOCAL,36215,CPT,,,,,,Outpatient,,,1917.07,1246,Humana,Humana,175.13,,,,,,,Fee Schedule,175.13,929.12,
PLACE ART 2ND THORAC/BRAC,8267109,LOCAL,36216,CPT,,,,,,Outpatient,,,1917.07,1246,Humana,Humana,222.85,,,,,,,Fee Schedule,222.85,929.12,
PLACE ART 3RD THORAC/BRAC,8267110,LOCAL,36217,CPT,,,,,,Outpatient,,,1917.07,1246,Humana,Humana,273.71,,,,,,,Fee Schedule,273.71,929.12,
NM Lung Vent/Perf Imaging,2425966,LOCAL,78582,CPT,A9540,HCPCS,,,,Outpatient,,,1919.6,1029.6,Humana,Humana,492.12,,,,,,,Fee Schedule,492.12,1409.71,
PLACE ART 3RD ABD & BELOW,8267114,LOCAL,36247,CPT,,,,,,Outpatient,,,1927.08,1253,Humana,Humana,240.87,,,,,,,Fee Schedule,240.87,929.12,
NM Lymphoscintigraphy Injection/Scan,1169292,LOCAL,78195,CPT,,,,,,Outpatient,,,1928.84,1034.55,Humana,Humana,492.12,,,,,,,Fee Schedule,492.12,1409.71,
Alpha-Globin Gene Deletion/Dupl. QSTC,13864435,LOCAL,81269,CPT,,,,,,Outpatient,,,1940.63,242.88,Humana,Humana,202.4,,,,,,,Fee Schedule,173.68,202.4,
NM Kidney Imaging Single w/o Pharm,1169264,LOCAL,78707,CPT,A9562,HCPCS,,,,Outpatient,,,1959.43,1051.05,Humana,Humana,492.12,,,,,,,Fee Schedule,492.12,560.96,
REF HLA Antibody ID,13479161,LOCAL,86830,CPT,,,,,,Outpatient,,,1962,114.62,Humana,Humana,95.52,,,,,,,Fee Schedule,38.27,95.52,
PERICARDIOCENTESIS INITIAL,8230050,LOCAL,33016,CPT,,,,,,Outpatient,,,1966.67,1278,Humana,Humana,1420.25,,,,,,,Fee Schedule,1291,1420.25,
REMOVAL BILIARY DRAIN CATH,8200538,LOCAL,47537,CPT,,,,,,Outpatient,,,1966.67,1278,Humana,Humana,857.17,,,,,,,Fee Schedule,291.97,1496,
"Apolipoprotein E Isoform, CSF QST",12677744,LOCAL,82542,CPT,,,,,,Outpatient,,,1975.5,28.91,Humana,Humana,24.09,,,,,,,Fee Schedule,17.73,24.09,
KERECIS OMEGA 3 - DISK 14MM,13962582,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,1975.5,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
CULL Selective Add'l Vessel S&I,13635231,LOCAL,75774,CPT,,,,,,Outpatient,,,1975.99,1059.3,Humana,Humana,44.32,,,,,,,Fee Schedule,44.32,6018.68,
SELECTIVE ADD'L VESSEL S&I,8210640,LOCAL,75774,CPT,,,,,,Outpatient,,,1975.99,1059.3,Humana,Humana,44.32,,,,,,,Fee Schedule,44.32,6018.68,
CATH PLACE LT RT PA,8267103,LOCAL,36014,CPT,,,,,,Outpatient,,,1986.67,1291,Humana,Humana,121.59,,,,,,,Fee Schedule,121.59,929.12,
remdesivir 100 mg Injection [CULL],11201128,LOCAL,J0248,CPT,,,,,,Outpatient,1,EA,1996.8,,Humana,Humana,6.73,,,,,,,Fee Schedule,6.73,771.25,
ECHO LIMITED WITH CONTRAST,8200178,LOCAL,,,C8924,HCPCS,,,,Outpatient,,,2022.58,1315,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,678.38,
US Echo 2D Limited w/ Contrast,7936274,LOCAL,93308,CPT,C8924,HCPCS,,,,Outpatient,,,2022.58,564,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,678.38,
".MOG Ab, CBA, Serum QSTC",10274091,LOCAL,86362,CPT,,,,,,Outpatient,,,2025,14.46,Humana,Humana,12.05,,,,,,,Fee Schedule,12.05,15.29,
"Myelin Oligodendrocyte Glycoprotein w/Rfx Titer, Serum QSTC",12613098,LOCAL,86362,CPT,,,,,,Outpatient,,,2025,14.46,Humana,Humana,12.05,,,,,,,Fee Schedule,12.05,15.29,
PURAPLY AM COMMERCIAL 1.6CM DISC,13962603,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,2025,3861,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
36589 - Removal of tunneled central venous catheter,12431092,LOCAL,36589,CPT,,,,,,Outpatient,,,2025.12,1316,Humana,Humana,565.25,,,,,,,Fee Schedule,565.25,1291,
37253 Invasc US Each Addl Vessel,8230057,LOCAL,37253,CPT,,,,,,Outpatient,,,2035,1323,Humana,Humana,57.61,,,,,,,Fee Schedule,57.61,2669.67,
"64449 N BLOCK INJ, LUMBAR PLEXUS",8882246,LOCAL,64449,CPT,,,,,,Outpatient,,,2035,890,Humana,Humana,813.96,,,,,,,Fee Schedule,813.96,1695.82,
"CRMP5/CV2 Ab, LB QSTC",13873513,LOCAL,84182,CPT,,,,,,Outpatient,,,2036.25,35.05,Humana,Humana,29.21,,,,,,,Fee Schedule,15.29,29.21,
"GAD65 Ab, LB QSTC",13873519,LOCAL,86341,CPT,,,,,,Outpatient,,,2036.25,28.28,Humana,Humana,23.57,,,,,,,Fee Schedule,15.29,23.57,
tocilizumab 20 mg/mL Sol 4 mL [CULL],11260558,LOCAL,J3262,CPT,,,,,,Outpatient,4,ML,2039.6544,,Humana,Humana,5.71,,,,,,,Fee Schedule,5.71,1641.22,
92953 TRANSCUTANEOUS PACING TechFee,8057710,LOCAL,92953,CPT,,,,,,Outpatient,,,2060.2,1339,Humana,Humana,598.27,,,,,,,Fee Schedule,598.27,1291,
92953-Temp transcutaneous pacing Charge,8212036,LOCAL,92953,CPT,,,,,,Outpatient,,,2060.2,1339,Humana,Humana,598.27,,,,,,,Fee Schedule,598.27,1291,
EXTERNAL PACER,4221033,LOCAL,92953,CPT,,,,,,Outpatient,,,2060.2,1339,Humana,Humana,598.27,,,,,,,Fee Schedule,598.27,1291,
NM Testicular Imaging w/ Vasc Flow,8733473,LOCAL,78761,CPT,A9512,HCPCS,,,,Outpatient,,,2063.03,1106.33,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,560.96,
11750 EXCISION NAIL MATRIX PERMANENT CHARGE,9303447,LOCAL,11750,CPT,,,,,,Outpatient,,,2064.41,1342,Humana,Humana,365.27,,,,,,,Fee Schedule,365.27,863,
33967 Insertion Intra-aortic Percutaneous Device Charge,8211150,LOCAL,33967,CPT,,,,,,Outpatient,,,2102.51,1367,Humana,Humana,205.15,,,,,,,Fee Schedule,205.15,12132.94,
KERECIS OMEGA 3 - 3 X 3.5CM,13962577,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,2106,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
ibutilide 0.1 mg/mL intravenous solution 10 mL [CULL],11201842,LOCAL,J1742,CPT,,,,,,Outpatient,10,ML,2107.584,,Humana,Humana,172.31,,,,,,,Fee Schedule,172.31,233.26,
NM Hepatobiliary Imaging w/ Drug,2425957,LOCAL,78226,CPT,A9537,HCPCS,,,,Outpatient,,,2134.97,567.6,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,560.96,
NM Hepatobiliary Imaging w/ EF,12894248,LOCAL,78227,CPT,A9537,HCPCS,,,,Outpatient,,,2134.97,1145.1,Humana,Humana,1384.56,,,,,,,Fee Schedule,560.96,1384.5568,
VENOGRAM BILATERAL EXT S&I,8211110,LOCAL,75822,CPT,,,,,,Outpatient,,,2159,1157.48,Humana,Humana,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
XR Venogram Extremity Bilateral,13085158,LOCAL,75822,CPT,,,,,,Outpatient,,,2159,1157.48,Humana,Humana,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
NUSHIELD 1.6CM DISC,10510071,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,2172.5,1155,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
64633 DESTR FACET CERV/THOR SNG LVL,5661057,LOCAL,64633,CPT,,,,,,Outpatient,,,2179,1416,Humana,Humana,1785.34,,,,,,,Fee Schedule,1250.53,2315,
64635 DESTR FACET LUM/SAC SINGLE LVL,5661055,LOCAL,64635,CPT,,,,,,Outpatient,,,2179,1416,Humana,Humana,1785.34,,,,,,,Fee Schedule,1250.53,2315,
93567 Inj Supra Aortography,8230011,LOCAL,93567,CPT,,,,,,Outpatient,,,2187.66,1422,Humana,Humana,29.54,,,,,,,Fee Schedule,29.54,863,
NM Gastric Emptying Study,1169236,LOCAL,78264,CPT,,,,,,Outpatient,,,2193.29,1176.45,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,560.96,
NM Bone Spect,1169188,LOCAL,78803,CPT,,,,,,Outpatient,,,2202.35,1181.4,Humana,Humana,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
APPLY SKIN SUB 1ST 255Q CM LEG UP TO 100,13531303,LOCAL,15271,CPT,,,,,25,Outpatient,,,2221.65,1092,Humana,Humana,1672.39,,,,,,,Fee Schedule,1496,2862.92,
CT Ankle w/o Contrast Left,1167903,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Ankle w/o Contrast Right,1167905,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Clavicle w/o Contrast Left,12885310,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Clavicle w/o Contrast Right,12885313,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Elbow w/o Contrast Left,1168002,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Elbow w/o Contrast Right,1168004,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Femur w/o Contrast Left,8202922,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Femur w/o Contrast Right,8202924,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Foot w/o Contrast Left,1168040,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Foot w/o Contrast Right,1168042,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Forearm w/o Contrast Left,8202950,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Forearm w/o Contrast Right,8202952,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Hand w/o Contrast Left,1168086,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Hand w/o Contrast Right,1168088,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Hip w/o Contrast Left,1168116,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Hip w/o Contrast Right,1168118,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Humerus w/o Contrast Left,8202997,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Humerus w/o Contrast Right,8202999,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Knee w/o Contrast Left,1168158,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Knee w/o Contrast Right,1168160,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Shoulder w/o Contrast Left,1168220,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Shoulder w/o Contrast Right,1168222,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Tibia/Fibula w/o Contrast Left,8203045,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Tibia/Fibula w/o Contrast Right,8203047,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Wrist w/o Contrast Left,1168341,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Wrist w/o Contrast Right,1168343,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Angio Abdomen Aorta + Iliofemoral,1167851,LOCAL,75635,CPT,,,,,,Outpatient,,,2242.64,1202.85,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,565.59,
37252 Invasc US Initial Vessel,8230056,LOCAL,37252,CPT,,,,,,Outpatient,,,2252.25,1464,Humana,Humana,72.79,,,,,,,Fee Schedule,72.79,2669.67,
15277 App Skin Sub Graft(TWSA>100cm2 f/a/h-ft diag add 100 cm2,12635466,LOCAL,15277,CPT,,,,,,Outpatient,,,2263.33,1471,Humana,Humana,1672.39,,,,,,,Fee Schedule,1496,2862.92,
93312 TEE 2D MM COMPLETE WO CHARGE,8200160,LOCAL,93312,CPT,,,,,,Outpatient,,,2279.37,1482,Humana,Humana,501.29,,,,,,,Fee Schedule,501.29,678.38,
US Echo Transesophageal,7936283,LOCAL,93312,CPT,,,,,,Outpatient,,,2279.37,1482,Humana,Humana,501.29,,,,,,,Fee Schedule,501.29,678.38,
G0278-CL ILIAC/FEM ANGIO FOR CLOSURE Charge,8212025,LOCAL,,,G0278,HCPCS,,,,Outpatient,,,2301.79,1496,Humana,Humana,10.66,,,,,,,Fee Schedule,10.66,6018.68,
NM Gastric Emptying w/ SB,10110882,LOCAL,78265,CPT,,,,,,Outpatient,,,2302.29,1234.2,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,560.96,
onabotulinumtoxinA 100 units injection [CULL],11212323,LOCAL,J0585,CPT,,,,,,Outpatient,1,EA,2307.84,,Humana,Humana,6.5,,,,,,,Fee Schedule,6.5,771.25,
MRI Brachial Plexus w/o Contrast Lt,8784911,LOCAL,73221,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Brachial Plexus w/o Contrast Rt,8784914,LOCAL,73221,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Clavicle w/o Contrast Left,9647312,LOCAL,71550,CPT,,,,,LT,Outpatient,,,2317.56,1765.5,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Clavicle w/o Contrast Right,9647315,LOCAL,71550,CPT,,,,,RT,Outpatient,,,2317.56,1765.5,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Fingers w/o Contrast Left,8513078,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Fingers w/o Contrast Right,8513081,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Forearm w/o Contrast Lt,8058719,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Forearm w/o Contrast Rt,8058722,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Hand w/o Contrast Left,1168930,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Hand w/o Contrast Right,1168932,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Humerus w/o Contrast Left,8203080,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Humerus w/o Contrast Right,8203082,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Scapula w/o Contrast Left,9647339,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Scapula w/o Contrast Right,9647342,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRA Neck w/o Contrast,1168683,LOCAL,70547,CPT,,,,,,Outpatient,,,2317.57,1242.45,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,729.93,
KERECIS OMEGA 3 - DISK 16MM,13962584,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,2331,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRA Pelvis w/o Contrast,1168691,LOCAL,72198,CPT,,,,,,Outpatient,,,2338.16,1767.15,Humana,Humana,222.29,,,,,,,Fee Schedule,220.99,729.93,
MRA Pelvis w/o Contrast,1168691,LOCAL,C8919,CPT,,,,,,Outpatient,,,2338.16,,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,729.93,
XR Myelogram Cervical Spine,1170319,LOCAL,62302,CPT,,,,,,Outpatient,,,2349.36,1527,Humana,Humana,722.32,,,,,,,Fee Schedule,722.32,1291,
XR Myelogram Thoracic Spine,1170327,LOCAL,62303,CPT,,,,,,Outpatient,,,2349.36,1527,Humana,Humana,722.32,,,,,,,Fee Schedule,722.32,1291,
MRI Spine Thoracic w/o Contrast,1169066,LOCAL,72146,CPT,,,,,,Outpatient,,,2365.31,1268.03,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
ILR REMOVAL,8267777,LOCAL,33286,CPT,,,,,,Outpatient,,,2381.18,1548,Humana,Humana,643.26,,,,,,,Fee Schedule,643.26,2484.2,
CT Spine Lumbar w/o Contrast,1168246,LOCAL,72131,CPT,,,,,,Outpatient,,,2398.23,1286.18,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
NM Bone Three Phase Study Injection/Scan,1169190,LOCAL,78315,CPT,,,,,,Outpatient,,,2428.11,1301.85,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,560.96,
36002 Pseudoanrsm Repair W Thrombin Us Gud,8212049,LOCAL,36002,CPT,,,,,,Outpatient,,,2429.28,1579,Humana,Humana,565.25,,,,,,,Fee Schedule,565.25,1291,
AV FISTULAGRAM S&I,8210332,LOCAL,36901,CPT,,,,,,Outpatient,,,2442.76,1588,Humana,Humana,1420.25,,,,,,,Fee Schedule,1420.25,2669.67,
"CRMP5/CV2 Ab, LB, CSF QSTC",13873605,LOCAL,84182,CPT,,,,,,Outpatient,,,2443.5,35.05,Humana,Humana,29.21,,,,,,,Fee Schedule,15.29,29.21,
"GAD65 Ab, LB, CSF QSTC",13873611,LOCAL,86341,CPT,,,,,,Outpatient,,,2443.5,28.28,Humana,Humana,23.57,,,,,,,Fee Schedule,15.29,23.57,
INTERNAL MAMMARY S&I,8210631,LOCAL,75756,CPT,,,,,,Outpatient,,,2455.14,1316.7,Humana,Humana,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
PULMONARY NONSELECTIVE S&I,8210620,LOCAL,75746,CPT,,,,,,Outpatient,,,2455.14,1316.7,Humana,Humana,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
CT Angio Pelvis,1167881,LOCAL,72191,CPT,,,,,,Outpatient,,,2457.05,1317.53,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Thoracentesis w/ CT Guidance,2424869,LOCAL,77012,CPT,,,,,,Outpatient,,,2458.4,1318.35,Humana,Humana,48.7,,,,,,,Fee Schedule,48.7,136.03,
KERECIS OMEGA 3 - 1.75 X 1.75 CM,13962574,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,2475,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
CT Neck Soft Tissue w/o Contrast,1168234,LOCAL,70490,CPT,,,,,,Outpatient,,,2479.06,1329.08,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
64450 INJECTION ANESTHETIC AGENT PERIPHERAL NE,13437921,LOCAL,64450,CPT,,,,,,Outpatient,,,2482.29,1613,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
tetanus immune globulin 250 units/mL intramuscular solution 1 mL [CULL],11212346,LOCAL,J1670,CPT,,,,,,Outpatient,1,ML,2492.8,,Humana,Humana,593,,,,,,,Fee Schedule,525.49,593,
CT Ankle w/ Contrast Left,1167897,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Ankle w/ Contrast Right,1167899,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Clavicle w/ Contrast Left,12885304,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Clavicle w/ Contrast Right,12885307,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Elbow w/ Contrast Left,1167996,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Elbow w/ Contrast Right,1167998,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Femur w/ Contrast Left,8202918,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Femur w/ Contrast Right,8202920,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Foot w/ Contrast Left,1168034,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Foot w/ Contrast Right,1168036,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Forearm w/ Contrast Left,8202943,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Forearm w/ Contrast Right,8202945,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Hand w/ Contrast Left,1168080,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Hand w/ Contrast Right,1168082,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Hip w/ Contrast Left,1168110,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hip w/ Contrast Right,1168112,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Humerus w/ Contrast Left,8202990,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Humerus w/ Contrast Right,8202992,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Knee w/ Contrast Left,1168152,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Knee w/ Contrast Right,1168154,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Shoulder w/ Contrast Left,1168214,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Shoulder w/ Contrast Right,1168216,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Tibia/Fibula w/ Contrast Left,8203041,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Tibia/Fibula w/ Contrast Right,8203043,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Wrist w/ Contrast Left,1168335,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Wrist w/ Contrast Right,1168337,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
64454 - Injection of anesthetic agent into genicular nerve branches including imaging guidance.,14144343,LOCAL,64454,CPT,,,,,,Outpatient,,,2500,244,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
"64624 Destruction by neurolytic agent, genicular nerve branches",9487180,LOCAL,64624,CPT,,,,,,Outpatient,,,2500,926,Humana,Humana,1785.34,,,,,,,Fee Schedule,1695.82,2315,
64421 NERVE BLOCK INTERCOSTAL MULTIPLE NERVES,5661026,LOCAL,64421,CPT,,,,,,Outpatient,,,2501.54,890,Humana,Humana,813.96,,,,,,,Fee Schedule,813.96,1695.82,
15273 ACELLULAR DERM REPL LTH 100 SQ CM,8716218,LOCAL,15273,CPT,,,,,,Outpatient,,,2508.54,1631,Humana,Humana,3347.08,,,,,,,Fee Schedule,2599,3347.08,
PRIMATRIX 3X3,13962595,LOCAL,,,Q4110,HCPCS,,,,Outpatient,,,2528.69,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
dimethyl sulfoxide 50% irrigation solution 50 mL [CULL],11205390,LOCAL,J1212,CPT,,,,,,Outpatient,50,ML,2541.664,,Humana,Humana,748.85,,,,,,,Fee Schedule,525.49,748.85,
INJ PERC CHOL W EXIS CATH,8210336,LOCAL,47531,CPT,,,,,,Outpatient,,,2566.23,298,Humana,Humana,3226.48,,,,,,,Fee Schedule,2599,3226.48,
MRI Elbow w/o Contrast Left,1168848,LOCAL,73221,CPT,,,,,LT,Outpatient,,,2584.17,1242.45,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Elbow w/o Contrast Right,1168850,LOCAL,73221,CPT,,,,,RT,Outpatient,,,2584.17,1242.45,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Shoulder w/o Contrast Left,1169044,LOCAL,73221,CPT,,,,,LT,Outpatient,,,2584.17,1242.45,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Shoulder w/o Contrast Right,1169046,LOCAL,73221,CPT,,,,,RT,Outpatient,,,2584.17,1242.45,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Wrist w/o Contrast Left,1169140,LOCAL,73221,CPT,,,,,LT,Outpatient,,,2584.17,1242.45,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Wrist w/o Contrast Right,1169142,LOCAL,73221,CPT,,,,,RT,Outpatient,,,2584.17,1242.45,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
ASPIRATION / INJECTION OF RENAL PELVIS,8210655,LOCAL,50390,CPT,,,,,,Outpatient,,,2587.86,1682,Humana,Humana,643.26,,,,,,,Fee Schedule,555.55,1291,
MRI Femur w/o Contrast Lt,8058707,LOCAL,73718,CPT,,,,,LT,Outpatient,,,2591.03,1389.3,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Femur w/o Contrast Rt,8058710,LOCAL,73718,CPT,,,,,RT,Outpatient,,,2591.03,1389.3,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Foot w/o Contrast Left,1168890,LOCAL,73718,CPT,,,,,LT,Outpatient,,,2591.03,1389.3,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Foot w/o Contrast Right,1168892,LOCAL,73718,CPT,,,,,RT,Outpatient,,,2591.03,1389.3,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Tibia/Fibula w/o Contrast Left,8206789,LOCAL,73718,CPT,,,,,LT,Outpatient,,,2591.03,1389.3,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Tibia/Fibula w/o Contrast Right,8206791,LOCAL,73718,CPT,,,,,RT,Outpatient,,,2591.03,1389.3,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRA Neck w/ Contrast,1168681,LOCAL,70548,CPT,,,,,,Outpatient,,,2591.04,1389.3,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,729.93,
AMNIOEXCEL SKIN SUBSTITUTE 18MM,13962552,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,2593.13,3028,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
LENS TORIC #SA6AT4,4853560,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,2596,410,Humana,Humana,145.73,,,,,,,Fee Schedule,145.73,145.73,
LENS TORIC ABSORBING SA6AT5,4853594,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,2596,410,Humana,Humana,145.73,,,,,,,Fee Schedule,145.73,145.73,
IR Venogram Cava Superior1,8071895,LOCAL,75827,CPT,,,,,,Outpatient,,,2596.75,1392.6,Humana,Humana,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
SUPERIOR VENA CAVA S&I,8210670,LOCAL,75827,CPT,,,,,,Outpatient,,,2596.75,1392.6,Humana,Humana,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
VENOGRAM UNILATERAL EXT S&I,8211100,LOCAL,75820,CPT,,,,,,Outpatient,,,2596.75,1392.6,Humana,Humana,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
XR Venogram Extremity Left,8115647,LOCAL,75820,CPT,,,,,LT,Outpatient,,,2596.75,1392.6,Humana,Humana,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
XR Venogram Extremity Right,8115650,LOCAL,75820,CPT,,,,,RT,Outpatient,,,2596.75,1392.6,Humana,Humana,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
Procedure Performed. -> Paracentesis,9739222,LOCAL,49082,CPT,,,,,,Outpatient,,,2601.5,1691,Humana,Humana,857.17,,,,,,,Fee Schedule,857.17,1496,
MRA Pelvis w/ Contrast,1168689,LOCAL,72198,CPT,,,,,,Outpatient,,,2611.62,1767.15,Humana,Humana,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Pelvis w/ Contrast,1168689,LOCAL,C8918,CPT,,,,,,Outpatient,,,2611.62,,Humana,Humana,326.51,,,,,,,Fee Schedule,222.29,729.93,
NM Bone Imaging Whole Body Injection,1169180,LOCAL,78306,CPT,,,,,,Outpatient,,,2623.86,1407.45,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,560.96,
CT Angio Lower Extremity Bilateral,8058637,LOCAL,73706,CPT,,,,,,Outpatient,,,2637.85,1414.88,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Lower Extremity Left,1167875,LOCAL,73706,CPT,,,,,LT,Outpatient,,,2637.85,1414.88,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Lower Extremity Right,1167877,LOCAL,73706,CPT,,,,,RT,Outpatient,,,2637.85,1414.88,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,565.59,
MRI Spine Thoracic w/ Contrast,1169064,LOCAL,72147,CPT,,,,,,Outpatient,,,2638.77,1414.88,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
AMNIOEXCEL PLUS 17MM,13962547,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,2639.25,3028,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
C8925 TEE COMPLETE 2D WWO CHARGE,8200184,LOCAL,,,C8925,HCPCS,,,,Outpatient,,,2643.51,1718,Humana,Humana,722.32,,,,,,,Fee Schedule,678.38,722.32,
ECHO COMPLETE WITH DOP/CONTRAST,8200176,LOCAL,,,C8929,HCPCS,,,,Outpatient,,,2643.51,1718,Humana,Humana,722.32,,,,,,,Fee Schedule,678.38,722.32,
US Echo Doppler Complete w/ Contrast,13780988,LOCAL,93306,CPT,C8929,HCPCS,,,,Outpatient,,,2643.51,1036,Humana,Humana,722.32,,,,,,,Fee Schedule,678.38,722.32,
95805 MAINTENANCE OF WAKEFULNESS CHARGE,9569825,LOCAL,95805,CPT,,,,,,Outpatient,,,2652.34,1724,Humana,Humana,485.11,,,,,,,Fee Schedule,485.11,1113.98,
95805 MSLT CHARGES,8795717,LOCAL,95805,CPT,,,,,,Outpatient,,,2652.34,1724,Humana,Humana,485.11,,,,,,,Fee Schedule,485.11,1113.98,
95805 MSLT/MWT CHARGES,9442365,LOCAL,95805,CPT,,,,,,Outpatient,,,2652.34,1724,Humana,Humana,485.11,,,,,,,Fee Schedule,485.11,1113.98,
".MOG Ab, Titer QSTC",13864468,LOCAL,86362,CPT,,,,,,Outpatient,,,2653.38,14.46,Humana,Humana,12.05,,,,,,,Fee Schedule,12.05,15.29,
PURAPLY AM 2X2 COMMERCIAL 4SQ CM,13962597,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,2664,3861,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
CT Spine Lumbar w/ Contrast,1168244,LOCAL,72132,CPT,,,,,,Outpatient,,,2671.69,1433.03,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
MRA Brain/Head w/o Contrast,1168653,LOCAL,70544,CPT,,,,,,Outpatient,,,2690.84,1442.93,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,729.93,
MRA Lower Extremity w/ + w/o Cnt Left,1168663,LOCAL,73725,CPT,,,,,LT,Outpatient,,,2690.84,1442.93,Humana,Humana,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Lower Extremity w/ + w/o Cnt Right,1168665,LOCAL,73725,CPT,,,,,RT,Outpatient,,,2690.84,1442.93,Humana,Humana,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRV Head w/o Contrast,8450965,LOCAL,70544,CPT,,,,,,Outpatient,,,2690.84,1442.93,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,729.93,
CT Clavicle w/ + w/o Contrast Left,12885298,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Clavicle w/ + w/o Contrast Right,12885301,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Elbow w/ + w/o Contrast Left,8202901,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Elbow w/ + w/o Contrast Right,8202903,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Forearm w/ + w/o Contrast Left,8202936,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Forearm w/ + w/o Contrast Right,8202938,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hand w/ + w/o Contrast Left,8202957,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hand w/ + w/o Contrast Right,8202959,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Humerus w/ + w/o Contrast Left,8202983,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Humerus w/ + w/o Contrast Right,8202985,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Shoulder w/ + w/o Contrast Left,8203023,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Shoulder w/ + w/o Contrast Right,8203025,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Wrist w/ + w/o Contrast Left,8203057,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Wrist w/ + w/o Contrast Right,8203059,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Spine Thoracic w/o Contrast,1168252,LOCAL,72128,CPT,,,,,,Outpatient,,,2704.58,1450.35,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Spine Cervical w/o Contrast,1168240,LOCAL,72125,CPT,,,,,,Outpatient,,,2712.02,1454.48,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Abdomen w/ Oral Contrast Only,8206354,LOCAL,74150,CPT,,,,,,Outpatient,,,2720.92,1459.43,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Abdomen w/o Contrast,1167849,LOCAL,74150,CPT,,,,,,Outpatient,,,2720.92,1459.43,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Pelvis w/ Oral Contrast Only,8206452,LOCAL,72192,CPT,,,,,,Outpatient,,,2720.92,1459.43,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Pelvis w/o Contrast,1168198,LOCAL,72192,CPT,,,,,,Outpatient,,,2720.92,1459.43,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
MRI Ankle w/o Contrast Left,1168750,LOCAL,73721,CPT,,,,,LT,Outpatient,,,2733.23,1466.03,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Ankle w/o Contrast Right,1168752,LOCAL,73721,CPT,,,,,RT,Outpatient,,,2733.23,1466.03,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Hip w/o Contrast Left,1168948,LOCAL,73721,CPT,,,,,LT,Outpatient,,,2733.23,1466.03,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Hip w/o Contrast Right,1168950,LOCAL,73721,CPT,,,,,RT,Outpatient,,,2733.23,1466.03,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Knee w/o Contrast Left,1168984,LOCAL,73721,CPT,,,,,LT,Outpatient,,,2733.23,1466.03,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Knee w/o Contrast Right,1168986,LOCAL,73721,CPT,,,,,RT,Outpatient,,,2733.23,1466.03,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Neck Soft Tissue w/ Contrast,1168232,LOCAL,70491,CPT,,,,,,Outpatient,,,2752.53,1475.93,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRA Abdomen w/o Contrast,1168639,LOCAL,74185,CPT,,,,,,Outpatient,,,2786.55,2017.13,Humana,Humana,221.41,,,,,,,Fee Schedule,221.41,729.93,
64483 TRANS INJ LUMB/SACR-BILATERAL CHARGE,5661040,LOCAL,64483,CPT,,,,,,Outpatient,,,2788.44,1812,Humana,Humana,813.96,,,,,,,Fee Schedule,813.96,1291,
64484 TRANS INJ LUMB/SACR EA ADD BIL CHARGE,5661049,LOCAL,64484,CPT,,,,,,Outpatient,,,2788.44,1812,Humana,Humana,41.55,,,,,,,Fee Schedule,41.55,1250.53,
MRA Chest w/o Contrast,1168647,LOCAL,71555,CPT,,,,,,Outpatient,,,2794.75,1645.05,Humana,Humana,220.24,,,,,,,Fee Schedule,220.24,729.93,
MRA Chest w/o Contrast,1168647,LOCAL,C8910,CPT,,,,,,Outpatient,,,2794.75,,Humana,Humana,220.99,,,,,,,Fee Schedule,220.24,729.93,
MRI Abdomen w/o Contrast,1168734,LOCAL,74181,CPT,,,,,,Outpatient,,,2804.32,1503.98,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI MRCP w/o Contrast,8203102,LOCAL,74181,CPT,,,,,,Outpatient,,,2804.32,1503.98,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Spine Cervical w/o Contrast,1169054,LOCAL,72141,CPT,,,,,,Outpatient,,,2804.32,1503.98,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Spine Lumbar w/o Contrast,1169060,LOCAL,72148,CPT,,,,,,Outpatient,,,2804.32,1503.98,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Brain/Head Stroke Alert,8202967,LOCAL,70450,CPT,,,,,,Outpatient,,,2816.63,1510.58,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,461.98,
CT Brain/Head w/o Contrast,1168094,LOCAL,70450,CPT,,,,,,Outpatient,,,2816.63,1510.58,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,461.98,
PLACE CENTRAL VENOUS LINE,8210290,LOCAL,36556,CPT,,,,,,Outpatient,,,2850.87,1853,Humana,Humana,2877.63,,,,,,,Fee Schedule,1291,2877.63,
MRI Brachial Plexus w/ Contrast Lt,10558521,LOCAL,73222,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,Humana,Humana,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Brachial Plexus w/ Contrast Rt,10558524,LOCAL,73222,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,Humana,Humana,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Clavicle w/ Contrast Left,12912772,LOCAL,71551,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,Humana,Humana,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Clavicle w/ Contrast Right,12912775,LOCAL,71551,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,Humana,Humana,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Elbow w/ Contrast Left,1168842,LOCAL,73222,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,Humana,Humana,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Elbow w/ Contrast Right,1168844,LOCAL,73222,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,Humana,Humana,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Shoulder w/ Contrast Left,1169038,LOCAL,73222,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,Humana,Humana,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Shoulder w/ Contrast Right,1169040,LOCAL,73222,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,Humana,Humana,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Wrist w/ Contrast Left,1169134,LOCAL,73222,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,Humana,Humana,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Wrist w/ Contrast Right,1169136,LOCAL,73222,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,Humana,Humana,722.32,,,,,,,Fee Schedule,652.35,722.32,
AMNIOEXCEL SKIN SUBSTITUTE 1.5CM X 1.5CM,13962551,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,2862.09,3028,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRI Femur w/ Contrast Left,8206704,LOCAL,73719,CPT,,,,,LT,Outpatient,,,2864.49,1536.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Femur w/ Contrast Right,8206706,LOCAL,73719,CPT,,,,,RT,Outpatient,,,2864.49,1536.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Foot w/ Contrast Left,1168884,LOCAL,73719,CPT,,,,,LT,Outpatient,,,2864.49,1536.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Foot w/ Contrast Right,1168886,LOCAL,73719,CPT,,,,,RT,Outpatient,,,2864.49,1536.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Tibia/Fibula w/ Contrast Left,8206783,LOCAL,73719,CPT,,,,,LT,Outpatient,,,2864.49,1536.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Tibia/Fibula w/ Contrast Right,8206785,LOCAL,73719,CPT,,,,,RT,Outpatient,,,2864.49,1536.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Angio Chest,1167863,LOCAL,71275,CPT,,,,,,Outpatient,,,2871.32,1539.45,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,565.59,
20220 BIOPSY BONE TROC/NDL SUPERFICL CHARGE,9709066,LOCAL,20220,CPT,,,,,,Outpatient,,,2874.06,1868,Humana,Humana,1481.32,,,,,,,Fee Schedule,923.18,1481.32,
CT Orbit Sella etc. or IAC w/o Cont,8362458,LOCAL,70480,CPT,,,,,,Outpatient,,,2874.06,1541.1,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
Antenatal Testing Type -> Non-Stress test,9848446,LOCAL,59025,CPT,,,,,,Outpatient,,,2886.2,1876,Humana,Humana,183.92,,,,,,,Fee Schedule,183.92,863,
Non Stress Test Charge,9919812,LOCAL,59025,CPT,,,,,,Outpatient,,,2886.2,1876,Humana,Humana,183.92,,,,,,,Fee Schedule,183.92,863,
Abeta 40 QST,13873829,LOCAL,82542,CPT,,,,,,Outpatient,,,2925,28.91,Humana,Humana,24.09,,,,,,,Fee Schedule,17.73,24.09,
Abeta 42/40 Ratio QST,13873830,LOCAL,82172,CPT,,,,,,Outpatient,,,2925,25.31,Humana,Humana,37.52,,,,,,,Fee Schedule,17.73,37.515,
MRI Pelvis w/o Contrast,1169028,LOCAL,72195,CPT,,,,,,Outpatient,,,2958.83,1586.48,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRA Lower Extremity w/o Contrast Left,1168675,LOCAL,73725,CPT,,,,,LT,Outpatient,,,2964.3,1442.93,Humana,Humana,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Lower Extremity w/o Contrast Right,1168677,LOCAL,73725,CPT,,,,,RT,Outpatient,,,2964.3,1442.93,Humana,Humana,222.29,,,,,,,Fee Schedule,222.29,729.93,
CT Angio Abdomen,1167853,LOCAL,74175,CPT,,,,,,Outpatient,,,2965.92,1590.6,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,565.59,
MRI TMJ,1169068,LOCAL,70336,CPT,,,,,,Outpatient,,,2973.87,1594.73,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Spine Thoracic w/ Contrast,1168250,LOCAL,72129,CPT,,,,,,Outpatient,,,2978.05,1597.2,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Spine Cervical w/ Contrast,1168238,LOCAL,72126,CPT,,,,,,Outpatient,,,2985.5,1601.33,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
NM Cisternography Injection,1169226,LOCAL,78630,CPT,A9548,HCPCS,,,,Outpatient,,,2985.52,1601.33,Humana,Humana,715.29,,,,,,,Fee Schedule,715.29,1409.71,
CT Angio Brain/Head,1167871,LOCAL,70496,CPT,,,,,,Outpatient,,,2990.01,1603.8,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Upper Extremity Bilateral,8058640,LOCAL,73206,CPT,,,,,,Outpatient,,,2990.01,1603.8,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Upper Extremity Left,1167885,LOCAL,73206,CPT,,,,,LT,Outpatient,,,2990.01,1603.8,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Upper Extremity Right,1167887,LOCAL,73206,CPT,,,,,RT,Outpatient,,,2990.01,1603.8,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Abdomen w/ Contrast,1167847,LOCAL,74160,CPT,,,,,,Outpatient,,,2994.38,1605.45,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Abdomen w/ Contrast + Oral,13452972,LOCAL,74160,CPT,,,,,,Outpatient,,,2994.38,1605.45,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Pelvis w/ Contrast,1168196,LOCAL,72193,CPT,,,,,,Outpatient,,,2994.38,1605.45,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Pelvis w/ Contrast + Oral,13554960,LOCAL,72193,CPT,,,,,,Outpatient,,,2994.38,1605.45,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRI Ankle w/ Contrast Left,1168744,LOCAL,73722,CPT,,,,,LT,Outpatient,,,3006.69,1612.05,Humana,Humana,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Ankle w/ Contrast Right,1168746,LOCAL,73722,CPT,,,,,RT,Outpatient,,,3006.69,1612.05,Humana,Humana,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Hip w/ Contrast Left,1168942,LOCAL,73722,CPT,,,,,LT,Outpatient,,,3006.69,1612.05,Humana,Humana,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Hip w/ Contrast Right,1168944,LOCAL,73722,CPT,,,,,RT,Outpatient,,,3006.69,1612.05,Humana,Humana,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Knee w/ Contrast Left,1168978,LOCAL,73722,CPT,,,,,LT,Outpatient,,,3006.69,1612.05,Humana,Humana,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Knee w/ Contrast Right,1168980,LOCAL,73722,CPT,,,,,RT,Outpatient,,,3006.69,1612.05,Humana,Humana,722.32,,,,,,,Fee Schedule,652.35,722.32,
IMPLANT BREAST 360CC,4850676,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3025,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
CT Angio Neck,1167879,LOCAL,70498,CPT,,,,,,Outpatient,,,3039.77,1630.2,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Chest High Resolution,8658939,LOCAL,71250,CPT,,,,,,Outpatient,,,3049.07,1635.15,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,461.98,
CT Chest High Resolution w/o Contrast,8658939,LOCAL,71250,CPT,,,,,,Outpatient,,,3049.07,1635.15,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,461.98,
CT Chest w/o Contrast,8071395,LOCAL,71250,CPT,,,,,,Outpatient,,,3049.07,1635.15,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Low Dose Lung Screening,8090304,LOCAL,71271,CPT,,,,,,Outpatient,,,3049.07,1635.15,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
MRA Abdomen w/ Contrast,1168637,LOCAL,74185,CPT,,,,,,Outpatient,,,3060.01,2017.13,Humana,Humana,221.41,,,,,,,Fee Schedule,221.41,729.93,
MRA Chest w/ Contrast,1168645,LOCAL,71555,CPT,,,,,,Outpatient,,,3068.21,1645.05,Humana,Humana,220.24,,,,,,,Fee Schedule,220.24,729.93,
MRA Chest w/ Contrast,1168645,LOCAL,C8909,CPT,,,,,,Outpatient,,,3068.21,,Humana,Humana,326.51,,,,,,,Fee Schedule,220.24,729.93,
MRI Abdomen w/ Contrast,1168732,LOCAL,74182,CPT,,,,,,Outpatient,,,3077.78,1650.83,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Spine Cervical w/ Contrast,1169052,LOCAL,72142,CPT,,,,,,Outpatient,,,3077.78,1650.83,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Spine Lumbar w/ Contrast,1169058,LOCAL,72149,CPT,,,,,,Outpatient,,,3077.78,1650.83,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Brain/Head w/ Contrast,1168092,LOCAL,70460,CPT,,,,,,Outpatient,,,3090.07,1657.43,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
immune globulin intravenous and subcutaneous 10% injectable solution 50 mL [CULL],11205108,LOCAL,J1561,CPT,,,,,,Outpatient,50,ML,3099.84,,Humana,Humana,48.96,,,,,,,Fee Schedule,48.96,2110.36,
CT Maxillofacial w/o Contrast,1168186,LOCAL,70486,CPT,,,,,,Outpatient,,,3131.11,1678.88,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,170.53,
Central Line Access Type. -> Peripherally inserted central catheter (PICC),9344166,LOCAL,36569,CPT,,,,,,Outpatient,,,3141.6,2042,Humana,Humana,1420.25,,,,,,,Fee Schedule,1291,1644.1,
CT Orbit Sella etc. or IAC w/ Cont,8362455,LOCAL,70481,CPT,,,,,,Outpatient,,,3147.52,1687.95,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
NM Tumor Loc Whole Body 2+ Days,1169416,LOCAL,78804,CPT,,,,,,Outpatient,,,3150.27,1689.6,Humana,Humana,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
NM Tumor Loc Whole Body 2+ Days Gallium,1169418,LOCAL,78804,CPT,A9556,HCPCS,,,,Outpatient,,,3150.27,1689.6,Humana,Humana,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
CT Ankle w/ + w/o Contrast Left,8202894,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Ankle w/ + w/o Contrast Right,8202896,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Femur w/ + w/o Contrast Left,8202914,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Femur w/ + w/o Contrast Right,8202916,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Foot w/ + w/o Contrast Left,8202926,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Foot w/ + w/o Contrast Right,8202928,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hip w/ + w/o Contrast Left,8202973,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hip w/ + w/o Contrast Right,8202975,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Knee w/ + w/o Contrast Left,8203007,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Knee w/ + w/o Contrast Right,8203009,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Tibia/Fibula w/ + w/o Contrast Left,8203037,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Tibia/Fibula w/ + w/o Contrast Right,8203039,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CHOLECYSTOSTOMY DRAIN PLACEMENT,8267773,LOCAL,47490,CPT,,,,,,Outpatient,,,3200,2080,Humana,Humana,3226.48,,,,,,,Fee Schedule,2599,3682.65,
"11047  Debridement Sub-Q, bone each add l 20sq cm",10013082,LOCAL,11047,CPT,,,,,,Outpatient,,,3218.96,2092,Humana,Humana,78.26,,,,,,,Fee Schedule,78.26,1466.58,
11047 Debrid bone > 20 sq cm charge,12508109,LOCAL,11047,CPT,,,,,,Outpatient,,,3218.96,2092,Humana,Humana,78.26,,,,,,,Fee Schedule,78.26,1466.58,
CT Guided Perc Drain/Placement,7936217,LOCAL,75989,CPT,,,,,,Outpatient,,,3232.87,618.75,Humana,Humana,50.75,,,,,,,Fee Schedule,50.75,262.79,
XR Drainage Perc Cath Placement,8058781,LOCAL,75989,CPT,,,,,,Outpatient,,,3232.87,618.75,Humana,Humana,50.75,,,,,,,Fee Schedule,50.75,262.79,
LENS DIU450,4852298,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,3272.5,410,Humana,Humana,145.73,,,,,,,Fee Schedule,145.73,145.73,
MRA Neck w/ + w/o Contrast,1168679,LOCAL,70549,CPT,,,,,,Outpatient,,,3274.68,1756.43,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,729.93,
MRI Brachial Plexus w/ + w/o Contrast Lt,8784905,LOCAL,73223,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Brachial Plexus w/ + w/o Contrast Rt,8784908,LOCAL,73223,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Clavicle w/ + w/o Contrast Left,9647306,LOCAL,71552,CPT,,,,,LT,Outpatient,,,3274.68,2131.8,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Clavicle w/ + w/o Contrast Right,9647309,LOCAL,71552,CPT,,,,,RT,Outpatient,,,3274.68,2131.8,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Fingers w/ + w/o Contrast Left,8513072,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Fingers w/ + w/o Contrast Right,8513075,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Forearm w/ + w/o Contrast Lt,8058713,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Forearm w/ + w/o Contrast Rt,8058716,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hand w/ + w/o Contrast Left,1168918,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hand w/ + w/o Contrast Right,1168920,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Humerus w/ + w/o Contrast Left,8203076,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Humerus w/ + w/o Contrast Right,8203078,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Scapula w/ + w/o Contrast Left,9647333,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Scapula w/ + w/o Contrast Right,9647336,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
XR Myelogram 2 or More Regions,10386814,LOCAL,62305,CPT,,,,,,Outpatient,,,3282.36,2134,Humana,Humana,722.32,,,,,,,Fee Schedule,722.32,1291,
MRI Chest w/o Contrast,1168824,LOCAL,71550,CPT,,,,,,Outpatient,,,3292.3,1765.5,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRA Pelvis w/ + w/o Contrast,1168687,LOCAL,72198,CPT,,,,,,Outpatient,,,3295.27,1767.15,Humana,Humana,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Pelvis w/ + w/o Contrast,1168687,LOCAL,C8920,CPT,,,,,,Outpatient,,,3295.27,,Humana,Humana,326.51,,,,,,,Fee Schedule,222.29,729.93,
CT Chest w/ Contrast,8071392,LOCAL,71260,CPT,,,,,,Outpatient,,,3322.53,1782,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,162.76,
US Echo Transesophag w/ Cont,13770878,LOCAL,93312,CPT,C8925,HCPCS,,,,Outpatient,,,3329.37,1482,Humana,Humana,722.32,,,,,,,Fee Schedule,678.38,722.32,
PERC PLEURAL INSERTION/DRAINAGE AND S&I,8230068,LOCAL,32557,CPT,,,,,,Outpatient,,,3332.77,2166,Humana,Humana,1420.25,,,,,,,Fee Schedule,1291,1420.25,
GRAFIX PRIME 1.5 X 2CM,13962569,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,3348,3671,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 18MM,13962561,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,3350.25,1755,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
CT Spine Lumbar w/ + w/o Contrast,1168242,LOCAL,72133,CPT,,,,,,Outpatient,,,3355.34,1799.33,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
EPIFIX SKIN SUBSTITUTE 18MM,10510009,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,3359.95,1755,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
"Poliovirus 1, 3 Ab, Neutralization QSTC",13864497,LOCAL,86382,CPT,,,,,,Outpatient,,,3375,20.29,Humana,Humana,16.91,,,,,,,Fee Schedule,15.29,16.91,
MRA Lower Extremity w/ Contrast Left,90720012,LOCAL,73725,CPT,,,,,LT,Outpatient,,,3383,1442.93,Humana,Humana,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Lower Extremity w/ Contrast Right,90720013,LOCAL,73725,CPT,,,,,RT,Outpatient,,,3383,1442.93,Humana,Humana,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Upper Extremity w/ Contrast Left,90720010,LOCAL,73225,CPT,,,,,LT,Outpatient,,,3383,2038.58,Humana,Humana,214.69,,,,,,,Fee Schedule,214.69,729.93,
MRA Upper Extremity w/ Contrast Right,90720011,LOCAL,73225,CPT,,,,,RT,Outpatient,,,3383,2038.58,Humana,Humana,214.69,,,,,,,Fee Schedule,214.69,729.93,
MRI Face Neck Orbit w/o Contrast,1168856,LOCAL,70540,CPT,,,,,,Outpatient,,,3383.36,1814.18,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Maxillofacial w/ Contrast,1168184,LOCAL,70487,CPT,,,,,,Outpatient,,,3404.57,1825.73,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
KERECIS OMEGA 3 - 3 X 3.5 CM,13962576,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,3406.5,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
TRANSCATH EMBOLIZATION S&I,8267120,LOCAL,75894,CPT,,,,,,Outpatient,,,3428.95,1838.93,Humana,Humana,165.4,,,,,,,Fee Schedule,165.4,262.79,
CT Neck Soft Tissue w/ + w/o Contrast,1168230,LOCAL,70492,CPT,,,,,,Outpatient,,,3436.18,1843.05,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Parathyroid 4-Phase Study,13554957,LOCAL,70492,CPT,,,,,,Outpatient,,,3436.18,1843.05,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRI Brain + IAC w/o Contrast,9427804,LOCAL,70551,CPT,,,,,,Outpatient,,,3446.61,1848,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Brain w/o Contrast,1168800,LOCAL,70551,CPT,,,,,,Outpatient,,,3446.61,1848,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Pituitary w/o Contrast,8203111,LOCAL,70551,CPT,,,,,,Outpatient,,,3446.61,1848,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
DISKOGRAM LUMBAR S & I,8299004,LOCAL,72295,CPT,,,,,,Outpatient,,,3452,1851.3,Humana,Humana,1785.34,,,,,,,Fee Schedule,857.13,1785.34,
NM Tumor Loc Spect,1169408,LOCAL,78803,CPT,,,,,,Outpatient,,,3466,1181.4,Humana,Humana,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
NM Tumor Loc Whole Body 1 Day,1169414,LOCAL,78802,CPT,,,,,,Outpatient,,,3466,2870.18,Humana,Humana,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
NUSHIELD 2X3CM,13962587,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,3487.5,1155,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
28090 EXCISION GANGLION CYST FOOT,13436341,LOCAL,28090,CPT,,,,,,Outpatient,,,3532.98,2296,Humana,Humana,1463.19,,,,,,,Fee Schedule,1463.19,3153.58,
ICD REMOVAL SC/DC LEAD TV EXTRACT,8231010,LOCAL,33244,CPT,,,,,,Outpatient,,,3541,2302,Humana,Humana,3327.27,,,,,,,Fee Schedule,2484.2,3327.27,
MRI Elbow w/ + w/o Contrast Left,1168836,LOCAL,73223,CPT,,,,,LT,Outpatient,,,3541.3,1756.43,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Elbow w/ + w/o Contrast Right,1168838,LOCAL,73223,CPT,,,,,RT,Outpatient,,,3541.3,1756.43,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Shoulder w/ + w/o Contrast Left,1169032,LOCAL,73223,CPT,,,,,LT,Outpatient,,,3541.3,1756.43,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Shoulder w/ + w/o Contrast Right,1169034,LOCAL,73223,CPT,,,,,RT,Outpatient,,,3541.3,1756.43,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Wrist w/ + w/o Contrast Left,1169128,LOCAL,73223,CPT,,,,,LT,Outpatient,,,3541.3,1756.43,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Wrist w/ + w/o Contrast Right,1169130,LOCAL,73223,CPT,,,,,RT,Outpatient,,,3541.3,1756.43,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Femur w/ + w/o Contrast Lt,8058701,LOCAL,73720,CPT,,,,,LT,Outpatient,,,3548.14,1902.45,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Femur w/ + w/o Contrast Rt,8058704,LOCAL,73720,CPT,,,,,RT,Outpatient,,,3548.14,1902.45,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Foot w/ + w/o Contrast Left,1168878,LOCAL,73720,CPT,,,,,LT,Outpatient,,,3548.14,1902.45,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Foot w/ + w/o Contrast Right,1168880,LOCAL,73720,CPT,,,,,RT,Outpatient,,,3548.14,1902.45,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Tibia/Fibula w/ + w/o Contrast Left,8206777,LOCAL,73720,CPT,,,,,LT,Outpatient,,,3548.14,1902.45,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Tibia/Fibula w/ + w/o Contrast Right,8206779,LOCAL,73720,CPT,,,,,RT,Outpatient,,,3548.14,1902.45,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
THERASKIN 1.75 X 1.75,13962605,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,3577.5,2431,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
L3900 WHFO DYNAMIC,9856098,LOCAL,,,L3900,HCPCS,,,,Outpatient,,,3580.05,2327,Humana,Humana,1756.7,,,,,,,Fee Schedule,1756.7,1756.7,
"L3900 Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger",9856099,LOCAL,,,L3900,HCPCS,,,,Outpatient,,,3580.05,2327,Humana,Humana,1756.7,,,,,,,Fee Schedule,1756.7,1756.7,
11044 DEBRID BONE FIRST 20SQ CM OR < CHARGE,8019965,LOCAL,11044,CPT,,,,,,Outpatient,,,3581.67,2328,Humana,Humana,1481.32,,,,,,,Fee Schedule,1291,1481.32,
MRI Face Neck Orbit w/ Contrast,1168854,LOCAL,70542,CPT,,,,,,Outpatient,,,3633.36,1948.65,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
bivalirudin 250 mg intravenous injection [CULL],11220339,LOCAL,J0583,CPT,,,,,,Outpatient,1,EA,3639.2608,,Humana,Humana,0.16,,,,,,,Fee Schedule,0.157,233.26,
MRI Pelvis w/ + w/o Contrast,1169024,LOCAL,72197,CPT,,,,,,Outpatient,,,3642.47,1953.6,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Prostate w/ + w/o Contrast,4126347,LOCAL,72197,CPT,,,,,,Outpatient,,,3642.47,1953.6,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Spine Thoracic w/ + w/o Contrast,1168248,LOCAL,72130,CPT,,,,,,Outpatient,,,3661.7,1963.5,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRI Breast w/o Contrast Bilateral.,8784923,LOCAL,77047,CPT,,,,,,Outpatient,,,3667.77,1966.8,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Spine Cervical w/ + w/o Contrast,1168236,LOCAL,72127,CPT,,,,,,Outpatient,,,3669.14,1967.63,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Abdomen w/ + w/o Contrast,1167845,LOCAL,74170,CPT,,,,,,Outpatient,,,3678.03,1972.58,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Pelvis w/ + w/o Contrast,1168194,LOCAL,72194,CPT,,,,,,Outpatient,,,3678.03,1972.58,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
28190 Appy Rigid Leg Cast (Professional Charge only if Provider Applies),12642333,LOCAL,28190,CPT,,,,,,Outpatient,,,3680.71,2392,Humana,Humana,643.26,,,,,,,Fee Schedule,643.26,1291,
MRI Ankle w/ + w/o Contrast Left,1168738,LOCAL,73723,CPT,,,,,LT,Outpatient,,,3690.34,1979.18,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Ankle w/ + w/o Contrast Right,1168740,LOCAL,73723,CPT,,,,,RT,Outpatient,,,3690.34,1979.18,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hip w/ + w/o Contrast Left,1168936,LOCAL,73723,CPT,,,,,LT,Outpatient,,,3690.34,1979.18,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hip w/ + w/o Contrast Right,1168938,LOCAL,73723,CPT,,,,,RT,Outpatient,,,3690.34,1979.18,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Knee w/ + w/o Contrast Left,1168972,LOCAL,73723,CPT,,,,,LT,Outpatient,,,3690.34,1979.18,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Knee w/ + w/o Contrast Right,1168974,LOCAL,73723,CPT,,,,,RT,Outpatient,,,3690.34,1979.18,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
IMPLANT BREAST #350-2004BC,4802098,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-3004 300cc,4801298,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-3504bc,4801299,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-4754BC,4852770,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-5504BC,4803723,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-6501BC,4805039,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST 445ML,4855517,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST GEL 700CC,4850683,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST MEMORY GEL 510CC,4853454,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT MEMORY GEL 225CC,4830332,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
MRA Brain/Head w/ + w/o Contrast,1168649,LOCAL,70546,CPT,,,,,,Outpatient,,,3690.84,1979.18,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,729.93,
MRI Brain + IAC w/ Contrast,9427801,LOCAL,70552,CPT,,,,,,Outpatient,,,3720.07,1994.85,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Brain w/ Contrast,1168798,LOCAL,70552,CPT,,,,,,Outpatient,,,3720.07,1994.85,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
THERASKIN 2.5 X 2.5 CM,13962606,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,3739.5,2431,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRA Abdomen w/ + w/o Contrast,1168635,LOCAL,74185,CPT,,,,,,Outpatient,,,3761.43,2017.13,Humana,Humana,221.41,,,,,,,Fee Schedule,221.41,729.93,
MRI Abdomen w/ + w/o Contrast,1168730,LOCAL,74183,CPT,,,,,,Outpatient,,,3761.43,2017.13,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Brain/Head w/ + w/o Contrast,1168090,LOCAL,70470,CPT,,,,,,Outpatient,,,3773.72,2023.73,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
10140 DRAINAGE OF HEMATOMA,8715913,LOCAL,10140,CPT,,,,,,Outpatient,,,3775.02,2454,Humana,Humana,1481.32,,,,,,,Fee Schedule,1481.32,1605.05,
MRA Upper Extremity w/ + w/o Cnt Left,1168704,LOCAL,73225,CPT,,,,,LT,Outpatient,,,3801.65,2038.58,Humana,Humana,214.69,,,,,,,Fee Schedule,214.69,729.93,
MRA Upper Extremity w/ + w/o Cnt Left,1168704,LOCAL,C8936,CPT,,,,,LT,Outpatient,,,3801.65,,Humana,Humana,326.51,,,,,,,Fee Schedule,214.69,729.93,
MRA Upper Extremity w/ + w/o Cnt Right,1168707,LOCAL,73225,CPT,,,,,RT,Outpatient,,,3801.65,2038.58,Humana,Humana,214.69,,,,,,,Fee Schedule,214.69,729.93,
MRA Upper Extremity w/ + w/o Cnt Right,1168707,LOCAL,C8936,CPT,,,,,RT,Outpatient,,,3801.65,,Humana,Humana,326.51,,,,,,,Fee Schedule,214.69,729.93,
CT Orbit Sella etc. or IAC w/ + w/o Cont,8362452,LOCAL,70482,CPT,,,,,,Outpatient,,,3831.16,2054.25,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
IMPLANT BREAST #350-2504 250CC,4801300,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3844.5,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-3501BC,4803006,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3844.5,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST 565CC,4851020,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3850,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
CT Abdomen and Pelvis w/ Oral Contrast,8206351,LOCAL,74176,CPT,,,,,,Outpatient,,,3869.45,2074.88,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,461.98,
CT Abdomen and Pelvis w/o Contrast,2424650,LOCAL,74176,CPT,,,,,,Outpatient,,,3869.45,2074.88,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,461.98,
AMNIOEXCEL SKIN SUBSTITUTE 2CM X 3CM,13962553,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,3902.85,3028,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
11404 EXCISION BENIGN LESION 3.1 CM TO 4.0 CM CHARGE,8726719,LOCAL,11404,CPT,,,,,,Outpatient,,,3913.86,2544,Humana,Humana,1481.32,,,,,,,Fee Schedule,1481.32,1679.75,
OASIS ULTRA THIN DRESSING 7 X 10 CM,13962594,LOCAL,,,Q4124,HCPCS,,,,Outpatient,,,3937.5,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
KERECIS OMEGA 3 - 3 X 7CM,13962579,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,3960,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRI Chest w/ + w/o Contrast,1168820,LOCAL,71552,CPT,,,,,,Outpatient,,,3975.96,2131.8,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
IMPLANT BREAST #350-3754BC,4804163,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3982,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
CT Chest High Resolution w/ + w/o Contrast,8658939,LOCAL,71270,CPT,,,,,,Outpatient,,,4006.18,2148.3,Humana,Humana,162.76,,,,,,,Fee Schedule,97.22,461.98,
CT Chest w/ + w/o Contrast,8071389,LOCAL,71270,CPT,,,,,,Outpatient,,,4006.18,2148.3,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRI Breast w/ + w/o Contrast Left.,8784917,LOCAL,77048,CPT,,,,,LT,Outpatient,,,4030.86,2161.5,Humana,Humana,207.49,,,,,,,Fee Schedule,207.49,652.35,
MRI Breast w/ + w/o Contrast Left.,8784917,LOCAL,C8905,CPT,,,,,LT,Outpatient,,,4030.86,,Humana,Humana,326.51,,,,,,,Fee Schedule,207.49,652.35,
MRI Breast w/ + w/o Contrast Right.,8784920,LOCAL,77048,CPT,,,,,RT,Outpatient,,,4030.86,2161.5,Humana,Humana,207.49,,,,,,,Fee Schedule,207.49,652.35,
MRI Breast w/ + w/o Contrast Right.,8784920,LOCAL,C8905,CPT,,,,,RT,Outpatient,,,4030.86,,Humana,Humana,326.51,,,,,,,Fee Schedule,207.49,652.35,
PACEMAKER POCKET,8210140,LOCAL,33222,CPT,,,,,,Outpatient,,,4031.48,2620,Humana,Humana,1672.39,,,,,,,Fee Schedule,1496,2484.2,
PURAPLY AM 2X4 COMMERCIAL 8SQ CM,13962598,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,4032,3861,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
AMNIOEXCEL PLUS 2CMX2CM,13962548,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,4050,3028,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRI Face Neck Orbit w/ + w/o Contrast,1168852,LOCAL,70543,CPT,,,,,,Outpatient,,,4067.02,2181.3,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Maxillofacial w/ + w/o Contrast,1168182,LOCAL,70488,CPT,,,,,,Outpatient,,,4088.22,2192.03,Humana,Humana,162.76,,,,,,,Fee Schedule,162.76,461.98,
"64625 Radiofrequency ablation, nerves innervating the SI joint",5661090,LOCAL,64625,CPT,,,,,,Outpatient,,,4100,2665,Humana,Humana,1785.34,,,,,,,Fee Schedule,1785.34,2315,
CT Abdomen and Pelvis w/ Contrast,2424647,LOCAL,74177,CPT,,,,,,Outpatient,,,4142.9,2221.73,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Abdomen and Pelvis w/ Contrast + Oral,13452969,LOCAL,74177,CPT,,,,,,Outpatient,,,4142.9,2221.73,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
95808 SLEEP STAGING CHARGE,13485403,LOCAL,95808,CPT,,,,,,Outpatient,,,4155.71,2701,Humana,Humana,930.16,,,,,,,Fee Schedule,930.16,1113.98,
PRIMATRIX 4X4 MESH,13962596,LOCAL,,,Q4110,HCPCS,,,,Outpatient,,,4162.5,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
THERASKIN 2.5 X 5.1 CM,13962607,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,4167,2431,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
"Beta Amyloid 42/40 Ratio, CSF QST",13873765,LOCAL,82542,CPT,,,,,,Outpatient,,,4168.13,28.91,Humana,Humana,24.09,,,,,,,Fee Schedule,17.73,24.09,
INSERTION OF INTRAPERITONEAL CATHETER,8267131,LOCAL,49418,CPT,,,,,,Outpatient,,,4189,2723,Humana,Humana,3226.48,,,,,,,Fee Schedule,2599,5444.44,
US Insert Tun IP Cath Perc,10460131,LOCAL,49418,CPT,,,,,,Outpatient,,,4189,2723,Humana,Humana,3226.48,,,,,,,Fee Schedule,2599,5444.44,
AMNIOEXCEL SKIN SUBSTITUTE 3.5CM X 3.5CM,13962554,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,4213.58,3028,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
NUSHIELD 2X3CM,10510072,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,4262.5,1155,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
NUSHIELD 2X4CM,13962588,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,4275,1155,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRI Breast w/ + w/o Contrast Bilateral.,8145272,LOCAL,77049,CPT,,,,,,Outpatient,,,4351.43,2333.1,Humana,Humana,204.56,,,,,,,Fee Schedule,204.56,652.35,
IR Nephro Plcmt New Access W Cath,8267190,LOCAL,50432,CPT,,,,,,Outpatient,,,4351.75,2829,Humana,Humana,1872.87,,,,,,,Fee Schedule,1872.87,2315,
NEPHROSTOGRAM CATHETER PLACEMENT S&I,8267190,LOCAL,50432,CPT,,,,,,Outpatient,,,4351.75,2829,Humana,Humana,1872.87,,,,,,,Fee Schedule,1872.87,2315,
EXCHANGE NEPHROSTOMY TUBE,8212021,LOCAL,50435,CPT,,,,,,Outpatient,,,4357.87,2833,Humana,Humana,1872.87,,,,,,,Fee Schedule,1291,2206.55,
ACTIGRAFT PRO-RD2301,10510000,LOCAL,,,G0460,HCPCS,,,,Outpatient,,,4400,,Humana,Humana,1672.39,,,,,,,Fee Schedule,1466.58,1672.39,
MRI Brain + IAC w/ + w/o Contrast,9427798,LOCAL,70553,CPT,,,,,,Outpatient,,,4403.72,2361.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Brain w/ + w/o Contrast,1168796,LOCAL,70553,CPT,,,,,,Outpatient,,,4403.72,2361.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Pituitary w/ + w/o Contrast,8058740,LOCAL,70553,CPT,,,,,,Outpatient,,,4403.72,2361.15,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
AMNIOEXCEL SKIN SUBSTITUTE 4CM X 4CM,13962555,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,4423.23,3028,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
PULMONARY UNILATERAL S&I,8210600,LOCAL,75741,CPT,,,,,,Outpatient,,,4485,2404.88,Humana,Humana,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
VENOUS SAMPLING WO/W ANGIO,8210720,LOCAL,75893,CPT,,,,,,Outpatient,,,4485,2404.88,Humana,Humana,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
VISCERAL S&I,8210570,LOCAL,75726,CPT,,,,,,Outpatient,,,4485,2404.88,Humana,Humana,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
CT Angio Abdomen and Pelvis,2424686,LOCAL,74174,CPT,,,,,,Outpatient,,,4538.98,2433.75,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,565.59,
THERASKIN 2.5 X 2.5 CM,10510018,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,4570.5,2431,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
IMPLANT BREAST #350-4004BC,4803833,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,4598,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-4504BC,4841089,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,4598,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT MEMORY GEL 300CC,4852825,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,4598,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
GRAFIX PRIME 2 X 3CM,13962571,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,4612.5,3671,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
PTA URETERAL STRICTURE WITH IMAGING,8267792,LOCAL,50706,CPT,,,,,,Outpatient,,,4747.36,3086,Humana,Humana,147.16,,,,,,,Fee Schedule,147.16,10138.5,
MRI Spine Cervical w/ + w/o Contrast,1169050,LOCAL,72156,CPT,,,,,,Outpatient,,,4747.92,2545.95,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
EPIFIX SKIN SUBSTITUTE 2 X 2 CM,13962562,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,4790.25,1755,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
CT Abdomen and Pelvis w/ + w/o Contrast,2424644,LOCAL,74178,CPT,,,,,,Outpatient,,,4826.55,2588.03,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Urogram,8203051,LOCAL,74178,CPT,,,,,,Outpatient,,,4826.55,2588.03,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,461.98,
EPIFIX SKIN SUBSTITUTE 2 X 2 CM,10510011,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,4950,1755,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
NM Inflammation Loc Spect,1169158,LOCAL,78803,CPT,,,,,,Outpatient,,,5051.75,1181.4,Humana,Humana,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
antivenin (Crotalidae equine) polyvalent intravenous injection [CULL],11250856,LOCAL,J0841,CPT,,,,,,Outpatient,1,EA,5068.8,,Humana,Humana,1045.15,,,,,,,Fee Schedule,1045.15,11608.84,
THERASKIN 2.5 X 5.1 CM,10510019,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,5093,2431,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
tocilizumab 20 mg/mL Sol 10 mL [CULL],11260565,LOCAL,J3262,CPT,,,,,,Outpatient,10,ML,5099.1744,,Humana,Humana,5.71,,,,,,,Fee Schedule,5.71,1641.22,
MRI Spine Thoracic w/ + w/o Contrast,1169062,LOCAL,72157,CPT,,,,,,Outpatient,,,5102.75,2736.53,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
CATH LAB INSERTION OF PLEURAL CATHETER,8230067,LOCAL,32550,CPT,,,,,,Outpatient,,,5132.46,3336,Humana,Humana,3226.48,,,,,,,Fee Schedule,1392.67,3226.48,
95782 PEDI POLYSOMNOGRAPHY (<6YO) CHARGE,9303178,LOCAL,95782,CPT,,,,,,Outpatient,,,5141.48,3342,Humana,Humana,930.16,,,,,,,Fee Schedule,930.16,1113.98,
95810 POLYSOMNOGRAPHY CHARGE.,8303749,LOCAL,95810,CPT,,,,,,Outpatient,,,5141.48,3342,Humana,Humana,930.16,,,,,,,Fee Schedule,930.16,1113.98,
NUSHIELD 2X4CM,10510073,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,5225,1155,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
NM Cardiac Amyloid PYP Spect,9955566,LOCAL,78803,CPT,A9538,HCPCS,,,,Outpatient,,,5230.76,1181.4,Humana,Humana,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
MRI Spine Lumbar w/ + w/o Contrast,1169056,LOCAL,72158,CPT,,,,,,Outpatient,,,5301.01,2842.95,Humana,Humana,326.51,,,,,,,Fee Schedule,326.51,652.35,
95783 POLYSOM <6 YRS SLP W/CPAP CHARGE,10732463,LOCAL,95783,CPT,,,,,,Outpatient,,,5349.1,3477,Humana,Humana,930.16,,,,,,,Fee Schedule,930.16,1113.98,
95811 POLYSOMMOGRAPHY w/ CPAP CHARGE,8303770,LOCAL,95811,CPT,,,,,,Outpatient,,,5349.1,3477,Humana,Humana,930.16,,,,,,,Fee Schedule,930.16,930.16,
NM Inflammation Loc Whole Body - Ceretec,1169152,LOCAL,78802,CPT,A9521,HCPCS,,,,Outpatient,,,5351.75,2870.18,Humana,Humana,802.34,,,,,,,Fee Schedule,802.34,1409.71,
EPIFIX SKIN SUBSTITUTE 2 X 3 CM,13962563,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,5377.5,1755,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
NM Inflammation Loc Limited - Indium,1169148,LOCAL,78801,CPT,,,,,,Outpatient,,,5399.5,2895.75,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,1409.71,
NM Inflammation Loc Multi,12113627,LOCAL,78801,CPT,,,,,,Outpatient,,,5399.5,2895.75,Humana,Humana,367.38,,,,,,,Fee Schedule,367.38,1409.71,
AMNIOEXCEL PLUS 3X3,13962549,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,5400,3028,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY VENOUS ADDL,8210394,LOCAL,37188,CPT,,,,,,Outpatient,,,5419.5,3523,Humana,Humana,2877.63,,,,,,,Fee Schedule,2599,5228.12,
KERECIS OMEGA 3 - 3 X 7,13962578,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,5436,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
THERASKIN 5.1 X 7.6 CM,13962608,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,5449.5,2431,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
NEW ACCESS NEPHROSTOMY TUBE,8200537,LOCAL,50433,CPT,,,,,,Outpatient,,,5454.2,3545,Humana,Humana,3153.26,,,,,,,Fee Schedule,2315,4301.28,
PTA RENAL ARTERY (ADD'L),8210240,LOCAL,37247,CPT,,,,,,Outpatient,,,5488.12,3567,Humana,Humana,140.82,,,,,,,Fee Schedule,140.82,8616.54,
IMPLANT BREAST #350-6504BC 650CC,4801608,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,5500,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-8004BC,4803074,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,5500,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST 700CC #350-7004BC MENTOR,4803075,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,5500,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST SILICONE 500CC,4805180,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,5500,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT SILICONE 750CC,4851569,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,5500,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
PURAPLY AM 3.76 CM X 4.76 CM,13962601,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,5512.5,3861,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
27603 DRAIN LOWER LEG LESION,13043453,LOCAL,27603,CPT,,,,,LT,Outpatient,,,5526.21,3592,Humana,Humana,2616.66,,,,,,,Fee Schedule,2315,2616.66,
NM Myocardial Planar Rest and Stress,2425972,LOCAL,78454,CPT,A9500,HCPCS,,,,Outpatient,,,5593.52,2999.7,Humana,Humana,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
EPIFIX SKIN SUBSTITUTE 3.5 X 3.5 CM,13962565,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,5602.5,1755,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
GRAFIX PRIME 2 X 3CM,10510014,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,5637.5,3671,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
GRAFIX PL 3.0 X 4.0CM,13962568,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,5647.5,3671,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
REVISION REPLACE GENERATOR  BLADDER,8268108,LOCAL,64595,CPT,,,,,,Outpatient,,,5690.13,3699,Humana,Humana,3144.15,,,,,,,Fee Schedule,2599,5487.33,
REVISION REPLACE LEAD BLADDER STIMULATOR,8268107,LOCAL,64585,CPT,,,,,,Outpatient,,,5690.13,3699,Humana,Humana,3144.15,,,,,,,Fee Schedule,2599,5487.33,
AMNIOEXCEL PLUS 2CMX2CM,10510060,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,5693.33,3028,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
INTRO AV SHUNT W S&I,8267106,LOCAL,36902,CPT,,,,,,Outpatient,,,5734.69,11107,Humana,Humana,5212.67,,,,,,,Fee Schedule,5212.67,5787,
APLIGRAF-COM,13962557,LOCAL,,,Q4101,HCPCS,,,,Outpatient,,,5737.5,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 4 X 4.5 CM,13962566,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,5737.5,1755,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 4 X 4.5CM,13962567,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,5737.5,1755,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
15120 SKN SPLT A-GRFT FAC/NCK/HF/G 100 SQ CM/1% BA,10006441,LOCAL,15120,CPT,,,,,,Outpatient,,,5746.86,3735,Humana,Humana,3347.08,,,,,,,Fee Schedule,2599,3347.08,
REPOSITION IVC FILTER,8267129,LOCAL,37192,CPT,,,,,,Outpatient,,,5771.49,3751,Humana,Humana,2877.63,,,,,,,Fee Schedule,2599,5228.12,
EPICORD 2CM X 3CM,13962558,LOCAL,,,Q4187,HCPCS,,,,Outpatient,,,5827.5,3788,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
VENOUS PTA EACH ADD'L,8267100,LOCAL,37249,CPT,,,,,,Outpatient,,,5876.95,3820,Humana,Humana,118.76,,,,,,,Fee Schedule,118.76,8616.54,
PURAPLY AM 3 CM X 4 CM,13962599,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,5940,3861,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
PURAPLY AM 3 X 4CM FEN FINISHED PROD,13962600,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,5940,3861,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
Central Line Access Type. -> Tunneled,13449753,LOCAL,36810,CPT,,,,,,Outpatient,,,5960.36,3874,Humana,Humana,2877.63,,,,,,,Fee Schedule,2599,3211.33,
NUSHIELD 3X4CM,13962589,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,5962.5,1155,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
NUSHIELD 4X4CM,13962590,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,5962.5,1155,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
prothrombin complex - Pow [CULL],11220535,LOCAL,J7168,CPT,,,,,,Outpatient,1,EA,6048,,Humana,Humana,2.14,,,,,,,Fee Schedule,2.14,3347.61,
AFFINITY 1.5 CM X 1.5 CM,10500119,LOCAL,,,Q4159,HCPCS,,,,Outpatient,,,6075,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 2 X 4 CM,13962564,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,6075,1755,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
33215 Reposition Pacing Defibrillator Lead,8212027,LOCAL,33215,CPT,,,,,,Outpatient,,,6104.24,3968,Humana,Humana,2877.63,,,,,,,Fee Schedule,2484.2,2877.63,
ICD REMOVAL ONLY,8231005,LOCAL,33241,CPT,,,,,,Outpatient,,,6104.24,3968,Humana,Humana,3327.27,,,,,,,Fee Schedule,2599,10220.8,
EXTREMITY UNILATERAL S&I,8210530,LOCAL,75710,CPT,,,,,,Outpatient,,,6132.32,3288.45,Humana,Humana,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
XR Angio Extremity in OR SI Left,2425383,LOCAL,75710,CPT,,,,,LT,Outpatient,,,6132.32,3288.45,Humana,Humana,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
XR Angio Extremity in OR SI Right,2425386,LOCAL,75710,CPT,,,,,RT,Outpatient,,,6132.32,3288.45,Humana,Humana,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
immune globulin intravenous and subcutaneous 10% injectable solution 100 mL [CULL],11205089,LOCAL,J1561,CPT,,,,,,Outpatient,100,ML,6199.68,,Humana,Humana,48.96,,,,,,,Fee Schedule,48.96,2110.36,
TRANSCATH THER.ART.INF.(FINAL DAY),8210027,LOCAL,37214,CPT,,,,,,Outpatient,,,6313.68,4104,Humana,Humana,2877.63,,,,,,,Fee Schedule,1291,5228.12,
BULKAMID URETHRAL BULKING SYSTEM,4830058,LOCAL,,,L8603,HCPCS,,,,Outpatient,,,6325,3364,Humana,Humana,536.91,,,,,,,Fee Schedule,536.91,536.91,
EXPANDER TISSUE 750-900ML,4854109,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6325,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE DERMASPAN 600-720CC,4805041,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6325,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE LPP-FH13S,4832956,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6325,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE LPP-FH14S,4803623,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6325,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
93503 INSERTION OF SWAN GANZ CHARGE,8210870,LOCAL,93503,CPT,,,,,,Outpatient,,,6394.68,4157,Humana,Humana,1420.25,,,,,,,Fee Schedule,1291,1644.1,
PA CATHETER SV02,4221129,LOCAL,93503,CPT,,,,,,Outpatient,,,6394.68,4157,Humana,Humana,1420.25,,,,,,,Fee Schedule,1291,1644.1,
GENERATOR REMOVAL ONLY,8210160,LOCAL,33233,CPT,,,,,,Outpatient,,,6446.76,4190,Humana,Humana,7566.4,,,,,,,Fee Schedule,2599,10220.8,
fomepizole 1 g/mL intravenous solution 1.5 mL [CULL],11290124,LOCAL,J1451,CPT,,,,,,Outpatient,1.5,ML,6649.376,,Humana,Humana,6.28,,,,,,,Fee Schedule,6.28,525.49,
NM Myocardial SPECT Drug Stress Multi,8567792,LOCAL,78452,CPT,,,,,,Outpatient,,,6759.97,3625.05,Humana,Humana,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
NM Myocardial SPECT Rest and Stress,2425975,LOCAL,78452,CPT,,,,,,Outpatient,,,6759.97,3625.05,Humana,Humana,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
dalbavancin 500 mg Pow [CULL],11287452,LOCAL,J0875,CPT,,,,,,Outpatient,1,UN,6831.8592,4440,Humana,Humana,15.61,,,,,,,Fee Schedule,0.21,5685.74,
IMPLANT BREAST SHPB-235,4852442,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6875,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST SHPB-585,4851979,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6875,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST SHPB-635,4805161,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6875,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
GRAFIX PL 3.0 X 4.0CM,10510066,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,6902.5,3671,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
PERC URETERAL STENT REMOVAL & REPLACE,8210741,LOCAL,50382,CPT,,,,,,Outpatient,,,6922.86,4500,Humana,Humana,1872.87,,,,,,,Fee Schedule,1872.87,2315,
CULL NM TC99M Ceretec Per Dose,13644947,LOCAL,,,A9521,HCPCS,,,,Outpatient,,,6990.26,4544,Humana,Humana,802.34,,,,,,,Fee Schedule,802.34,802.34,
EPICORD 2CM X 3CM,10510051,LOCAL,,,Q4187,HCPCS,,,,Outpatient,,,7122.5,3788,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
IMPLANT BREAST 775,4850675,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,7150,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
"BRCAvantage(R), Comprehensive QSTC",9039435,LOCAL,81162,CPT,,,,,,Outpatient,,,7200,2189.86,Humana,Humana,1824.88,,,,,,,Fee Schedule,590.67,1824.88,
PURAPLY AM 3 X 4CM FEN FINISHED PROD,10510076,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,7260,3861,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
NUSHIELD 4X4CM,10510075,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,7287.5,1155,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY ARTERIAL SECONDARY PERC,8210390,LOCAL,37186,CPT,,,,,,Outpatient,,,7383.75,4799,Humana,Humana,199.65,,,,,,,Fee Schedule,199.65,16037.41,
"15100 AUTO-SPLIT THICK T/A/L, 1ST 100 SQCM CHARGE",12816476,LOCAL,15100,CPT,,,,,,Outpatient,,,7387.97,4802,Humana,Humana,1672.39,,,,,,,Fee Schedule,1496,2862.92,
AFFINITY 1.5CM X 1.5CM,10500119,LOCAL,,,Q4159,HCPCS,,,,Outpatient,,,7425,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY VENOUS PRIMARY,8210393,LOCAL,37187,CPT,,,,,,Outpatient,,,7579,4926,Humana,Humana,10368.23,,,,,,,Fee Schedule,5228.12,10368.23,
GRAFT STRAVIX 2 X 4,13962572,LOCAL,,,Q4132,HCPCS,,,,Outpatient,,,7650,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 4 X 4.5 CM,10510064,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,7672.5,1755,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
EXCHANGE OF BILIARY DRAIN CATH,8267769,LOCAL,47536,CPT,,,,,,Outpatient,,,7882.57,5124,Humana,Humana,3226.48,,,,,,,Fee Schedule,2599,3682.65,
PLACEMENT BILIARY DRAIN CATH INT/EXT,8201219,LOCAL,47534,CPT,,,,,,Outpatient,,,7882.57,5124,Humana,Humana,3226.48,,,,,,,Fee Schedule,2599,3682.65,
36253 Insertion Of Cath Renal Arterial 2Nd Unilateral,8212045,LOCAL,36253,CPT,,,,,,Outpatient,,,8050.63,5233,Humana,Humana,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
CERVICOCEREBRAL S&I,8201615,LOCAL,36221,CPT,,,,,,Outpatient,,,8050.63,5233,Humana,Humana,2877.63,,,,,,,Fee Schedule,2599,6018.68,
COMMON CAROTID UNI S&I,8201600,LOCAL,36223,CPT,,,,,,Outpatient,,,8050.63,5233,Humana,Humana,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
EXTERNAL CAROTID UNI S&I,8201610,LOCAL,36222,CPT,,,,,,Outpatient,,,8050.63,5233,Humana,Humana,2877.63,,,,,,,Fee Schedule,2599,6018.68,
INFERIOR VENA CAVA S&I,8210660,LOCAL,75825,CPT,,,,,,Outpatient,,,8050.63,4317.23,Humana,Humana,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
IR Angio Pulmonary Bilateral,7949335,LOCAL,75743,CPT,,,,,,Outpatient,,,8050.63,4317.23,Humana,Humana,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
PULMONARY BILATERAL S&I,8210610,LOCAL,75743,CPT,,,,,,Outpatient,,,8050.63,4317.23,Humana,Humana,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
RENAL UNILATERAL PLACEMENT & SI,8210550,LOCAL,36251,CPT,,,,,,Outpatient,,,8050.63,5233,Humana,Humana,2877.63,,,,,,,Fee Schedule,2599,6018.68,
VERTEBRAL SUBCLAVIAN OR INNOMINATE,8201625,LOCAL,36225,CPT,,,,,,Outpatient,,,8050.63,5233,Humana,Humana,2877.63,,,,,,,Fee Schedule,2599,6018.68,
XR Venogram Cava Inferior,10386826,LOCAL,75825,CPT,,,,,,Outpatient,,,8050.63,4317.23,Humana,Humana,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
25040 FOREIGN BODY REMOVAL FOREARM LEFT,13416875,LOCAL,25040,CPT,,,,,LT,Outpatient,,,8076.78,5250,Humana,Humana,2966.42,,,,,,,Fee Schedule,2528.75,2966.42,
FOREIGN BODY RETRIEVAL,8201630,LOCAL,37197,CPT,,,,,,Outpatient,,,8080.32,5252,Humana,Humana,2877.63,,,,,,,Fee Schedule,2599,5228.12,
FOREIGN BODY RETRIEVAL S&I,8201635,LOCAL,37197,CPT,,,,,,Outpatient,,,8080.32,5252,Humana,Humana,2877.63,,,,,,,Fee Schedule,2599,5228.12,
REMOVAL IVC FILTER,8267130,LOCAL,37193,CPT,,,,,,Outpatient,,,8080.32,5252,Humana,Humana,2877.63,,,,,,,Fee Schedule,2599,5228.12,
CULL NM Indium WBC Per 0.5 MCI,13644939,LOCAL,,,A9547,HCPCS,,,,Outpatient,,,8102.03,5266,Humana,Humana,772.64,,,,,,,Fee Schedule,772.64,772.64,
CULL NM Kinevac Per 5 MCG Vial,13644941,LOCAL,,,A9547,HCPCS,,,,Outpatient,,,8102.03,5266,Humana,Humana,772.64,,,,,,,Fee Schedule,772.64,772.64,
PERC INTRO CATH/STENT URETERAL PREEXIST,8200532,LOCAL,50693,CPT,,,,,,Outpatient,,,8122.9,5280,Humana,Humana,3153.26,,,,,,,Fee Schedule,2599,4301.28,
PERC INTRO URETERAL NEW ACCESS W CATH,8200534,LOCAL,50695,CPT,,,,,,Outpatient,,,8122.9,5280,Humana,Humana,3153.26,,,,,,,Fee Schedule,2599,4301.28,
PERC INTRO URETERAL NEW ACCESS WO CATH,8200533,LOCAL,50694,CPT,,,,,,Outpatient,,,8122.9,5280,Humana,Humana,3153.26,,,,,,,Fee Schedule,2599,4301.28,
VERTEBROPLASTY ADDL THOR/LUMB,8267765,LOCAL,22512,CPT,,,,,,Outpatient,,,8365.99,5438,Humana,Humana,167.55,,,,,,,Fee Schedule,167.55,6803.47,
VERTEBROPLASTY LUMBAR,8211170,LOCAL,22511,CPT,,,,,,Outpatient,,,8365.99,5438,Humana,Humana,2966.42,,,,,,,Fee Schedule,2599,6803.47,
VERTEBROPLASTY THORACIC,8211160,LOCAL,22510,CPT,,,,,,Outpatient,,,8365.99,5438,Humana,Humana,2966.42,,,,,,,Fee Schedule,2599,6803.47,
RENAL BILATERAL PLACEMENT & SI,8210560,LOCAL,36252,CPT,,,,,,Outpatient,,,8539.16,5550,Humana,Humana,2877.63,,,,,,,Fee Schedule,2599,6018.68,
93452 Left Heart Cath,8230003,LOCAL,93452,CPT,,,,,,Outpatient,,,8778,5706,Humana,Humana,2940.64,,,,,,,Fee Schedule,2940.64,4325,
TEMP SACRAL ELECTRODE WITH IMAGING,8268102,LOCAL,64561,CPT,,,,,,Outpatient,,,8900,5785,Humana,Humana,6000.2,,,,,,,Fee Schedule,5787,8672.71,
27372 FOREIGN BODY REMOVAL KNEE,13435628,LOCAL,27372,CPT,,,,,,Outpatient,,,8946.89,5815,Humana,Humana,2616.66,,,,,,,Fee Schedule,2315,2616.66,
IMPLANT BREAST ARTOURA 455CC SMOOTH,4853890,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,8976,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
75630-IR Aortogram Abdominal + Iliofemoral1,8071871,LOCAL,75630,CPT,,,,,,Outpatient,,,9016.7,4835.33,Humana,Humana,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
AORTO ABD+ILIOFEMORAL SERIAL,8210430,LOCAL,75630,CPT,,,,,,Outpatient,,,9016.7,4835.33,Humana,Humana,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
AORTOGRAM THORACIC S&I,8210410,LOCAL,75605,CPT,,,,,,Outpatient,,,9016.7,4835.33,Humana,Humana,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
EXTREMITY BILATERAL S&I,8210540,LOCAL,75716,CPT,,,,,,Outpatient,,,9016.7,4835.33,Humana,Humana,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
IR Aortogram Thoracic w/ Serialography,7949377,LOCAL,75605,CPT,,,,,,Outpatient,,,9016.7,4835.33,Humana,Humana,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
XR Angio Extremity in OR SI Bilat,9343676,LOCAL,75716,CPT,,,,,,Outpatient,,,9016.7,4835.33,Humana,Humana,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
20240 BIOPSY BONE EXCISIONAL SUPERFI CHARGE,8020082,LOCAL,20240,CPT,,,,,,Outpatient,,,9171.4,5961,Humana,Humana,2616.66,,,,,,,Fee Schedule,2315,2616.66,
20240-BIOPSY BONE EXCISIONAL SUPERFI CHARGE,8020082,LOCAL,20240,CPT,,,,,,Outpatient,,,9171.4,5961,Humana,Humana,2616.66,,,,,,,Fee Schedule,2315,2616.66,
EXPANDER TISSUE ALLOX2,4850383,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,9350,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE ALLOX2-15SE,4800802,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,9350,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE ALLOX2-FH13E,4800497,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,9350,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE ALLOX2-FH14E,4840653,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,9350,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
TISSUE EXPANDER ALLOX2-FH15E,4810961,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,9350,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
AMINOFIX 7CM X 6CM,13962545,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,9515.25,3028,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
AMNIOEXCEL PLUS  3 X 4CM,13962546,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,9548.1,3028,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
"93451 Catheterization, Right Heart",8230000,LOCAL,93451,CPT,,,,,,Outpatient,,,9609.02,6246,Humana,Humana,2940.64,,,,,,,Fee Schedule,2940.64,4325,
93453 Combined Left and Right Heart Cath,8230006,LOCAL,93453,CPT,,,,,,Outpatient,,,9609.02,6246,Humana,Humana,2940.64,,,,,,,Fee Schedule,2940.64,4325,
AMNIOFIX 4X6CM,13962556,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,9654.75,3028,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY ARTERIAL ADDL,8210392,LOCAL,37185,CPT,,,,,,Outpatient,,,9751.88,6339,Humana,Humana,130.9,,,,,,,Fee Schedule,130.9,8616.54,
93454 HT Left Heart Cath WO LV,8210890,LOCAL,93454,CPT,,,,,,Outpatient,,,9833.36,6392,Humana,Humana,2940.64,,,,,,,Fee Schedule,2940.64,4325,
92973 PTC Thromebectomy Add On,8200030,LOCAL,92973,CPT,,,,,,Outpatient,,,9838.19,6395,Humana,Humana,74.32,,,,,,,Fee Schedule,74.32,12572.64,
NUSHIELD 6CM X 6CM,13962591,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,10012.5,1155,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
TRANSCATH THER ART INFUSION FOR THROM,8210026,LOCAL,37211,CPT,,,,,,Outpatient,,,10140.58,6591,Humana,Humana,4942.22,,,,,,,Fee Schedule,4942.22,5787,
CATH LAB IVC FILTER PLACEMENT,8210330,LOCAL,37191,CPT,,,,,,Outpatient,,,10180.79,6618,Humana,Humana,4942.22,,,,,,,Fee Schedule,4942.22,5787,
INSERTION IVC FILTER,8267128,LOCAL,37191,CPT,,,,,,Outpatient,,,10180.79,6618,Humana,Humana,4942.22,,,,,,,Fee Schedule,4942.22,5787,
PERC PLACE IVC FILTER S&I,8210740,LOCAL,37191,CPT,,,,,,Outpatient,,,10180.79,6618,Humana,Humana,4942.22,,,,,,,Fee Schedule,4942.22,5787,
leuprolide 45 mg/6 months Pow [CULL],11299002,LOCAL,J9217,CPT,,,,,,Outpatient,1,ML,10406.8992,,Humana,Humana,176.45,,,,,,,Fee Schedule,176.45,733.68,
CULL NM Indium DTPA Per 0.5 MCI,13644937,LOCAL,,,A9548,HCPCS,,,,Outpatient,,,10432.89,6781,Humana,Humana,715.29,,,,,,,Fee Schedule,715.29,715.29,
KERECIS OMEGA 3 - 7 X 10CM,13962581,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,10552.5,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY ARTERIAL PRIMARY,8210391,LOCAL,37184,CPT,,,,,,Outpatient,,,10806,7024,Humana,Humana,16417.11,,,,,,,Fee Schedule,5787,16417.11,
AORTOGRAM ABDOMEN S&I,8210420,LOCAL,75625,CPT,,,,,,Outpatient,,,10898.6,5844.3,Humana,Humana,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
IR Aortogram Abdominal w/ Serialography1,8071874,LOCAL,75625,CPT,,,,,,Outpatient,,,10898.6,5844.3,Humana,Humana,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
XR Aorta Abdomen Catheter in OR SI,2425389,LOCAL,75625,CPT,,,,,,Outpatient,,,10898.6,5844.3,Humana,Humana,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
PURAPLY AM 5 CM X 5 CM,13962602,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,11025,3861,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
EXPANDER BREAST TISSUE ARTOURA 375CC,4853226,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,11385,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE ARTOURA SDC100UH,4803722,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,11385,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDERS TISSUE 475CC SDC-130H,4852707,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,11385,644,Humana,Humana,764.47,,,,,,,Fee Schedule,764.47,764.47,
TRANSCATH STENT CERV CAROTID WITH DEVICE,8210025,LOCAL,37215,CPT,,,,,,Outpatient,,,11474.94,7459,Humana,Humana,802.87,,,,,,,Fee Schedule,802.87,16429.41,
VERTEBRAL CERVICAL/CRANIAL S&I,8201620,LOCAL,36226,CPT,,,,,,Outpatient,,,11520.61,7488,Humana,Humana,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
LEAD REPLACEMENT DUAL,8210110,LOCAL,33217,CPT,,,,,,Outpatient,,,11951.06,7768,Humana,Humana,7566.4,,,,,,,Fee Schedule,2484.2,7566.4,
LEAD REPLACEMENT SGL,8210100,LOCAL,33216,CPT,,,,,,Outpatient,,,11951.06,7768,Humana,Humana,7566.4,,,,,,,Fee Schedule,2484.2,7566.4,
calcitonin 200 intl units/mL Sol [CULL],J0630,CPT,,,,,,,,Outpatient,200,ML,12023.04,,Humana,Humana,484.97,,,,,,,Fee Schedule,484.97,2110.36,
93455 HT Left Cath W Cor Inj WO LV,8230002,LOCAL,93455,CPT,,,,,,Outpatient,,,12026.07,7817,Humana,Humana,2940.64,,,,,,,Fee Schedule,2940.64,4325,
immune globulin intravenous and subcutaneous 10% injectable solution 200 mL [CULL],11205107,LOCAL,J1561,CPT,,,,,,Outpatient,200,ML,12399.36,,Humana,Humana,48.96,,,,,,,Fee Schedule,48.96,2110.36,
ALLOGRAFT DERMAPURE 7X10CM,4810278,LOCAL,Q4152,CPT,Q4152,HCPCS,,,,Outpatient,,,12446.5,,Humana,Humana,111.35,,,,,,,Fee Schedule,111.35,111.35,
93458 HT Cath Left W LV and Cor Angio,8230004,LOCAL,93458,CPT,,,,,,Outpatient,,,12512.89,8133,Humana,Humana,2940.64,,,,,,,Fee Schedule,2940.64,4325,
93460 HT Cath L or R W LV and Cor Angio,8230007,LOCAL,93460,CPT,,,,,,Outpatient,,,12512.89,8133,Humana,Humana,2940.64,,,,,,,Fee Schedule,2940.64,4325,
33210 INSERTION TEMP PACEMAKER SINGLE CHAMBER CHARGE,13707085,LOCAL,33210,CPT,,,,,,Outpatient,,,12542.69,8153,Humana,Humana,7566.4,,,,,,,Fee Schedule,2484.2,7566.4,
TEMP PACEMAKER SGL CHAMBER,8210050,LOCAL,33210,CPT,,,,,,Outpatient,,,12542.69,8153,Humana,Humana,7566.4,,,,,,,Fee Schedule,2484.2,7566.4,
92920 PTCA 1st Vessel,8201256,LOCAL,92920,CPT,,,,,,Outpatient,,,12766.62,8298,Humana,Humana,5212.67,,,,,,,Fee Schedule,5212.67,12572.64,
PTA RENAL ARTERY (INITIAL),8267124,LOCAL,37246,CPT,,,,,,Outpatient,,,12766.62,17592,Humana,Humana,5212.67,,,,,,,Fee Schedule,5212.67,5787,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ANGIO CPLX 1,8230034,LOCAL,37224,CPT,,,,,,Outpatient,,,12766.62,8298,Humana,Humana,5212.67,,,,,,,Fee Schedule,5212.67,5787,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS IVT ANGIO CPLX1,8230030,LOCAL,37220,CPT,,,,,,Outpatient,,,12766.62,8298,Humana,Humana,5212.67,,,,,,,Fee Schedule,5212.67,5787,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS TPVT ANGIO SF 1ST,8230022,LOCAL,37228,CPT,,,,,,Outpatient,,,12766.62,8298,Humana,Humana,10368.23,,,,,,,Fee Schedule,5787,10368.23,
THERASKIN 7.6 X 15.2 CM,13962609,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,12802.5,2431,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
93459 HT Cath Left W LV and Cor Grf Angio,8230005,LOCAL,93459,CPT,,,,,,Outpatient,,,13484.51,8765,Humana,Humana,2940.64,,,,,,,Fee Schedule,2940.64,4325,
93461 HT Cath L or R W LV Cor Grf Angio,8230008,LOCAL,93461,CPT,,,,,,Outpatient,,,13484.51,8765,Humana,Humana,2940.64,,,,,,,Fee Schedule,2940.64,4325,
riTUXimab pvvr 10 mg/mL Sol 50 mL [CULL],11211085,LOCAL,Q5119,CPT,,,,,,Outpatient,50,ML,13762.56,,Humana,Humana,27.85,,,,,,,Fee Schedule,27.85,7537.07,
"C1 esterase inhibitor, human 500 intl units intravenous kit [CULL]",11201256,LOCAL,J0597,CPT,,,,,,Outpatient,1,EA,13903.4496,,Humana,Humana,75.86,,,,,,,Fee Schedule,75.86,5685.74,
AMNIOEXCEL PLUS 4X5CM,13962550,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,13974.52,3028,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
ATHERECTOMY ABD AORTA,8230043,LOCAL,0236T,CPT,,,,,,Outpatient,,,14443,9388,Humana,Humana,10368.23,,,,,,,Fee Schedule,6417,16037.41,
ATHERECTOMY BRACHIOCEPHALIC & BRANCHES,8230044,LOCAL,0237T,CPT,,,,,,Outpatient,,,14443,9388,Humana,Humana,10368.23,,,,,,,Fee Schedule,6417,16037.41,
ATHERECTOMY ILIAC EACH,8230045,LOCAL,0238T,CPT,,,,,,Outpatient,,,14443,12175,Humana,Humana,16417.11,,,,,,,Fee Schedule,6417,16417.11,
ATHERECTOMY RENAL,8230041,LOCAL,0234T,CPT,,,,,,Outpatient,,,14443,9388,Humana,Humana,10368.23,,,,,,,Fee Schedule,6417,26140.53,
ATHERECTOMY VISCERAL,8230042,LOCAL,0235T,CPT,,,,,,Outpatient,,,14443,9388,Humana,Humana,515.34,,,,,,,Fee Schedule,515.34,8616.54,
EPICORD 3 X 5,13962559,LOCAL,,,Q4187,HCPCS,,,,Outpatient,,,14445,3788,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
INTERNAL CAROTID UNI S&I,8201636,LOCAL,36224,CPT,,,,,,Outpatient,,,14812.21,9628,Humana,Humana,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
37239 STENT ANGIO VEIN EA ADDL CHARGE,8230063,LOCAL,37239,CPT,,,,,,Outpatient,,,15683.4,10194,Humana,Humana,121.17,,,,,,,Fee Schedule,121.17,16037.41,
ARTERY STENT ADD'L (NONCORONARY),8230061,LOCAL,37237,CPT,,,,,,Outpatient,,,15683.4,10194,Humana,Humana,171.21,,,,,,,Fee Schedule,171.21,16037.41,
93456 Right Heart Catheterization With Angiography,8230009,LOCAL,93456,CPT,,,,,,Outpatient,,,16019.61,10413,Humana,Humana,2940.64,,,,,,,Fee Schedule,2940.64,4325,
33285 Implant Pt Activated Cardiac Event Recorder,8267776,LOCAL,33285,CPT,,,,,,Outpatient,,,16029.82,10419,Humana,Humana,7566.4,,,,,,,Fee Schedule,6417,12132.94,
92928 Trnscath Plcmnt Metal Single,8201254,LOCAL,92928,CPT,,,,,,Outpatient,,,16620.58,10803,Humana,Humana,10368.23,,,,,,,Fee Schedule,5787,12572.64,
CULL Octreotide,14874647,LOCAL,,,A9572,HCPCS,,,,Outpatient,,,16720.11,,Humana,Humana,1914.61,,,,,,,Fee Schedule,1914.61,1914.61,
alteplase 50 mg intravenous injection [CULL],11201048,LOCAL,J2997,CPT,,,,,,Outpatient,1,ML,16896.704,,Humana,Humana,94.45,,,,,,,Fee Schedule,94.45,122.4,
93457 Right or Left Heart Cath with No LV Gram Charge,8230010,LOCAL,93457,CPT,,,,,,Outpatient,,,16991.23,11044,Humana,Humana,2940.64,,,,,,,Fee Schedule,2940.64,4325,
AV FISTULAGRAM WITH ANGIOPLASTY,8210331,LOCAL,36902,CPT,,,,,,Outpatient,,,17087.76,11107,Humana,Humana,5212.67,,,,,,,Fee Schedule,5212.67,5787,
"C9764 Revasculation, Endovascular, With Intravascular Lithotripsy, Includes Angioplasty",8230070,LOCAL,,,C9764,HCPCS,,,,Outpatient,,,17339,11270,Humana,Humana,10368.23,,,,,,,Fee Schedule,5228.12,10368.23,
digoxin immune FAB 40 mg intravenous injection [CULL],11201675,LOCAL,J1162,CPT,,,,,,Outpatient,1,EA,17660.16,,Humana,Humana,5168.23,,,,,,,Fee Schedule,5168.23,7537.07,
KERECIS OMEGA 3 - 7 X 10,13962580,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,17959.5,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
GENERATOR ONLY SGL CHAMBER INSERTION,8210070,LOCAL,33212,CPT,,,,,,Outpatient,,,17985.84,11691,Humana,Humana,7566.4,,,,,,,Fee Schedule,6417,12132.94,
PACEMAKER REMOVAL SINGLE,8210171,LOCAL,33227,CPT,,,,,,Outpatient,,,17985.84,11691,Humana,Humana,7566.4,,,,,,,Fee Schedule,6417,12132.94,
immune globulin intravenous and subcutaneous 10% injectable solution 300 mL [CULL],11205109,LOCAL,J1561,CPT,,,,,,Outpatient,300,ML,18599.04,,Humana,Humana,48.96,,,,,,,Fee Schedule,48.96,2110.36,
0238T Iliac Athrectomy with or without PTA,8230069,LOCAL,0238T,CPT,,,,,,Outpatient,,,18730.19,12175,Humana,Humana,16417.11,,,,,,,Fee Schedule,6417,16417.11,
INSERTION NEUROSTIMULATOR GENERATOR,8268101,LOCAL,64590,CPT,,,,,,Outpatient,,,19804,519,Humana,Humana,19605.75,,,,,,,Fee Schedule,9233,30196.67,
GENERATOR REMOVAL AND REPLACEMENT DUAL,8210172,LOCAL,33228,CPT,,,,,,Outpatient,,,20984.23,13640,Humana,Humana,9568.03,,,,,,,Fee Schedule,6417,12132.94,
C9604 Revasc thru Bypass Single Vessel w DES (M'care),8201640,LOCAL,,,C9604,HCPCS,,,,Outpatient,,,21116.1,13725,Humana,Humana,10368.23,,,,,,,Fee Schedule,6417,12572.64,
C9607 Revasc CTO Single Vessel w DES (M'care),8201642,LOCAL,,,C9607,HCPCS,,,,Outpatient,,,21116.1,13725,Humana,Humana,16417.11,,,,,,,Fee Schedule,6417,16417.11,
PERQ BM STENT ADD ON  RAMUS,8201252,LOCAL,,,C9600,HCPCS,,,,Outpatient,,,21116.1,13725,Humana,Humana,10368.23,,,,,,,Fee Schedule,6417,12572.64,
TIB/PER REVASC W/ATHER ADD ON  LT,8210020,LOCAL,33206,CPT,,,,,,Outpatient,,,21534.36,13997,Humana,Humana,9568.03,,,,,,,Fee Schedule,6417,12132.94,
C9772 Revasc Lithotrip Tibi/Peroneal Artery (Shockwave IVL),8230074,LOCAL,,,C9772,HCPCS,,,,Outpatient,,,22157.75,14403,Humana,Humana,10368.23,,,,,,,Fee Schedule,6417,10368.23,
PTA VENOUS PERC W S&I,8267099,LOCAL,37248,CPT,,,,,,Outpatient,,,22271.43,14476,Humana,Humana,5212.67,,,,,,,Fee Schedule,5212.67,5787,
VENTRICULAR PACEMAKER IMPLANT INS OR REP,8210030,LOCAL,33207,CPT,,,,,,Outpatient,,,22386.25,14551,Humana,Humana,9568.03,,,,,,,Fee Schedule,6417,12132.94,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ATHRC CPLX 1,8230035,LOCAL,37225,CPT,,,,,,Outpatient,,,23546.83,15305,Humana,Humana,16417.11,,,,,,,Fee Schedule,6417,16417.11,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ST CPLX 1ST,8230036,LOCAL,37226,CPT,,,,,,Outpatient,,,23546.83,15305,Humana,Humana,10368.23,,,,,,,Fee Schedule,6417,10368.23,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS IVT ST CPLX 1ST,8230031,LOCAL,37221,CPT,,,,,,Outpatient,,,23546.83,15305,Humana,Humana,10368.23,,,,,,,Fee Schedule,6417,10368.23,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS TPVT ATHRC CPLX 1,8230023,LOCAL,37229,CPT,,,,,,Outpatient,,,23546.83,15305,Humana,Humana,16417.11,,,,,,,Fee Schedule,6417,16417.11,
VASC EMBOLIZE OCCLUDE ARTERY,8210362,LOCAL,37242,CPT,,,,,,Outpatient,,,23819.19,15482,Humana,Humana,16417.11,,,,,,,Fee Schedule,6417,16417.11,
VASC EMBOLIZE OCCLUDE BLEED,8210364,LOCAL,37244,CPT,,,,,,Outpatient,,,23819.19,15482,Humana,Humana,10368.23,,,,,,,Fee Schedule,6417,16037.41,
VASC EMBOLIZE OCCLUDE ORGAN,8210363,LOCAL,37243,CPT,,,,,,Outpatient,,,23819.19,15482,Humana,Humana,10368.23,,,,,,,Fee Schedule,6417,16037.41,
VASC EMBOLIZE OCCLUDE VENOUS,8210361,LOCAL,37241,CPT,,,,,,Outpatient,,,23819.19,15482,Humana,Humana,10368.23,,,,,,,Fee Schedule,6417,16037.41,
37238 STENT ANGIO VEIN INITIAL CHARGE,8230062,LOCAL,37238,CPT,,,,,,Outpatient,,,24322.23,15809,Humana,Humana,10368.23,,,,,,,Fee Schedule,6417,16037.41,
37236 Stent Angioplasty Artery Int,8230060,LOCAL,37236,CPT,,,,,,Outpatient,,,24565.45,15968,Humana,Humana,10368.23,,,,,,,Fee Schedule,6417,16037.41,
SACRAL NERVE (TRANSFORAMINAL PLACEMENT),8268100,LOCAL,64581,CPT,,,,,,Outpatient,,,25121.42,1108,Humana,Humana,6000.2,,,,,,,Fee Schedule,6000.2,8672.71,
SHOULDER SYSTEMHEAD DWF041,4811086,LOCAL,,,L3975,HCPCS,,,,Outpatient,,,25817,,Humana,Humana,1889.33,,,,,,,Fee Schedule,1889.33,1889.33,
PTA BRACHIOCEPHALIC TRUNK W S&I,8210280,LOCAL,37246,CPT,,,,,,Outpatient,,,27065.23,17592,Humana,Humana,5212.67,,,,,,,Fee Schedule,5212.67,5787,
A V PACEMAKER IMPLANT INS OR REPLACE,8210040,LOCAL,33208,CPT,,,,,,Outpatient,,,27707.8,18010,Humana,Humana,9568.03,,,,,,,Fee Schedule,8379,12132.94,
UPGRADE SGL DUAL LEAD/CHAMBER,8210090,LOCAL,33214,CPT,,,,,,Outpatient,,,27707.8,18010,Humana,Humana,9568.03,,,,,,,Fee Schedule,8379,12132.94,
C9773 Revasc Lithotrip-Stent Tib/Peroneal Atr (Shockwave IVL),8230075,LOCAL,,,C9773,HCPCS,,,,Outpatient,,,28353.6,18430,Humana,Humana,16417.11,,,,,,,Fee Schedule,6417,16417.11,
C9774 Revasc Lithotr-Ather Tib/Peroneal Atr (Shockwave IVL),8230076,LOCAL,,,C9774,HCPCS,,,,Outpatient,,,28353.6,18430,Humana,Humana,16417.11,,,,,,,Fee Schedule,6417,16417.11,
C9775 Revasc Lithotr-Stent-Ather-Peroneal Atr (Shockwave IVL),8230077,LOCAL,,,C9775,HCPCS,,,,Outpatient,,,28353.6,18430,Humana,Humana,16417.11,,,,,,,Fee Schedule,6417,16417.11,
"C9765 Revasculation, Endovascular, With Intravascular Lithotripsy, With Stent Placement Includes Ang",8230071,LOCAL,,,C9765,HCPCS,,,,Outpatient,,,29724,19321,Humana,Humana,16417.11,,,,,,,Fee Schedule,6417,16417.11,
"C9766 Revasculation, Endovascular, With Intravascular Lithotripsy, Includes Atherectomy",8230072,LOCAL,,,C9766,HCPCS,,,,Outpatient,,,29724,19321,Humana,Humana,16417.11,,,,,,,Fee Schedule,6417,16417.11,
tenecteplase 50 mg intravenous injection [CULL],11211269,LOCAL,J3101,CPT,,,,,,Outpatient,1,EA,31861.472,,Humana,Humana,172.22,,,,,,,Fee Schedule,172.22,7537.07,
PTA STENT TIBPERONEAL INITIAL,8230024,LOCAL,37230,CPT,,,,,,Outpatient,,,32737,21279,Humana,Humana,16417.11,,,,,,,Fee Schedule,6417,16417.11,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ST ATHRC CPX 1,8230037,LOCAL,37227,CPT,,,,,,Outpatient,,,33085.18,21505,Humana,Humana,16417.11,,,,,,,Fee Schedule,9233,16417.11,
alteplase 100 mg intravenous injection [CULL],11201042,LOCAL,J2997,CPT,,,,,,Outpatient,1,ML,33793.376,,Humana,Humana,94.45,,,,,,,Fee Schedule,94.45,122.4,
SIMPLIDERM ACELLULAR DERMAL,13962604,LOCAL,,,Q4116,HCPCS,,,,Outpatient,,,38160,,Humana,Humana,111.91,,,,,,,Fee Schedule,111.91,111.91,
"C9767 Revasculation, Endovascular, With Intravascular Lithotripsy, With Stent Placement And Atherect",8230073,LOCAL,,,C9767,HCPCS,,,,Outpatient,,,39850,25903,Humana,Humana,16417.11,,,,,,,Fee Schedule,6417,16417.11,
IMPLANTABLE STIM 2-LEAD EBI 10-1335M,4802519,LOCAL,,,E0749,HCPCS,,,,Outpatient,,,43032,22885,Humana,Humana,347.98,,,,,,,Fee Schedule,347.98,347.98,
PTA ARTHRECTOMY STENT TIBPERONEAL INITIA,8230025,LOCAL,37231,CPT,,,,,,Outpatient,,,50564,32867,Humana,Humana,16417.11,,,,,,,Fee Schedule,9233,16417.11,
ICD INSERTION WITH EXISTING SINGLE LEAD,8231000,LOCAL,33240,CPT,,,,,,Outpatient,,,51027.88,33168,Humana,Humana,20521.65,,,,,,,Fee Schedule,12499,36378.11,
ICD REMOVAL&REPLACE SINGLE,8267790,LOCAL,33262,CPT,,,,,,Outpatient,,,65510.7,42582,Humana,Humana,20521.65,,,,,,,Fee Schedule,12499,36378.11,
ICD REMOVAL&REPLACE DUAL LEAD,8267778,LOCAL,33263,CPT,,,,,,Outpatient,,,67510.7,43882,Humana,Humana,20521.65,,,,,,,Fee Schedule,12499,36378.11,
ICD REMOVAL&REPLACE MULTIPLE,8267791,LOCAL,33264,CPT,,,,,,Outpatient,,,70510.7,45832,Humana,Humana,29312.62,,,,,,,Fee Schedule,12499,36378.11,
"45300 Proctosigmoidoscopy, rigid; diagnostic, w/ or w/o collection by brushing or washing",7962380,LOCAL,45300,CPT,,,,,,Outpatient,,,198,129,Humana,Humana,833.54,,,,,,,Fee Schedule,833.54,1419.32,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,90471,CPT,,,,,,Outpatient,,,216.15,140,Humana,Humana,65.07,,,,,,,Fee Schedule,42.18,65.07,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,G0010,CPT,,,,,,Outpatient,,,216.15,,Humana,Humana,42.18,,,,,,,Fee Schedule,42.18,65.07,
"25105 ARTHROTOMY, WRIST JOINT WITH SYNOVECTOMY",14130163,LOCAL,25105,CPT,,,,,,Outpatient,,,895,3245,Humana,Humana,2966.42,,,,,,,Fee Schedule,2528.75,2966.42,
PC DOPP ART BIL REST MULTIPLE/SINGLE,8230015,LOCAL,93923,CPT,,,,,26,Outpatient,,,57.19,401,Humana,Humana,143.05,,,,,,,Fee Schedule,143.05,244.97,
PC DOPP ART W/TREADMILL,8230020,LOCAL,93924,CPT,,,,,26,Outpatient,,,241,302,Humana,Humana,143.05,,,,,,,Fee Schedule,143.05,161.71,
PC DOPP LEA LIMITED,8230019,LOCAL,93922,CPT,,,,,26,Outpatient,,,150,265,Humana,Humana,117.85,,,,,,,Fee Schedule,117.85,161.71,
PC DUP ABD RENAL COMPLETE,8200571,LOCAL,93975,CPT,,,,,26,Outpatient,,,229.11,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP ABD RENAL LIMITED,8200581,LOCAL,93976,CPT,,,,,26,Outpatient,,,134.88,482,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,245.49,
PC DUP AO IVC COMPLETE,8200570,LOCAL,93978,CPT,,,,,26,Outpatient,,,74.95,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP AO IVC LIMITED,8200580,LOCAL,93979,CPT,,,,,26,Outpatient,,,50.12,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP CAROTID BILATERAL,8200229,LOCAL,93880,CPT,,,,,26,Outpatient,,,76.13,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP CAROTID UNILATERAL,8200228,LOCAL,93882,CPT,,,,,26,Outpatient,,,46.65,482,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP HEMODIALYSIS ACCESS,8200582,LOCAL,93990,CPT,,,,,26,Outpatient,,,29.64,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP LEA BIL,8200577,LOCAL,93925,CPT,,,,,26,Outpatient,,,66.27,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP LEA UNI,8200576,LOCAL,93926,CPT,,,,,26,Outpatient,,,45.08,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP UPPER ART BIL,8200575,LOCAL,93930,CPT,,,,,26,Outpatient,,,53.18,482,Humana,Humana,220.99,,,,,,,Fee Schedule,161.71,220.99,
PC DUP UPPER ART UNI,8200574,LOCAL,93931,CPT,,,,,26,Outpatient,,,35.48,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP VENOUS BIL,8200573,LOCAL,93970,CPT,,,,,26,Outpatient,,,87.58,482,Humana,Humana,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP VENOUS UNI,8200572,LOCAL,93971,CPT,,,,,26,Outpatient,,,57.12,310,Humana,Humana,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC US PSEUDOANEURYSM COMPRESSION REPAIR,8200583,LOCAL,76936,CPT,,,,,26,Outpatient,,,285.6,237.6,Humana,Humana,284.7,,,,,,,Fee Schedule,262.79,284.7,
97802 MEDICAL NUTRITIONAL THERAPY PROF CHARGE,13475611,LOCAL,97802,CPT,,,,,,Outpatient,,,70,55,Humana,Humana,25.2,,,,,,,Fee Schedule,25.2,287.34,
97803 MEDICAL NUTRITIONAL RE-ASSESSMENT PROF CHARG,13481228,LOCAL,97803,CPT,,,,,,Outpatient,,,60,48,Humana,Humana,21.06,,,,,,,Fee Schedule,21.06,287.34,
"64640 Destruction by neurolytic agent, other perip",13959658,LOCAL,64640,CPT,,,,,,Outpatient,,,500,927,Humana,Humana,813.96,,,,,,,Fee Schedule,813.96,1695.82,
10060 PROFEE Drainage of skin abscess,13954453,LOCAL,10060,CPT,,,,,,Outpatient,,,220,420,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
10061  I&D abscess complicated/multiple Profee,13769279,LOCAL,10061,CPT,,,,,,Outpatient,,,385,420,Humana,Humana,365.27,,,,,,,Fee Schedule,239.03,863,
10120 Incision & Removal Foreign Body Simp PROFEE,14006132,LOCAL,10120,CPT,,,,,,Outpatient,,,285,893,Humana,Humana,365.27,,,,,,,Fee Schedule,239.03,863,
"11042 PROFEE Debride subcutaneous tissue, 1st 20 s",13962336,LOCAL,11042,CPT,,,,,,Outpatient,,,145,836,Humana,Humana,365.27,,,,,,,Fee Schedule,365.27,863,
11043 PROFEE DEB MUSC/FASCIA 20 SQ CM/<,13967660,LOCAL,11043,CPT,,,,,,Outpatient,,,340,836,Humana,Humana,559.65,,,,,,,Fee Schedule,549.61,863,
"11044 Debride bone, 1st 20 sq cm or less Pro Fee",11221020,LOCAL,11044,CPT,,,,,,Outpatient,,,465,2328,Humana,Humana,1481.32,,,,,,,Fee Schedule,1291,1481.32,
"11045 Debride subq tissue, ea addl 20 sq cm Pro Fe",11221021,LOCAL,11045,CPT,,,,,,Outpatient,,,50,836,Humana,Humana,20.61,,,,,,,Fee Schedule,20.61,1466.58,
11046 PROFEE Debride muscle and/or fascia; ea addl,13954830,LOCAL,11046,CPT,,,,,,Outpatient,,,128,836,Humana,Humana,44.01,,,,,,,Fee Schedule,44.01,1466.58,
"11047 PROFEE Debridement, sus tissue each add 20 s",13967661,LOCAL,11047,CPT,,,,,,Outpatient,,,195,2092,Humana,Humana,78.26,,,,,,,Fee Schedule,78.26,1466.58,
11104 Punch Biopsy of Skin; Single Lesion ProFee,8768419,LOCAL,11104,CPT,,,,,,Outpatient,,,243.42,449,Humana,Humana,365.27,,,,,,,Fee Schedule,365.27,863,
11106  Incisional biopsy of skin single lesion Pro,13759967,LOCAL,11106,CPT,,,,,,Outpatient,,,296,800,Humana,Humana,559.65,,,,,,,Fee Schedule,559.65,1291,
"11400 EXCISION, BENIGN LESION INCLUDING MARGINS, E",7929974,LOCAL,11400,CPT,,,,,,Outpatient,,,160,935,Humana,Humana,643.26,,,,,,,Fee Schedule,643.26,1291,
"11406 EXCISION, BENIGN LESION INCLUDING MARGINS, E",7929979,LOCAL,11406,CPT,,,,,,Outpatient,,,470,1620,Humana,Humana,1481.32,,,,,,,Fee Schedule,1481.32,2584.84,
"11604 EXCISION, MALIGNANT LESION INCLUDING MARGINS",7930002,LOCAL,11604,CPT,,,,,,Outpatient,,,410,704,Humana,Humana,643.26,,,,,,,Fee Schedule,643.26,1679.75,
"11730 PROFEE Avulsion nail plate simple, single",13967650,LOCAL,11730,CPT,,,,,,Outpatient,,,195,228,Humana,Humana,181.66,,,,,,,Fee Schedule,95.93,863,
"11750 PROFEE Excision of nail and nail matrix, par",13954836,LOCAL,11750,CPT,,,,,,Outpatient,,,305,1342,Humana,Humana,365.27,,,,,,,Fee Schedule,365.27,863,
15271 PROFEE Application of skin substitute graft,13967652,LOCAL,15271,CPT,,,,,,Outpatient,,,296,1092,Humana,Humana,1672.39,,,,,,,Fee Schedule,1496,2862.92,
15275 PROFEE APPLICATION OF SKIN SUBSTITUTE GRAFT,13954832,LOCAL,15275,CPT,,,,,,Outpatient,,,306,1092,Humana,Humana,1672.39,,,,,,,Fee Schedule,1496,2862.92,
"28810 AMPUTATION, METATARSAL, WITH TOE, SINGLE Pro",7931853,LOCAL,28810,CPT,,,,,,Outpatient,,,820,3245,Humana,Humana,2966.42,,,,,,,Fee Schedule,2315,7645.84,
29445 PROFEE APPLICATION OF RIGID TOTAL CONTACT LE,13962328,LOCAL,29445,CPT,,,,,,Outpatient,,,200,266,Humana,Humana,242.81,,,,,,,Fee Schedule,242.81,863,
31502 Tracheotomy tube change prior to establishme,14397259,LOCAL,31502,CPT,,,,,,Outpatient,,,80,232,Humana,Humana,212.31,,,,,,,Fee Schedule,162.41,863,
"31899 UNLISTED PROCEDURE, TRACHEA, BRONCHI ProFee",7932202,LOCAL,31899,CPT,,,,,,Outpatient,,,91,194,Humana,Humana,177.49,,,,,,,Fee Schedule,177.49,2400.33,
"58573 LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTO",14831670,LOCAL,58573,CPT,,,,,,Outpatient,,,2172,10411,Humana,Humana,9518.56,,,,,,,Fee Schedule,5787,9518.56,
64454 Genicular Nerve Block Profee,13911832,LOCAL,64454,CPT,,,,,,Outpatient,,,227,244,Humana,Humana,633.14,,,,,,,Fee Schedule,633.14,1291,
64999 XX UNLISTED NERVOUS SYSTEM INJECTION,7939552,LOCAL,64999,CPT,,,,,,Outpatient,,,250,620,Humana,Humana,269.88,,,,,,,Fee Schedule,269.88,863,
93010 EKG INTERPRETATION,7939709,LOCAL,93010,CPT,,,,,,Outpatient,,,65,,Humana,Humana,10.44,,,,,,,Fee Schedule,10.44333333,38.53,
93451 RIGHT HEART CATHERIZATION (OR),8192212,LOCAL,93451,CPT,,,,,26,Outpatient,,,1008,6246,Humana,Humana,2940.64,,,,,,,Fee Schedule,2940.64,4325,
97597 WOUND DEBRIDEMENT ProFee,7935939,LOCAL,97597,CPT,,,,,,Outpatient,,,188.32,395,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,863,
97598 DEBRID SELCT EA ADD20SQCM ProFee,7935940,LOCAL,97598,CPT,,,,,,Outpatient,,,83,395,Humana,Humana,20.42,,,,,,,Fee Schedule,20.42,1466.58,
97605 Negative pressure wound therapy less than 50,14327888,LOCAL,97605,CPT,,,,,,Outpatient,,,80,285,Humana,Humana,181.66,,,,,,,Fee Schedule,181.66,273.27,
99183 HBO PER SESSION ProFee,7935966,LOCAL,99183,CPT,,,,,,Outpatient,,,210,,Humana,Humana,145.15,,,,,,,Fee Schedule,145.1479032,145.1479032,
99202 LEVEL 2 VISIT NEW PT ProFee,7935970,LOCAL,99202,CPT,,,,,,Outpatient,,,140,294,Humana,Humana,39.11,,,,,,,Fee Schedule,39.11,39.11,
99203 LEVEL 3 VISIT NEW PT ProFee,7935971,LOCAL,99203,CPT,,,,,,Outpatient,,,200,387,Humana,Humana,67.57,,,,,,,Fee Schedule,67.57,67.57,
99204 LEVEL 4 NEW PT PROF CHARGE,8700762,LOCAL,99204,CPT,,,,,,Outpatient,,,305,513,Humana,Humana,110.67,,,,,,,Fee Schedule,110.67,110.67,
99205 PROFEE OFFICE VISIT LEV 5 NEW PT,13962366,LOCAL,99205,CPT,,,,,,Outpatient,,,385,701,Humana,Humana,151.18,,,,,,,Fee Schedule,151.18,151.18,
99211 LEVEL 1 EST PT PROF CHARGE,8700763,LOCAL,99211,CPT,,,,,,Outpatient,,,40,226,Humana,Humana,7.37,,,,,,,Fee Schedule,7.37,7.37,
99212 LEVEL 2 EST PT PROF CHARGE,8700764,LOCAL,99212,CPT,,,,,,Outpatient,,,100,294,Humana,Humana,29.48,,,,,,,Fee Schedule,29.48,29.48,
99213 LEVEL 3 EST PT PROF CHARGE,8700765,LOCAL,99213,CPT,,,,,,Outpatient,,,135,387,Humana,Humana,54.77,,,,,,,Fee Schedule,54.77,54.77,
99214 LEVEL 4 EST PT PROF CHARGE,8700766,LOCAL,99214,CPT,,,,,,Outpatient,,,200,513,Humana,Humana,80.51,,,,,,,Fee Schedule,80.51,80.51,
99215 LEVEL 5 EST PT PROF CHARGE,8700767,LOCAL,99215,CPT,,,,,,Outpatient,,,270,701,Humana,Humana,119.41,,,,,,,Fee Schedule,119.41,119.41,
G0108 DIABETES SERVICE 30 MIN PROF CHARGE,13484119,LOCAL,G0108,CPT,,,,,,Outpatient,,,105,128,Humana,Humana,52.15,,,,,,,Fee Schedule,52.15,95.93,
G0109 DSMT DIABETES GROUP 30 MIN ProFee,7936084,LOCAL,G0109,CPT,,,,,,Outpatient,,,30,18,Humana,Humana,14.97,,,,,,,Fee Schedule,14.97,67.18,
IMPLANT MEMORY GEL #350-6004BC,4803876,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,0.01,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
"Protein, Tot & Prot Electrop Interp QSTC",8852423,LOCAL,84165,CPT,,,,,,Outpatient,,,3.92,12.89,United Health ,United Health Medicare Advantage,2.8,,,,,,,Fee Schedule,2.796363636,17.73,
"Protein, Total QSTC",8852413,LOCAL,84165,CPT,,,,,,Outpatient,,,3.92,12.89,United Health ,United Health Medicare Advantage,2.8,,,,,,,Fee Schedule,2.796363636,17.73,
DRESSING TELFA ISLAND 4X10,11074306,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,4.29,86,United Health ,United Health Medicare Advantage,67.37,,,,,,,Fee Schedule,67.37,67.37,
.RPR Titer QSTC,6231113,LOCAL,86593,CPT,,,,,,Outpatient,,,5.9,5.28,United Health ,United Health Medicare Advantage,4.4,,,,,,,Fee Schedule,4.4,15.29,
UA Microscopic,633864,LOCAL,81015,CPT,,,,,,Outpatient,,,6,3.66,United Health ,United Health Medicare Advantage,1.68,,,,,,,Fee Schedule,1.68192607,4.02,
Urinalysis Review Manual,8502419,LOCAL,81015,CPT,,,,,,Outpatient,,,6,3.66,United Health ,United Health Medicare Advantage,1.68,,,,,,,Fee Schedule,1.68192607,4.02,
Hematocrit QSTC,8852782,LOCAL,85014,CPT,,,,,,Outpatient,,,7.21,2.84,United Health ,United Health Medicare Advantage,12.62,,,,,,,Fee Schedule,8.21,12.62068493,
Hemoglobin A2 (Quant) QSTC,8852791,LOCAL,83020,CPT,,,,,,Outpatient,,,7.21,15.44,United Health ,United Health Medicare Advantage,12.87,,,,,,,Fee Schedule,12.87,17.73,
Hemoglobin QSTC,8852780,LOCAL,85018,CPT,,,,,,Outpatient,,,7.21,2.84,United Health ,United Health Medicare Advantage,10.94,,,,,,,Fee Schedule,8.21,10.94316176,
Red Blood Cell Count QSTC,8852779,LOCAL,85041,CPT,,,,,,Outpatient,,,7.21,3.62,United Health ,United Health Medicare Advantage,3.02,,,,,,,Fee Schedule,3.02,8.21,
87107 Fungal Isolate Identification QST,14813753,LOCAL,87107,CPT,,,,,,Outpatient,,,7.5,12.38,United Health ,United Health Medicare Advantage,10.32,,,,,,,Fee Schedule,10.32,20.05,
87143 Fungal Isolate Identification QST,14815667,LOCAL,87143,CPT,,,,,,Outpatient,,,7.5,15.02,United Health ,United Health Medicare Advantage,12.52,,,,,,,Fee Schedule,10.57,12.52,
87149 Fungal Isolate Identification QST,14813753,LOCAL,87149,CPT,,,,,,Outpatient,,,7.5,24.06,United Health ,United Health Medicare Advantage,20.05,,,,,,,Fee Schedule,10.32,20.05,
Glucose Fasting Urine,7974487,LOCAL,81003,CPT,,,,,,Outpatient,,,7.88,2.7,United Health ,United Health Medicare Advantage,3.8,,,,,,,Fee Schedule,3.795286195,4.02,
"Uric Acid, Synovial Fluid QSTC",9607980,LOCAL,84560,CPT,,,,,,Outpatient,,,8.37,6.1,United Health ,United Health Medicare Advantage,19.49,,,,,,,Fee Schedule,7.16,19.49,
Alkaline Phosphatase QSTC,8848272,LOCAL,84075,CPT,,,,,,Outpatient,,,9.11,6.22,United Health ,United Health Medicare Advantage,5.18,,,,,,,Fee Schedule,5.18,7.16,
Bone Isoenzymes QSTC,8848275,LOCAL,84080,CPT,,,,,,Outpatient,,,9.11,17.74,United Health ,United Health Medicare Advantage,14.78,,,,,,,Fee Schedule,14.78,17.73,
SLING ARM MEDIUM,11070727,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,9.3,158,United Health ,United Health Medicare Advantage,77.23,,,,,,,Fee Schedule,77.23,77.23,
acetylcysteine 20% Inhalation Sol [CULL],11208888,LOCAL,J7608,CPT,,,,,,Outpatient,1,ML,10,,United Health ,United Health Medicare Advantage,8.46,,,,,,,Fee Schedule,8.455,8.455,
albuterol 1.25 mg/3 mL (0.042%) Sol [CULL],11203025,LOCAL,J7613,CPT,,,,,,Outpatient,3,ML,10,,United Health ,United Health Medicare Advantage,4.66,,,,,,,Fee Schedule,4.66,4.66,
albuterol 2.5 mg/3 mL (0.083%) inhalation solution 3 mL [CULL],11203024,LOCAL,J7613,CPT,,,,,,Outpatient,3,ML,10,,United Health ,United Health Medicare Advantage,4.66,,,,,,,Fee Schedule,4.66,4.66,
albuterol 5 mg/mL (0.5%) inhalation solution [CULL],11203026,LOCAL,J7611,CPT,,,,,,Outpatient,1,ML,10,,United Health ,United Health Medicare Advantage,0.26,,,,,,,Fee Schedule,0.262,0.262,
amiodarone 50 mg/mL intravenous solution 3 mL [CULL],11200004,LOCAL,J0282,CPT,,,,,,Outpatient,3,ML,10,,United Health ,United Health Medicare Advantage,0.41,,,,,,,Fee Schedule,0.409,0.409,
azaTHIOprine 50 mg oral tablet [CULL],11200492,LOCAL,J7500,CPT,,,,,,Outpatient,1,EA,10,,United Health ,United Health Medicare Advantage,0.06,,,,,,,Fee Schedule,0.057,0.057,
BUPivacaine 0.25% preservative-free Sol [CULL],11282035,LOCAL,J0665,CPT,,,,,,Outpatient,10,ML,10,,United Health ,United Health Medicare Advantage,0.01,,,,,,,Fee Schedule,0.01,0.011,
BUPivacaine 0.75%-D8.25% preservative-free intrathecal solution 2 mL [CULL],11202136,LOCAL,J0665,CPT,,,,,,Outpatient,2,ML,10,,United Health ,United Health Medicare Advantage,0.01,,,,,,,Fee Schedule,0.01,0.011,
cycloSPORINE modified 25 mg oral capsule [CULL],11210499,LOCAL,J7515,CPT,,,,,,Outpatient,1,EA,10,,United Health ,United Health Medicare Advantage,0.53,,,,,,,Fee Schedule,0.526,0.526,
dexAMETHasone 10 mg/mL injectable solution 1 mL [CULL],11202292,LOCAL,J1100,CPT,,,,,,Outpatient,1,ML,10,,United Health ,United Health Medicare Advantage,10.49,,,,,,,Fee Schedule,10.48743758,10.48743758,
ipratropium 500 mcg/2.5 mL inhalation solution 2.5 mL [CULL],11203105,LOCAL,J7644,CPT,,,,,,Outpatient,2.5,ML,10,,United Health ,United Health Medicare Advantage,0.4,,,,,,,Fee Schedule,0.4,0.4,
ketorolac 60 mg/2 mL Sol [CULL],11202716,LOCAL,J1885,CPT,,,,,,Outpatient,2,ML,10,,United Health ,United Health Medicare Advantage,0.27,,,,,,,Fee Schedule,0.27,0.27,
levalbuterol 0.31 mg/3 mL inhalation solution 3 mL [CULL],11203125,LOCAL,J7614,CPT,,,,,,Outpatient,3,ML,10,,United Health ,United Health Medicare Advantage,0.08,,,,,,,Fee Schedule,0.083,0.083,
levalbuterol 0.63 mg/3 mL inhalation solution 3 mL [CULL],11203127,LOCAL,J7614,CPT,,,,,,Outpatient,3,ML,10,,United Health ,United Health Medicare Advantage,0.08,,,,,,,Fee Schedule,0.083,0.083,
levalbuterol 1.25 mg/3 mL inhalation solution 3 mL [CULL],11203128,LOCAL,J7614,CPT,,,,,,Outpatient,3,ML,10,,United Health ,United Health Medicare Advantage,0.08,,,,,,,Fee Schedule,0.083,0.083,
methylPREDNISolone 4 mg oral tablet [CULL],11230944,LOCAL,J7509,CPT,,,,,,Outpatient,1,EA,10,,United Health ,United Health Medicare Advantage,0.14,,,,,,,Fee Schedule,0.139,0.139,
mitoMYcin 20 mg/40 mL Sol [CULL],11205507,LOCAL,J9280,CPT,,,,,,Outpatient,0.5,ML,10,,United Health ,United Health Medicare Advantage,20.35,,,,,,,Fee Schedule,20.35,525.49,
ondansetron 2 mg/mL injectable solution 2 mL [CULL],11211057,LOCAL,J2405,CPT,,,,,,Outpatient,2,ML,10,,United Health ,United Health Medicare Advantage,0.06,,,,,,,Fee Schedule,0.057806268,0.057806268,
phenytoin 50 mg/mL injectable solution 2 mL [CULL],11282560,LOCAL,J1165,CPT,,,,,,Outpatient,2,ML,10,,United Health ,United Health Medicare Advantage,0.6,,,,,,,Fee Schedule,0.595,0.595,
phenytoin 50 mg/mL injectable solution 5 mL [CULL],11212135,LOCAL,J1165,CPT,,,,,,Outpatient,5,ML,10,,United Health ,United Health Medicare Advantage,0.6,,,,,,,Fee Schedule,0.595,0.595,
prednisoLONE sodium phosphate 15 mg/5 mL Liq [CULL],11250339,LOCAL,J7510,CPT,,,,,,Outpatient,5,ML,10,,United Health ,United Health Medicare Advantage,0.92,,,,,,,Fee Schedule,0.919,0.919,
"rabies immune globulin, human 150 intl units/mL intramuscular solution 2 mL [CULL]",11212251,LOCAL,90376,CPT,,,,,,Outpatient,0.007,ML,10,347,United Health ,United Health Medicare Advantage,347.32,,,,,,,Fee Schedule,347.32,2110.36,
tacrolimus 0.5 mg oral capsule [CULL],11205999,LOCAL,J7507,CPT,,,,,,Outpatient,1,EA,10,,United Health ,United Health Medicare Advantage,0.2,,,,,,,Fee Schedule,0.197,0.197,
tobramycin 40 mg/mL injectable solution 2 mL [CULL],11212375,LOCAL,J3260,CPT,,,,,,Outpatient,2,ML,10,,United Health ,United Health Medicare Advantage,2.07,,,,,,,Fee Schedule,2.071,2.071,
BUPivacaine 0.25% preservative-free injectable solution 30 mL [CULL],11202111,LOCAL,J0665,CPT,,,,,,Outpatient,30,ML,10.24,,United Health ,United Health Medicare Advantage,0.01,,,,,,,Fee Schedule,0.01,0.011,
"Protein, Total, Peritoneal Fluid QSTC",9039313,LOCAL,84157,CPT,,,,,,Outpatient,,,10.44,4.8,United Health ,United Health Medicare Advantage,4,,,,,,,Fee Schedule,4,7.16,
Rheumatoid Factor QSTC,9039252,LOCAL,86431,CPT,,,,,,Outpatient,,,10.8,6.8,United Health ,United Health Medicare Advantage,6.3,,,,,,,Fee Schedule,6.29875,15.29,
ketorolac 30 mg/mL injectable solution 1 mL [CULL],11202715,LOCAL,J1885,CPT,,,,,,Outpatient,1,ML,10.944,,United Health ,United Health Medicare Advantage,0.27,,,,,,,Fee Schedule,0.27,0.27,
RPR (Dx) w/Refl Titer/Confrm Testing QST,8972905,LOCAL,86592,CPT,,,,,,Outpatient,,,11.16,5.12,United Health ,United Health Medicare Advantage,19.99,,,,,,,Fee Schedule,15.29,19.99375,
RPR (Monitor) w/Refl Titer QSTC,8972905,LOCAL,86592,CPT,,,,,,Outpatient,,,11.16,5.12,United Health ,United Health Medicare Advantage,19.99,,,,,,,Fee Schedule,15.29,19.99375,
cefuroxime 750 mg injection [CULL],11201445,LOCAL,J0697,CPT,,,,,,Outpatient,1,EA,11.22304,,United Health ,United Health Medicare Advantage,2.05,,,,,,,Fee Schedule,2.054,2.054,
"Creatinine, Random Ur QSTC",9320766,LOCAL,82570,CPT,,,,,,Outpatient,,,11.25,6.22,United Health ,United Health Medicare Advantage,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
BUPivacaine 0.5% preservative-free injectable solution 10 mL [CULL],11282050,LOCAL,J0665,CPT,,,,,,Outpatient,10,ML,11.52,,United Health ,United Health Medicare Advantage,0.01,,,,,,,Fee Schedule,0.01,0.011,
ciprofloxacin 200 mg/100 mL-D5% intravenous solution 100 mL [CULL],11201485,LOCAL,J0744,CPT,,,,,,Outpatient,100,ML,11.52,,United Health ,United Health Medicare Advantage,2,,,,,,,Fee Schedule,1.997,1.997,
diphenhydrAMINE 50 mg/mL injectable solution 1 mL [CULL],11202342,LOCAL,J1200,CPT,,,,,,Outpatient,1,ML,11.5584,,United Health ,United Health Medicare Advantage,0.14,,,,,,,Fee Schedule,0.143,0.143,
HYDROmorphone 2 mg/mL Sol [CULL],11202621,LOCAL,J1171,CPT,,,,,,Outpatient,1,ML,11.7504,,United Health ,United Health Medicare Advantage,1.84,,,,,,,Fee Schedule,1.836603774,1.836603774,
Source QSTC,8983584,LOCAL,87209,CPT,,,,,,Outpatient,,,13.19,21.58,United Health ,United Health Medicare Advantage,17.98,,,,,,,Fee Schedule,10.57,17.98,
ampicillin 500 mg injection [CULL],11201162,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,13.28,,United Health ,United Health Medicare Advantage,0.59,,,,,,,Fee Schedule,0.591,0.591,
ampicillin 250 mg injection [CULL],11201150,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,13.3952,,United Health ,United Health Medicare Advantage,0.59,,,,,,,Fee Schedule,0.591,0.591,
clindamycin 150 mg/mL injectable solution 4 mL [CULL],11202228,LOCAL,J0736,CPT,,,,,,Outpatient,4,ML,13.4784,,United Health ,United Health Medicare Advantage,0.82,,,,,,,Fee Schedule,0.819,0.819,
"ANA IFA Scrn w/Rfx Titr & Patt, IFA QSTC",8764654,LOCAL,86038,CPT,,,,,,Outpatient,,,13.5,14.51,United Health ,United Health Medicare Advantage,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
"ANA Scr,IFA w/R Tit/Ptn/MPX Ab Casc QSTC",8764642,LOCAL,86038,CPT,,,,,,Outpatient,,,13.5,14.51,United Health ,United Health Medicare Advantage,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
"Bacterial Identification, Aerobic QST",13344175,LOCAL,87077,CPT,,,,,,Outpatient,,,13.5,9.7,United Health ,United Health Medicare Advantage,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
T3 Uptake QSTC,9039244,LOCAL,84479,CPT,,,,,,Outpatient,,,13.5,7.76,United Health ,United Health Medicare Advantage,6.47,,,,,,,Fee Schedule,6.47,18.43,
COLLAR CERVICAL SOFT MEDIUM,11071045,LOCAL,,,L0120,HCPCS,,,,Outpatient,,,13.75,44,United Health ,United Health Medicare Advantage,34.57,,,,,,,Fee Schedule,34.57,34.57,
HYDROmorphone 1 mg/mL Sol,11202620,LOCAL,J1171,CPT,,,,,,Outpatient,1,ML,13.824,,United Health ,United Health Medicare Advantage,1.84,,,,,,,Fee Schedule,1.836603774,1.836603774,
tacrolimus 1 mg oral capsule [CULL],11205998,LOCAL,J7507,CPT,,,,,,Outpatient,1,EA,14.2704,,United Health ,United Health Medicare Advantage,0.2,,,,,,,Fee Schedule,0.197,0.197,
Measles Antibody (IgG) QSTC,8764682,LOCAL,86765,CPT,,,,,,Outpatient,,,14.63,15.46,United Health ,United Health Medicare Advantage,12.88,,,,,,,Fee Schedule,12.88,15.29,
gentamicin 60 mg/50 mL-NaCl 0.9% intravenous solution 50 mL [CULL],11201825,LOCAL,J1580,CPT,,,,,,Outpatient,50,ML,14.69466667,,United Health ,United Health Medicare Advantage,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
SLING ARM LARGE,11071011,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,14.8,158,United Health ,United Health Medicare Advantage,77.23,,,,,,,Fee Schedule,77.23,77.23,
HYDROmorphone 10 mg/mL Sol [CULL],11202625,LOCAL,J1171,CPT,,,,,,Outpatient,1,ML,14.96064,,United Health ,United Health Medicare Advantage,1.84,,,,,,,Fee Schedule,1.836603774,1.836603774,
"hCG, Total, QN Male Only QSTC",8853229,LOCAL,84702,CPT,,,,,,Outpatient,,,15,18.06,United Health ,United Health Medicare Advantage,15.05,,,,,,,Fee Schedule,15.05,18.43,
"Herpes Simplex Virus 2 (IgG), with Reflex to HSV-2 Inhibition QST",14811888,LOCAL,86696,CPT,,,,,,Outpatient,,,15,23.22,United Health ,United Health Medicare Advantage,19.35,,,,,,,Fee Schedule,15.29,19.35,
gentamicin 80 mg/50 mL-NaCl 0.9% intravenous solution 50 mL [CULL],11201824,LOCAL,J1580,CPT,,,,,,Outpatient,50,ML,15.62533333,,United Health ,United Health Medicare Advantage,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
gentamicin 40 mg/mL injectable solution 2 mL [CULL],11282205,LOCAL,J1580,CPT,,,,,,Outpatient,2,ML,15.6288,,United Health ,United Health Medicare Advantage,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
HYDROmorphone 0.5 mg/0.5 mL Sol [CULL],11202622,LOCAL,J1171,CPT,,,,,,Outpatient,0.5,ML,15.936,,United Health ,United Health Medicare Advantage,1.84,,,,,,,Fee Schedule,1.836603774,1.836603774,
gentamicin 120 mg/100 mL-NaCl 0.9% intravenous solution 100 mL [CULL],11209100,LOCAL,J1580,CPT,,,,,,Outpatient,100,ML,15.98666667,,United Health ,United Health Medicare Advantage,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
alpha 1-proteinase inhibitor human Sol 10 mg [CULL],11211124,LOCAL,J0256,CPT,,,,,,Outpatient,1,EA,16,,United Health ,United Health Medicare Advantage,5.46,,,,,,,Fee Schedule,5.46,2110.36,
"Chloride, Random Urine without Creatinine QSTC",10011691,LOCAL,82436,CPT,,,,,,Outpatient,,,16.25,6.9,United Health ,United Health Medicare Advantage,5.75,,,,,,,Fee Schedule,5.75,7.16,
"Potassium, U24 w/o Creatinine QSTC",13864422,LOCAL,84133,CPT,,,,,,Outpatient,,,16.25,5.68,United Health ,United Health Medicare Advantage,19.32,,,,,,,Fee Schedule,7.16,19.32,
Sickle Cell Screen QSTC,10073685,LOCAL,85660,CPT,,,,,,Outpatient,,,16.25,6.61,United Health ,United Health Medicare Advantage,5.51,,,,,,,Fee Schedule,5.51,8.21,
gentamicin 100 mg/100 mL-NaCl 0.9% intravenous solution 100 mL [CULL],11201827,LOCAL,J1580,CPT,,,,,,Outpatient,100,ML,16.41066667,,United Health ,United Health Medicare Advantage,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
"Creatinine, Random Ur, Microalbumin QSTC",9041589,LOCAL,82570,CPT,,,,,,Outpatient,,,16.88,6.22,United Health ,United Health Medicare Advantage,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Ratio, Microalbumin Random Ur QSTC",9041592,LOCAL,82043,CPT,,,,,,Outpatient,,,16.88,6.94,United Health ,United Health Medicare Advantage,20.16,,,,,,,Fee Schedule,4.02,20.15557971,
Protein Level 24 Hour Urine,633811,LOCAL,84156,CPT,,,,,,Outpatient,,,17,4.4,United Health ,United Health Medicare Advantage,11.68,,,,,,,Fee Schedule,7.16,11.68,
Thrombin Clotting Time QSTC,8764547,LOCAL,85670,CPT,,,,,,Outpatient,,,17.1,6.92,United Health ,United Health Medicare Advantage,5.77,,,,,,,Fee Schedule,5.42,5.77,
"Urea Nitrogen Ur, Rand QSTC",13864416,LOCAL,84540,CPT,,,,,,Outpatient,,,17.1,6.67,United Health ,United Health Medicare Advantage,5.56,,,,,,,Fee Schedule,5.56,7.16,
nalbuphine 10 mg/mL Sol,J2300,CPT,,,,,,,,Outpatient,10,ML,17.12,,United Health ,United Health Medicare Advantage,3.45,,,,,,,Fee Schedule,3.45,3.45,
cycloSPORINE modified 100 mg oral capsule [CULL],11210500,LOCAL,J7502,CPT,,,,,,Outpatient,1,EA,17.58826667,,United Health ,United Health Medicare Advantage,1.81,,,,,,,Fee Schedule,1.81,1.81,
SPLINT WRIST FOREARM LEFT LG,11071054,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,United Health ,United Health Medicare Advantage,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM LT MED,11071053,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,United Health ,United Health Medicare Advantage,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM LT SM,11071052,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,United Health ,United Health Medicare Advantage,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM RT LG,11071050,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,United Health ,United Health Medicare Advantage,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM RT MED,11071049,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,United Health ,United Health Medicare Advantage,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM RT PED,11071047,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,United Health ,United Health Medicare Advantage,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT WRIST FOREARM RT SM,11071048,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.66,86,United Health ,United Health Medicare Advantage,67.37,,,,,,,Fee Schedule,67.37,67.37,
95852 RANGE OF MOTION-HAND 15 MIN CHARGE,9410221,LOCAL,95852,CPT,,,,,GP,Outpatient,,,17.86,12,United Health ,United Health Medicare Advantage,4.74,,,,,,,Fee Schedule,4.74,4.74,
SPLINT WRIST FOREARM LEFT X L,11074363,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.88,86,United Health ,United Health Medicare Advantage,67.37,,,,,,,Fee Schedule,67.37,67.37,
SPLINT XLG WRIST FOREARM RIGHT,11074362,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,17.88,86,United Health ,United Health Medicare Advantage,67.37,,,,,,,Fee Schedule,67.37,67.37,
Creatine Kinase Isoenzyme Interp. QSTC,8852390,LOCAL,82550,CPT,,,,,,Outpatient,,,18,7.81,United Health ,United Health Medicare Advantage,23.74,,,,,,,Fee Schedule,7.16,23.7373913,
Creatine Kinase Isoenzyme w/ Tot CK QSTC,8764767,LOCAL,82552,CPT,,,,,,Outpatient,,,18,16.07,United Health ,United Health Medicare Advantage,13.39,,,,,,,Fee Schedule,13.39,17.73,
Creatine Kinase Isoenzymes w/o Ttl QSTC,13864524,LOCAL,82552,CPT,,,,,,Outpatient,,,18,16.07,United Health ,United Health Medicare Advantage,13.39,,,,,,,Fee Schedule,13.39,17.73,
"Creatine Kinase, Total QSTC",8852386,LOCAL,82552,CPT,,,,,,Outpatient,,,18,16.07,United Health ,United Health Medicare Advantage,13.39,,,,,,,Fee Schedule,13.39,17.73,
Rubella Antibody (IgG) QSTC,8853250,LOCAL,86762,CPT,,,,,,Outpatient,,,18,17.27,United Health ,United Health Medicare Advantage,14.39,,,,,,,Fee Schedule,14.39,15.29,
Urine Creatinine,7050475,LOCAL,82570,CPT,,,,,,Outpatient,,,18,6.22,United Health ,United Health Medicare Advantage,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
Urine Protein Level,7412757,LOCAL,84156,CPT,,,,,,Outpatient,,,18,4.4,United Health ,United Health Medicare Advantage,11.68,,,,,,,Fee Schedule,7.16,11.68,
phytonadione 1 mg/0.5 mL injectable solution 0.5 mL [CULL],11212147,LOCAL,J3430,CPT,,,,,,Outpatient,0.5,ML,18.223104,,United Health ,United Health Medicare Advantage,2.81,,,,,,,Fee Schedule,2.808,2.808,
SPLINT WRIST FOREARM LT PED,11070883,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,18.43,86,United Health ,United Health Medicare Advantage,67.37,,,,,,,Fee Schedule,67.37,67.37,
fosphenytoin 100 mgPE/2 mL Sol [CULL],11205072,LOCAL,Q2009,CPT,,,,,,Outpatient,2,ML,18.432,,United Health ,United Health Medicare Advantage,1.47,,,,,,,Fee Schedule,1.47,1.47,
methylPREDNISolone 40 mg Pow [CULL],11204478,LOCAL,J2919,CPT,,,,,,Outpatient,1,UN,18.432,,United Health ,United Health Medicare Advantage,0.21,,,,,,,Fee Schedule,0.21,0.21,
Almond (F20) IgE QST,14586519,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Alternaria Alternata (M6) IgE QST,14586545,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Brazil Nut (F18) IgE QST,14586553,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cashew Nut (F202) IgE QST,14586555,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cat Dander (E1) IgE QST,14586539,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cladosporium Herbarum (M2) IgE QST,14586543,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cockroach (I6) IgE QST,14586549,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Codfish (F3) IgE QST,14586521,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cow's Milk (F2) IgE QST,14586529,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dermatophagoides Farinae (D2) IgE QST,14586537,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dermatophagoides Pteronyssinu D1 IgE QST,14586535,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dog Dander (E5) IgE QST,14586541,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Egg White (F1) IgE QST,14586527,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Hazelnut (F17) IgE QST,14586551,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Immunoglobulin E QST,14586516,LOCAL,82785,CPT,,,,,,Outpatient,,,18.5,19.75,United Health ,United Health Medicare Advantage,203.96,,,,,,,Fee Schedule,17.73,203.9616667,
Macadamia Nut (RF345) IgE QST,14586525,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Mouse Urine Proteins (E72) IgE QST,14586547,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Peanut (F13) IgE QST,14586517,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Shrimp (F24) IgE QST,14586523,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Soybean (F14) IgE QST,14586533,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Walnut (F256) IgE QST,14586557,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Wheat (F4) IgE QST,14586531,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
droNABinol 2.5 mg Cap [CULL],11220183,LOCAL,Q0167,CPT,,,,,,Outpatient,1,EA,18.853344,,United Health ,United Health Medicare Advantage,1.35,,,,,,,Fee Schedule,1.352,1.352,
"HPV mRNA E6/E7, POST-$HYST, VAGINAL W/REFL QST",14782711,LOCAL,87624,CPT,,,,,,Outpatient,,,18.9,42.11,United Health ,United Health Medicare Advantage,67.2,,,,,,,Fee Schedule,40.19,67.195,
Lead Capillary QSTC,14116315,LOCAL,83655,CPT,,,,,,Outpatient,,,19.12,14.53,United Health ,United Health Medicare Advantage,13.99,,,,,,,Fee Schedule,13.99076923,16.07,
"Lead, Blood QSTC",8764839,LOCAL,83655,CPT,,,,,,Outpatient,,,19.13,14.53,United Health ,United Health Medicare Advantage,13.99,,,,,,,Fee Schedule,13.99076923,16.07,
"Lead, Blood QSTC",13864923,LOCAL,83655,CPT,,,,,,Outpatient,,,19.13,14.53,United Health ,United Health Medicare Advantage,13.99,,,,,,,Fee Schedule,13.99076923,16.07,
fluconazole 100 mg/50 mL-NaCl 0.9% intravenous solution 50 mL [CULL],11291246,LOCAL,J1450,CPT,,,,,,Outpatient,50,ML,19.2,,United Health ,United Health Medicare Advantage,4.48,,,,,,,Fee Schedule,4.48,4.48,
"Albumin, Peritoneal Fluid QSTC",8972935,LOCAL,82042,CPT,,,,,,Outpatient,,,19.4,9.34,United Health ,United Health Medicare Advantage,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Albumin, Pleural Fluid QST",12130816,LOCAL,82042,CPT,,,,,,Outpatient,,,19.4,9.34,United Health ,United Health Medicare Advantage,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Albumin, Pleural Fluid QSTC",12130706,LOCAL,82042,CPT,,,,,,Outpatient,,,19.4,9.34,United Health ,United Health Medicare Advantage,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Glucose, Peritoneal Fluid QSTC",9039310,LOCAL,82945,CPT,,,,,,Outpatient,,,19.4,4.72,United Health ,United Health Medicare Advantage,3.93,,,,,,,Fee Schedule,3.93,7.16,
Cardiolipin Ab (IgA)QSTC,9215429,LOCAL,86147,CPT,,,,,,Outpatient,,,19.58,30.54,United Health ,United Health Medicare Advantage,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Antibody IgG QSTC,10100354,LOCAL,86147,CPT,,,,,,Outpatient,,,19.58,30.54,United Health ,United Health Medicare Advantage,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Antibody IgM QSTC,10100355,LOCAL,86147,CPT,,,,,,Outpatient,,,19.58,30.54,United Health ,United Health Medicare Advantage,25.45,,,,,,,Fee Schedule,15.29,25.45,
24hr Urine Creatinine QSTC,10005155,LOCAL,82570,CPT,,,,,,Outpatient,,,19.76,6.22,United Health ,United Health Medicare Advantage,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Creatinine, Random U QSTC",12290061,LOCAL,82570,CPT,,,,,,Outpatient,,,19.76,6.22,United Health ,United Health Medicare Advantage,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
Interp: QSTC,8851928,LOCAL,84166,CPT,,,,,,Outpatient,,,19.76,21.4,United Health ,United Health Medicare Advantage,18.62,,,,,,,Fee Schedule,17.73,18.62,
Interp: QSTC,8851952,LOCAL,84166,CPT,,,,,,Outpatient,,,19.76,21.4,United Health ,United Health Medicare Advantage,18.62,,,,,,,Fee Schedule,17.73,18.62,
"Protein, Total, Random Urine QSTC",8851945,LOCAL,84156,CPT,,,,,,Outpatient,,,19.76,4.4,United Health ,United Health Medicare Advantage,11.68,,,,,,,Fee Schedule,7.16,11.68,
SHOE POST OP MALE LARGE,11070723,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,19.86,223,United Health ,United Health Medicare Advantage,175.72,,,,,,,Fee Schedule,175.72,175.72,
SHOE POST OP MALE MD,11071019,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,19.86,12,United Health ,United Health Medicare Advantage,67.31,,,,,,,Fee Schedule,67.31,67.31,
SHOE POST OP MALE SMALL,11070721,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,19.86,223,United Health ,United Health Medicare Advantage,175.72,,,,,,,Fee Schedule,175.72,175.72,
methotrexate 2.5 mg oral tablet [CULL],11240138,LOCAL,J8610,CPT,,,,,,Outpatient,1,EA,19.9584,,United Health ,United Health Medicare Advantage,0.15,,,,,,,Fee Schedule,0.151,0.151,
cefTAZidime 1 g injection [CULL],11201385,LOCAL,J0713,CPT,,,,,,Outpatient,1,EA,19.968,,United Health ,United Health Medicare Advantage,1.47,,,,,,,Fee Schedule,1.468,1.468,
Carbon Dioxide Level,7903173,LOCAL,82374,CPT,,,,,,Outpatient,,,20,5.86,United Health ,United Health Medicare Advantage,4.88,,,,,,,Fee Schedule,4.88,7.16,
Creatinine,3454470,LOCAL,82565,CPT,,,,,,Outpatient,,,20,6.14,United Health ,United Health Medicare Advantage,10.06,,,,,,,Fee Schedule,7.16,10.061625,
COLLAR CERVICAL SOFT SMALL,11071044,LOCAL,,,L0120,HCPCS,,,,Outpatient,,,20.13,44,United Health ,United Health Medicare Advantage,34.57,,,,,,,Fee Schedule,34.57,34.57,
Gastric Occult Blood,7974128,LOCAL,82271,CPT,,,,,,Outpatient,,,20.16,6.38,United Health ,United Health Medicare Advantage,5.32,,,,,,,Fee Schedule,5.32,7.16,
Immunoglobulin A QSTC,8764567,LOCAL,82784,CPT,,,,,,Outpatient,,,20.25,11.16,United Health ,United Health Medicare Advantage,34.96,,,,,,,Fee Schedule,7.16,34.958,
Immunoglobulin M QSTC,8853219,LOCAL,82784,CPT,,,,,,Outpatient,,,20.25,11.16,United Health ,United Health Medicare Advantage,34.96,,,,,,,Fee Schedule,7.16,34.958,
"PSA, Free QSTC",8852652,LOCAL,84154,CPT,,,,,,Outpatient,,,20.25,22.07,United Health ,United Health Medicare Advantage,19.14,,,,,,,Fee Schedule,17.73,19.14,
COLLAR CERVICAL SOFT LARGE,11071046,LOCAL,,,L0120,HCPCS,,,,Outpatient,,,20.63,44,United Health ,United Health Medicare Advantage,34.57,,,,,,,Fee Schedule,34.57,34.57,
gentamicin 10 mg/mL injectable solution 2 mL [CULL],11201813,LOCAL,J1580,CPT,,,,,,Outpatient,2,ML,20.7744,,United Health ,United Health Medicare Advantage,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
.Manual Differential (CULL),13467987,LOCAL,85007,CPT,,,,,,Outpatient,,,20.81,4.56,United Health ,United Health Medicare Advantage,3.34,,,,,,,Fee Schedule,3.338698061,8.21,
.Manual Differential (CULL_AL),6237143,LOCAL,85007,CPT,,,,,,Outpatient,,,20.81,4.56,United Health ,United Health Medicare Advantage,3.34,,,,,,,Fee Schedule,3.338698061,8.21,
cefuroxime 1.5 g injection [CULL],11201459,LOCAL,J0697,CPT,,,,,,Outpatient,1,EA,20.83712,,United Health ,United Health Medicare Advantage,2.05,,,,,,,Fee Schedule,2.054,2.054,
"Albumin, CSF QSTC",13873322,LOCAL,82042,CPT,,,,,,Outpatient,,,20.95,9.34,United Health ,United Health Medicare Advantage,7.78,,,,,,,Fee Schedule,7.16,7.78,
"IgG, CSF QSTC",13873321,LOCAL,82784,CPT,,,,,,Outpatient,,,20.95,11.16,United Health ,United Health Medicare Advantage,34.96,,,,,,,Fee Schedule,7.16,34.958,
"Amylase, Pleural Fluid QSTC",9039309,LOCAL,82150,CPT,,,,,,Outpatient,,,20.97,7.78,United Health ,United Health Medicare Advantage,1.24,,,,,,,Fee Schedule,1.237209302,7.16,
"Calcium, Random Ur QSTC",13864744,LOCAL,82310,CPT,,,,,,Outpatient,,,20.99,6.19,United Health ,United Health Medicare Advantage,5.16,,,,,,,Fee Schedule,5.16,7.16,
"Creatinine, Random U QSTC",13864745,LOCAL,82570,CPT,,,,,,Outpatient,,,20.99,6.22,United Health ,United Health Medicare Advantage,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
Fructosamine QSTC,8853273,LOCAL,82985,CPT,,,,,,Outpatient,,,21.02,20.11,United Health ,United Health Medicare Advantage,16.76,,,,,,,Fee Schedule,16.76,17.73,
butorphanol 1 mg/mL Sol [CULL],11202144,LOCAL,J0595,CPT,,,,,,Outpatient,1,ML,21.40416,,United Health ,United Health Medicare Advantage,5.54,,,,,,,Fee Schedule,5.544,5.544,
Direct LDL QSTC,9039357,LOCAL,83721,CPT,,,,,,Outpatient,,,21.6,12.6,United Health ,United Health Medicare Advantage,10.5,,,,,,,Fee Schedule,10.5,17.73,
Hemoglobin A1c QSTC,6213055,LOCAL,83036,CPT,,,,,,Outpatient,,,21.6,11.65,United Health ,United Health Medicare Advantage,28.6,,,,,,,Fee Schedule,7.16,28.59604426,
Varicella-Zoster Virus Ab (IgG) QSTC,8853252,LOCAL,86787,CPT,,,,,,Outpatient,,,21.6,15.46,United Health ,United Health Medicare Advantage,12.88,,,,,,,Fee Schedule,12.88,15.29,
Serum Osmolality QSTC,8972765,LOCAL,83930,CPT,,,,,,Outpatient,,,21.65,7.93,United Health ,United Health Medicare Advantage,6.61,,,,,,,Fee Schedule,6.61,7.16,
76376 3D RENDER W/O POSTPR CHARGE,9284912,LOCAL,76376,CPT,,,,,,Outpatient,,,22,391.88,United Health ,United Health Medicare Advantage,13.93,,,,,,,Fee Schedule,13.93,13.93,
POC Hgb,7160347,LOCAL,83036,CPT,,,,,,Outpatient,,,22,11.65,United Health ,United Health Medicare Advantage,28.6,,,,,,,Fee Schedule,7.16,28.59604426,
Creatinine Level 24 Hour Urine,1634894,LOCAL,82570,CPT,,,,,,Outpatient,,,22.03,6.22,United Health ,United Health Medicare Advantage,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Albumin, 24 Hour Urine w/o Creat QSTC",13864523,LOCAL,82043,CPT,,,,,,Outpatient,,,22.5,6.94,United Health ,United Health Medicare Advantage,20.16,,,,,,,Fee Schedule,4.02,20.15557971,
"Folate, RBC QSTS",13899938,LOCAL,82747,CPT,,,,,,Outpatient,,,22.5,21.18,United Health ,United Health Medicare Advantage,17.65,,,,,,,Fee Schedule,17.65,46.74,
Hepatitis C Ab rfx HCV RNA Qnt PCR QSTC,8764583,LOCAL,86803,CPT,,,,,,Outpatient,,,22.5,17.12,United Health ,United Health Medicare Advantage,32.1,,,,,,,Fee Schedule,15.29,32.10014925,
IMMOBILIZER  SHOULDER MEDIUM,11070739,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,22.5,12,United Health ,United Health Medicare Advantage,67.31,,,,,,,Fee Schedule,67.31,67.31,
IMMOBILIZER SHOULDER XL,11070165,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,22.5,12,United Health ,United Health Medicare Advantage,67.31,,,,,,,Fee Schedule,67.31,67.31,
"PSA, Total QSTC",8852651,LOCAL,84153,CPT,,,,,,Outpatient,,,22.5,22.07,United Health ,United Health Medicare Advantage,104.84,,,,,,,Fee Schedule,17.73,104.8447059,
"T4, Free QSTC",9291013,LOCAL,84439,CPT,,,,,,Outpatient,,,22.5,10.82,United Health ,United Health Medicare Advantage,28.58,,,,,,,Fee Schedule,18.43,28.58065455,
DRAIN ROUND JP 10FR----OR,11071535,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,22.55,12,United Health ,United Health Medicare Advantage,67.31,,,,,,,Fee Schedule,67.31,67.31,
"Heterophile, Mono Screen QSTC",13864506,LOCAL,86308,CPT,,,,,,Outpatient,,,22.68,6.22,United Health ,United Health Medicare Advantage,5.18,,,,,,,Fee Schedule,5.18,15.29,
"T3, Free QSTC",8972902,LOCAL,84481,CPT,,,,,,Outpatient,,,22.68,20.33,United Health ,United Health Medicare Advantage,34.46,,,,,,,Fee Schedule,18.43,34.46424242,
IMMOBILIZER SHOULDER SMALL,11071014,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,22.72,12,United Health ,United Health Medicare Advantage,67.31,,,,,,,Fee Schedule,67.31,67.31,
COLLECTION: Venous Draw,1779389,LOCAL,36415,CPT,,,,,,Outpatient,,,22.73,10.91,United Health ,United Health Medicare Advantage,6.74,,,,,,,Fee Schedule,3.41,6.740753664,
IMMOBILIZER SHOULDER LARGE,11071760,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,22.77,12,United Health ,United Health Medicare Advantage,67.31,,,,,,,Fee Schedule,67.31,67.31,
Urine Eosinophil Smear,8690390,LOCAL,85008,CPT,,,,,,Outpatient,,,22.85,4.12,United Health ,United Health Medicare Advantage,3.43,,,,,,,Fee Schedule,3.43,8.21,
Urine Eosinophils,7974116,LOCAL,89051,CPT,,,,,,Outpatient,,,22.85,6.72,United Health ,United Health Medicare Advantage,35.8,,,,,,,Fee Schedule,14.07,35.795,
Sodium Level Urine,4185817,LOCAL,84300,CPT,,,,,,Outpatient,,,23,6.07,United Health ,United Health Medicare Advantage,9.74,,,,,,,Fee Schedule,7.16,9.74,
Almond (F20) IgE QST,13344505,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Almond (f20) IgE QSTC,8764712,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Beef (f27) IgE QSTC,8764717,LOCAL,86003,CPT,86003,HCPCS,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Brazil Nut (F18) IgE QST,13344495,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Brazil Nut (f18) IgE QSTC,8764711,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cashew Nut (F202) IgE QST,13344499,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cashew Nut (f202) IgE QSTC,8764689,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cat Dander (e1) IgE QSTC,6241002,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Catfish (f369) IgE QSTC,8764761,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Chicken Meat (f83) IgE QSTC,8761426,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Clam (f207) IgE QSTC,8764592,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cocoa (f93) IgE QSTC,8764728,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Coconut (f36) IgE QSTC,8764719,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cow'S Milk (F2) IgE w/Rflx to Panel QST,12886535,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Cow'S Milk(F2) IgE W/Rfx Panel QSTC,14129187,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Crab (f23) IgE QSTC,6210507,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Crayfish (Rf320) IgE** QSTC,9039458,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
D. Pteronyssinus (d1) IgE QST,6241001,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dermatophagoides Farinae (d2) IgE QST,10217085,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Dog Dander (e5) IgE QSTC,6241003,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Egg White (f1) IgE QSTC,8764699,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Egg White (F2) IgE w/Rflx to Panel QST,12886536,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Egg Yolk (f75) IgE QSTC,8764725,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Fire Ant (i70) IgE QSTC,8764698,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Gluten (f79) IgE QSTC,9039341,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Hazelnut (F17) IgE QST,13344503,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Hazelnut (f17) IgE QSTC,8764710,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Lobster (f80) IgE QSTC,6210505,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Macadamia Nut (RF345) IgE QST,13344491,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Milk Component Panel QST,10217179,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Oyster (f290) IgE QSTC,6210503,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Peanut (F13) IgE QST,13344507,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Peanut (f13) IgE QSTC,8764708,LOCAL,86003,CPT,86003,HCPCS,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
"Peanut,Tot w/rfx to Peanut Comp Pnl QSTC",8764811,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pecan Nut (F201) IgE QST,13344493,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pecan Nut (f201) IgE QSTC,8764727,LOCAL,86003,CPT,86003,HCPCS,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Perch Ocean IgE QSTC,8764760,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pistachio (F203) IgE QST,13344501,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pork (f26) IgE QSTC,8764716,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Scallop (f338) IgE QSTC,6210506,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Shrimp (f24) IgE QSTC,6241010,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Soybean (f14) IgE QSTC,8764709,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Strawberry (f44) IgE QSTC,8764722,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Tilapia IgE* QSTC,8972793,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Tomato (f25) IgE QSTC,8764715,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Walnut (F256) IgE QST,13344497,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Walnut (f256) IgE QSTC,8764747,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Wheat (f4) IgE QSTC,6241013,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
95851 ROM MEASUREMENT(EXCLUDE HANDS) CHARGE,9410226,LOCAL,95851,CPT,,,,,GP,Outpatient,,,23.49,15,United Health ,United Health Medicare Advantage,6.41,,,,,,,Fee Schedule,6.41,6.41,
digoxin 250 mcg/mL (0.25 mg/mL) injectable solution 2 mL [CULL],11282125,LOCAL,J1160,CPT,,,,,,Outpatient,2,ML,23.92,,United Health ,United Health Medicare Advantage,9.57,,,,,,,Fee Schedule,9.574,9.574,
sulfamethoxazole-trimethoprim 80 mg-16 mg/mL Sol [CULL],11211277,LOCAL,J2865,CPT,,,,,,Outpatient,5,ML,24.3328,,United Health ,United Health Medicare Advantage,0.04,,,,,,,Fee Schedule,0.01,0.038,
Immunoglobulin G QSTC,8764569,LOCAL,82784,CPT,,,,,,Outpatient,,,24.75,11.16,United Health ,United Health Medicare Advantage,34.96,,,,,,,Fee Schedule,7.16,34.958,
Sjogren's Antibody (SS-A) QSTC,8860711,LOCAL,86235,CPT,,,,,,Outpatient,,,24.75,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-A) QSTC,9039451,LOCAL,86235,CPT,,,,,,Outpatient,,,24.75,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-B) QSTC,8860712,LOCAL,86235,CPT,,,,,,Outpatient,,,24.75,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-B) QSTC,9039452,LOCAL,86235,CPT,,,,,,Outpatient,,,24.75,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
methylPREDNISolone 125 mg Pow [CULL],11247586,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,24.8064,,United Health ,United Health Medicare Advantage,0.21,,,,,,,Fee Schedule,0.21,0.21,
STRAP CLAVACLE LARGE,11070713,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,24.97,12,United Health ,United Health Medicare Advantage,67.31,,,,,,,Fee Schedule,67.31,67.31,
STRAP CLAVICLE MED 3IN,11098246,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,24.97,12,United Health ,United Health Medicare Advantage,67.31,,,,,,,Fee Schedule,67.31,67.31,
Aerobic Bacterium ID/ Susceptibility QST,13344167,LOCAL,87077,CPT,,,,,,Outpatient,,,25,9.7,United Health ,United Health Medicare Advantage,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
"Catecholamines, Fractionated, Plasma QSTC",11335672,LOCAL,82384,CPT,,,,,,Outpatient,,,25,30.3,United Health ,United Health Medicare Advantage,25.25,,,,,,,Fee Schedule,18.43,25.25,
Tissue A Clinical Impression QST,10148697,LOCAL,88300,CPT,,,,,,Outpatient,,,25,,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,22.39,32.32,
Tissue A Comment QST,10148702,LOCAL,88302,CPT,,,,,,Outpatient,,,25,,United Health ,United Health Medicare Advantage,35.88,,,,,,,Fee Schedule,32.32,35.88,
Tissue A Diagnosis QST,10148701,LOCAL,88304,CPT,,,,,,Outpatient,,,25,,United Health ,United Health Medicare Advantage,48.85,,,,,,,Fee Schedule,32.32,48.85,
Tissue A Gross Description QST,10148699,LOCAL,88305,CPT,,,,,,Outpatient,,,25,,United Health ,United Health Medicare Advantage,48.85,,,,,,,Fee Schedule,48.85,59.06,
Tissue A Micro Description QST,10148700,LOCAL,88307,CPT,,,,,,Outpatient,,,25,,United Health ,United Health Medicare Advantage,328.88,,,,,,,Fee Schedule,59.06,328.88,
Tissue A Procedure QST,10148698,LOCAL,88309,CPT,,,,,,Outpatient,,,25,,United Health ,United Health Medicare Advantage,746.86,,,,,,,Fee Schedule,59.06,746.86,
Childhood Allergy Profile QSTC,8972792,LOCAL,86003,CPT,,,,,,Outpatient,,,25.16,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Expanded Childhood Allergy Profile ADD ON,14019143,LOCAL,86003,CPT,,,,,,Outpatient,,,25.16,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
"Albumin, CSF QSTC",8861454,LOCAL,82042,CPT,,,,,,Outpatient,,,25.28,9.34,United Health ,United Health Medicare Advantage,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Albumin, Serum QSTC",8861457,LOCAL,82040,CPT,,,,,,Outpatient,,,25.28,5.94,United Health ,United Health Medicare Advantage,127.89,,,,,,,Fee Schedule,7.16,127.89,
Immunoglobulin G QSTC,8861456,LOCAL,82784,CPT,,,,,,Outpatient,,,25.28,11.16,United Health ,United Health Medicare Advantage,34.96,,,,,,,Fee Schedule,7.16,34.958,
Maternal Serum AFP QST,8972825,LOCAL,82105,CPT,,,,,,Outpatient,,,25.88,20.12,United Health ,United Health Medicare Advantage,26.22,,,,,,,Fee Schedule,17.73,26.22,
Maternal Serum AFP QSTC,8972825,LOCAL,82105,CPT,,,,,,Outpatient,,,25.88,20.12,United Health ,United Health Medicare Advantage,26.22,,,,,,,Fee Schedule,17.73,26.22,
"G-6-PD, RBC QSTC",8764537,LOCAL,82955,CPT,,,,,,Outpatient,,,26.15,11.64,United Health ,United Health Medicare Advantage,9.7,,,,,,,Fee Schedule,7.16,9.7,
ampicillin 1 g injection [CULL],11201129,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,26.256,,United Health ,United Health Medicare Advantage,0.59,,,,,,,Fee Schedule,0.591,0.591,
DOBUTamine 12.5 mg/mL intravenous solution 20 mL [CULL],11201690,LOCAL,J1250,CPT,,,,,,Outpatient,20,ML,26.6144,,United Health ,United Health Medicare Advantage,8.02,,,,,,,Fee Schedule,8.024,8.024,
Serotype 1 (1) QST,10243602,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 12 (12F) QST,10243608,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 14 (14) QST,10243609,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 17 (17F) QST,10242538,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 19 (19F) QST,10243610,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 2 (2) QST,10242514,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 20 (20) QST,10242544,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 22 (22F) QST,10242547,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 23 (23F) QST,10243611,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 26 (6B) QST,10243612,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 3 (3) QST,10243603,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 34 (10A) QST,10242556,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 4 (4) QST,10243604,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 43 (11A) QST,10242559,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 5 (5) QST,10243605,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 51 (7F) QST,10243613,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 54 (15B) QST,10242565,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 56 (18C) QST,10243614,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 57 (19A) QST,10242571,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 68 (9V) QST,10243615,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 70 (33F) QST,10242577,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 8 (8) QST,10243606,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
Serotype 9 (9N) QST,10243607,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,United Health ,United Health Medicare Advantage,14.99,,,,,,,Fee Schedule,14.99,15.29,
ciprofloxacin 400 mg/200 mL-5% Sol,11201486,LOCAL,J0744,CPT,,,,,,Outpatient,200,ML,26.8416,,United Health ,United Health Medicare Advantage,2,,,,,,,Fee Schedule,1.997,1.997,
Aldolase QSTC,8764531,LOCAL,82085,CPT,,,,,,Outpatient,,,26.87,11.65,United Health ,United Health Medicare Advantage,18.2,,,,,,,Fee Schedule,7.16,18.195,
Glucose Fingerstick Clinic POC (RE),4192199,LOCAL,82962,CPT,,,,,,Outpatient,,,26.93,3.94,United Health ,United Health Medicare Advantage,9.08,,,,,,,Fee Schedule,7.16,9.084767596,
".Smooth Muscle Ab, Titer QSTC",13864540,LOCAL,86256,CPT,,,,,,Outpatient,,,27,14.46,United Health ,United Health Medicare Advantage,12.05,,,,,,,Fee Schedule,12.05,15.29,
DNA (ds) Antibody QSTC,8764566,LOCAL,86225,CPT,,,,,,Outpatient,,,27,16.49,United Health ,United Health Medicare Advantage,14.72,,,,,,,Fee Schedule,14.71636364,15.29,
Hepatitis B Core Ab (IgM) QSTC,8764681,LOCAL,86705,CPT,,,,,,Outpatient,,,27,14.12,United Health ,United Health Medicare Advantage,32.8,,,,,,,Fee Schedule,15.29,32.80285714,
Mumps Virus Antibody (IgG) QSTC,8764679,LOCAL,86735,CPT,,,,,,Outpatient,,,27,15.66,United Health ,United Health Medicare Advantage,13.05,,,,,,,Fee Schedule,13.05,15.29,
Prolactin QSTC,8972761,LOCAL,84146,CPT,,,,,,Outpatient,,,27,23.26,United Health ,United Health Medicare Advantage,19.38,,,,,,,Fee Schedule,18.43,19.38,
Smooth Muscle Ab w/refl Titer QSTC,13864539,LOCAL,83497,CPT,,,,,,Outpatient,,,27,15.48,United Health ,United Health Medicare Advantage,12.9,,,,,,,Fee Schedule,12.9,19.405,
Smooth Muscle Ab w/rfx Titer QSTC,13864539,LOCAL,86015,CPT,,,,,,Outpatient,,,27,14.46,United Health ,United Health Medicare Advantage,19.41,,,,,,,Fee Schedule,12.9,19.405,
"Treponema pall Ab, Particle Agg QSTC",8972906,LOCAL,86780,CPT,,,,,,Outpatient,,,27,15.89,United Health ,United Health Medicare Advantage,13.24,,,,,,,Fee Schedule,13.24,15.29,
Protein Level Urine,4186691,LOCAL,84156,CPT,,,,,,Outpatient,,,27.74,4.4,United Health ,United Health Medicare Advantage,11.68,,,,,,,Fee Schedule,7.16,11.68,
Lipid Panel w/ Rfx to Direct LDL QSTC,13864433,LOCAL,80061,CPT,,,,,,Outpatient,,,27.9,16.07,United Health ,United Health Medicare Advantage,16.6,,,,,,,Fee Schedule,12.14,16.59934459,
cyanocobalamin 1000 mcg/mL injectable solution 1 mL [CULL],11202258,LOCAL,J3420,CPT,,,,,,Outpatient,1,ML,27.968,,United Health ,United Health Medicare Advantage,3.17,,,,,,,Fee Schedule,3.167142857,3.167142857,
G0109 DM OP SMT GRP PER 30 MIN CHARGE,8709096,LOCAL,,,G0109,HCPCS,,,,Outpatient,,,27.99,18,United Health ,United Health Medicare Advantage,15.04,,,,,,,Fee Schedule,15.04,67.18,
ID,8131550,LOCAL,87077,CPT,,,,,,Outpatient,,,28.15,9.7,United Health ,United Health Medicare Advantage,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
ID Add On,13661571,LOCAL,87077,CPT,,,,,,Outpatient,,,28.15,9.7,United Health ,United Health Medicare Advantage,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
Mitochondria M2 Ab (IgG) QSTC,8764575,LOCAL,86381,CPT,,,,,,Outpatient,,,28.26,30.54,United Health ,United Health Medicare Advantage,26.61,,,,,,,Fee Schedule,15.29,26.605,
PC DOPP LOWER EXT ART/ABI,8200227,LOCAL,93922,CPT,,,,,,Outpatient,,,28.29,265,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,117.85,161.71,
clindamycin 300 mg/50 mL-NaCl 0.9% Sol [CULL],11290065,LOCAL,J0737,CPT,,,,,,Outpatient,50,ML,28.32,,United Health ,United Health Medicare Advantage,2.35,,,,,,,Fee Schedule,0.819,2.346,
butorphanol 2 mg/mL Sol [CULL],11202147,LOCAL,J0595,CPT,,,,,,Outpatient,1,ML,28.7968,,United Health ,United Health Medicare Advantage,5.54,,,,,,,Fee Schedule,5.544,5.544,
"Gastrin, Serum QSTC",8764526,LOCAL,82941,CPT,,,,,,Outpatient,,,28.8,21.16,United Health ,United Health Medicare Advantage,17.63,,,,,,,Fee Schedule,17.63,18.43,
Hep B Core Ab (Total)w/Rfx to IgM QSTC,9039408,LOCAL,86704,CPT,,,,,,Outpatient,,,28.8,14.46,United Health ,United Health Medicare Advantage,17.4,,,,,,,Fee Schedule,15.29,17.40428571,
Hepatitis A IgM QSTC,8764600,LOCAL,86709,CPT,,,,,,Outpatient,,,28.8,13.51,United Health ,United Health Medicare Advantage,11.26,,,,,,,Fee Schedule,11.26,15.29,
"Hepatitis B Core Ab, Total QSTC",8764579,LOCAL,86704,CPT,,,,,,Outpatient,,,28.8,14.46,United Health ,United Health Medicare Advantage,17.4,,,,,,,Fee Schedule,15.29,17.40428571,
Complement Component C3c QSTC,8972768,LOCAL,86160,CPT,,,,,,Outpatient,,,29.25,14.4,United Health ,United Health Medicare Advantage,36.91,,,,,,,Fee Schedule,15.29,36.909,
Complement Component C4c QSTC,8972769,LOCAL,86160,CPT,,,,,,Outpatient,,,29.25,14.4,United Health ,United Health Medicare Advantage,36.91,,,,,,,Fee Schedule,15.29,36.909,
Insulin QSTC,9039285,LOCAL,83525,CPT,,,,,,Outpatient,,,29.25,13.72,United Health ,United Health Medicare Advantage,11.43,,,,,,,Fee Schedule,11.43,18.43,
Clozapine QSTC,8764629,LOCAL,80159,CPT,,,,,,Outpatient,,,29.7,24.18,United Health ,United Health Medicare Advantage,20.15,,,,,,,Fee Schedule,15.38,20.15,
HSV 1 and 2 IgG Antibodies QSTC,8853241,LOCAL,86695,CPT,,,,,,Outpatient,,,29.97,15.83,United Health ,United Health Medicare Advantage,13.19,,,,,,,Fee Schedule,13.19,15.29,
"HSV 1/2 IgG,Type Specific Ab QST",8389465,LOCAL,86695,CPT,,,,,,Outpatient,,,29.97,15.83,United Health ,United Health Medicare Advantage,13.19,,,,,,,Fee Schedule,13.19,15.29,
97804 Medical Nutrit Group 30Min CHARGE,9323172,LOCAL,97804,CPT,,,,,,Outpatient,,,30,20,United Health ,United Health Medicare Advantage,11.75,,,,,,,Fee Schedule,11.75,287.34,
Insulin Level Total,3454335,LOCAL,83525,CPT,,,,,,Outpatient,,,30,13.72,United Health ,United Health Medicare Advantage,11.43,,,,,,,Fee Schedule,11.43,18.43,
budesonide 0.25 mg/2 mL inhalation suspension 2 mL [CULL],11205254,LOCAL,J7626,CPT,,,,,,Outpatient,2,ML,30.1056,,United Health ,United Health Medicare Advantage,1.05,,,,,,,Fee Schedule,1.049,1.049,
cefTRIAXone 2 g injection ADDV [CULL],11282070,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,30.61632,,United Health ,United Health Medicare Advantage,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
labetalol 5 mg/mL intravenous solution 20 mL [CULL],11201873,LOCAL,J1920,CPT,,,,,,Outpatient,20,ML,30.72,,United Health ,United Health Medicare Advantage,5.46,,,,,,,Fee Schedule,5.464225352,5.464225352,
triamcinolone acetonide 40 mg/mL injectable suspension 1 mL [CULL],11212390,LOCAL,J3301,CPT,,,,,,Outpatient,1,ML,31.072,,United Health ,United Health Medicare Advantage,3.03,,,,,,,Fee Schedule,3.025614035,3.025614035,
clindamycin 300 mg/50 mL-D5% intravenous solution 50 mL [CULL],11290065,LOCAL,J0736,CPT,,,,,,Outpatient,50,ML,31.48133333,,United Health ,United Health Medicare Advantage,0.82,,,,,,,Fee Schedule,0.819,2.346,
".ANA, Titer and Pattern QSTC",8764643,LOCAL,86039,CPT,,,,,,Outpatient,,,31.5,13.39,United Health ,United Health Medicare Advantage,21.22,,,,,,,Fee Schedule,15.29,21.22,
Cytomegalovirus Antibody (IgG) QSTC,13972135,LOCAL,86644,CPT,,,,,,Outpatient,,,31.5,17.27,United Health ,United Health Medicare Advantage,14.39,,,,,,,Fee Schedule,14.39,15.29,
Cytomegalovirus Antibody (IgG) QSTC,8853227,LOCAL,86644,CPT,,,,,,Outpatient,,,31.5,17.27,United Health ,United Health Medicare Advantage,14.39,,,,,,,Fee Schedule,14.39,15.29,
C-Reactive Protein,1628890,LOCAL,86140,CPT,,,,,,Outpatient,,,32,6.22,United Health ,United Health Medicare Advantage,13.3,,,,,,,Fee Schedule,13.29690962,15.29,
Fecal WBC,4123047,LOCAL,87205,CPT,,,,,,Outpatient,,,32,5.12,United Health ,United Health Medicare Advantage,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
Stool WBC,10294481,LOCAL,87205,CPT,,,,,,Outpatient,,,32,5.12,United Health ,United Health Medicare Advantage,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
"Complement, Total (CH50) QSTC",8764582,LOCAL,86162,CPT,,,,,,Outpatient,,,32.4,24.38,United Health ,United Health Medicare Advantage,20.32,,,,,,,Fee Schedule,15.29,20.32,
DHEA Sulfate QSTC,9696140,LOCAL,82627,CPT,,,,,,Outpatient,,,32.4,26.68,United Health ,United Health Medicare Advantage,27.1,,,,,,,Fee Schedule,18.43,27.095,
Haptoglobin QSTC,8764542,LOCAL,83010,CPT,,,,,,Outpatient,,,32.4,15.1,United Health ,United Health Medicare Advantage,12.58,,,,,,,Fee Schedule,12.58,17.73,
"Hepatitis A Ab, Total QSTC",8764599,LOCAL,86708,CPT,,,,,,Outpatient,,,32.4,14.87,United Health ,United Health Medicare Advantage,12.39,,,,,,,Fee Schedule,12.39,15.29,
Jo-1 Antibody QSTC,8764688,LOCAL,86235,CPT,,,,,,Outpatient,,,32.4,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
"RNP Antibody, QSTC",10100359,LOCAL,86235,CPT,,,,,,Outpatient,,,32.4,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
"Sm Antibody, QSTC",10100362,LOCAL,86235,CPT,,,,,,Outpatient,,,32.4,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
"STRAP, CLAVICLE SMALL-3004-06",6010605,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,32.4,12,United Health ,United Health Medicare Advantage,67.31,,,,,,,Fee Schedule,67.31,67.31,
"Albumin, CSF QSTC",13873031,LOCAL,82042,CPT,,,,,,Outpatient,,,32.46,9.34,United Health ,United Health Medicare Advantage,7.78,,,,,,,Fee Schedule,7.16,7.78,
"Albumin, Serum QSTC",13873034,LOCAL,82040,CPT,,,,,,Outpatient,,,32.46,5.94,United Health ,United Health Medicare Advantage,127.89,,,,,,,Fee Schedule,7.16,127.89,
Immunoglobulin G QSTC,13873033,LOCAL,82784,CPT,,,,,,Outpatient,,,32.46,11.16,United Health ,United Health Medicare Advantage,34.96,,,,,,,Fee Schedule,7.16,34.958,
"Oligoclonal Bands (IgG),CSF QSTC",13873028,LOCAL,83916,CPT,,,,,,Outpatient,,,32.46,32.87,United Health ,United Health Medicare Advantage,27.39,,,,,,,Fee Schedule,17.73,27.39,
Immunoglobulin A QSTC,13904383,LOCAL,82784,CPT,,,,,,Outpatient,,,32.62,11.16,United Health ,United Health Medicare Advantage,34.96,,,,,,,Fee Schedule,7.16,34.958,
tTG IgA Ab QSTC,13904382,LOCAL,86364,CPT,,,,,,Outpatient,,,32.63,13.84,United Health ,United Health Medicare Advantage,61.9,,,,,,,Fee Schedule,15.29,61.9,
"Delta-Aminolevulinic Acid, Random Urine QSTC",12329984,LOCAL,82135,CPT,,,,,,Outpatient,,,32.81,19.74,United Health ,United Health Medicare Advantage,16.45,,,,,,,Fee Schedule,16.45,17.73,
Bilirubin Cord Blood,10237211,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,United Health ,United Health Medicare Advantage,5.02,,,,,,,Fee Schedule,5.02,7.16,
Bilirubin Neonatal (Bu/Bc),14541767,LOCAL,82248,CPT,,,,,,Outpatient,,,33.46,6.02,United Health ,United Health Medicare Advantage,26.63,,,,,,,Fee Schedule,7.16,26.6275,
Bilirubin Neonatal 2,8883195,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,United Health ,United Health Medicare Advantage,5.02,,,,,,,Fee Schedule,5.02,7.16,
Bilirubin Total,633672,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,United Health ,United Health Medicare Advantage,5.02,,,,,,,Fee Schedule,5.02,7.16,
Bilirubin Total,7939102,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,United Health ,United Health Medicare Advantage,5.02,,,,,,,Fee Schedule,5.02,7.16,
Bilirubin Total,8443661,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,United Health ,United Health Medicare Advantage,5.02,,,,,,,Fee Schedule,5.02,7.16,
Cyclic Citrull Peptide (CCP) Ab IgG QSTC,8764613,LOCAL,86200,CPT,,,,,,Outpatient,,,33.75,15.54,United Health ,United Health Medicare Advantage,7.49,,,,,,,Fee Schedule,7.491935484,15.29,
"Cholinesterase, Plasma QSTC",13873320,LOCAL,82482,CPT,,,,,,Outpatient,,,33.8,11.77,United Health ,United Health Medicare Advantage,9.81,,,,,,,Fee Schedule,7.16,9.81,
"Cholinesterase, RBC QSTC",13873317,LOCAL,82480,CPT,,,,,,Outpatient,,,33.8,9.44,United Health ,United Health Medicare Advantage,7.87,,,,,,,Fee Schedule,7.16,7.87,
STRAP CLAVICLE PED.,11071010,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,33.94,12,United Health ,United Health Medicare Advantage,67.31,,,,,,,Fee Schedule,67.31,67.31,
"Calcium, 24 hour Urine QSTC",13864700,LOCAL,82340,CPT,,,,,,Outpatient,,,33.95,7.24,United Health ,United Health Medicare Advantage,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
"Citric Acid, 24 Hour Urine QSTC",13864703,LOCAL,82507,CPT,,,,,,Outpatient,,,33.95,33.36,United Health ,United Health Medicare Advantage,30.63,,,,,,,Fee Schedule,17.73,30.625,
"Creatinine, 24 Hour Urine QSTC",13864712,LOCAL,82570,CPT,,,,,,Outpatient,,,33.95,6.22,United Health ,United Health Medicare Advantage,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Magnesium, 24 Hour Urine QSTC",13864709,LOCAL,83735,CPT,,,,,,Outpatient,,,33.95,8.04,United Health ,United Health Medicare Advantage,3.66,,,,,,,Fee Schedule,3.657824427,7.16,
"Oxalate, 24 Hour Urine QSTC",13864701,LOCAL,83945,CPT,,,,,,Outpatient,,,33.95,17.34,United Health ,United Health Medicare Advantage,24.09,,,,,,,Fee Schedule,17.73,24.085,
pH Urine QSTC,13864699,LOCAL,83986,CPT,,,,,,Outpatient,,,33.95,4.3,United Health ,United Health Medicare Advantage,18.76,,,,,,,Fee Schedule,7.16,18.755,
"Phosphorus, 24 Hour Urine QSTC",13864707,LOCAL,84105,CPT,,,,,,Outpatient,,,33.95,6.94,United Health ,United Health Medicare Advantage,19.84,,,,,,,Fee Schedule,7.16,19.835,
"Potassium, 24 Hour Urine QSTC",13864711,LOCAL,84133,CPT,,,,,,Outpatient,,,33.95,5.68,United Health ,United Health Medicare Advantage,19.32,,,,,,,Fee Schedule,7.16,19.32,
"Sodium, 24 Hour Urine QSTC",13864704,LOCAL,84300,CPT,,,,,,Outpatient,,,33.95,6.07,United Health ,United Health Medicare Advantage,9.74,,,,,,,Fee Schedule,7.16,9.74,
"Sulfate, 24 Hour Urine QSTC",13864705,LOCAL,84392,CPT,,,,,,Outpatient,,,33.95,6.59,United Health ,United Health Medicare Advantage,19.7,,,,,,,Fee Schedule,4.02,19.695,
Uric Acid QSTC,13864716,LOCAL,84560,CPT,,,,,,Outpatient,,,33.95,6.1,United Health ,United Health Medicare Advantage,19.49,,,,,,,Fee Schedule,7.16,19.49,
Ammonium Urine QSTC,8997190,LOCAL,82140,CPT,,,,,,Outpatient,,,34,17.48,United Health ,United Health Medicare Advantage,22.63,,,,,,,Fee Schedule,17.73,22.62909091,
"Calcium, 24 hour Urine QSTC",8997182,LOCAL,82340,CPT,,,,,,Outpatient,,,34,7.24,United Health ,United Health Medicare Advantage,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
"Citric Acid, 24 Hour Urine QSTC",8997185,LOCAL,82507,CPT,,,,,,Outpatient,,,34,33.36,United Health ,United Health Medicare Advantage,30.63,,,,,,,Fee Schedule,17.73,30.625,
"Creatinine, 24 Hour Urine QSTC",8997192,LOCAL,82570,CPT,,,,,,Outpatient,,,34,6.22,United Health ,United Health Medicare Advantage,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Magnesium, 24 Hour Urine QSTC",8997189,LOCAL,83735,CPT,,,,,,Outpatient,,,34,8.04,United Health ,United Health Medicare Advantage,3.66,,,,,,,Fee Schedule,3.657824427,7.16,
"Oxalate, 24 Hour Urine QSTC",8997183,LOCAL,83945,CPT,,,,,,Outpatient,,,34,17.34,United Health ,United Health Medicare Advantage,24.09,,,,,,,Fee Schedule,17.73,24.085,
pH Urine QSTC,8997180,LOCAL,83986,CPT,,,,,,Outpatient,,,34,4.3,United Health ,United Health Medicare Advantage,18.76,,,,,,,Fee Schedule,7.16,18.755,
"Phosphorus, 24 Hour Urine QSTC",8997188,LOCAL,84105,CPT,,,,,,Outpatient,,,34,6.94,United Health ,United Health Medicare Advantage,19.84,,,,,,,Fee Schedule,7.16,19.835,
"Potassium, 24 Hour Urine QSTC",8997191,LOCAL,84133,CPT,,,,,,Outpatient,,,34,5.68,United Health ,United Health Medicare Advantage,19.32,,,,,,,Fee Schedule,7.16,19.32,
"Sodium, 24 Hour Urine QSTC",8997186,LOCAL,84300,CPT,,,,,,Outpatient,,,34,6.07,United Health ,United Health Medicare Advantage,9.74,,,,,,,Fee Schedule,7.16,9.74,
"Sulfate, 24 Hour Urine QSTC",8997187,LOCAL,84392,CPT,,,,,,Outpatient,,,34,6.59,United Health ,United Health Medicare Advantage,19.7,,,,,,,Fee Schedule,4.02,19.695,
"Uric Acid, 24 Hour Urine QSTC",8997184,LOCAL,84560,CPT,,,,,,Outpatient,,,34,6.1,United Health ,United Health Medicare Advantage,19.49,,,,,,,Fee Schedule,7.16,19.49,
BINDER ABDOMINAL MALE,11070715,LOCAL,,,L0625,HCPCS,,,,Outpatient,,,34.21,86,United Health ,United Health Medicare Advantage,42.8,,,,,,,Fee Schedule,42.8,42.8,
Lipase Level,633776,LOCAL,83690,CPT,,,,,,Outpatient,,,34.27,8.27,United Health ,United Health Medicare Advantage,1.3,,,,,,,Fee Schedule,1.304132029,7.16,
fluconazole 200 mg/100 mL-NaCl 0.9% intravenous solution 100 mL [CULL],11220720,LOCAL,J1450,CPT,,,,,,Outpatient,100,ML,34.56,,United Health ,United Health Medicare Advantage,4.48,,,,,,,Fee Schedule,4.48,4.48,
vancomycin 500 mg/100 mL intravenous solution 100 mL [CULL],11290008,LOCAL,J3375,CPT,,,,,,Outpatient,100,ML,34.56,,United Health ,United Health Medicare Advantage,0.13,,,,,,,Fee Schedule,0.134,0.134,
Ceruloplasmin QSTC,8764535,LOCAL,82390,CPT,,,,,,Outpatient,,,34.88,12.89,United Health ,United Health Medicare Advantage,10.74,,,,,,,Fee Schedule,10.74,17.73,
labetalol 5 mg/mL intravenous solution 4 mL [CULL],11201874,LOCAL,J1920,CPT,,,,,,Outpatient,4,ML,34.88,,United Health ,United Health Medicare Advantage,5.46,,,,,,,Fee Schedule,5.464225352,5.464225352,
Amikacin Level,9034955,LOCAL,80150,CPT,,,,,,Outpatient,,,35,18.1,United Health ,United Health Medicare Advantage,15.08,,,,,,,Fee Schedule,15.08,15.38,
"ANA Screen, IFA QSTC",14116751,LOCAL,86038,CPT,,,,,,Outpatient,,,35,14.51,United Health ,United Health Medicare Advantage,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
Breath Alcohol,9687753,LOCAL,82075,CPT,,,,,,Outpatient,,,35,36,United Health ,United Health Medicare Advantage,30,,,,,,,Fee Schedule,17.73,30,
"CCP, Antibody (IgG) QSTC",14116753,LOCAL,86200,CPT,,,,,,Outpatient,,,35,15.54,United Health ,United Health Medicare Advantage,7.49,,,,,,,Fee Schedule,7.491935484,15.29,
"MCV, Antibody QSTC",14116754,LOCAL,83520,CPT,,,,,,Outpatient,,,35,20.72,United Health ,United Health Medicare Advantage,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rheumatoid Factor QSTC,14116752,LOCAL,86431,CPT,,,,,,Outpatient,,,35,6.8,United Health ,United Health Medicare Advantage,6.3,,,,,,,Fee Schedule,6.29875,15.29,
T4 Total,633845,LOCAL,84436,CPT,,,,,,Outpatient,,,35.09,8.24,United Health ,United Health Medicare Advantage,17.54,,,,,,,Fee Schedule,17.54230769,18.43,
Rheumatoid Factor Qualitative,7906954,LOCAL,86430,CPT,,,,,,Outpatient,,,35.1,7.37,United Health ,United Health Medicare Advantage,20.56,,,,,,,Fee Schedule,15.29,20.56,
Protein Tot & Protein Electrophore QSTC,8764768,LOCAL,84155,CPT,,,,,,Outpatient,,,35.23,4.4,United Health ,United Health Medicare Advantage,3.67,,,,,,,Fee Schedule,3.67,7.16,
Glucose 2 Hour Post Prandial,7973897,LOCAL,82947,CPT,,,,,,Outpatient,,,35.5,4.72,United Health ,United Health Medicare Advantage,10.3,,,,,,,Fee Schedule,7.16,10.29541667,
Lithium Level,2046348,LOCAL,80178,CPT,,,,,,Outpatient,,,35.5,7.93,United Health ,United Health Medicare Advantage,20.99,,,,,,,Fee Schedule,15.38,20.99,
Magnesium Level,633781,LOCAL,83735,CPT,,,,,,Outpatient,,,35.5,8.04,United Health ,United Health Medicare Advantage,3.66,,,,,,,Fee Schedule,3.657824427,7.16,
BINDER ABDOMINAL FEMALE,11070714,LOCAL,,,L0625,HCPCS,,,,Outpatient,,,35.59,86,United Health ,United Health Medicare Advantage,42.8,,,,,,,Fee Schedule,42.8,42.8,
Crystal Analysis QSTC,9658951,LOCAL,89060,CPT,,,,,,Outpatient,,,35.87,8.8,United Health ,United Health Medicare Advantage,21.53,,,,,,,Fee Schedule,14.07,21.53,
Glucose 1 Hour,7973889,LOCAL,82951,CPT,,,,,,Outpatient,,,35.9,15.44,United Health ,United Health Medicare Advantage,12.87,,,,,,,Fee Schedule,12.87,17.73,
Glucose 2 Hour,7973890,LOCAL,82952,CPT,,,,,,Outpatient,,,35.9,4.7,United Health ,United Health Medicare Advantage,3.92,,,,,,,Fee Schedule,3.92,7.16,
Glucose Level,633594,LOCAL,82947,CPT,,,,,,Outpatient,,,35.9,4.72,United Health ,United Health Medicare Advantage,10.3,,,,,,,Fee Schedule,7.16,10.29541667,
Thyroid Peroxidase Abs QSTC,8861417,LOCAL,86376,CPT,,,,,,Outpatient,,,35.91,17.46,United Health ,United Health Medicare Advantage,25.09,,,,,,,Fee Schedule,15.29,25.085,
Thyroid Peroxidase Antibodies QSTC,8764563,LOCAL,86376,CPT,,,,,,Outpatient,,,35.91,17.46,United Health ,United Health Medicare Advantage,25.09,,,,,,,Fee Schedule,15.29,25.085,
"Alpha-1-Antitrypsin, Qn QSTC",9039253,LOCAL,82103,CPT,,,,,,Outpatient,,,36,16.13,United Health ,United Health Medicare Advantage,60.59,,,,,,,Fee Schedule,17.73,60.59,
"Alpha-Fetoprotein, Tumor Marker QSTC",8764596,LOCAL,82105,CPT,,,,,,Outpatient,,,36,20.12,United Health ,United Health Medicare Advantage,26.22,,,,,,,Fee Schedule,17.73,26.22,
"B2 Microglobulin, Serum QSTC",8764794,LOCAL,82232,CPT,,,,,,Outpatient,,,36,19.42,United Health ,United Health Medicare Advantage,16.18,,,,,,,Fee Schedule,16.18,18.43,
Bill Decalcification Procedure,8489589,LOCAL,88311,CPT,,,,,,Outpatient,,,36,,United Health ,United Health Medicare Advantage,7.2,,,,,,,Fee Schedule,7.2,59.06,
CA 125 QSTC,8764680,LOCAL,86304,CPT,,,,,,Outpatient,,,36,24.97,United Health ,United Health Medicare Advantage,20.81,,,,,,,Fee Schedule,15.29,20.81,
CA 19-9 QSTC,8764669,LOCAL,86301,CPT,,,,,,Outpatient,,,36,24.97,United Health ,United Health Medicare Advantage,20.81,,,,,,,Fee Schedule,15.29,20.81,
CA 27.29 QSTC,8764762,LOCAL,86300,CPT,,,,,,Outpatient,,,36,24.97,United Health ,United Health Medicare Advantage,43.34,,,,,,,Fee Schedule,15.29,43.34448276,
Copper QSTC,8764536,LOCAL,82525,CPT,,,,,,Outpatient,,,36,14.89,United Health ,United Health Medicare Advantage,24.09,,,,,,,Fee Schedule,16.07,24.085,
"Fungal Identification, Molds QSTC",8873558,LOCAL,87107,CPT,,,,,,Outpatient,,,36,12.38,United Health ,United Health Medicare Advantage,10.32,,,,,,,Fee Schedule,10.32,10.57,
"Gliadin(Deamidated) Ab,IgA QSTC",9039363,LOCAL,86258,CPT,,,,,,Outpatient,,,36,14.46,United Health ,United Health Medicare Advantage,12.05,,,,,,,Fee Schedule,12.05,15.29,
"Gliadin(Deamidated) Ab,IgG QSTC",9039362,LOCAL,86258,CPT,,,,,,Outpatient,,,36,14.46,United Health ,United Health Medicare Advantage,12.05,,,,,,,Fee Schedule,12.05,15.29,
Lamotrigine QSTC,8853218,LOCAL,80175,CPT,,,,,,Outpatient,,,36,15.9,United Health ,United Health Medicare Advantage,13.25,,,,,,,Fee Schedule,13.25,15.38,
"Protein, Total, w/Creat, Random Ur QSTC",9291011,LOCAL,84156,CPT,,,,,,Outpatient,,,36,4.4,United Health ,United Health Medicare Advantage,11.68,,,,,,,Fee Schedule,7.16,11.68,
"Testosterone, Total, MS QSTC",8848606,LOCAL,84402,CPT,,,,,,Outpatient,,,36,30.56,United Health ,United Health Medicare Advantage,30.49,,,,,,,Fee Schedule,18.43,30.485,
SLING PED/INFANT 5'X9,6000156,LOCAL,,,A4565,HCPCS,,,,Outpatient,,,36.19,19,United Health ,United Health Medicare Advantage,10.98,,,,,,,Fee Schedule,10.98,10.98,
"Copper, 24-Hour Urine QSTC",9390117,LOCAL,82525,CPT,,,,,,Outpatient,,,36.27,14.89,United Health ,United Health Medicare Advantage,24.09,,,,,,,Fee Schedule,16.07,24.085,
MALDI ID,X87077,LOCAL,87077,CPT,,,,,,Outpatient,,,36.36,9.7,United Health ,United Health Medicare Advantage,16.48,,,,,,,Fee Schedule,10.57,16.47987421,
cefTAZidime 2 g injection [CULL],11201395,LOCAL,J0713,CPT,,,,,,Outpatient,1,EA,36.67968,,United Health ,United Health Medicare Advantage,1.47,,,,,,,Fee Schedule,1.468,1.468,
"ANA Screen, IFA QST",9110748,LOCAL,86038,CPT,,,,,,Outpatient,,,37,14.51,United Health ,United Health Medicare Advantage,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
Complement Component C3C QST,12876950,LOCAL,86160,CPT,,,,,,Outpatient,,,37,14.4,United Health ,United Health Medicare Advantage,36.91,,,,,,,Fee Schedule,15.29,36.909,
Complement Component C4C QST,12876951,LOCAL,86160,CPT,,,,,,Outpatient,,,37,14.4,United Health ,United Health Medicare Advantage,36.91,,,,,,,Fee Schedule,15.29,36.909,
DNA (DS) Antibody QST,9110747,LOCAL,86225,CPT,,,,,,Outpatient,,,37,16.49,United Health ,United Health Medicare Advantage,14.72,,,,,,,Fee Schedule,14.71636364,15.29,
Microalbumin Level Urine,7974117,LOCAL,82043,CPT,,,,,,Outpatient,,,37,6.94,United Health ,United Health Medicare Advantage,20.16,,,,,,,Fee Schedule,4.02,20.15557971,
Rheumatoid Factor QST,9110751,LOCAL,86431,CPT,,,,,,Outpatient,,,37,6.8,United Health ,United Health Medicare Advantage,6.3,,,,,,,Fee Schedule,6.29875,15.29,
Ribosomal P Antibody QST,9110754,LOCAL,83516,CPT,,,,,,Outpatient,,,37,13.84,United Health ,United Health Medicare Advantage,11.53,,,,,,,Fee Schedule,11.53,17.73,
SCL-70 Antibody QST,9110757,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-A) QST,9110760,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-B) QST,9110763,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sm Antibody QST,9110766,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
SM/RNP Antibody QST,9110769,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Thyroid Peroxidase Antibodies QST,9110772,LOCAL,86376,CPT,,,,,,Outpatient,,,37,17.46,United Health ,United Health Medicare Advantage,25.09,,,,,,,Fee Schedule,15.29,25.085,
EBV EBNA Ab (IgG) Interp QSTC,8849012,LOCAL,86664,CPT,,,,,,Outpatient,,,37.13,18.35,United Health ,United Health Medicare Advantage,15.29,,,,,,,Fee Schedule,15.29,15.29,
EBV VCA Ab (IgM) QSTC,8849009,LOCAL,86665,CPT,,,,,,Outpatient,,,37.13,21.77,United Health ,United Health Medicare Advantage,18.14,,,,,,,Fee Schedule,15.29,18.14,
".B. henselae Ab(IgG),Titer QSTC",8764830,LOCAL,86611,CPT,,,,,,Outpatient,,,37.35,12.22,United Health ,United Health Medicare Advantage,10.18,,,,,,,Fee Schedule,10.18,15.29,
".B. henselae Ab(IgM),Titer QSTC",8764831,LOCAL,86611,CPT,,,,,,Outpatient,,,37.35,12.22,United Health ,United Health Medicare Advantage,10.18,,,,,,,Fee Schedule,10.18,15.29,
".B. quintana Ab(IgG),Titer QSTC",10128892,LOCAL,86611,CPT,,,,,,Outpatient,,,37.35,12.22,United Health ,United Health Medicare Advantage,10.18,,,,,,,Fee Schedule,10.18,15.29,
IMMOBLIZER KNEE XX-LARGE,11070340,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,37.9,158,United Health ,United Health Medicare Advantage,77.23,,,,,,,Fee Schedule,77.23,77.23,
methocarbamol 100 mg/mL injectable solution 10 mL [CULL],11201939,LOCAL,J2800,CPT,,,,,,Outpatient,10,ML,38.4,,United Health ,United Health Medicare Advantage,4.54,,,,,,,Fee Schedule,4.535,4.535,
calcium gluconate 100 mg/mL injectable solution 10 mL [CULL],11201252,LOCAL,J0612,CPT,,,,,,Outpatient,10,ML,38.4768,,United Health ,United Health Medicare Advantage,0.03,,,,,,,Fee Schedule,0.01,0.03,
SLING & SWATHE W/SLEEVE,11071056,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,38.89,12,United Health ,United Health Medicare Advantage,67.31,,,,,,,Fee Schedule,67.31,67.31,
TBG QSTC,8853216,LOCAL,84442,CPT,,,,,,Outpatient,,,39.06,17.74,United Health ,United Health Medicare Advantage,14.78,,,,,,,Fee Schedule,14.78,18.43,
"Culture, Fungus, Skin, Hair, Nails QSTC",8972785,LOCAL,87101,CPT,,,,,,Outpatient,,,39.11,9.25,United Health ,United Health Medicare Advantage,7.71,,,,,,,Fee Schedule,7.71,10.57,
Prostate Specific Antigen Total,7939094,LOCAL,84153,CPT,,,,,,Outpatient,,,39.17,22.07,United Health ,United Health Medicare Advantage,104.84,,,,,,,Fee Schedule,17.73,104.8447059,
Prealbumin,3454341,LOCAL,84134,CPT,,,,,,Outpatient,,,39.98,17.51,United Health ,United Health Medicare Advantage,4.93,,,,,,,Fee Schedule,4.934545455,17.73,
20560 DRY NEEDLING 1 OR 2 MUSCLES WO INJECTION,9650048,LOCAL,20560,CPT,,,,,,Outpatient,,,40,26,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,22.39,863,
Beef (F27) IgE Class QSTC,14129407,LOCAL,86003,CPT,,,,,,Outpatient,,,40,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Glucose Body Fluid,1628896,LOCAL,82945,CPT,,,,,,Outpatient,,,40,4.72,United Health ,United Health Medicare Advantage,3.93,,,,,,,Fee Schedule,3.93,7.16,
Lamb (F88) IgE Class QSTC,14129413,LOCAL,86003,CPT,,,,,,Outpatient,,,40,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Pork (F26) IgE Class QSTC,14129419,LOCAL,86003,CPT,,,,,,Outpatient,,,40,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
RESULTS_QSTC,14755730,LOCAL,86008,CPT,,,,,,Outpatient,,,40,21.52,United Health ,United Health Medicare Advantage,17.93,,,,,,,Fee Schedule,15.29,17.93,
"Pyruvic Acid (Pyruvate),B QSTC",13864526,LOCAL,84210,CPT,,,,,,Outpatient,,,40.1,17.38,United Health ,United Health Medicare Advantage,14.48,,,,,,,Fee Schedule,14.48,17.73,
"VDRL, CSF QSTC",8764738,LOCAL,86592,CPT,,,,,,Outpatient,,,40.41,5.12,United Health ,United Health Medicare Advantage,19.99,,,,,,,Fee Schedule,15.29,19.99375,
Angiotensin Converting Enzyme QSTC,8764564,LOCAL,82164,CPT,,,,,,Outpatient,,,40.5,17.52,United Health ,United Health Medicare Advantage,27.41,,,,,,,Fee Schedule,17.73,27.405,
Intrinsic Factor Blocking Antibody QSTC,8764611,LOCAL,86340,CPT,,,,,,Outpatient,,,40.5,18.1,United Health ,United Health Medicare Advantage,15.08,,,,,,,Fee Schedule,15.08,15.29,
Osmolality Serum,9414322,LOCAL,83930,CPT,,,,,,Outpatient,,,40.5,7.93,United Health ,United Health Medicare Advantage,6.61,,,,,,,Fee Schedule,6.61,7.16,
97018 OT PARAFFIN BATH 1+ AREAS APPLIC CHARGE,9850020,LOCAL,97018,CPT,,,,,GO,Outpatient,,,40.9,27,United Health ,United Health Medicare Advantage,5.41,,,,,,,Fee Schedule,5.41,47.26,
97018 OT PARAFFIN BATH CHARGE,9860020,LOCAL,97018,CPT,,,,,GO|CO,Outpatient,,,40.9,27,United Health ,United Health Medicare Advantage,5.41,,,,,,,Fee Schedule,5.41,47.26,
OT Paraffin Bath Assistant Units,7895270,LOCAL,97018,CPT,,,,,CQ,Outpatient,,,40.9,27,United Health ,United Health Medicare Advantage,5.41,,,,,,,Fee Schedule,5.41,47.26,
OT Paraffin Bath Units,1373447,LOCAL,97018,CPT,,,,,GO,Outpatient,,,40.9,27,United Health ,United Health Medicare Advantage,5.41,,,,,,,Fee Schedule,5.41,47.26,
Paraffin Bath Charge,7895270,LOCAL,97018,CPT,,,,,GO,Outpatient,,,40.9,27,United Health ,United Health Medicare Advantage,5.41,,,,,,,Fee Schedule,5.41,47.26,
Centromere B Antibody QSTC,8764633,LOCAL,86235,CPT,,,,,,Outpatient,,,40.91,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
COLLAR LG HARD C,11070731,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,41.14,223,United Health ,United Health Medicare Advantage,175.72,,,,,,,Fee Schedule,175.72,175.72,
COLLAR MED.HARD,11071039,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,41.14,223,United Health ,United Health Medicare Advantage,175.72,,,,,,,Fee Schedule,175.72,175.72,
COLLAR SM HARD C,11070729,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,41.14,223,United Health ,United Health Medicare Advantage,175.72,,,,,,,Fee Schedule,175.72,175.72,
M. pneumoniae Ab (IgM) QSTC,8764773,LOCAL,86738,CPT,,,,,,Outpatient,,,41.49,15.89,United Health ,United Health Medicare Advantage,13.24,,,,,,,Fee Schedule,13.24,15.29,
CULL Pre-MRI Device Screening,14536295,LOCAL,76014,CPT,,,,,,Outpatient,,,41.5,19.8,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,22.39,22.39,
MRI Safety Screening,14536295,LOCAL,76014,CPT,,,,,,Outpatient,,,41.5,19.8,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,22.39,22.39,
Zinc QSTC,8764557,LOCAL,84630,CPT,,,,,,Outpatient,,,41.58,13.67,United Health ,United Health Medicare Advantage,26.38,,,,,,,Fee Schedule,16.07,26.375,
Gram Stain (General Lab),8726050,LOCAL,87205,CPT,,,,,,Outpatient,,,41.62,5.12,United Health ,United Health Medicare Advantage,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
Gram Stain Intraoperative,13436049,LOCAL,87205,CPT,,,,,,Outpatient,,,41.62,5.12,United Health ,United Health Medicare Advantage,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
Gram Stain Report,634217,LOCAL,87205,CPT,,,,,,Outpatient,,,41.62,5.12,United Health ,United Health Medicare Advantage,12.27,,,,,,,Fee Schedule,10.57,12.26595628,
"Bile Acids, Fractionated and Total QSTC",13864500,LOCAL,82542,CPT,,,,,,Outpatient,,,41.85,28.91,United Health ,United Health Medicare Advantage,24.09,,,,,,,Fee Schedule,17.73,24.09,
"Calcium, 24 hr Ur (w/o Creatinine) QSTC",9039238,LOCAL,82340,CPT,,,,,,Outpatient,,,41.99,7.24,United Health ,United Health Medicare Advantage,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
Drug Panel (10),13954356,LOCAL,80306,CPT,,,,,,Outpatient,,,42.45,20.57,United Health ,United Health Medicare Advantage,0.24,,,,,,,Fee Schedule,0.2416,17.73,
Bill Intraoperative Additonal,14048005,LOCAL,88332,CPT,,,,,,Outpatient,,,42.46,,United Health ,United Health Medicare Advantage,21.23,,,,,,,Fee Schedule,21.23,53.82,
Toxoplasma Antibody (IgG) QSTC,8861628,LOCAL,86777,CPT,,,,,,Outpatient,,,42.48,17.27,United Health ,United Health Medicare Advantage,14.39,,,,,,,Fee Schedule,14.39,15.29,
Toxoplasma Antibody (IgM) QSTC,8861629,LOCAL,86778,CPT,,,,,,Outpatient,,,42.48,17.29,United Health ,United Health Medicare Advantage,14.41,,,,,,,Fee Schedule,14.41,15.29,
clindamycin 600 mg/50 mL-NaCl 0.9% Sol [CULL],11290024,LOCAL,J0737,CPT,,,,,,Outpatient,50,ML,42.72,,United Health ,United Health Medicare Advantage,2.35,,,,,,,Fee Schedule,0.819,2.346,
"Cadmium, Blood, QSTC",13864925,LOCAL,82300,CPT,,,,,,Outpatient,,,42.75,28.37,United Health ,United Health Medicare Advantage,29.91,,,,,,,Fee Schedule,16.07,29.91,
"Vitamin B1 (Thiamine), B QSTC",8972833,LOCAL,84425,CPT,,,,,,Outpatient,,,42.75,25.48,United Health ,United Health Medicare Advantage,30.05,,,,,,,Fee Schedule,17.73,30.04654545,
"Calcium, Ionized QSTC",9039239,LOCAL,82330,CPT,,,,,,Outpatient,,,43.2,16.42,United Health ,United Health Medicare Advantage,28.31,,,,,,,Fee Schedule,17.73,28.305,
"Cortisol, Free, U24 QSTC",8764823,LOCAL,82530,CPT,,,,,,Outpatient,,,43.2,20.05,United Health ,United Health Medicare Advantage,29.79,,,,,,,Fee Schedule,17.73,29.79,
"Vanillylmandelic Acid, U24 QSTC",8764683,LOCAL,84585,CPT,,,,,,Outpatient,,,43.2,18.6,United Health ,United Health Medicare Advantage,15.5,,,,,,,Fee Schedule,15.5,18.43,
"Aspergillus fumigatus, IgG Ab QSTC",13864492,LOCAL,86606,CPT,,,,,,Outpatient,,,43.25,18.06,United Health ,United Health Medicare Advantage,15.05,,,,,,,Fee Schedule,15.05,15.29,
"Blastomyces Ab,Immunodiff QSTC",10100364,LOCAL,86612,CPT,,,,,,Outpatient,,,43.25,15.48,United Health ,United Health Medicare Advantage,12.9,,,,,,,Fee Schedule,12.9,15.29,
Cryptococcal Antigen Latex QSTC,8972754,LOCAL,86403,CPT,,,,,,Outpatient,,,43.25,13.85,United Health ,United Health Medicare Advantage,11.54,,,,,,,Fee Schedule,11.54,15.29,
"5HIAA, 24-Hour Urine QSTC",8764545,LOCAL,83497,CPT,,,,,,Outpatient,,,43.34,15.48,United Health ,United Health Medicare Advantage,12.9,,,,,,,Fee Schedule,12.9,18.43,
betamethasone 12 mg/mL injectable suspension 2mL [CULL],11205515,LOCAL,J0702,CPT,,,,,,Outpatient,1,ML,43.4048,,United Health ,United Health Medicare Advantage,22.48,,,,,,,Fee Schedule,22.47566502,22.47566502,
O2 Saturation Arterial,12487723,LOCAL,82810,CPT,,,,,,Outpatient,,,43.6,11.72,United Health ,United Health Medicare Advantage,9.77,,,,,,,Fee Schedule,9.77,17.73,
O2 Saturation Venous,12487723,LOCAL,82810,CPT,,,,,,Outpatient,,,43.6,11.72,United Health ,United Health Medicare Advantage,9.77,,,,,,,Fee Schedule,9.77,17.73,
"Creatinine Random Ur, QSTC",10127838,LOCAL,82570,CPT,,,,,,Outpatient,,,43.61,6.22,United Health ,United Health Medicare Advantage,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Metanephrine Ur, Total QSTC",10127837,LOCAL,83835,CPT,,,,,,Outpatient,,,43.61,20.33,United Health ,United Health Medicare Advantage,98.31,,,,,,,Fee Schedule,18.43,98.305,
CA 15-3 QSTC,8764684,LOCAL,86300,CPT,,,,,,Outpatient,,,44.55,24.97,United Health ,United Health Medicare Advantage,43.34,,,,,,,Fee Schedule,15.29,43.34448276,
"Electrolytes, Urine",12312936,LOCAL,84166,CPT,,,,,,Outpatient,,,44.88,21.4,United Health ,United Health Medicare Advantage,18.62,,,,,,,Fee Schedule,17.73,18.62,
Occult Blood Stool Screen,7909957,LOCAL,82272,CPT,,,,,,Outpatient,,,44.88,5.08,United Health ,United Health Medicare Advantage,4.46,,,,,,,Fee Schedule,4.457272727,7.16,
"Carbamazepine, Total QSTC",9039320,LOCAL,80156,CPT,,,,,,Outpatient,,,44.95,17.48,United Health ,United Health Medicare Advantage,16.45,,,,,,,Fee Schedule,15.38,16.45277778,
Gastric Parietal Cell AB QSTC,8764524,LOCAL,83516,CPT,,,,,,Outpatient,,,44.96,13.84,United Health ,United Health Medicare Advantage,11.53,,,,,,,Fee Schedule,11.53,17.73,
"ACTH, Plasma QSTC",8764544,LOCAL,82024,CPT,,,,,,Outpatient,,,45,46.34,United Health ,United Health Medicare Advantage,38.62,,,,,,,Fee Schedule,18.43,38.62,
Beta2-Glycoprotein IgA QSTC,10100357,LOCAL,86146,CPT,,,,,,Outpatient,,,45,30.54,United Health ,United Health Medicare Advantage,25.45,,,,,,,Fee Schedule,15.29,25.45,
Immunoglobulin G Subclass 4 QSTC,10100372,LOCAL,82787,CPT,,,,,,Outpatient,,,45,9.62,United Health ,United Health Medicare Advantage,8.02,,,,,,,Fee Schedule,7.16,8.02,
Testosterone Free & Total MS QSTC,8764632,LOCAL,84403,CPT,,,,,,Outpatient,,,45,30.97,United Health ,United Health Medicare Advantage,52.38,,,,,,,Fee Schedule,18.43,52.3775,
Tissue Transglutaminase IgA Ab QSTC,8764753,LOCAL,86364,CPT,,,,,,Outpatient,,,45,13.84,United Health ,United Health Medicare Advantage,61.9,,,,,,,Fee Schedule,15.29,61.9,
acetaminophen 10 mg/mL intravenous solution 100 mL [CULL],11200037,LOCAL,J0134,CPT,,,,,,Outpatient,100,ML,46.08,,United Health ,United Health Medicare Advantage,3.16,,,,,,,Fee Schedule,3.159596774,3.159596774,
Scl-70 Antibody QSTC,8853206,LOCAL,86235,CPT,,,,,,Outpatient,,,46.17,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Egg Component Panel QSTC,9039428,LOCAL,86008,CPT,,,,,,Outpatient,,,46.26,21.52,United Health ,United Health Medicare Advantage,17.93,,,,,,,Fee Schedule,15.29,17.93,
Total Iron Binding Capacity,7909796,LOCAL,83550,CPT,,,,,,Outpatient,,,47,10.49,United Health ,United Health Medicare Advantage,8.74,,,,,,,Fee Schedule,8.74,17.73,
amikacin 250 mg/mL injectable solution 2 mL [CULL],11201051,LOCAL,J0278,CPT,,,,,,Outpatient,2,ML,47.0592,,United Health ,United Health Medicare Advantage,0.62,,,,,,,Fee Schedule,0.621,0.621,
cefTRIAXone 250 mg injection [CULL],11202192,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,47.4112,,United Health ,United Health Medicare Advantage,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
clindamycin 600 mg/50 mL-D5% intravenous solution 50 mL [CULL],11290024,LOCAL,J0736,CPT,,,,,,Outpatient,50,ML,47.484,,United Health ,United Health Medicare Advantage,0.82,,,,,,,Fee Schedule,0.819,2.346,
Yeast Culture,7909554,LOCAL,87101,CPT,,,,,,Outpatient,,,47.7,9.25,United Health ,United Health Medicare Advantage,7.71,,,,,,,Fee Schedule,7.71,10.57,
T3 Total,633833,LOCAL,84480,CPT,,,,,,Outpatient,,,48,17.02,United Health ,United Health Medicare Advantage,33.01,,,,,,,Fee Schedule,18.43,33.01411765,
97035 OT ULTRASOUND,9850026,LOCAL,97035,CPT,,,,,GO,Outpatient,,,48.35,31,United Health ,United Health Medicare Advantage,13.34,,,,,,,Fee Schedule,13.34,47.26,
97035 OT Ultrasound Assistant Units,9860026,LOCAL,97035,CPT,,,,,GO|CO,Outpatient,,,48.35,31,United Health ,United Health Medicare Advantage,13.34,,,,,,,Fee Schedule,13.34,47.26,
97035 PT ULTRASOUND,9640026,LOCAL,97035,CPT,,,,,GP,Outpatient,,,48.35,31,United Health ,United Health Medicare Advantage,13.34,,,,,,,Fee Schedule,13.34,47.26,
97035 PT Ultrasound Assistant Units,9650026,LOCAL,97035,CPT,,,,,GP|CQ,Outpatient,,,48.35,31,United Health ,United Health Medicare Advantage,13.34,,,,,,,Fee Schedule,13.34,47.26,
97035 ULTRASOUND EA 15 MIN CHARGE,9410126,LOCAL,97035,CPT,,,,,GP,Outpatient,,,48.35,31,United Health ,United Health Medicare Advantage,13.34,,,,,,,Fee Schedule,13.34,47.26,
OT Ultrasound Assistant Units,1366376,LOCAL,97035,CPT,,,,,CQ,Outpatient,,,48.35,31,United Health ,United Health Medicare Advantage,13.34,,,,,,,Fee Schedule,13.34,47.26,
OT Ultrasound Charges,1366376,LOCAL,97035,CPT,,,,,GO,Outpatient,,,48.35,31,United Health ,United Health Medicare Advantage,13.34,,,,,,,Fee Schedule,13.34,47.26,
OT Ultrasound Units,1373448,LOCAL,97035,CPT,,,,,GO,Outpatient,,,48.35,31,United Health ,United Health Medicare Advantage,13.34,,,,,,,Fee Schedule,13.34,47.26,
PT Ultrasound Assistant Units,9390428,LOCAL,97035,CPT,,,,,CQ,Outpatient,,,48.35,31,United Health ,United Health Medicare Advantage,13.34,,,,,,,Fee Schedule,13.34,47.26,
Ultrasound Charges,1366376,LOCAL,97035,CPT,,,,,GO,Outpatient,,,48.35,31,United Health ,United Health Medicare Advantage,13.34,,,,,,,Fee Schedule,13.34,47.26,
Ultrasound Charges,7895933,LOCAL,97035,CPT,,,,,GP,Outpatient,,,48.35,31,United Health ,United Health Medicare Advantage,13.34,,,,,,,Fee Schedule,13.34,47.26,
Phenobarbital QSTC,8972760,LOCAL,80184,CPT,,,,,,Outpatient,,,48.65,18.36,United Health ,United Health Medicare Advantage,15.3,,,,,,,Fee Schedule,15.3,15.38,
"penicillin G potassium 5,000,000 units injection [CULL]",11211091,LOCAL,J2540,CPT,,,,,,Outpatient,1,EA,48.84864,,United Health ,United Health Medicare Advantage,0.78,,,,,,,Fee Schedule,0.78,0.78,
Semen Analysis Post Vasectomy,3454457,LOCAL,89320,CPT,,,,,,Outpatient,,,48.96,14.77,United Health ,United Health Medicare Advantage,12.31,,,,,,,Fee Schedule,12.31,14.07,
"HIV Ag/Ab, 4th Gen w reflexes QSTC",8764806,LOCAL,87389,CPT,,,,,,Outpatient,,,49.5,28.9,United Health ,United Health Medicare Advantage,36.55,,,,,,,Fee Schedule,10.57,36.55,
"Phenytoin, Free QSTC",8764686,LOCAL,80186,CPT,,,,,,Outpatient,,,49.5,16.51,United Health ,United Health Medicare Advantage,31.5,,,,,,,Fee Schedule,15.38,31.495,
"T3, Reverse, LCMSMS QSTC",8764804,LOCAL,84482,CPT,,,,,,Outpatient,,,49.5,18.91,United Health ,United Health Medicare Advantage,32.48,,,,,,,Fee Schedule,18.43,32.475,
"82140 Ammonium, 24 HR, U",14789403,LOCAL,82140,CPT,,,,,,Outpatient,,,49.65,17.48,United Health ,United Health Medicare Advantage,22.63,,,,,,,Fee Schedule,17.73,22.62909091,
"82340 Calcium, 24 HR, U",14797185,LOCAL,82340,CPT,,,,,,Outpatient,,,49.65,7.24,United Health ,United Health Medicare Advantage,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
"82436 Chloride, 24 HR, U",14797182,LOCAL,82436,CPT,,,,,,Outpatient,,,49.65,6.9,United Health ,United Health Medicare Advantage,5.75,,,,,,,Fee Schedule,5.75,7.16,
"82507 Citrate Excretion, 24 HR, U",14787436,LOCAL,82507,CPT,,,,,,Outpatient,,,49.65,33.36,United Health ,United Health Medicare Advantage,30.63,,,,,,,Fee Schedule,17.73,30.625,
"82570 Creatinine, 24 HR, U",14798767,LOCAL,82570,CPT,,,,,,Outpatient,,,49.65,6.22,United Health ,United Health Medicare Advantage,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"83735 Magnesium, 24 HR, U",14789401,LOCAL,83735,CPT,,,,,,Outpatient,,,49.65,8.04,United Health ,United Health Medicare Advantage,3.66,,,,,,,Fee Schedule,3.657824427,7.16,
"83945 Oxalate, 24 HR, U",14797186,LOCAL,83945,CPT,,,,,,Outpatient,,,49.65,17.34,United Health ,United Health Medicare Advantage,24.09,,,,,,,Fee Schedule,17.73,24.085,
"84105 Phosphorus, 24 HR, U",14787442,LOCAL,84105,CPT,,,,,,Outpatient,,,49.65,6.94,United Health ,United Health Medicare Advantage,19.84,,,,,,,Fee Schedule,7.16,19.835,
"84133 Potassium, 24 HR, U",14797183,LOCAL,84133,CPT,,,,,,Outpatient,,,49.65,5.68,United Health ,United Health Medicare Advantage,19.32,,,,,,,Fee Schedule,7.16,19.32,
"84300 Sodium, 24 HR, U",14797184,LOCAL,84300,CPT,,,,,,Outpatient,,,49.65,6.07,United Health ,United Health Medicare Advantage,9.74,,,,,,,Fee Schedule,7.16,9.74,
"84540 Urea Nitrogen, 24 HR, U",14789404,LOCAL,84540,CPT,,,,,,Outpatient,,,49.65,6.67,United Health ,United Health Medicare Advantage,5.56,,,,,,,Fee Schedule,5.56,7.16,
"84560 Uric Acid, 24 HR, U",14787441,LOCAL,84560,CPT,,,,,,Outpatient,,,49.65,6.1,United Health ,United Health Medicare Advantage,19.49,,,,,,,Fee Schedule,7.16,19.49,
BUPivacaine 0.5% preservative-free injectable solution 30 mL [CULL],11282051,LOCAL,J0665,CPT,,,,,,Outpatient,30,ML,49.68576,,United Health ,United Health Medicare Advantage,0.01,,,,,,,Fee Schedule,0.01,0.011,
deferoxamine 500 mg injection [CULL],11214520,LOCAL,J0895,CPT,,,,,,Outpatient,1,EA,49.728,,United Health ,United Health Medicare Advantage,8.47,,,,,,,Fee Schedule,8.468,8.468,
C-Peptide,12252873,LOCAL,84681,CPT,,,,,,Outpatient,,,50,24.97,United Health ,United Health Medicare Advantage,33.24,,,,,,,Fee Schedule,17.73,33.24444444,
D-Dimer,3454398,LOCAL,85380,CPT,,,,,,Outpatient,,,50,12.22,United Health ,United Health Medicare Advantage,5.76,,,,,,,Fee Schedule,5.76079096,8.21,
G0447 BEHAVIORAL COUNSIL OBESITY 15 MIN CHARGE,8635988,LOCAL,,,G0447,HCPCS,,,,Outpatient,,,50,33,United Health ,United Health Medicare Advantage,84.57,,,,,,,Fee Schedule,84.57,177.17,
Hepatitis B S Ab,1628908,LOCAL,86706,CPT,,,,,,Outpatient,,,50,12.89,United Health ,United Health Medicare Advantage,17.79,,,,,,,Fee Schedule,15.29,17.794,
Hepatitis B Surface Antibody w/ Interp,9299896,LOCAL,86706,CPT,,,,,,Outpatient,,,50,12.89,United Health ,United Health Medicare Advantage,17.79,,,,,,,Fee Schedule,15.29,17.794,
Lactate Dehydrogenase Body Fluid,3454444,LOCAL,83615,CPT,,,,,,Outpatient,,,50,7.25,United Health ,United Health Medicare Advantage,21.68,,,,,,,Fee Schedule,7.16,21.675,
"Cytomegalovirus Antibodies (IgG,IgM) QSTC",8972893,LOCAL,86645,CPT,,,,,,Outpatient,,,50.4,20.22,United Health ,United Health Medicare Advantage,16.85,,,,,,,Fee Schedule,15.29,16.85,
Cytomegalovirus Antibody (IgM) QSTC,8764581,LOCAL,86645,CPT,,,,,,Outpatient,,,50.4,20.22,United Health ,United Health Medicare Advantage,16.85,,,,,,,Fee Schedule,15.29,16.85,
Micronutrient Vitamin E QSTC,14116320,LOCAL,84446,CPT,,,,,,Outpatient,,,50.4,17.02,United Health ,United Health Medicare Advantage,14.18,,,,,,,Fee Schedule,14.18,17.73,
Vitamin A (Retinol) QSTC,8764529,LOCAL,84590,CPT,,,,,,Outpatient,,,50.4,13.93,United Health ,United Health Medicare Advantage,30.89,,,,,,,Fee Schedule,17.73,30.89,
Ethosuximide QSTC,8764552,LOCAL,80168,CPT,,,,,,Outpatient,,,50.54,19.61,United Health ,United Health Medicare Advantage,16.34,,,,,,,Fee Schedule,15.38,16.34,
77061 MG Diagnostic Tomo Charge: AddOn Left,13960722,LOCAL,G0279,CPT,,,,,LT,Outpatient,,,50.92,,United Health ,United Health Medicare Advantage,11.11,,,,,,,Fee Schedule,11.11,74,
77061 MG Diagnostic Tomo Charge: AddOn Right,13960723,LOCAL,G0279,CPT,,,,,RT,Outpatient,,,50.92,,United Health ,United Health Medicare Advantage,11.11,,,,,,,Fee Schedule,11.11,74,
77061 MG Diagnostic Tomo Charge: AddOn Right,13969683,LOCAL,G0279,CPT,,,,,RT,Outpatient,,,50.92,,United Health ,United Health Medicare Advantage,11.11,,,,,,,Fee Schedule,11.11,74,
77063 MG Tomo Charge: AddOn Left,13621442,LOCAL,77063,CPT,,,,,LT,Outpatient,,,50.92,54.45,United Health ,United Health Medicare Advantage,20.75,,,,,,,Fee Schedule,20.75,74,
77063 MG Tomo Charge: AddOn Right,13621441,LOCAL,77063,CPT,,,,,RT,Outpatient,,,50.92,54.45,United Health ,United Health Medicare Advantage,20.75,,,,,,,Fee Schedule,20.75,74,
PC DOPP ART BIL REST,8200579,LOCAL,93923,CPT,,,,,,Outpatient,,,51.06,401,United Health ,United Health Medicare Advantage,143.05,,,,,,,Fee Schedule,143.05,244.97,
acyclovir 50 mg/mL intravenous solution 10 mL [CULL],11201009,LOCAL,J0133,CPT,,,,,,Outpatient,10,ML,51.2,,United Health ,United Health Medicare Advantage,0.12,,,,,,,Fee Schedule,0.119,0.119,
Chloride Level,633621,LOCAL,82435,CPT,,,,,,Outpatient,,,51.41,5.52,United Health ,United Health Medicare Advantage,4.6,,,,,,,Fee Schedule,4.6,7.16,
KOH POCT,10913182,LOCAL,87220,CPT,,,,,,Outpatient,,,51.41,5.12,United Health ,United Health Medicare Advantage,4.27,,,,,,,Fee Schedule,4.27,10.57,
E-Stim for Wound Other Charge,7895924,LOCAL,G0283,CPT,G0283,HCPCS,,,GP,Outpatient,,,51.51,33,United Health ,United Health Medicare Advantage,11.75,,,,,,,Fee Schedule,11.75,47.26,
G0283 INTERFERENCE CHARGES,9640019,LOCAL,,,G0283,HCPCS,,,GP,Outpatient,,,51.51,33,United Health ,United Health Medicare Advantage,11.81,,,,,,,Fee Schedule,11.81,47.26,
G0283 PT Elect Stim Unattended Assistant Units Charge,9650019,LOCAL,,,G0283,HCPCS,,,GP,Outpatient,,,51.51,33,United Health ,United Health Medicare Advantage,11.81,,,,,,,Fee Schedule,11.81,47.26,
G0283 OT ELEC STIM MEDICARE CHARGE,9860018,LOCAL,,,G0283,HCPCS,,,GO|CO,Outpatient,,,51.52,33,United Health ,United Health Medicare Advantage,11.81,,,,,,,Fee Schedule,11.81,47.26,
G0283 OT ESTIM UNATTENDED CHARGE,9850018,LOCAL,,,G0283,HCPCS,,,GO,Outpatient,,,51.52,33,United Health ,United Health Medicare Advantage,11.81,,,,,,,Fee Schedule,11.81,47.26,
OT Unattended E-Stim Assistant Units,7895266,LOCAL,,,G0283,HCPCS,,,CQ,Outpatient,,,51.52,33,United Health ,United Health Medicare Advantage,11.81,,,,,,,Fee Schedule,11.81,47.26,
OTElectrical Stim (Unattended) - Non-Wound,1373552,LOCAL,,,G0283,HCPCS,,,GO,Outpatient,,,51.52,33,United Health ,United Health Medicare Advantage,11.81,,,,,,,Fee Schedule,11.81,47.26,
UA w Micro if Ind,1148022,LOCAL,81003,CPT,,,,,,Outpatient,,,51.6,2.7,United Health ,United Health Medicare Advantage,3.8,,,,,,,Fee Schedule,3.795286195,4.02,
UA w Micro if Ind & Cult if Ind,8088555,LOCAL,81003,CPT,,,,,,Outpatient,,,51.6,2.7,United Health ,United Health Medicare Advantage,3.8,,,,,,,Fee Schedule,3.795286195,4.02,
Urinalysis Macroscopic,633863,LOCAL,81003,CPT,,,,,,Outpatient,,,51.6,2.7,United Health ,United Health Medicare Advantage,3.8,,,,,,,Fee Schedule,3.795286195,4.02,
"T4, Free, Direct Dialysis QSTC",13864535,LOCAL,84439,CPT,,,,,,Outpatient,,,51.98,10.82,United Health ,United Health Medicare Advantage,28.58,,,,,,,Fee Schedule,18.43,28.58065455,
"Immunofixation, Serum QSTC",8764779,LOCAL,86334,CPT,,,,,,Outpatient,,,52.7,26.81,United Health ,United Health Medicare Advantage,37.3,,,,,,,Fee Schedule,15.29,37.3,
77061 MG Diagnostic Tomo Charge: AddOn Left,13960724,LOCAL,G0279,CPT,,,,,LT,Outpatient,,,52.92,,United Health ,United Health Medicare Advantage,11.11,,,,,,,Fee Schedule,11.11,74,
"CtrachomatisRNA, TMA, Urog QSTC",8996973,LOCAL,87491,CPT,,,,,QW,Outpatient,,,53.48,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
"NgonorrhoeaeRNA, TMA, Urog QSTC",8996974,LOCAL,87591,CPT,,,,,QW,Outpatient,,,53.48,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Chlamydia Trachomatis RNA, TMA QST",8395007,LOCAL,87491,CPT,,,,,,Outpatient,,,53.5,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",8395010,LOCAL,87591,CPT,,,,,,Outpatient,,,53.5,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
"N. Gonorrhoeae RNA, TMA, Urogenital QSTC",13864518,LOCAL,87591,CPT,,,,,QW,Outpatient,,,53.51,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
Homocysteine QSTC,8764574,LOCAL,83090,CPT,,,,,,Outpatient,,,53.55,21.5,United Health ,United Health Medicare Advantage,17.92,,,,,,,Fee Schedule,17.92,18.43,
"Mycobact Culture, w Fluorochrome Sm QSTC",9039257,LOCAL,87116,CPT,,,,,,Outpatient,,,53.55,12.96,United Health ,United Health Medicare Advantage,25.66,,,,,,,Fee Schedule,10.57,25.656,
"Mycobacteria, Cult, w Fluoro Smear QST",9039257,LOCAL,87116,CPT,,,,,,Outpatient,,,53.55,12.96,United Health ,United Health Medicare Advantage,25.66,,,,,,,Fee Schedule,10.57,25.656,
ampicillin 2 g injection [CULL],11201144,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,53.6096,,United Health ,United Health Medicare Advantage,0.59,,,,,,,Fee Schedule,0.591,0.591,
DOBUTamine 2 mg/mL-D5% intravenous solution 250 mL [CULL],11201692,LOCAL,J1250,CPT,,,,,,Outpatient,250,ML,53.68,,United Health ,United Health Medicare Advantage,8.02,,,,,,,Fee Schedule,8.024,8.024,
acetylcysteine 20% inhalation solution 4 mL [CULL],11205094,LOCAL,J7608,CPT,,,,,,Outpatient,4,ML,53.7984,,United Health ,United Health Medicare Advantage,8.46,,,,,,,Fee Schedule,8.455,8.455,
"Angiotensin Converting Enzyme (ACE), CSF QSTC",10170069,LOCAL,82164,CPT,,,,,,Outpatient,,,54,17.52,United Health ,United Health Medicare Advantage,27.41,,,,,,,Fee Schedule,17.73,27.405,
"Endomysial Ab Screen IgA, Rfx Titer QSTC",8764677,LOCAL,86231,CPT,,,,,,Outpatient,,,54,14.51,United Health ,United Health Medicare Advantage,106.94,,,,,,,Fee Schedule,15.29,106.935,
Hexagonal Phase Confirm. QSTC,9039456,LOCAL,85598,CPT,,,,,,Outpatient,,,54,21.58,United Health ,United Health Medicare Advantage,17.98,,,,,,,Fee Schedule,5.42,17.98,
hs-CRP QSTC,8853237,LOCAL,86141,CPT,,,,,,Outpatient,,,54,15.54,United Health ,United Health Medicare Advantage,12.95,,,,,,,Fee Schedule,12.95,15.29,
Lipoprotein (a) QSTC,8853258,LOCAL,83695,CPT,,,,,,Outpatient,,,54,17.18,United Health ,United Health Medicare Advantage,14.32,,,,,,,Fee Schedule,14.32,17.73,
"Oligoclonal Bands (IgG), CSF QSTC",8764540,LOCAL,83916,CPT,,,,,,Outpatient,,,54,32.87,United Health ,United Health Medicare Advantage,27.39,,,,,,,Fee Schedule,17.73,27.39,
"Plasma Renin Activity, LC/MS/MS QSTC",8764647,LOCAL,84244,CPT,,,,,,Outpatient,,,54,26.39,United Health ,United Health Medicare Advantage,37.78,,,,,,,Fee Schedule,18.43,37.78,
"Vitamin D, 1,25-Dihydroxy QSTC",8764639,LOCAL,82652,CPT,,,,,,Outpatient,,,54,46.2,United Health ,United Health Medicare Advantage,38.5,,,,,,,Fee Schedule,38.5,46.74,
Apolipoprotein Evaluation QSTC,13864521,LOCAL,82172,CPT,,,,,,Outpatient,,,54.36,25.31,United Health ,United Health Medicare Advantage,37.52,,,,,,,Fee Schedule,17.73,37.515,
nitroglycerin 5 mg/mL intravenous solution 10 mL [CULL],11211028,LOCAL,J2305,CPT,,,,,,Outpatient,10,ML,54.7968,,United Health ,United Health Medicare Advantage,1.52,,,,,,,Fee Schedule,1.523,1.523,
"C1 Esterase Inhibitor, Protein QSTC",8764554,LOCAL,86160,CPT,,,,,,Outpatient,,,54.9,14.4,United Health ,United Health Medicare Advantage,36.91,,,,,,,Fee Schedule,15.29,36.909,
droNABinol 5 mg Cap [CULL],11200011,LOCAL,Q0167,CPT,,,,,,Outpatient,1,EA,54.9824,,United Health ,United Health Medicare Advantage,1.35,,,,,,,Fee Schedule,1.352,1.352,
Hepatitis B Surface Antigen,633752,LOCAL,87340,CPT,,,,,,Outpatient,,,55,12.4,United Health ,United Health Medicare Advantage,22.2,,,,,,,Fee Schedule,10.57,22.20058824,
Hepatitis B Surface Antigen w/ Interp,9517997,LOCAL,87340,CPT,,,,,,Outpatient,,,55,12.4,United Health ,United Health Medicare Advantage,22.2,,,,,,,Fee Schedule,10.57,22.20058824,
HIV 1/2 Antibody Screen (exposure only),9609059,LOCAL,86701,CPT,,,,,,Outpatient,,,55,10.67,United Health ,United Health Medicare Advantage,8.89,,,,,,,Fee Schedule,8.89,15.29,
IMMOBILIZER KNEE LARGE,11071020,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,55,158,United Health ,United Health Medicare Advantage,77.23,,,,,,,Fee Schedule,77.23,77.23,
IMMOBILIZER KNEE XL 79-80028,11070735,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,55,158,United Health ,United Health Medicare Advantage,77.23,,,,,,,Fee Schedule,77.23,77.23,
Potassium POCT,9616981,LOCAL,84132,CPT,,,,,,Outpatient,,,55,5.71,United Health ,United Health Medicare Advantage,8.7,,,,,,,Fee Schedule,7.16,8.697880184,
IMMOBILIZER KNEE MEDIUM,11071084,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,55.06,158,United Health ,United Health Medicare Advantage,77.23,,,,,,,Fee Schedule,77.23,77.23,
IMMOBILIZER KNEE SMALL,11071082,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,55.06,158,United Health ,United Health Medicare Advantage,77.23,,,,,,,Fee Schedule,77.23,77.23,
Additional Testing PTT-LA QSTC,9004754,LOCAL,85730,CPT,,,,,,Outpatient,,,55.1,7.21,United Health ,United Health Medicare Advantage,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
dRVVT Mix Interpretation: QSTC,9004757,LOCAL,85613,CPT,,,,,,Outpatient,,,55.1,11.5,United Health ,United Health Medicare Advantage,9.58,,,,,,,Fee Schedule,5.42,9.58,
Valproic Acid Level,3170351,LOCAL,80164,CPT,,,,,,Outpatient,,,55.49,16.25,United Health ,United Health Medicare Advantage,34.38,,,,,,,Fee Schedule,15.38,34.38,
.RMSF IgG Titer QSTC,8764766,LOCAL,86757,CPT,,,,,,Outpatient,,,56.25,23.22,United Health ,United Health Medicare Advantage,19.35,,,,,,,Fee Schedule,15.29,19.35,
.RMSF IgM Titer QSTC,8764765,LOCAL,86757,CPT,,,,,,Outpatient,,,56.25,23.22,United Health ,United Health Medicare Advantage,19.35,,,,,,,Fee Schedule,15.29,19.35,
HIV 1 Antibody QSTC,8852095,LOCAL,86701,CPT,,,,,,Outpatient,,,56.25,10.67,United Health ,United Health Medicare Advantage,8.89,,,,,,,Fee Schedule,8.89,15.29,
HIV 2 Antibody QSTC,8852096,LOCAL,86702,CPT,,,,,,Outpatient,,,56.25,16.22,United Health ,United Health Medicare Advantage,13.52,,,,,,,Fee Schedule,13.52,15.29,
"Aldosterone, LC/MS QSTC",8853271,LOCAL,82088,CPT,,,,,,Outpatient,,,56.93,48.9,United Health ,United Health Medicare Advantage,48.44,,,,,,,Fee Schedule,18.43,48.435,
Calcium Level Total,1628887,LOCAL,82310,CPT,,,,,,Outpatient,,,57.12,6.19,United Health ,United Health Medicare Advantage,5.16,,,,,,,Fee Schedule,5.16,7.16,
EPINEPHrine 1 mg/mL injectable solution 1 mL [CULL],11202413,LOCAL,J0169,CPT,,,,,,Outpatient,1,ML,57.4464,,United Health ,United Health Medicare Advantage,1.38,,,,,,,Fee Schedule,1.383,1.383,
Bill UA With Microscopic,14634624,LOCAL,81001,CPT,,,,,,Outpatient,,,57.6,3.8,United Health ,United Health Medicare Advantage,6.91,,,,,,,Fee Schedule,4.02,6.910081301,
PC DOPP ART BIL EXERCISE,8200578,LOCAL,93924,CPT,,,,,,Outpatient,,,57.94,302,United Health ,United Health Medicare Advantage,143.05,,,,,,,Fee Schedule,143.05,161.71,
Reticulocyte Count,7909814,LOCAL,85044,CPT,,,,,,Outpatient,,,57.94,5.17,United Health ,United Health Medicare Advantage,16.96,,,,,,,Fee Schedule,8.21,16.95545455,
Reticulocyte Count with Immature Reticulocyte Fraction,3454466,LOCAL,85044,CPT,,,,,,Outpatient,,,57.94,5.17,United Health ,United Health Medicare Advantage,16.96,,,,,,,Fee Schedule,8.21,16.95545455,
clindamycin 900 mg/50 mL-D5% intravenous solution 50 mL [CULL],11212348,LOCAL,J0736,CPT,,,,,,Outpatient,50,ML,57.99733333,,United Health ,United Health Medicare Advantage,0.82,,,,,,,Fee Schedule,0.819,0.819,
milrinone 200 mcg/mL-D5% intravenous solution 100 mL [CULL],11290134,LOCAL,J2260,CPT,,,,,,Outpatient,100,ML,58.368,,United Health ,United Health Medicare Advantage,1.35,,,,,,,Fee Schedule,1.351,1.351,
"Vitamin B6, Plasma QSTC",8853234,LOCAL,84207,CPT,,,,,,Outpatient,,,58.5,33.72,United Health ,United Health Medicare Advantage,40.33,,,,,,,Fee Schedule,17.73,40.33125,
Total Iron Binding Capacity,7050172,LOCAL,84466,CPT,,,,,,Outpatient,,,58.75,15.31,United Health ,United Health Medicare Advantage,29.64,,,,,,,Fee Schedule,17.73,29.64248366,
Total Iron Binding Capacity,10543521,LOCAL,84466,CPT,,,,,,Outpatient,,,58.75,15.31,United Health ,United Health Medicare Advantage,29.64,,,,,,,Fee Schedule,17.73,29.64248366,
"Varicella-Zoster Virus Abs(IgG,IgM) QSTC",8853253,LOCAL,86787,CPT,,,,,,Outpatient,,,59.4,15.46,United Health ,United Health Medicare Advantage,12.88,,,,,,,Fee Schedule,12.88,15.29,
protamine 10 mg/mL injectable solution 5 mL [CULL],11211135,LOCAL,J2720,CPT,,,,,,Outpatient,5,ML,59.4432,,United Health ,United Health Medicare Advantage,1.57,,,,,,,Fee Schedule,1.571,1.571,
Immunoglobulin E QSTC,8764571,LOCAL,82785,CPT,,,,,,Outpatient,,,59.49,19.75,United Health ,United Health Medicare Advantage,203.96,,,,,,,Fee Schedule,17.73,203.9616667,
IMMOBILIZER SHOULDER XXXLARGE,4803390,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,59.62,12,United Health ,United Health Medicare Advantage,67.31,,,,,,,Fee Schedule,67.31,67.31,
orphenadrine 30 mg/mL injectable solution 2 mL [CULL],11212051,LOCAL,J2360,CPT,,,,,,Outpatient,2,ML,59.904,,United Health ,United Health Medicare Advantage,1.76,,,,,,,Fee Schedule,1.756666667,1.756666667,
Cortisol,3352314,LOCAL,82533,CPT,,,,,,Outpatient,,,60,19.56,United Health ,United Health Medicare Advantage,15.2,,,,,,,Fee Schedule,15.196,18.43,
Cortisol 60 Min,8373789,LOCAL,82533,CPT,,,,,,Outpatient,,,60,19.56,United Health ,United Health Medicare Advantage,15.2,,,,,,,Fee Schedule,15.196,18.43,
Free T4 Level,3170324,LOCAL,84439,CPT,,,,,,Outpatient,,,60,10.82,United Health ,United Health Medicare Advantage,28.58,,,,,,,Fee Schedule,18.43,28.58065455,
Hepatitis A Antibody IgM,1628904,LOCAL,86709,CPT,,,,,,Outpatient,,,60,13.51,United Health ,United Health Medicare Advantage,11.26,,,,,,,Fee Schedule,11.26,15.29,
HIV 1/2 Antibody and P24 Screen,633757,LOCAL,87389,CPT,,,,,,Outpatient,,,60,28.9,United Health ,United Health Medicare Advantage,36.55,,,,,,,Fee Schedule,10.57,36.55,
HIV 1/2 Antibody and P24 Screen,633757,LOCAL,G0475,CPT,,,,,,Outpatient,,,60,28.9,United Health ,United Health Medicare Advantage,20.9,,,,,,,Fee Schedule,10.57,36.55,
Protein Body Fluid,1634879,LOCAL,84157,CPT,,,,,,Outpatient,,,60.38,4.8,United Health ,United Health Medicare Advantage,4,,,,,,,Fee Schedule,4,7.16,
IMMOBILIZER SHOULDER XXLARGE 9008-05,4803139,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,60.39,12,United Health ,United Health Medicare Advantage,67.31,,,,,,,Fee Schedule,67.31,67.31,
Aspergillus fumigatus QSTC,9966204,LOCAL,86331,CPT,,,,,,Outpatient,,,60.8,14.38,United Health ,United Health Medicare Advantage,11.98,,,,,,,Fee Schedule,11.98,15.29,
S. viridis QSTC,9966214,LOCAL,86609,CPT,,,,,,Outpatient,,,60.8,15.46,United Health ,United Health Medicare Advantage,12.88,,,,,,,Fee Schedule,12.88,15.29,
T. candidus QSTC,9966205,LOCAL,86606,CPT,,,,,,Outpatient,,,60.8,18.06,United Health ,United Health Medicare Advantage,15.05,,,,,,,Fee Schedule,15.05,15.29,
adenosine 3 mg/mL intravenous solution 2 mL [CULL],11201015,LOCAL,J0153,CPT,,,,,,Outpatient,2,ML,61.056,,United Health ,United Health Medicare Advantage,0.53,,,,,,,Fee Schedule,0.529,0.529,
"Mercury, Blood QSTC",13864924,LOCAL,83825,CPT,,,,,,Outpatient,,,61.2,19.51,United Health ,United Health Medicare Advantage,35.86,,,,,,,Fee Schedule,16.07,35.86038462,
Sex Hormone Binding Glob QSTC,8764670,LOCAL,84270,CPT,,,,,,Outpatient,,,61.2,26.08,United Health ,United Health Medicare Advantage,21.73,,,,,,,Fee Schedule,17.73,21.73,
Stone Analysis w/ Image QSTC,9777240,LOCAL,82365,CPT,,,,,,Outpatient,,,61.2,15.48,United Health ,United Health Medicare Advantage,24.62,,,,,,,Fee Schedule,17.73,24.61666667,
97012 APPLICATION OF TRACTION/MECH CHARGE,8133034,LOCAL,97012,CPT,,,,,GP,Outpatient,,,61.28,40,United Health ,United Health Medicare Advantage,13.47,,,,,,,Fee Schedule,13.47,47.26,
97012 MECH TRACTION THERAPY Assistant Charge,9860050,LOCAL,97012,CPT,,,,,GO|CO,Outpatient,,,61.28,40,United Health ,United Health Medicare Advantage,13.47,,,,,,,Fee Schedule,13.47,47.26,
97012 Mechanical Traction PT,9850050,LOCAL,97012,CPT,,,,,GO,Outpatient,,,61.28,40,United Health ,United Health Medicare Advantage,13.47,,,,,,,Fee Schedule,13.47,47.26,
97012 TRACTION - MECHANICAL,9640018,LOCAL,97012,CPT,,,,,GP,Outpatient,,,61.28,40,United Health ,United Health Medicare Advantage,13.47,,,,,,,Fee Schedule,13.47,47.26,
Mechanical Traction Charge -> Yes,13786833,LOCAL,97012,CPT,,,,,GP,Outpatient,,,61.28,40,United Health ,United Health Medicare Advantage,13.47,,,,,,,Fee Schedule,13.47,47.26,
Mechanical Traction Provided,8510678,LOCAL,97012,CPT,,,,,GP,Outpatient,,,61.28,40,United Health ,United Health Medicare Advantage,13.47,,,,,,,Fee Schedule,13.47,47.26,
OT Mechanical Trac Therapy Asist Units,7897758,LOCAL,97012,CPT,,,,,CQ,Outpatient,,,61.28,40,United Health ,United Health Medicare Advantage,13.47,,,,,,,Fee Schedule,13.47,47.26,
OT Mechanical Traction Therapy Units,7897758,LOCAL,97012,CPT,,,,,GO,Outpatient,,,61.28,40,United Health ,United Health Medicare Advantage,13.47,,,,,,,Fee Schedule,13.47,47.26,
PT Mechanical Traction Assistant Units,9390392,LOCAL,97012,CPT,,,,,CQ,Outpatient,,,61.28,40,United Health ,United Health Medicare Advantage,13.47,,,,,,,Fee Schedule,13.47,47.26,
PT TRACTION MECHANICAL,9650018,LOCAL,97012,CPT,,,,,GP|CQ,Outpatient,,,61.28,40,United Health ,United Health Medicare Advantage,13.47,,,,,,,Fee Schedule,13.47,47.26,
"Ethylene Glycol, Blood QSTC",8764539,LOCAL,82693,CPT,,,,,,Outpatient,,,61.34,17.88,United Health ,United Health Medicare Advantage,14.9,,,,,,,Fee Schedule,14.9,16.07,
vancomycin 1 g/200 mL intravenous solution 200 mL [CULL],11291267,LOCAL,J3372,CPT,,,,,,Outpatient,200,ML,61.44,,United Health ,United Health Medicare Advantage,5.49,,,,,,,Fee Schedule,5.487407407,5.487407407,
HIV 1/2 Antibody Screen,7939338,LOCAL,86703,CPT,,,,,,Outpatient,,,61.7,16.45,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.57,
"Alprazolam (Xanax), Serum QSTC",8972830,LOCAL,80299,CPT,,,,,,Outpatient,,,62.06,22.37,United Health ,United Health Medicare Advantage,18.64,,,,,,,Fee Schedule,15.38,18.64,
Glucose 3 Hour,7973891,LOCAL,82952,CPT,,,,,,Outpatient,,,62.17,4.7,United Health ,United Health Medicare Advantage,3.92,,,,,,,Fee Schedule,3.92,7.16,
Glucose 4 Hour,7973892,LOCAL,82952,CPT,,,,,,Outpatient,,,62.17,4.7,United Health ,United Health Medicare Advantage,3.92,,,,,,,Fee Schedule,3.92,7.16,
Glucose 5 Hour,7973894,LOCAL,82952,CPT,,,,,,Outpatient,,,62.17,4.7,United Health ,United Health Medicare Advantage,3.92,,,,,,,Fee Schedule,3.92,7.16,
"Cyclosporine Trough,LCMSMS QSTC",8764656,LOCAL,80158,CPT,,,,,,Outpatient,,,62.37,21.66,United Health ,United Health Medicare Advantage,18.05,,,,,,,Fee Schedule,15.38,18.05,
"Ova&Parasite,Conc&Perm Smear Result QSTC",8873966,LOCAL,87177,CPT,,,,,,Outpatient,,,62.37,10.68,United Health ,United Health Medicare Advantage,8.9,,,,,,,Fee Schedule,8.9,10.57,
97150  Group Therapeutic Procedure,9640074,LOCAL,97150,CPT,,,,,GP,Outpatient,,,62.69,41,United Health ,United Health Medicare Advantage,16.89,,,,,,,Fee Schedule,16.89,56.44,
97150 OT Group Therapy Charge,9850058,LOCAL,97150,CPT,,,,,GO,Outpatient,,,62.69,41,United Health ,United Health Medicare Advantage,16.89,,,,,,,Fee Schedule,16.89,56.44,
97150 OT Group Therapy Modifier Charge,9860058,LOCAL,97150,CPT,,,,,GO|CO,Outpatient,,,62.69,41,United Health ,United Health Medicare Advantage,16.89,,,,,,,Fee Schedule,16.89,56.44,
97150 PT Group Therapy Assistant Units,9650074,LOCAL,97150,CPT,,,,,GP|CQ,Outpatient,,,62.69,41,United Health ,United Health Medicare Advantage,16.89,,,,,,,Fee Schedule,16.89,56.44,
Group Therapy Charge,7895938,LOCAL,97150,CPT,,,,,GP,Outpatient,,,62.69,41,United Health ,United Health Medicare Advantage,16.89,,,,,,,Fee Schedule,16.89,56.44,
Group Therapy Provided,7895280,LOCAL,97150,CPT,,,,,GO,Outpatient,,,62.69,41,United Health ,United Health Medicare Advantage,16.89,,,,,,,Fee Schedule,16.89,56.44,
OT Group Therapy Assistant Units,7895280,LOCAL,97150,CPT,,,,,CQ,Outpatient,,,62.69,41,United Health ,United Health Medicare Advantage,16.89,,,,,,,Fee Schedule,16.89,56.44,
OT Group Therapy Assistant Units,7897695,LOCAL,97150,CPT,,,,,CQ,Outpatient,,,62.69,41,United Health ,United Health Medicare Advantage,16.89,,,,,,,Fee Schedule,16.89,56.44,
OT Group Therapy Rehab Units,7897695,LOCAL,97150,CPT,,,,,GO,Outpatient,,,62.69,41,United Health ,United Health Medicare Advantage,16.89,,,,,,,Fee Schedule,16.89,56.44,
PT Group Therapy Assistant Units,9390418,LOCAL,97150,CPT,,,,,CQ,Outpatient,,,62.69,41,United Health ,United Health Medicare Advantage,16.89,,,,,,,Fee Schedule,16.89,56.44,
"Giardia Antigen, EIA, Stool QSTC",8972764,LOCAL,87329,CPT,,,,,,Outpatient,,,63,14.38,United Health ,United Health Medicare Advantage,11.98,,,,,,,Fee Schedule,10.57,11.98,
Methylmalonic Acid QSTC,8853212,LOCAL,83921,CPT,,,,,,Outpatient,,,63,25.45,United Health ,United Health Medicare Advantage,21.21,,,,,,,Fee Schedule,17.73,21.21,
Nortriptyline QSTC,8853203,LOCAL,80299,CPT,,,,,,Outpatient,,,63.45,22.37,United Health ,United Health Medicare Advantage,18.64,,,,,,,Fee Schedule,15.38,18.64,
97034 CONTRAST BATH THERAPY,9860025,LOCAL,97034,CPT,,,,,GO|CO,Outpatient,,,63.72,41,United Health ,United Health Medicare Advantage,13.05,,,,,,,Fee Schedule,13.05,47.26,
97034 CONTRAST BATHS EACH 15 MIN CHARGE,9640025,LOCAL,97034,CPT,,,,,GP,Outpatient,,,63.72,41,United Health ,United Health Medicare Advantage,13.05,,,,,,,Fee Schedule,13.05,47.26,
97034 OT CONTRAST BATH 15 MIN APPL CHARGE,9850025,LOCAL,97034,CPT,,,,,GO,Outpatient,,,63.72,41,United Health ,United Health Medicare Advantage,13.05,,,,,,,Fee Schedule,13.05,47.26,
97034 PT CONTRAST BATH 15 MIN ASST,9650025,LOCAL,97034,CPT,,,,,GP|CQ,Outpatient,,,63.72,41,United Health ,United Health Medicare Advantage,13.05,,,,,,,Fee Schedule,13.05,47.26,
OT Contrast Bath Assistant Units,7895283,LOCAL,97034,CPT,,,,,CQ,Outpatient,,,63.72,41,United Health ,United Health Medicare Advantage,13.05,,,,,,,Fee Schedule,13.05,47.26,
OT Contrast Bath Assistant Units,1373567,LOCAL,97034,CPT,,,,,CQ,Outpatient,,,63.72,41,United Health ,United Health Medicare Advantage,13.05,,,,,,,Fee Schedule,13.05,47.26,
OT Contrast Bath Charges,7895283,LOCAL,97034,CPT,,,,,GO,Outpatient,,,63.72,41,United Health ,United Health Medicare Advantage,13.05,,,,,,,Fee Schedule,13.05,47.26,
OT Contrast Bath Units,1373567,LOCAL,97034,CPT,,,,,GO,Outpatient,,,63.72,41,United Health ,United Health Medicare Advantage,13.05,,,,,,,Fee Schedule,13.05,47.26,
PT Attended E-Stim Assistant Units,9390422,LOCAL,97034,CPT,,,,,CQ,Outpatient,,,63.72,41,United Health ,United Health Medicare Advantage,13.05,,,,,,,Fee Schedule,13.05,47.26,
PT Contrast Bath Charges,7895979,LOCAL,97034,CPT,,,,,GP,Outpatient,,,63.72,41,United Health ,United Health Medicare Advantage,13.05,,,,,,,Fee Schedule,13.05,47.26,
BRACE ANKLE LG,9400076,LOCAL,,,L1902,HCPCS,,,,Outpatient,,,64.13,,United Health ,United Health Medicare Advantage,94.39,,,,,,,Fee Schedule,94.39,94.39,
Medium Ankle Brace,9400086,LOCAL,,,L1902,HCPCS,,,,Outpatient,,,64.13,,United Health ,United Health Medicare Advantage,94.39,,,,,,,Fee Schedule,94.39,94.39,
"ANA Screen, IFA QSTC",14127792,LOCAL,86038,CPT,,,,,,Outpatient,,,64.31,14.51,United Health ,United Health Medicare Advantage,10.7,,,,,,,Fee Schedule,10.70333333,15.29,
Beta2-Glycoprotein I (IgA) QSTC,14127808,LOCAL,86146,CPT,,,,,,Outpatient,,,64.31,30.54,United Health ,United Health Medicare Advantage,25.45,,,,,,,Fee Schedule,15.29,25.45,
Beta2-Glycoprotein I (IgG) QSTC,14127809,LOCAL,86146,CPT,,,,,,Outpatient,,,64.31,30.54,United Health ,United Health Medicare Advantage,25.45,,,,,,,Fee Schedule,15.29,25.45,
Beta2-Glycoprotein I (IgM) QSTC,14127810,LOCAL,86146,CPT,,,,,,Outpatient,,,64.31,30.54,United Health ,United Health Medicare Advantage,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Ab (IgA) QSTC,14127805,LOCAL,86147,CPT,,,,,,Outpatient,,,64.31,30.54,United Health ,United Health Medicare Advantage,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Ab (IgG) QSTC,14127806,LOCAL,86147,CPT,,,,,,Outpatient,,,64.31,30.54,United Health ,United Health Medicare Advantage,25.45,,,,,,,Fee Schedule,15.29,25.45,
Cardiolipin Ab (IgM) QSTC,14127807,LOCAL,86147,CPT,,,,,,Outpatient,,,64.31,30.54,United Health ,United Health Medicare Advantage,25.45,,,,,,,Fee Schedule,15.29,25.45,
"CCP, Antibody (IgG) QSTC",14127817,LOCAL,86200,CPT,,,,,,Outpatient,,,64.31,15.54,United Health ,United Health Medicare Advantage,7.49,,,,,,,Fee Schedule,7.491935484,15.29,
Centromere B Antibody QSTC,14127802,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Chromatin (Nucleosomal) Ab QSTC,14127794,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Complement Component C3c QSTC,14127803,LOCAL,86160,CPT,,,,,,Outpatient,,,64.31,14.4,United Health ,United Health Medicare Advantage,36.91,,,,,,,Fee Schedule,15.29,36.909,
Complement Component C4c QSTC,14127804,LOCAL,86160,CPT,,,,,,Outpatient,,,64.31,14.4,United Health ,United Health Medicare Advantage,36.91,,,,,,,Fee Schedule,15.29,36.909,
"DNA Ab (DS) Crithidia, IFA QSTC",14127793,LOCAL,86255,CPT,,,,,,Outpatient,,,64.31,14.46,United Health ,United Health Medicare Advantage,12.05,,,,,,,Fee Schedule,12.05,15.29,
Jo-1 Antibody QSTC,14127801,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
"MCV, Antibody QSTC",14127818,LOCAL,83520,CPT,,,,,,Outpatient,,,64.31,20.72,United Health ,United Health Medicare Advantage,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rheumatoid Factor (IgA) QSTC,14127812,LOCAL,83520,CPT,,,,,,Outpatient,,,64.31,20.72,United Health ,United Health Medicare Advantage,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rheumatoid Factor (IgG) QSTC,14127814,LOCAL,83520,CPT,,,,,,Outpatient,,,64.31,20.72,United Health ,United Health Medicare Advantage,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rheumatoid Factor (IgM) QSTC,14127816,LOCAL,83520,CPT,,,,,,Outpatient,,,64.31,20.72,United Health ,United Health Medicare Advantage,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
RNP Antibody QSTC,14127797,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Scl-70 Antibody QSTC,14127800,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-A) QSTC,14127798,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sjogren's Antibody (SS-B) QSTC,14127799,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sm Antibody QSTC,14127795,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Sm/RNP Antibody QSTC,14127796,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Thyroid Peroxidase Abs QSTC,14127819,LOCAL,86376,CPT,,,,,,Outpatient,,,64.31,17.46,United Health ,United Health Medicare Advantage,25.09,,,,,,,Fee Schedule,15.29,25.085,
Calcitonin QSTC,8764739,LOCAL,82308,CPT,,,,,,Outpatient,,,64.8,32.15,United Health ,United Health Medicare Advantage,26.79,,,,,,,Fee Schedule,18.43,26.79,
"DHEA, Unconjugated QSTC",8853248,LOCAL,82626,CPT,,,,,,Outpatient,,,64.8,30.32,United Health ,United Health Medicare Advantage,25.27,,,,,,,Fee Schedule,17.73,25.27,
"Sjogren's Antibodies (SS-A, SS-B) QSTC",8853207,LOCAL,86235,CPT,,,,,,Outpatient,,,64.85,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
Bill Special Stains Group II,8489591,LOCAL,88313,CPT,,,,,,Outpatient,,,64.93,,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,32.32,117.85,
17-Hydroxyprogesterone QSTC,8853287,LOCAL,83498,CPT,,,,,,Outpatient,,,64.94,32.6,United Health ,United Health Medicare Advantage,27.17,,,,,,,Fee Schedule,18.43,27.17,
Carcinoembryonic Antigen,633697,LOCAL,82378,CPT,,,,,,Outpatient,,,65,22.75,United Health ,United Health Medicare Advantage,36.03,,,,,,,Fee Schedule,17.73,36.03017241,
Hepatitis B Core Antibody IgM,1628907,LOCAL,86705,CPT,,,,,,Outpatient,,,65,14.12,United Health ,United Health Medicare Advantage,32.8,,,,,,,Fee Schedule,15.29,32.80285714,
Celiac Disease Comp w/Gliadin Ab IgG QSTC,13864455,LOCAL,82784,CPT,,,,,,Outpatient,,,65.25,11.16,United Health ,United Health Medicare Advantage,34.96,,,,,,,Fee Schedule,7.16,34.958,
Hep B Surface Ag w/Rflx to Confirm. QSTC,9039254,LOCAL,87340,CPT,,,,,,Outpatient,,,65.25,12.4,United Health ,United Health Medicare Advantage,22.2,,,,,,,Fee Schedule,10.57,22.20058824,
Immunoglobulin Panel QSTC,8764543,LOCAL,82784,CPT,,,,,,Outpatient,,,65.25,11.16,United Health ,United Health Medicare Advantage,34.96,,,,,,,Fee Schedule,7.16,34.958,
Body Fluid Cell Count w/ Diff,6213822,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,United Health ,United Health Medicare Advantage,35.8,,,,,,,Fee Schedule,14.07,35.795,
Body Fluid Cell Count with Differential If Indicated,8127214,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,United Health ,United Health Medicare Advantage,35.8,,,,,,,Fee Schedule,14.07,35.795,
Body Fluid Differential,4240538,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,United Health ,United Health Medicare Advantage,35.8,,,,,,,Fee Schedule,14.07,35.795,
CSF Cell Count with Differential If Indicated,3454318,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,United Health ,United Health Medicare Advantage,35.8,,,,,,,Fee Schedule,14.07,35.795,
CSF Differential,3454393,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,United Health ,United Health Medicare Advantage,35.8,,,,,,,Fee Schedule,14.07,35.795,
Digoxin Level,1628891,LOCAL,80162,CPT,,,,,,Outpatient,,,66.1,15.94,United Health ,United Health Medicare Advantage,26.44,,,,,,,Fee Schedule,15.38,26.44,
Potassium Level,633616,LOCAL,84132,CPT,,,,,,Outpatient,,,66.1,5.71,United Health ,United Health Medicare Advantage,8.7,,,,,,,Fee Schedule,7.16,8.697880184,
24hr Urine Creatinine QSTC,10600648,LOCAL,82570,CPT,,,,,,Outpatient,,,66.76,6.22,United Health ,United Health Medicare Advantage,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Aldosterone, 24-Hour Urine QSTC",8995528,LOCAL,82088,CPT,,,,,,Outpatient,,,66.76,48.9,United Health ,United Health Medicare Advantage,48.44,,,,,,,Fee Schedule,18.43,48.435,
"Aspergillus Ab, Immunodiffusion QSTC",13864516,LOCAL,86606,CPT,,,,,,Outpatient,,,66.87,18.06,United Health ,United Health Medicare Advantage,15.05,,,,,,,Fee Schedule,15.05,15.29,
T3 Free,3170323,LOCAL,84481,CPT,,,,,,Outpatient,,,67,20.33,United Health ,United Health Medicare Advantage,34.46,,,,,,,Fee Schedule,18.43,34.46424242,
ANCA Screen w Reflex to ANCA Titer QSTC,8764789,LOCAL,86036,CPT,,,,,,Outpatient,,,67.5,14.46,United Health ,United Health Medicare Advantage,39.66,,,,,,,Fee Schedule,15.29,39.655,
Androstenedione QSTC,8764648,LOCAL,82157,CPT,,,,,,Outpatient,,,67.5,35.14,United Health ,United Health Medicare Advantage,29.28,,,,,,,Fee Schedule,18.43,29.28,
Antithrombin III Activity QSTC,8764597,LOCAL,85300,CPT,,,,,,Outpatient,,,67.5,14.22,United Health ,United Health Medicare Advantage,11.85,,,,,,,Fee Schedule,5.42,11.85,
Influenza A,7909953,LOCAL,87804,CPT,,,,,,Outpatient,,,67.5,19.86,United Health ,United Health Medicare Advantage,6.42,,,,,,,Fee Schedule,6.419753086,10.57,
Influenza B,7909954,LOCAL,87804,CPT,,,,,,Outpatient,,,67.5,19.86,United Health ,United Health Medicare Advantage,6.42,,,,,,,Fee Schedule,6.419753086,10.57,
"Protein C, Activity QSTC",8764685,LOCAL,85303,CPT,,,,,,Outpatient,,,67.5,16.61,United Health ,United Health Medicare Advantage,13.84,,,,,,,Fee Schedule,5.42,13.84,
"Protein S Antigen, Free QSTC",9777259,LOCAL,85306,CPT,,,,,,Outpatient,,,67.5,18.38,United Health ,United Health Medicare Advantage,15.32,,,,,,,Fee Schedule,5.42,15.32,
"Protein S, Activity QSTC",8764774,LOCAL,85306,CPT,,,,,,Outpatient,,,67.5,18.38,United Health ,United Health Medicare Advantage,15.32,,,,,,,Fee Schedule,5.42,15.32,
Shiga Toxin 1 and 2,7939191,LOCAL,87427,CPT,,,,,,Outpatient,,,67.5,14.38,United Health ,United Health Medicare Advantage,29.72,,,,,,,Fee Schedule,10.57,29.71875,
Shiga Toxin 1 and 2,8875416,LOCAL,87427,CPT,,,,,,Outpatient,,,67.5,14.38,United Health ,United Health Medicare Advantage,29.72,,,,,,,Fee Schedule,10.57,29.71875,
Tissue Transglutaminase IgG Ab QSTC,8764825,LOCAL,86364,CPT,,,,,,Outpatient,,,67.5,13.84,United Health ,United Health Medicare Advantage,61.9,,,,,,,Fee Schedule,15.29,61.9,
Vitamin B12 QSTC,9291002,LOCAL,82607,CPT,,,,,,Outpatient,,,67.5,18.1,United Health ,United Health Medicare Advantage,82.43,,,,,,,Fee Schedule,18.43,82.43266533,
Glucose CSF,1628897,LOCAL,82945,CPT,,,,,,Outpatient,,,67.73,4.72,United Health ,United Health Medicare Advantage,3.93,,,,,,,Fee Schedule,3.93,7.16,
Protein CSF,1634881,LOCAL,84157,CPT,,,,,,Outpatient,,,67.73,4.8,United Health ,United Health Medicare Advantage,4,,,,,,,Fee Schedule,4,7.16,
Erythropoietin (EPO) QSTC,8764551,LOCAL,82668,CPT,,,,,,Outpatient,,,68.4,22.55,United Health ,United Health Medicare Advantage,43.41,,,,,,,Fee Schedule,17.73,43.41,
RT Vapotherm Subsequent CHARGE,8143879,LOCAL,94003,CPT,,,,,,Outpatient,,,68.49,613,United Health ,United Health Medicare Advantage,604.42,,,,,,,Fee Schedule,604.42,941,
Hematocrit,633742,LOCAL,85014,CPT,,,,,,Outpatient,,,68.54,2.84,United Health ,United Health Medicare Advantage,12.62,,,,,,,Fee Schedule,8.21,12.62068493,
Hematocrit,1635636,LOCAL,85014,CPT,,,,,,Outpatient,,,68.54,2.84,United Health ,United Health Medicare Advantage,12.62,,,,,,,Fee Schedule,8.21,12.62068493,
Hemoglobin,633741,LOCAL,85018,CPT,,,,,,Outpatient,,,68.54,2.84,United Health ,United Health Medicare Advantage,10.94,,,,,,,Fee Schedule,8.21,10.94316176,
Hemoglobin,1635635,LOCAL,85018,CPT,,,,,,Outpatient,,,68.54,2.84,United Health ,United Health Medicare Advantage,10.94,,,,,,,Fee Schedule,8.21,10.94316176,
C1 Esterase Inhibitor QST,13870084,LOCAL,86160,CPT,,,,,,Outpatient,,,68.85,14.4,United Health ,United Health Medicare Advantage,36.91,,,,,,,Fee Schedule,15.29,36.909,
"C1 Esterase Inhibitor, Functional QSTC",8853251,LOCAL,86161,CPT,,,,,,Outpatient,,,68.85,14.4,United Health ,United Health Medicare Advantage,12,,,,,,,Fee Schedule,12,15.29,
Antibody Screen Gel 2,8196056,LOCAL,86850,CPT,,,,,,Outpatient,,,68.88,11.72,United Health ,United Health Medicare Advantage,48.85,,,,,,,Fee Schedule,6.29,48.85,
Antibody Screen Tube.,8417431,LOCAL,86850,CPT,,,,,,Outpatient,,,68.88,11.72,United Health ,United Health Medicare Advantage,48.85,,,,,,,Fee Schedule,6.29,48.85,
BB RH (D) TYPE XX,6432042,LOCAL,86901,CPT,,,,,,Outpatient,,,68.88,3.59,United Health ,United Health Medicare Advantage,35.88,,,,,,,Fee Schedule,6.29,35.88,
Acid Fast Stain Report,634214,LOCAL,87206,CPT,,,,,,Outpatient,,,69.36,6.47,United Health ,United Health Medicare Advantage,34.45,,,,,,,Fee Schedule,10.57,34.45384615,
Milk Component Panel QSTC,8912186,LOCAL,86008,CPT,,,,,,Outpatient,,,69.39,21.52,United Health ,United Health Medicare Advantage,17.93,,,,,,,Fee Schedule,15.29,17.93,
REF TRXN Pathologist Interp,13479165,LOCAL,86078,CPT,,,,,,Outpatient,,,69.8,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.88,156.67,
BB REF RH(D) TYPING TRANSFUSION RXN,6433001,LOCAL,86901,CPT,,,,,,Outpatient,,,69.86,3.59,United Health ,United Health Medicare Advantage,35.88,,,,,,,Fee Schedule,6.29,35.88,
BB REF XMATCH (IAT) TRANSFUSION RXN,6433004,LOCAL,86922,CPT,,,,,,Outpatient,,,69.86,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
REF ABO/Rh (TRXN),13479164,LOCAL,86900,CPT,,,,,,Outpatient,,,69.86,3.59,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,6.29,117.85,
REF Antibody Screen (TRXN),13479162,LOCAL,86850,CPT,,,,,,Outpatient,,,69.86,11.72,United Health ,United Health Medicare Advantage,48.85,,,,,,,Fee Schedule,6.29,48.85,
REF Crossmatch (TRXN),13481255,LOCAL,86920,CPT,,,,,,Outpatient,,,69.86,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
REF DAT (TRXN),13479163,LOCAL,86880,CPT,,,,,,Outpatient,,,69.86,6.47,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,6.29,54.31,
Clostridium difficile Quik Chek Complete,10574492,LOCAL,87324,CPT,,,,,,Outpatient,,,70,14.38,United Health ,United Health Medicare Advantage,20.44,,,,,,,Fee Schedule,10.57,20.4375,
Hemoglobin (POCT),4192190,LOCAL,85018,CPT,,,,,,Outpatient,,,70,2.84,United Health ,United Health Medicare Advantage,10.94,,,,,,,Fee Schedule,8.21,10.94316176,
Hepatitis C Ab,1628911,LOCAL,86803,CPT,,,,,,Outpatient,,,70,17.12,United Health ,United Health Medicare Advantage,32.1,,,,,,,Fee Schedule,15.29,32.10014925,
RT Education/Instruction CHARGE,90840011,LOCAL,94664,CPT,,,,,,Outpatient,,,70.15,46,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,185.95,
"RT Evaluation, Respiratory CHARGE",90840013,LOCAL,94664,CPT,,,,,,Outpatient,,,70.15,46,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,185.95,
tacrolimus 5 mg oral capsule [CULL],11205997,LOCAL,J7507,CPT,,,,,,Outpatient,1,EA,71.352,,United Health ,United Health Medicare Advantage,0.2,,,,,,,Fee Schedule,0.197,0.197,
"Gliadin (Deamidated) Ab (IgG, IgA) QSTC",8764748,LOCAL,86258,CPT,,,,,,Outpatient,,,72,14.46,United Health ,United Health Medicare Advantage,12.05,,,,,,,Fee Schedule,12.05,15.29,
HFO (L3929),10393294,LOCAL,,,L3929,HCPCS,,,,Outpatient,,,72,,United Health ,United Health Medicare Advantage,94.67,,,,,,,Fee Schedule,94.67,94.67,
Hemoglobin A1c,1383763,LOCAL,83036,CPT,,,,,,Outpatient,,,72.22,11.65,United Health ,United Health Medicare Advantage,28.6,,,,,,,Fee Schedule,7.16,28.59604426,
"Arsenic, Blood QSTC",13864922,LOCAL,82175,CPT,,,,,,Outpatient,,,72.27,22.76,United Health ,United Health Medicare Advantage,42.26,,,,,,,Fee Schedule,16.07,42.25673077,
97032 ELECTRIC STIM,8478060,LOCAL,97032,CPT,,,,,GN,Outpatient,,,72.32,47,United Health ,United Health Medicare Advantage,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 ELECTRIC STIM OT,9630084,LOCAL,97032,CPT,,,,,GN,Outpatient,,,72.32,47,United Health ,United Health Medicare Advantage,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 OT E STIM CON - EA 15MIN CHARGE,9856105,LOCAL,97032,CPT,,,,,GO,Outpatient,,,72.32,47,United Health ,United Health Medicare Advantage,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 OT Elec Stim Attended Assistant Units,9866105,LOCAL,97032,CPT,,,,,GO|CO,Outpatient,,,72.32,47,United Health ,United Health Medicare Advantage,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 PT E STIM CON - EA 15MIN CHARGE,9640023,LOCAL,97032,CPT,,,,,GP,Outpatient,,,72.32,47,United Health ,United Health Medicare Advantage,13.8,,,,,,,Fee Schedule,13.8,47.26,
97032 PT Elect Stim Attended Assistant Units,9650023,LOCAL,97032,CPT,,,,,GP|CQ,Outpatient,,,72.32,47,United Health ,United Health Medicare Advantage,13.8,,,,,,,Fee Schedule,13.8,47.26,
Attended E-Stim Charges,1366373,LOCAL,97032,CPT,,,,,GO,Outpatient,,,72.32,47,United Health ,United Health Medicare Advantage,13.8,,,,,,,Fee Schedule,13.8,47.26,
Attended E-Stim Charges,7895926,LOCAL,97032,CPT,,,,,GP,Outpatient,,,72.32,47,United Health ,United Health Medicare Advantage,13.8,,,,,,,Fee Schedule,13.8,47.26,
OT Attended E-Stim Assistant Units,1366373,LOCAL,97032,CPT,,,,,CQ,Outpatient,,,72.32,47,United Health ,United Health Medicare Advantage,13.8,,,,,,,Fee Schedule,13.8,47.26,
OT Attended E-Stim Assistant Units,1373442,LOCAL,97032,CPT,,,,,CQ,Outpatient,,,72.32,47,United Health ,United Health Medicare Advantage,13.8,,,,,,,Fee Schedule,13.8,47.26,
OT Attended E-Stim Charges,1366373,LOCAL,97032,CPT,,,,,GO,Outpatient,,,72.32,47,United Health ,United Health Medicare Advantage,13.8,,,,,,,Fee Schedule,13.8,47.26,
OT Attended E-Stim Units,1373442,LOCAL,97032,CPT,,,,,GO,Outpatient,,,72.32,47,United Health ,United Health Medicare Advantage,13.8,,,,,,,Fee Schedule,13.8,47.26,
PT Attended E-Stim Assistant Units,9396343,LOCAL,97032,CPT,,,,,CQ,Outpatient,,,72.32,47,United Health ,United Health Medicare Advantage,13.8,,,,,,,Fee Schedule,13.8,47.26,
Newborn Hearing Test Type -> Auditory brainstem response,8982858,LOCAL,92700,CPT,,,,,,Outpatient,,,72.72,47,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,22.39,162.41,
"IGF-1, LC/MS QSTC",8764636,LOCAL,84305,CPT,,,,,,Outpatient,,,72.9,25.51,United Health ,United Health Medicare Advantage,46.87,,,,,,,Fee Schedule,18.43,46.87,
"Chlamydia Trachomatis RNA, TMA QST",10578255,LOCAL,87491,CPT,,,,,,Outpatient,,,73.16,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",10578245,LOCAL,87591,CPT,,,,,,Outpatient,,,73.16,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
Thinprep Review Cytotechnologist: QST,10590230,LOCAL,88175,CPT,,,,,,Outpatient,,,73.16,31.93,United Health ,United Health Medicare Advantage,26.61,,,,,,,Fee Schedule,25.25,26.61,
pyridoxine 100 mg/mL injectable solution 1 mL [CULL],11212249,LOCAL,J3415,CPT,,,,,,Outpatient,1,ML,73.1904,,United Health ,United Health Medicare Advantage,15.56,,,,,,,Fee Schedule,15.555,15.555,
97803 RE-ASSESSMENT & INTERVENTION CHARGE,8821410,LOCAL,97803,CPT,,,,,,Outpatient,,,73.41,48,United Health ,United Health Medicare Advantage,21.06,,,,,,,Fee Schedule,21.06,287.34,
Amylase Level,631567,LOCAL,82150,CPT,,,,,,Outpatient,,,73.44,7.78,United Health ,United Health Medicare Advantage,1.24,,,,,,,Fee Schedule,1.237209302,7.16,
Prothrombin Time,7904947,LOCAL,85610,CPT,,,,,,Outpatient,,,73.44,5.15,United Health ,United Health Medicare Advantage,2.36,,,,,,,Fee Schedule,2.355196507,5.42,
Prothrombin Time and INR,633793,LOCAL,85610,CPT,,,,,,Outpatient,,,73.44,5.15,United Health ,United Health Medicare Advantage,2.36,,,,,,,Fee Schedule,2.355196507,5.42,
Vancomycin Level,1634895,LOCAL,80202,CPT,,,,,,Outpatient,,,73.44,16.25,United Health ,United Health Medicare Advantage,29.02,,,,,,,Fee Schedule,15.38,29.0215,
Vancomycin Level Peak,1634896,LOCAL,80202,CPT,,,,,,Outpatient,,,73.44,16.25,United Health ,United Health Medicare Advantage,29.02,,,,,,,Fee Schedule,15.38,29.0215,
Vancomycin Level Trough,1634897,LOCAL,80202,CPT,,,,,,Outpatient,,,73.44,16.25,United Health ,United Health Medicare Advantage,29.02,,,,,,,Fee Schedule,15.38,29.0215,
97016 OT VASOPNEUMATIC DEVICE CHARGE,9850019,LOCAL,97016,CPT,,,,,GO,Outpatient,,,73.6,48,United Health ,United Health Medicare Advantage,11.17,,,,,,,Fee Schedule,11.17,47.26,
97016 PT JOBST COMPRESSION CHARGE,9640020,LOCAL,97016,CPT,,,,,GP,Outpatient,,,73.6,48,United Health ,United Health Medicare Advantage,11.17,,,,,,,Fee Schedule,11.17,47.26,
97016 PT VASOPNEUMATIC DEVICE CHARGE,9650020,LOCAL,97016,CPT,,,,,GP|CQ,Outpatient,,,73.6,48,United Health ,United Health Medicare Advantage,11.17,,,,,,,Fee Schedule,11.17,47.26,
OT Vasopneumatic Device Charge,7895255,LOCAL,97016,CPT,,,,,GO,Outpatient,,,73.6,48,United Health ,United Health Medicare Advantage,11.17,,,,,,,Fee Schedule,11.17,47.26,
OT Vasopneumatic Devices Assistant Units,7895255,LOCAL,97016,CPT,,,,,CQ,Outpatient,,,73.6,48,United Health ,United Health Medicare Advantage,11.17,,,,,,,Fee Schedule,11.17,47.26,
OT Vasopneumatic Devices Units,1373553,LOCAL,97016,CPT,,,,,GO,Outpatient,,,73.6,48,United Health ,United Health Medicare Advantage,11.17,,,,,,,Fee Schedule,11.17,47.26,
PT Vasopneumatic Devices Assistant Units,9390396,LOCAL,97016,CPT,,,,,CQ,Outpatient,,,73.6,48,United Health ,United Health Medicare Advantage,11.17,,,,,,,Fee Schedule,11.17,47.26,
Vasopneumatic Device Charge,7895963,LOCAL,97016,CPT,,,,,GP,Outpatient,,,73.6,48,United Health ,United Health Medicare Advantage,11.17,,,,,,,Fee Schedule,11.17,47.26,
Beta hCG Quantitative,633665,LOCAL,84702,CPT,,,,,,Outpatient,,,75,18.06,United Health ,United Health Medicare Advantage,15.05,,,,,,,Fee Schedule,15.05,18.43,
Flu A -Sofia,8267167,LOCAL,87804,CPT,,,,,,Outpatient,,,75,19.86,United Health ,United Health Medicare Advantage,6.42,,,,,,,Fee Schedule,6.419753086,10.57,
Flu B -Sofia,8267168,LOCAL,87804,CPT,,,,,,Outpatient,,,75,19.86,United Health ,United Health Medicare Advantage,6.42,,,,,,,Fee Schedule,6.419753086,10.57,
pH Venous,3454453,LOCAL,82800,CPT,,,,,,Outpatient,,,75,13.2,United Health ,United Health Medicare Advantage,11,,,,,,,Fee Schedule,11,17.73,
"Protein, Total, 24 Hr Ur QSTC",8851917,LOCAL,84156,CPT,,,,,,Outpatient,,,75,4.4,United Health ,United Health Medicare Advantage,11.68,,,,,,,Fee Schedule,7.16,11.68,
SARS-CoV-2 (COVID-19) IgG Ab,9706404,LOCAL,86769,CPT,,,,,,Outpatient,,,75,50.56,United Health ,United Health Medicare Advantage,42.13,,,,,,,Fee Schedule,15.29,42.13,
Total hCG Quantitative,9299894,LOCAL,84702,CPT,,,,,,Outpatient,,,75,18.06,United Health ,United Health Medicare Advantage,15.05,,,,,,,Fee Schedule,15.05,18.43,
pH Pleural Fluid,9631697,LOCAL,83986,CPT,,,,,,Outpatient,,,75.14,4.3,United Health ,United Health Medicare Advantage,18.76,,,,,,,Fee Schedule,7.16,18.755,
terbutaline 1 mg/mL injectable solution 1 mL [CULL],11212324,LOCAL,J3105,CPT,,,,,,Outpatient,1,ML,75.648,,United Health ,United Health Medicare Advantage,2.47,,,,,,,Fee Schedule,2.473,2.473,
Estradiol Lvl,3170319,LOCAL,82670,CPT,,,,,,Outpatient,,,75.89,33.53,United Health ,United Health Medicare Advantage,51.64,,,,,,,Fee Schedule,18.43,51.64,
"Metanephrines, Fraction, LCMSMS,U24 QSTC",8764626,LOCAL,83835,CPT,,,,,,Outpatient,,,75.96,20.33,United Health ,United Health Medicare Advantage,98.31,,,,,,,Fee Schedule,18.43,98.305,
"Mycobacteria Stain, Acid Fast, Fluorochrome QST",12126168,LOCAL,87206,CPT,,,,,,Outpatient,,,76,6.47,United Health ,United Health Medicare Advantage,34.45,,,,,,,Fee Schedule,10.57,34.45384615,
C1 Esterase Inhibitor Protein QST,13870086,LOCAL,86160,CPT,,,,,,Outpatient,,,76.5,14.4,United Health ,United Health Medicare Advantage,36.91,,,,,,,Fee Schedule,15.29,36.909,
Complement Component C4C QST,13870085,LOCAL,86161,CPT,,,,,,Outpatient,,,76.5,14.4,United Health ,United Health Medicare Advantage,12,,,,,,,Fee Schedule,12,15.29,
"Serotonin, Serum QSTC",8853235,LOCAL,84260,CPT,,,,,,Outpatient,,,76.5,37.18,United Health ,United Health Medicare Advantage,30.98,,,,,,,Fee Schedule,18.43,30.98,
.Thyroglobulin QSTC,13864485,LOCAL,84432,CPT,,,,,,Outpatient,,,76.73,19.27,United Health ,United Health Medicare Advantage,46.24,,,,,,,Fee Schedule,18.43,46.235,
dexAMETHasone 4 mg/mL Sol [CULL],11202297,LOCAL,J1100,CPT,,,,,,Outpatient,1,ML,76.9408,,United Health ,United Health Medicare Advantage,10.49,,,,,,,Fee Schedule,10.48743758,10.48743758,
CT PCR,12526323,LOCAL,87491,CPT,,,,,,Outpatient,,,76.95,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
NG PCR,12526324,LOCAL,87591,CPT,,,,,,Outpatient,,,76.95,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
Alkaline Phosphatase,1620878,LOCAL,84075,CPT,,,,,,Outpatient,,,77.11,6.22,United Health ,United Health Medicare Advantage,5.18,,,,,,,Fee Schedule,5.18,7.16,
G0008 MC ADMIN INFLUENZA VIRUS VACCINE CHARGE,7923017,LOCAL,,,G0008,HCPCS,,,,Outpatient,,,77.13,50,United Health ,United Health Medicare Advantage,42.18,,,,,,,Fee Schedule,42.18,56.18,
G0009 VACCINE ADMINISTRATION PNEUMONIA,12214659,LOCAL,,,G0009,HCPCS,,,,Outpatient,,,77.13,50,United Health ,United Health Medicare Advantage,42.18,,,,,,,Fee Schedule,42.18,56.18,
64461 THORACIC PARAVERTEBRAL BLOCK,5661020,LOCAL,64461,CPT,,,,,,Outpatient,,,77.31,50,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
"Cryoglobulin (% Cryocrit), Serum QSTC",8764756,LOCAL,82595,CPT,,,,,,Outpatient,,,78.75,7.76,United Health ,United Health Medicare Advantage,6.47,,,,,,,Fee Schedule,6.47,7.16,
Group B Strep Culture,7842541,LOCAL,87070,CPT,,,,,,Outpatient,,,79.56,10.34,United Health ,United Health Medicare Advantage,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Partial Thromboplastin Time,633794,LOCAL,85730,CPT,,,,,,Outpatient,,,79.56,7.21,United Health ,United Health Medicare Advantage,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
Partial Thromboplastin Time,7904949,LOCAL,85730,CPT,,,,,,Outpatient,,,79.56,7.21,United Health ,United Health Medicare Advantage,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
Strep Confirmation,8019111,LOCAL,87081,CPT,,,,,,Outpatient,,,79.56,7.96,United Health ,United Health Medicare Advantage,37.18,,,,,,,Fee Schedule,10.57,37.17627685,
99152 MOD SED SAME PHYS/QHP 5/>YRS,8653149,LOCAL,99152,CPT,,,,,,Outpatient,,,79.64,52,United Health ,United Health Medicare Advantage,10.38,,,,,,,Fee Schedule,10.38,34.95,
fluconazole 400 mg/200 mL-NaCl 0.9% intravenous solution 200 mL [CULL],11220722,LOCAL,J1450,CPT,,,,,,Outpatient,200,ML,79.9168,,United Health ,United Health Medicare Advantage,4.48,,,,,,,Fee Schedule,4.48,4.48,
20561 DRY NEEDLING 3+ MUSCLES WO INJECTION,9650049,LOCAL,20561,CPT,,,,,,Outpatient,,,80,52,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,22.39,863,
GC Culture,633895,LOCAL,87081,CPT,,,,,,Outpatient,,,80.78,7.96,United Health ,United Health Medicare Advantage,37.18,,,,,,,Fee Schedule,10.57,37.17627685,
Lactate Dehydrogenase,633770,LOCAL,83615,CPT,,,,,,Outpatient,,,80.78,7.25,United Health ,United Health Medicare Advantage,21.68,,,,,,,Fee Schedule,7.16,21.675,
MRSA Screen Culture,8244872,LOCAL,87081,CPT,,,,,,Outpatient,,,80.78,7.96,United Health ,United Health Medicare Advantage,37.18,,,,,,,Fee Schedule,10.57,37.17627685,
Protein Total,633818,LOCAL,84155,CPT,,,,,,Outpatient,,,80.78,4.4,United Health ,United Health Medicare Advantage,3.67,,,,,,,Fee Schedule,3.67,7.16,
"Bill Only ABID Panel, Selected Cell",8629507,LOCAL,86885,CPT,,,,,,Outpatient,,,81,6.86,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,6.29,156.67,
"Chromium, Serum QSTC",9701437,LOCAL,82495,CPT,,,,,,Outpatient,,,81,24.34,United Health ,United Health Medicare Advantage,20.28,,,,,,,Fee Schedule,16.07,20.28,
Levetiracetam QSTC,8764628,LOCAL,80177,CPT,,,,,,Outpatient,,,81,15.9,United Health ,United Health Medicare Advantage,9.4,,,,,,,Fee Schedule,9.399,15.38,
"Chlamydia Trachomatis RNA, TMA QST",10585658,LOCAL,87491,CPT,,,,,,Outpatient,,,82,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
HPV mRNA E6/E7 QST,10585657,LOCAL,87624,CPT,,,,,,Outpatient,,,82,42.11,United Health ,United Health Medicare Advantage,67.2,,,,,,,Fee Schedule,40.19,67.195,
"Neisseria Gonorrhoeae RNA, TMA QST",10585659,LOCAL,87591,CPT,,,,,,Outpatient,,,82,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
Thinprep Review Cytotechnologist: QST,10585654,LOCAL,88175,CPT,,,,,,Outpatient,,,82,31.93,United Health ,United Health Medicare Advantage,26.61,,,,,,,Fee Schedule,25.25,26.61,
Testosterone Level Total,3170320,LOCAL,84403,CPT,,,,,,Outpatient,,,82.01,30.97,United Health ,United Health Medicare Advantage,52.38,,,,,,,Fee Schedule,18.43,52.3775,
methadone 10 mg/mL Injectable Sol 20 mL UD [CULL],11240064,LOCAL,J1230,CPT,,,,,,Outpatient,1,ML,82.07808,,United Health ,United Health Medicare Advantage,17.7,,,,,,,Fee Schedule,17.7,17.7,
Malaria/Babesia/Other Blood Parasites QSTC,10707969,LOCAL,87207,CPT,,,,,,Outpatient,,,82.35,7.19,United Health ,United Health Medicare Advantage,5.99,,,,,,,Fee Schedule,5.99,10.57,
H. Pylori CLO,9517164,LOCAL,86677,CPT,,,,,,Outpatient,,,83.23,20.22,United Health ,United Health Medicare Advantage,16.85,,,,,,,Fee Schedule,15.29,16.85,
Phosphorus Level,633803,LOCAL,84100,CPT,,,,,,Outpatient,,,83.23,5.69,United Health ,United Health Medicare Advantage,26.45,,,,,,,Fee Schedule,7.16,26.45123596,
"Estrogen, Total, Serum QSTC",8764701,LOCAL,82672,CPT,,,,,,Outpatient,,,83.25,26.04,United Health ,United Health Medicare Advantage,21.7,,,,,,,Fee Schedule,18.43,21.7,
PHENobarbital 65 mg/mL Sol [CULL],11211087,LOCAL,J2560,CPT,,,,,,Outpatient,1,ML,83.7888,,United Health ,United Health Medicare Advantage,29.08,,,,,,,Fee Schedule,29.077,29.077,
97129 ST COG/ATTEN/MEM/PROD CHARGE,9600117,LOCAL,97129,CPT,,,,,GN,Outpatient,,,84.77,114,United Health ,United Health Medicare Advantage,18.94,,,,,,,Fee Schedule,18.94,56.44,
97130 ST Cognitive skills development each additional 15 minutes,9600118,LOCAL,97130,CPT,,,,,GN,Outpatient,,,84.77,114,United Health ,United Health Medicare Advantage,18.08,,,,,,,Fee Schedule,18.08,56.44,
"SLP Cog Ther Intervent, Addl 15Min Units",9399379,LOCAL,97130,CPT,,,,,GN,Outpatient,,,84.77,114,United Health ,United Health Medicare Advantage,18.08,,,,,,,Fee Schedule,18.08,56.44,
"SLP Cog Ther Intervent,First 15Min Units",9399375,LOCAL,97129,CPT,,,,,GN,Outpatient,,,84.77,114,United Health ,United Health Medicare Advantage,18.94,,,,,,,Fee Schedule,18.94,56.44,
97802 MEDICAL NUTRITIONAL THERAPY CHARGE,13475610,LOCAL,97802,CPT,,,,,,Outpatient,,,84.82,55,United Health ,United Health Medicare Advantage,25.2,,,,,,,Fee Schedule,25.2,287.34,
Minimum Inhibitory Concentration,294946,LOCAL,87186,CPT,,,,,,Outpatient,,,85,10.38,United Health ,United Health Medicare Advantage,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
"HPV mRNA E6/E7, POST-$HYSTERECTOMY, VAGINAL QST",14782713,LOCAL,87624,CPT,,,,,,Outpatient,,,85.05,42.11,United Health ,United Health Medicare Advantage,67.2,,,,,,,Fee Schedule,40.19,67.195,
BB REF LAB RH (D) TYPING,6413256,LOCAL,86901,CPT,,,,,,Outpatient,,,85.5,3.59,United Health ,United Health Medicare Advantage,35.88,,,,,,,Fee Schedule,6.29,35.88,
"Ehrlichia chaffeensis Ab (IgG,IgM) QSTC",8853255,LOCAL,86666,CPT,,,,,,Outpatient,,,85.5,12.22,United Health ,United Health Medicare Advantage,10.18,,,,,,,Fee Schedule,10.18,15.29,
REF ABO/Rh,7939266,LOCAL,86900,CPT,,,,,,Outpatient,,,85.5,3.59,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,6.29,117.85,
Uric Acid,633858,LOCAL,84550,CPT,,,,,,Outpatient,,,85.68,5.42,United Health ,United Health Medicare Advantage,35.18,,,,,,,Fee Schedule,7.16,35.17852564,
cefTRIAXone 500 mg injection [CULL],11202193,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,85.9328,,United Health ,United Health Medicare Advantage,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
chloroprocaine 3% preservative-free Sol [CULL],11202203,LOCAL,J2401,CPT,,,,,,Outpatient,20,ML,85.9392,,United Health ,United Health Medicare Advantage,0.04,,,,,,,Fee Schedule,0.01,0.038,
Chol/HDL C QSTC,14129541,LOCAL,80061,CPT,,,,,,Outpatient,,,86,16.07,United Health ,United Health Medicare Advantage,16.6,,,,,,,Fee Schedule,12.14,16.59934459,
HDL P QSTC,14129559,LOCAL,83704,CPT,,,,,,Outpatient,,,86,41.03,United Health ,United Health Medicare Advantage,34.19,,,,,,,Fee Schedule,34.19,46.74,
HPV mRNA E6/E7 QST,9773934,LOCAL,87624,CPT,,,,,,Outpatient,,,86,42.11,United Health ,United Health Medicare Advantage,67.2,,,,,,,Fee Schedule,40.19,67.195,
HPV mRNA E6/E7 QST,9773934,LOCAL,87624,CPT,,,,,,Outpatient,,,86,42.11,United Health ,United Health Medicare Advantage,67.2,,,,,,,Fee Schedule,40.19,67.195,
HPV mRNA E6/E7 QSTC,9773934,LOCAL,87624,CPT,,,,,,Outpatient,,,86,42.11,United Health ,United Health Medicare Advantage,67.2,,,,,,,Fee Schedule,40.19,67.195,
DOBUTamine 1 mg/mL-D5% Sol [CULL],11201073,LOCAL,J1250,CPT,,,,,,Outpatient,250,ML,86.208,,United Health ,United Health Medicare Advantage,8.02,,,,,,,Fee Schedule,8.024,8.024,
Estrone QSTC,8853208,LOCAL,82679,CPT,,,,,,Outpatient,,,86.4,29.94,United Health ,United Health Medicare Advantage,24.95,,,,,,,Fee Schedule,18.43,24.95,
fosphenytoin 500 mgPE/10 mL injectable solution 10 mL [CULL],11205071,LOCAL,Q2009,CPT,,,,,,Outpatient,10,ML,86.4,,United Health ,United Health Medicare Advantage,1.47,,,,,,,Fee Schedule,1.47,1.47,
methacholine varying strength inhalation solution [CULL],11290186,LOCAL,J7674,CPT,,,,,,Outpatient,3,ML,86.4,,United Health ,United Health Medicare Advantage,1.9,,,,,,,Fee Schedule,1.898,1.898,
Cyanide QSTC,13864508,LOCAL,82600,CPT,,,,,,Outpatient,,,86.45,23.28,United Health ,United Health Medicare Advantage,19.4,,,,,,,Fee Schedule,16.07,19.4,
nitroglycerin 200 mcg/mL-D5% intravenous solution 250 mL [CULL],11211024,LOCAL,J2305,CPT,,,,,,Outpatient,250,ML,86.54666667,,United Health ,United Health Medicare Advantage,1.52,,,,,,,Fee Schedule,1.523,1.523,
Electrolyte Panel,633610,LOCAL,80051,CPT,,,,,,Outpatient,,,86.9,8.41,United Health ,United Health Medicare Advantage,7.01,,,,,,,Fee Schedule,7.01,12.14,
Sodium Level,633611,LOCAL,84295,CPT,,,,,,Outpatient,,,86.9,5.77,United Health ,United Health Medicare Advantage,18.32,,,,,,,Fee Schedule,7.16,18.324,
76377 Requiring image post processing on an independent workstation,10740136,LOCAL,76377,CPT,,,,,,Outpatient,,,87,,United Health ,United Health Medicare Advantage,36.62,,,,,,,Fee Schedule,36.62,36.62,
acetylcysteine 20% inhalation solution 30 mL [CULL],11203022,LOCAL,J7608,CPT,,,,,,Outpatient,30,ML,87.62688,,United Health ,United Health Medicare Advantage,8.46,,,,,,,Fee Schedule,8.455,8.455,
Measles Antibody (IgM) QSTC,8853259,LOCAL,86765,CPT,,,,,,Outpatient,,,87.8,15.46,United Health ,United Health Medicare Advantage,12.88,,,,,,,Fee Schedule,12.88,15.29,
Maize/Corn (F8) IgE QSTC,14116318,LOCAL,86001,CPT,,,,,,Outpatient,,,87.93,9.38,United Health ,United Health Medicare Advantage,7.82,,,,,,,Fee Schedule,7.82,15.29,
97022 FLUIDOTHERAPY CHARGES,9646093,LOCAL,97022,CPT,,,,,GP,Outpatient,,,88.1,57,United Health ,United Health Medicare Advantage,14.34,,,,,,,Fee Schedule,14.34,47.26,
97022 OT WHIRLPOOL - ASEPTIC,9856111,LOCAL,97022,CPT,,,,,GO,Outpatient,,,88.1,57,United Health ,United Health Medicare Advantage,14.34,,,,,,,Fee Schedule,14.34,47.26,
97022 OT WHIRLPOOL 1+ AREAS APPL CHARGE,9866111,LOCAL,97022,CPT,,,,,GO|CO,Outpatient,,,88.1,57,United Health ,United Health Medicare Advantage,14.34,,,,,,,Fee Schedule,14.34,47.26,
97022 PT SMALL WHIRLPOOL CHARGE,9656093,LOCAL,97022,CPT,,,,,GP|CQ,Outpatient,,,88.1,57,United Health ,United Health Medicare Advantage,14.34,,,,,,,Fee Schedule,14.34,47.26,
97022 WHIRLPOOL CHARGE,9410091,LOCAL,97022,CPT,,,,,GP,Outpatient,,,88.1,57,United Health ,United Health Medicare Advantage,14.34,,,,,,,Fee Schedule,14.34,47.26,
OT Whirlpool Therapy Assitant Units,9401114,LOCAL,97022,CPT,,,,,CQ,Outpatient,,,88.1,57,United Health ,United Health Medicare Advantage,14.34,,,,,,,Fee Schedule,14.34,47.26,
OT Whirlpool Units,9401114,LOCAL,97022,CPT,,,,,GO,Outpatient,,,88.1,57,United Health ,United Health Medicare Advantage,14.34,,,,,,,Fee Schedule,14.34,47.26,
"OT Whirlpool, Fluidotherapy Assistant Units",1373554,LOCAL,97022,CPT,,,,,CQ,Outpatient,,,88.1,57,United Health ,United Health Medicare Advantage,14.34,,,,,,,Fee Schedule,14.34,47.26,
"OT Whirlpool, Fluidotherapy Units",1373554,LOCAL,97022,CPT,,,,,GO,Outpatient,,,88.1,57,United Health ,United Health Medicare Advantage,14.34,,,,,,,Fee Schedule,14.34,47.26,
Whirlpool Full Body Charge,7895951,LOCAL,97022,CPT,,,,,GP,Outpatient,,,88.1,57,United Health ,United Health Medicare Advantage,14.34,,,,,,,Fee Schedule,14.34,47.26,
"Whirlpool, 1+ Areas 97022",9640021,LOCAL,97022,CPT,,,,,,Outpatient,,,88.1,57,United Health ,United Health Medicare Advantage,14.34,,,,,,,Fee Schedule,14.34,47.26,
"Factor XI Activity, Clotting QSTC",10358416,LOCAL,85270,CPT,,,,,,Outpatient,,,88.2,21.48,United Health ,United Health Medicare Advantage,17.9,,,,,,,Fee Schedule,5.42,17.9,
99151 MOD SED SAME PHYS/QHP <5 YRS,8653147,LOCAL,99151,CPT,,,,,,Outpatient,,,88.82,58,United Health ,United Health Medicare Advantage,20.19,,,,,,,Fee Schedule,20.19,34.95,
Selenium QSTC,8972757,LOCAL,84255,CPT,,,,,,Outpatient,,,89.6,30.64,United Health ,United Health Medicare Advantage,57.31,,,,,,,Fee Schedule,17.73,57.31,
Theophylline Level,1634886,LOCAL,80198,CPT,,,,,,Outpatient,,,89.76,16.97,United Health ,United Health Medicare Advantage,14.14,,,,,,,Fee Schedule,14.14,15.38,
97552 OT Caregiver Training Group,13649812,LOCAL,97552,CPT,,,,,,Outpatient,,,90,,United Health ,United Health Medicare Advantage,9.04,,,,,,,Fee Schedule,9.04,67.18,
97552 Speech Caregiver Training Group,13767339,LOCAL,97552,CPT,,,,,,Outpatient,,,90,,United Health ,United Health Medicare Advantage,9.04,,,,,,,Fee Schedule,9.04,67.18,
"Beta-2-Glycoprotein I Antibodies (IgG, IgM) QSTC",10094523,LOCAL,86146,CPT,,,,,,Outpatient,,,90,30.54,United Health ,United Health Medicare Advantage,25.45,,,,,,,Fee Schedule,15.29,25.45,
Bill Only ABO,7936964,LOCAL,86900,CPT,,,,,,Outpatient,,,90,3.59,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,6.29,117.85,
Bill Only Rh,7936965,LOCAL,86901,CPT,,,,,,Outpatient,,,90,3.59,United Health ,United Health Medicare Advantage,35.88,,,,,,,Fee Schedule,6.29,35.88,
B-Type Natriuretic Peptide,1383771,LOCAL,83880,CPT,,,,,,Outpatient,,,90,47.11,United Health ,United Health Medicare Advantage,13.36,,,,,,,Fee Schedule,13.36379562,46.74,
"GROUP CAREGIVER TRAINING IN STRATEGIES & TECHNIQUES, FACE TO FACE, INITIAL 30 MIN 97552",13788179,LOCAL,97552,CPT,,,,,,Outpatient,,,90,,United Health ,United Health Medicare Advantage,9.04,,,,,,,Fee Schedule,9.04,67.18,
"Helicobacter pylori Ag, EIA, Stool QSTC",8873559,LOCAL,87338,CPT,,,,,,Outpatient,,,90,17.26,United Health ,United Health Medicare Advantage,14.38,,,,,,,Fee Schedule,10.57,14.38,
Heparin Induced Plt Ab QSTC,8995550,LOCAL,86022,CPT,,,,,,Outpatient,,,90,22.04,United Health ,United Health Medicare Advantage,18.37,,,,,,,Fee Schedule,15.29,18.37,
"HPV Genotypes 16,18/45 QST",9773953,LOCAL,87625,CPT,,,,,,Outpatient,,,90,48.66,United Health ,United Health Medicare Advantage,64.87,,,,,,,Fee Schedule,40.19,64.87,
"HPV GENOTYPES 16,18/45,$POST-HYST, VAGINAL QST",14782712,LOCAL,87625,CPT,,,,,,Outpatient,,,90,48.66,United Health ,United Health Medicare Advantage,64.87,,,,,,,Fee Schedule,40.19,64.87,
N-Terminal Pro B-Type Natriuretic Peptide,1503769,LOCAL,83880,CPT,,,,,,Outpatient,,,90,47.11,United Health ,United Health Medicare Advantage,13.36,,,,,,,Fee Schedule,13.36379562,46.74,
OT Group Caregiver Training Units,13624357,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,90,,United Health ,United Health Medicare Advantage,20.25,,,,,,,Fee Schedule,20.25,67.18,
SLP Group Caregiver Training Time,14466882,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,90,,United Health ,United Health Medicare Advantage,20.25,,,,,,,Fee Schedule,20.25,67.18,
"Tacrolimus, Highly Sens, LC/MS/MS QSTC",8764783,LOCAL,80197,CPT,,,,,,Outpatient,,,90,16.48,United Health ,United Health Medicare Advantage,51.73,,,,,,,Fee Schedule,15.38,51.73,
Topiramate QSTC,8764585,LOCAL,80201,CPT,,,,,,Outpatient,,,90,14.3,United Health ,United Health Medicare Advantage,11.92,,,,,,,Fee Schedule,11.92,15.38,
Vitamin D 25 Hydroxy Level,4240407,LOCAL,82306,CPT,,,,,,Outpatient,,,90,35.52,United Health ,United Health Medicare Advantage,45.2,,,,,,,Fee Schedule,17.73,45.19775253,
NEUROPSYCHOLOGICAL TEST ADMINISTRATION,13472049,LOCAL,96146,CPT,,,,,,Outpatient,,,91.31,59,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,22.39,846.56,
Creatinine Urine,1930782,LOCAL,82570,CPT,,,,,,Outpatient,,,91.8,6.22,United Health ,United Health Medicare Advantage,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
Fibrinogen Level,633728,LOCAL,85384,CPT,,,,,,Outpatient,,,92.21,11.66,United Health ,United Health Medicare Advantage,9.72,,,,,,,Fee Schedule,5.42,9.72,
Rapid Plasma Reagin,633820,LOCAL,86592,CPT,,,,,,Outpatient,,,92.21,5.12,United Health ,United Health Medicare Advantage,19.99,,,,,,,Fee Schedule,15.29,19.99375,
Rapid Plasma Reagin Qualitative,7948395,LOCAL,86592,CPT,,,,,,Outpatient,,,92.21,5.12,United Health ,United Health Medicare Advantage,19.99,,,,,,,Fee Schedule,15.29,19.99375,
Rapid Plasma Reagin Qualitative w/ Reflex,8166073,LOCAL,86592,CPT,,,,,,Outpatient,,,92.21,5.12,United Health ,United Health Medicare Advantage,19.99,,,,,,,Fee Schedule,15.29,19.99375,
Blood Type ABO/Rh Typing,634326,LOCAL,86900,CPT,,,,,,Outpatient,,,92.71,3.59,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,6.29,117.85,
Cord ABORh,8019069,LOCAL,86900,CPT,,,,,,Outpatient,,,92.71,3.59,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,6.29,117.85,
Neonatal ABORh,8070665,LOCAL,86900,CPT,,,,,,Outpatient,,,92.71,3.59,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,6.29,117.85,
Fetal Screen,634335,LOCAL,85461,CPT,,,,,,Outpatient,,,93.02,11.23,United Health ,United Health Medicare Advantage,9.36,,,,,,,Fee Schedule,8.21,9.36,
methylPREDNISolone sodium succinate 500 mg injection [CULL],11201954,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,93.2352,,United Health ,United Health Medicare Advantage,0.21,,,,,,,Fee Schedule,0.21,0.21,
99175 IPECAC EMESIS W/OBSERVATION TechFee,8057714,LOCAL,99175,CPT,,,,,,Outpatient,,,93.74,61,United Health ,United Health Medicare Advantage,39.94,,,,,,,Fee Schedule,39.94,983.02,
RT Vapotherm Initial CHARGE,8144190,LOCAL,94002,CPT,,,,,,Outpatient,,,94.68,663,United Health ,United Health Medicare Advantage,604.42,,,,,,,Fee Schedule,604.42,941,
"Coccidioides Antibody, CF & ID, S QSTC",8764815,LOCAL,86635,CPT,,,,,,Outpatient,,,95.18,13.76,United Health ,United Health Medicare Advantage,11.47,,,,,,,Fee Schedule,11.47,15.29,
"Chlamydia Trachomatis RNA, TMA QST",9774353,LOCAL,87491,CPT,,,,,,Outpatient,,,96,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
DAPTOmycin 350 mg intravenous injection [CULL],11210540,LOCAL,J0878,CPT,,,,,,Outpatient,1,EA,96,480,United Health ,United Health Medicare Advantage,0.03,,,,,,,Fee Schedule,0.01,122.4,
"Neisseria Gonorrhoeae RNA, TMA QST",9774354,LOCAL,87591,CPT,,,,,,Outpatient,,,96,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Trichomonas Vaginalis RNA, Ql, TMA QST",9774358,LOCAL,87661,CPT,,,,,,Outpatient,,,96,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
Creat Clear,633609,LOCAL,82575,CPT,,,,,,Outpatient,,,96.29,11.35,United Health ,United Health Medicare Advantage,52.79,,,,,,,Fee Schedule,7.16,52.785,
Creat Clear (No U24),8477916,LOCAL,82575,CPT,,,,,,Outpatient,,,96.29,11.35,United Health ,United Health Medicare Advantage,52.79,,,,,,,Fee Schedule,7.16,52.785,
doxycycline 100 mg injection [CULL],11201705,LOCAL,J1271,CPT,,,,,,Outpatient,1,EA,96.64,,United Health ,United Health Medicare Advantage,0.1,,,,,,,Fee Schedule,0.102,0.102,
Aspartate aminotransferase,633633,LOCAL,84450,CPT,,,,,,Outpatient,,,96.7,6.22,United Health ,United Health Medicare Advantage,50.89,,,,,,,Fee Schedule,7.16,50.89,
Blood Urea Nitrogen,633605,LOCAL,84520,CPT,,,,,,Outpatient,,,96.7,4.74,United Health ,United Health Medicare Advantage,26.82,,,,,,,Fee Schedule,7.16,26.82133333,
Mononucleosis Screen,633785,LOCAL,86308,CPT,,,,,,Outpatient,,,96.7,6.22,United Health ,United Health Medicare Advantage,5.18,,,,,,,Fee Schedule,5.18,15.29,
Monospot POCT,9038464,LOCAL,86308,CPT,,,,,,Outpatient,,,96.7,6.22,United Health ,United Health Medicare Advantage,5.18,,,,,,,Fee Schedule,5.18,15.29,
Gentamicin Level,3454415,LOCAL,80170,CPT,,,,,,Outpatient,,,97.1,19.66,United Health ,United Health Medicare Advantage,16.38,,,,,,,Fee Schedule,15.38,16.38,
Gentamicin Level Peak,633736,LOCAL,80170,CPT,,,,,,Outpatient,,,97.1,19.66,United Health ,United Health Medicare Advantage,16.38,,,,,,,Fee Schedule,15.38,16.38,
Gentamicin Level Trough,633737,LOCAL,80170,CPT,,,,,,Outpatient,,,97.1,19.66,United Health ,United Health Medicare Advantage,16.38,,,,,,,Fee Schedule,15.38,16.38,
Gamma Glutamyl Transferase,1628895,LOCAL,82977,CPT,,,,,,Outpatient,,,97.92,8.64,United Health ,United Health Medicare Advantage,52.49,,,,,,,Fee Schedule,7.16,52.49,
Renal Function Panel,1634883,LOCAL,80069,CPT,,,,,,Outpatient,,,97.92,10.42,United Health ,United Health Medicare Advantage,37.66,,,,,,,Fee Schedule,12.14,37.65984615,
CULL NM Therapy I131 Cap Per MCI,13644969,LOCAL,,,A9517,HCPCS,,,,Outpatient,,,98.48,64,United Health ,United Health Medicare Advantage,23.13,,,,,,,Fee Schedule,23.13,662.39,
96423 CHEMO ARTRL INF EA ADDL HR CHARGE,9404493,LOCAL,96423,CPT,,,,,,Outpatient,,,98.94,64,United Health ,United Health Medicare Advantage,42.18,,,,,,,Fee Schedule,42.18,749.76,
90913 - Bfb training ea addl 15 min.,9442436,LOCAL,90913,CPT,,,,,,Outpatient,,,99,64,United Health ,United Health Medicare Advantage,20.19,,,,,,,Fee Schedule,20.19,233.61,
Caregiver Agreement on Discipline,7355021,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,99,,United Health ,United Health Medicare Advantage,20.25,,,,,,,Fee Schedule,20.25,67.18,
Caregiver Agreement on Discipline,7355021,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,99,,United Health ,United Health Medicare Advantage,20.25,,,,,,,Fee Schedule,20.25,67.18,
Cholesterol Total,633705,LOCAL,82465,CPT,,,,,,Outpatient,,,99.14,5.22,United Health ,United Health Medicare Advantage,4.35,,,,,,,Fee Schedule,4.35,7.16,
Progesterone Level,3454459,LOCAL,84144,CPT,,,,,,Outpatient,,,99.14,25.03,United Health ,United Health Medicare Advantage,59.8,,,,,,,Fee Schedule,18.43,59.795,
Triglyceride,633852,LOCAL,84478,CPT,,,,,,Outpatient,,,99.14,6.89,United Health ,United Health Medicare Advantage,52.39,,,,,,,Fee Schedule,7.16,52.385,
"Histoplasma Antibody Panel, CF and ID, Serum QSTC",10185600,LOCAL,86698,CPT,,,,,,Outpatient,,,99.5,16.55,United Health ,United Health Medicare Advantage,13.79,,,,,,,Fee Schedule,13.79,15.29,
"64420 INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVE, SINGLE ProFee",13959631,LOCAL,64420,CPT,,,,,,Outpatient,,,100,693,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
E3581 Thawed Cryo AHF,7267123,LOCAL,,,P9012,HCPCS,,,,Outpatient,,,100,65,United Health ,United Health Medicare Advantage,63.57,,,,,,,Fee Schedule,63.57,217.45,
HPV mRNA E6/E7 QST,9775619,LOCAL,87624,CPT,,,,,,Outpatient,,,100,42.11,United Health ,United Health Medicare Advantage,67.2,,,,,,,Fee Schedule,40.19,67.195,
HPV mRNA E6/E7 QST,10585636,LOCAL,87624,CPT,,,,,,Outpatient,,,100,42.11,United Health ,United Health Medicare Advantage,67.2,,,,,,,Fee Schedule,40.19,67.195,
POC Chem8+ Panel,8920330,LOCAL,80048,CPT,,,,,,Outpatient,,,100,10.15,United Health ,United Health Medicare Advantage,37.17,,,,,,,Fee Schedule,12.14,37.17170492,
Thinprep Review Cytotechnologist: QST,9775616,LOCAL,88175,CPT,,,,,,Outpatient,,,100,31.93,United Health ,United Health Medicare Advantage,26.61,,,,,,,Fee Schedule,25.25,26.61,
Thinprep Review Cytotechnologist: QST,10585633,LOCAL,88175,CPT,,,,,,Outpatient,,,100,31.93,United Health ,United Health Medicare Advantage,26.61,,,,,,,Fee Schedule,25.25,26.61,
97116  SB Pt Gait Train 15 mn,9640030,LOCAL,97116,CPT,,,,,GP,Outpatient,,,100.04,65,United Health ,United Health Medicare Advantage,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
97116 GAIT TRAINING CHARGE,9410151,LOCAL,97116,CPT,,,,,GP,Outpatient,,,100.04,65,United Health ,United Health Medicare Advantage,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
97116 PT Gait Training Assistant Units,9650030,LOCAL,97116,CPT,,,,,GP|CQ,Outpatient,,,100.04,65,United Health ,United Health Medicare Advantage,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
Gait Training Charges,7895941,LOCAL,97116,CPT,,,,,GP,Outpatient,,,100.04,65,United Health ,United Health Medicare Advantage,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
PT Gait Training Assistant Units,9390436,LOCAL,97116,CPT,,,,,CQ,Outpatient,,,100.04,65,United Health ,United Health Medicare Advantage,12.13,,,,,,,Fee Schedule,12.1333871,47.26,
Activated PTT,7938959,LOCAL,85730,CPT,,,,,,Outpatient,,,101.52,7.21,United Health ,United Health Medicare Advantage,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
Bilirubin Direct,4240528,LOCAL,82248,CPT,,,,,,Outpatient,,,101.59,6.02,United Health ,United Health Medicare Advantage,26.63,,,,,,,Fee Schedule,7.16,26.6275,
Bilirubin Direct,7939101,LOCAL,82248,CPT,,,,,,Outpatient,,,101.59,6.02,United Health ,United Health Medicare Advantage,26.63,,,,,,,Fee Schedule,7.16,26.6275,
Bilirubin Direct,8443662,LOCAL,82248,CPT,,,,,,Outpatient,,,101.59,6.02,United Health ,United Health Medicare Advantage,26.63,,,,,,,Fee Schedule,7.16,26.6275,
iSTAT Creatinine POCT,11673045,LOCAL,82565,CPT,,,,,,Outpatient,,,101.59,6.14,United Health ,United Health Medicare Advantage,10.06,,,,,,,Fee Schedule,7.16,10.061625,
Lipid Pnl,633777,LOCAL,80061,CPT,,,,,,Outpatient,,,101.59,16.07,United Health ,United Health Medicare Advantage,16.6,,,,,,,Fee Schedule,12.14,16.59934459,
77062 MG Diagnostic Tomo Charge: AddOn Bilateral,13969682,LOCAL,G0279,CPT,,,,,,Outpatient,,,101.84,,United Health ,United Health Medicare Advantage,11.11,,,,,,,Fee Schedule,11.11,74,
77063 MG Tomo Charge: AddOn Bilateral,13621440,LOCAL,77063,CPT,,,,,,Outpatient,,,101.84,54.45,United Health ,United Health Medicare Advantage,20.75,,,,,,,Fee Schedule,20.75,74,
CULL Mammo Tomo Add On,7867705,LOCAL,77063,CPT,,,,,,Outpatient,,,101.84,54.45,United Health ,United Health Medicare Advantage,20.75,,,,,,,Fee Schedule,20.75,74,
hepatitis B pediatric vaccine 10 mcg/0.5 mL intramuscular suspension 0.5 mL [CULL],11202559,LOCAL,90744,CPT,,,,,,Outpatient,0.5,ML,102.17472,,United Health ,United Health Medicare Advantage,33.2,,,,,,,Fee Schedule,33.204,39.58,
Immunoglobulin G Subclass 1 QSTC,8851875,LOCAL,82787,CPT,,,,,,Outpatient,,,102.38,9.62,United Health ,United Health Medicare Advantage,8.02,,,,,,,Fee Schedule,7.16,8.02,
"Immunoglobulin G, Serum QSTC",8851879,LOCAL,82784,CPT,,,,,,Outpatient,,,102.38,11.16,United Health ,United Health Medicare Advantage,34.96,,,,,,,Fee Schedule,7.16,34.958,
"HVA, 24h Urine w/o Creat QSTC",13864511,LOCAL,83150,CPT,,,,,,Outpatient,,,102.56,26.89,United Health ,United Health Medicare Advantage,22.41,,,,,,,Fee Schedule,18.43,22.41,
CYSTOGRAM INJ,8210035,LOCAL,51600,CPT,,,,,,Outpatient,,,103,246,United Health ,United Health Medicare Advantage,35.39,,,,,,,Fee Schedule,35.39,863,
Therapeutic Phlebotomy,8118276,LOCAL,99195,CPT,,,,,,Outpatient,,,103.04,67,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,85.79,117.85,
Strep A Xpress (GeneXpert),8642789,LOCAL,87651,CPT,,,,,,Outpatient,,,103.5,42.11,United Health ,United Health Medicare Advantage,3.7,,,,,,,Fee Schedule,3.7,40.19,
Cerebrospinal Fluid Culture,4122737,LOCAL,87070,CPT,,,,,,Outpatient,,,103.63,10.34,United Health ,United Health Medicare Advantage,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
pamidronate 3 mg/mL intravenous solution 10 mL [CULL],11211072,LOCAL,J2430,CPT,,,,,,Outpatient,10,ML,103.68,,United Health ,United Health Medicare Advantage,11.29,,,,,,,Fee Schedule,11.29,11.29,
Coronavirus SARS Ag (Sofia),9803641,LOCAL,87426,CPT,,,,,,Outpatient,,,104,42.4,United Health ,United Health Medicare Advantage,56.41,,,,,,,Fee Schedule,10.57,56.40806897,
COVID-19 Ag,11561110,LOCAL,87426,CPT,,,,,,Outpatient,,,104,42.4,United Health ,United Health Medicare Advantage,56.41,,,,,,,Fee Schedule,10.57,56.40806897,
Urine Drug Screen,3454403,LOCAL,80306,CPT,,,,,,Outpatient,,,104,20.57,United Health ,United Health Medicare Advantage,0.24,,,,,,,Fee Schedule,0.2416,17.73,
97533 PT SENSORY INTEGRATIVE TECH 15MIN,9866109,LOCAL,97533,CPT,,,,,GO|CO,Outpatient,,,104.14,68,United Health ,United Health Medicare Advantage,55.09,,,,,,,Fee Schedule,55.09,56.44,
97533 SENSORY INTEGATIVE TECHNIQUES EACH 15 MINS,9856109,LOCAL,97533,CPT,,,,,GO,Outpatient,,,104.14,68,United Health ,United Health Medicare Advantage,55.09,,,,,,,Fee Schedule,55.09,56.44,
OT Sensory Integrative Tech Assistant Units,7895276,LOCAL,97533,CPT,,,,,CQ,Outpatient,,,104.14,68,United Health ,United Health Medicare Advantage,55.09,,,,,,,Fee Schedule,55.09,56.44,
OT Sensory Integrative Techniques Units,1373568,LOCAL,97533,CPT,,,,,GO,Outpatient,,,104.14,68,United Health ,United Health Medicare Advantage,55.09,,,,,,,Fee Schedule,55.09,56.44,
Sensory Stimulation Charge,7895276,LOCAL,97533,CPT,,,,,GO,Outpatient,,,104.14,68,United Health ,United Health Medicare Advantage,55.09,,,,,,,Fee Schedule,55.09,56.44,
L3908 Clavicle Brace,9800048,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,104.31,86,United Health ,United Health Medicare Advantage,67.37,,,,,,,Fee Schedule,67.37,67.37,
L3908 Wrist/forearm Brace,9800047,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,104.31,86,United Health ,United Health Medicare Advantage,67.37,,,,,,,Fee Schedule,67.37,67.37,
"Chlamydia Trachomatis RNA, TMA QST",14435138,LOCAL,87491,CPT,,,,,,Outpatient,,,105,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
HPV mRNA E6/E7 QST,14435137,LOCAL,87624,CPT,,,,,,Outpatient,,,105,42.11,United Health ,United Health Medicare Advantage,67.2,,,,,,,Fee Schedule,40.19,67.195,
"Neisseria Gonorrhoeae RNA, TMA QST",14435139,LOCAL,87591,CPT,,,,,,Outpatient,,,105,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
Thinprep Review Cytotechnologist: QST,14435134,LOCAL,88175,CPT,,,,,,Outpatient,,,105,31.93,United Health ,United Health Medicare Advantage,26.61,,,,,,,Fee Schedule,25.25,26.61,
Iron Level,633765,LOCAL,83540,CPT,,,,,,Outpatient,,,105.26,7.76,United Health ,United Health Medicare Advantage,48.88,,,,,,,Fee Schedule,7.16,48.87820628,
Iron Level,7050169,LOCAL,83540,CPT,,,,,,Outpatient,,,105.26,7.76,United Health ,United Health Medicare Advantage,48.88,,,,,,,Fee Schedule,7.16,48.87820628,
Iron Level,10543519,LOCAL,83540,CPT,,,,,,Outpatient,,,105.26,7.76,United Health ,United Health Medicare Advantage,48.88,,,,,,,Fee Schedule,7.16,48.87820628,
"Vitamin B2 (Riboflavin), P QSTC",8972877,LOCAL,84252,CPT,,,,,,Outpatient,,,106.2,24.29,United Health ,United Health Medicare Advantage,20.24,,,,,,,Fee Schedule,17.73,20.24,
L3908 Daytimer Wrist Support,9800046,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,106.38,86,United Health ,United Health Medicare Advantage,67.37,,,,,,,Fee Schedule,67.37,67.37,
97537 COMMUNITY/WORK REINTEGRATION,9650036,LOCAL,97537,CPT,,,,,GP|CQ,Outpatient,,,107.75,70,United Health ,United Health Medicare Advantage,29.96,,,,,,,Fee Schedule,29.96,56.44,
97537 Community/work reintegration training; each 15 minutes,9860034,LOCAL,97537,CPT,,,,,GO|CO,Outpatient,,,107.75,70,United Health ,United Health Medicare Advantage,29.96,,,,,,,Fee Schedule,29.96,56.44,
97537 OT COMM WORK INTEGRATION CHARGE,9850034,LOCAL,97537,CPT,,,,,GO,Outpatient,,,107.75,70,United Health ,United Health Medicare Advantage,29.96,,,,,,,Fee Schedule,29.96,56.44,
97537 PT ERGONOMIC TRAINING,9640036,LOCAL,97537,CPT,,,,,GP,Outpatient,,,107.75,70,United Health ,United Health Medicare Advantage,29.96,,,,,,,Fee Schedule,29.96,56.44,
Community/Work Reintegration Charges,1366455,LOCAL,97537,CPT,,,,,GO,Outpatient,,,107.75,70,United Health ,United Health Medicare Advantage,29.96,,,,,,,Fee Schedule,29.96,56.44,
"OT Community, Work Reintegration Assistant Units",1366455,LOCAL,97537,CPT,,,,,CQ,Outpatient,,,107.75,70,United Health ,United Health Medicare Advantage,29.96,,,,,,,Fee Schedule,29.96,56.44,
"OT Community, Work Reintegration Assistant Units",1373453,LOCAL,97537,CPT,,,,,CQ,Outpatient,,,107.75,70,United Health ,United Health Medicare Advantage,29.96,,,,,,,Fee Schedule,29.96,56.44,
"OT Community, Work Reintegration Units",1373453,LOCAL,97537,CPT,,,,,GO,Outpatient,,,107.75,70,United Health ,United Health Medicare Advantage,29.96,,,,,,,Fee Schedule,29.96,56.44,
OT Community/Work Reintegration Charges,1366455,LOCAL,97537,CPT,,,,,GO,Outpatient,,,107.75,70,United Health ,United Health Medicare Advantage,29.96,,,,,,,Fee Schedule,29.96,56.44,
"PT Community,Work Reintegration Assistant Units",9390450,LOCAL,97537,CPT,,,,,CQ,Outpatient,,,107.75,70,United Health ,United Health Medicare Advantage,29.96,,,,,,,Fee Schedule,29.96,56.44,
PT Community/Work Reintegration Charge,7895991,LOCAL,97537,CPT,,,,,GP,Outpatient,,,107.75,70,United Health ,United Health Medicare Advantage,29.96,,,,,,,Fee Schedule,29.96,56.44,
AChR Bind Ab w/rfx MuSK Ab QSTC,13864498,LOCAL,86041,CPT,,,,,,Outpatient,,,108,22.08,United Health ,United Health Medicare Advantage,18.4,,,,,,,Fee Schedule,15.29,18.4,
Alpha-1-Antitrypsin QN QSTC,13873077,LOCAL,82103,CPT,,,,,,Outpatient,,,108,16.13,United Health ,United Health Medicare Advantage,60.59,,,,,,,Fee Schedule,17.73,60.59,
Carnitine QSTC,8764784,LOCAL,82379,CPT,,,,,,Outpatient,,,108,20.24,United Health ,United Health Medicare Advantage,16.87,,,,,,,Fee Schedule,16.87,17.73,
EKG Charges - RT -> Routine ECG 12 lead/15 lead tracing only,5367589,LOCAL,93041,CPT,,,,,,Outpatient,,,108.53,71,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,38.53,54.31,
97542  SB PT Wheelchair Mgt,9640037,LOCAL,97542,CPT,,,,,GP,Outpatient,,,108.91,71,United Health ,United Health Medicare Advantage,29.37,,,,,,,Fee Schedule,29.37,56.44,
97542 OT WHEELCHAIR MANAGE/TRAIN 15MIN,9820201,LOCAL,97542,CPT,,,,,GO,Outpatient,,,108.91,71,United Health ,United Health Medicare Advantage,29.37,,,,,,,Fee Schedule,29.37,56.44,
97542 PT WC SEATING EVAL CHARGE,9650037,LOCAL,97542,CPT,,,,,GP|CQ,Outpatient,,,108.91,71,United Health ,United Health Medicare Advantage,29.37,,,,,,,Fee Schedule,29.37,56.44,
"97542 Wheelchair management (eg, assessment, fitting, training), each 15 minutes",9860201,LOCAL,97542,CPT,,,,,GO|CO,Outpatient,,,108.91,71,United Health ,United Health Medicare Advantage,29.37,,,,,,,Fee Schedule,29.37,56.44,
97542 WHEELCHAIR MANAGEMENT CHARGE,9410201,LOCAL,97542,CPT,,,,,GP,Outpatient,,,108.91,71,United Health ,United Health Medicare Advantage,29.37,,,,,,,Fee Schedule,29.37,56.44,
OT Wheelchair Management Assistant Units,7895273,LOCAL,97542,CPT,,,,,CQ,Outpatient,,,108.91,71,United Health ,United Health Medicare Advantage,29.37,,,,,,,Fee Schedule,29.37,56.44,
OT Wheelchair Management Units,1373570,LOCAL,97542,CPT,,,,,GO,Outpatient,,,108.91,71,United Health ,United Health Medicare Advantage,29.37,,,,,,,Fee Schedule,29.37,56.44,
PT Wheelchair Management Assistant Units,9390452,LOCAL,97542,CPT,,,,,CQ,Outpatient,,,108.91,71,United Health ,United Health Medicare Advantage,29.37,,,,,,,Fee Schedule,29.37,56.44,
Wheelchair Charge,7895273,LOCAL,97542,CPT,,,,,GO,Outpatient,,,108.91,71,United Health ,United Health Medicare Advantage,29.37,,,,,,,Fee Schedule,29.37,56.44,
Wheelchair Management Charges,7895931,LOCAL,97542,CPT,,,,,GP,Outpatient,,,108.91,71,United Health ,United Health Medicare Advantage,29.37,,,,,,,Fee Schedule,29.37,56.44,
97551 OT Caregiver Training Ea Add'l 15 Mins,13647370,LOCAL,97551,CPT,,,,,,Outpatient,,,110,,United Health ,United Health Medicare Advantage,20.67,,,,,,,Fee Schedule,20.67,95.93,
97551 PT Caregiver Training Ea Add'l 15 Mins,13645598,LOCAL,97551,CPT,,,,,,Outpatient,,,110,,United Health ,United Health Medicare Advantage,20.67,,,,,,,Fee Schedule,20.67,95.93,
97551 ST Caregiver Training Ea  Addl 15 min,14017194,LOCAL,97551,CPT,,,,,,Outpatient,,,110,,United Health ,United Health Medicare Advantage,20.67,,,,,,,Fee Schedule,20.67,95.93,
Facility Eval and Management Level 1 99211,10633491,LOCAL,99211,CPT,,,,,,Outpatient,,,110,226,United Health ,United Health Medicare Advantage,7.37,,,,,,,Fee Schedule,7.37,7.37,
Medical Day Dressing Change,10633491,LOCAL,99211,CPT,,,,,,Outpatient,,,110,226,United Health ,United Health Medicare Advantage,7.37,,,,,,,Fee Schedule,7.37,7.37,
"OT Caregiver Training, Addl 15 Min Asst",13623455,LOCAL,,,G0542,HCPCS,,,,Outpatient,,,110,,United Health ,United Health Medicare Advantage,25.18,,,,,,,Fee Schedule,25.18,95.93,
"OT Caregiver Training, First 30 Min Asst",13623453,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,110,,United Health ,United Health Medicare Advantage,50.79,,,,,,,Fee Schedule,50.79,95.93,
"SLP Caregiver Training, Addl 15 Min Time",14466886,LOCAL,,,G0542,HCPCS,,,,Outpatient,,,110,,United Health ,United Health Medicare Advantage,25.18,,,,,,,Fee Schedule,25.18,95.93,
% CD19 (B Cells) QSTC,9416397,LOCAL,86355,CPT,,,,,,Outpatient,,,110.25,45.28,United Health ,United Health Medicare Advantage,37.73,,,,,,,Fee Schedule,15.29,37.73,
%CD 16+CD56 (NK Cells) QSTC,9416395,LOCAL,86357,CPT,,,,,,Outpatient,,,110.25,45.28,United Health ,United Health Medicare Advantage,37.73,,,,,,,Fee Schedule,15.29,37.73,
%CD3 Mature T Cells QSTC,9416288,LOCAL,86359,CPT,,,,,,Outpatient,,,110.25,45.28,United Health ,United Health Medicare Advantage,37.73,,,,,,,Fee Schedule,15.29,37.73,
CD4/CD8 Ratio QSTC,8852258,LOCAL,86360,CPT,,,,,,Outpatient,,,110.25,56.38,United Health ,United Health Medicare Advantage,46.98,,,,,,,Fee Schedule,44.29,46.98,
"Parvovirus B19 Antibodies(IgG, IgM) QSTC",8764577,LOCAL,86747,CPT,,,,,,Outpatient,,,110.25,18.04,United Health ,United Health Medicare Advantage,15.03,,,,,,,Fee Schedule,15.03,15.29,
chlorproMAZINE 25 mg/mL injectable solution 1 mL [CULL],11202221,LOCAL,J3230,CPT,,,,,,Outpatient,1,ML,110.9376,,United Health ,United Health Medicare Advantage,23.77,,,,,,,Fee Schedule,23.767,23.767,
CBC w/ Manual Differential,633682,LOCAL,85027,CPT,,,,,,Outpatient,,,111.38,7.76,United Health ,United Health Medicare Advantage,27.03,,,,,,,Fee Schedule,8.21,27.02937879,
CBC without Differential,3798345,LOCAL,85027,CPT,,,,,,Outpatient,,,111.38,7.76,United Health ,United Health Medicare Advantage,27.03,,,,,,,Fee Schedule,8.21,27.02937879,
gentamicin 40 mg/mL injectable solution 20 mL [CULL],11205229,LOCAL,J1580,CPT,,,,,,Outpatient,20,ML,112.2048,,United Health ,United Health Medicare Advantage,2.45,,,,,,,Fee Schedule,2.452580645,2.452580645,
DNase-B Antibody QSTC,8764548,LOCAL,86215,CPT,,,,,,Outpatient,,,112.5,15.9,United Health ,United Health Medicare Advantage,13.25,,,,,,,Fee Schedule,13.25,15.29,
"Tissue Transglutaminase Ab(IgG,IgA) QSTC",8972930,LOCAL,86364,CPT,,,,,,Outpatient,,,112.5,13.84,United Health ,United Health Medicare Advantage,61.9,,,,,,,Fee Schedule,15.29,61.9,
Cord DAT Gel,8416626,LOCAL,86880,CPT,,,,,,Outpatient,,,112.65,6.47,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,6.29,54.31,
DAT IgG Gel,7906396,LOCAL,86880,CPT,,,,,,Outpatient,,,112.65,6.47,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,6.29,54.31,
Neonatal DAT Gel,13460490,LOCAL,86880,CPT,,,,,,Outpatient,,,112.65,6.47,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,6.29,54.31,
LA Ven - Sepsis 2Hr,8485386,LOCAL,83605,CPT,,,,,,Outpatient,,,113.42,13.88,United Health ,United Health Medicare Advantage,0.9,,,,,,,Fee Schedule,0.901879518,17.73,
Lactic Acid (Venous),3454442,LOCAL,83605,CPT,,,,,,Outpatient,,,113.42,13.88,United Health ,United Health Medicare Advantage,0.9,,,,,,,Fee Schedule,0.901879518,17.73,
Lactic Acid (Venous) - Sepsis,8058058,LOCAL,83605,CPT,,,,,,Outpatient,,,113.42,13.88,United Health ,United Health Medicare Advantage,0.9,,,,,,,Fee Schedule,0.901879518,17.73,
Unstable Hemoglobin QSTC,13864449,LOCAL,83068,CPT,,,,,,Outpatient,,,113.63,11.36,United Health ,United Health Medicare Advantage,9.47,,,,,,,Fee Schedule,7.16,9.47,
97124 MASSAGE CHARGE,9640031,LOCAL,97124,CPT,,,,,GP,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,27.37,,,,,,,Fee Schedule,27.37,47.26,
97124 OT MASSAGE CHARGE,9850029,LOCAL,97124,CPT,,,,,GO,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,27.37,,,,,,,Fee Schedule,27.37,47.26,
97124 OT-MASSAGE EA 15 MIN,9860029,LOCAL,97124,CPT,,,,,GO|CO,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,27.37,,,,,,,Fee Schedule,27.37,47.26,
97124 PT Massage Assistant Units,9650031,LOCAL,97124,CPT,,,,,GP|CQ,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,27.37,,,,,,,Fee Schedule,27.37,47.26,
97140  Manual Therapy 15 min,9850047,LOCAL,97140,CPT,,,,,GO,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,65.85,,,,,,,Fee Schedule,56.44,65.845,
97140 MAN THER EA 15 MIN CHARGES,9640047,LOCAL,97140,CPT,,,,,GP,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,65.85,,,,,,,Fee Schedule,56.44,65.845,
97140 OT Manual Therapy Assistant Units,9860047,LOCAL,97140,CPT,,,,,GO|CO,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,65.85,,,,,,,Fee Schedule,56.44,65.845,
97140 PT Manual Therapy Assistant Units,9650047,LOCAL,97140,CPT,,,,,GP|CQ,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,65.85,,,,,,,Fee Schedule,56.44,65.845,
Manual Therapy Charge Units,7895928,LOCAL,97140,CPT,,,,,GP,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,65.85,,,,,,,Fee Schedule,56.44,65.845,
Manual Traction Charge,7895279,LOCAL,97140,CPT,,,,,GO,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,65.85,,,,,,,Fee Schedule,56.44,65.845,
Massage Charge Units,1041799,LOCAL,97124,CPT,,,,,GO,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,27.37,,,,,,,Fee Schedule,27.37,47.26,
Massage Charge Units,7895954,LOCAL,97124,CPT,,,,,GP,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,27.37,,,,,,,Fee Schedule,27.37,47.26,
OT Manual Therapy Assistant Units,1373444,LOCAL,97140,CPT,,,,,CQ,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,65.85,,,,,,,Fee Schedule,56.44,65.845,
OT Manual Therapy Units,1373444,LOCAL,97140,CPT,,,,,GO,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,65.85,,,,,,,Fee Schedule,56.44,65.845,
OT Massage Assistant Units,1041799,LOCAL,97124,CPT,,,,,CQ,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,27.37,,,,,,,Fee Schedule,27.37,47.26,
OT Massage Charge Units,1041799,LOCAL,97124,CPT,,,,,GO,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,27.37,,,,,,,Fee Schedule,27.37,47.26,
OT Massage Rehab Assist Units,7897698,LOCAL,97124,CPT,,,,,CQ,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,27.37,,,,,,,Fee Schedule,27.37,47.26,
OT Massage Rehab Units,7897698,LOCAL,97124,CPT,,,,,GO,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,27.37,,,,,,,Fee Schedule,27.37,47.26,
PT Manual Therapy Assistant Units,9390440,LOCAL,97140,CPT,,,,,CQ,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,65.85,,,,,,,Fee Schedule,56.44,65.845,
PT Massage Assistant Units,9390438,LOCAL,97124,CPT,,,,,CQ,Outpatient,,,114.56,74,United Health ,United Health Medicare Advantage,27.37,,,,,,,Fee Schedule,27.37,47.26,
methylergonovine 0.2 mg/mL injectable solution 1 mL [CULL],11202918,LOCAL,J2210,CPT,,,,,,Outpatient,1,ML,114.8928,,United Health ,United Health Medicare Advantage,21.36,,,,,,,Fee Schedule,21.363,21.363,
Thinprep TIS Pap QST,9773891,LOCAL,88175,CPT,,,,,,Outpatient,,,115,31.93,United Health ,United Health Medicare Advantage,26.61,,,,,,,Fee Schedule,25.25,26.61,
Thinprep TIS Pap Rfx HPV mRNA E6/E7 QST,9773936,LOCAL,88175,CPT,,,,,,Outpatient,,,115,31.93,United Health ,United Health Medicare Advantage,26.61,,,,,,,Fee Schedule,25.25,26.61,
97033 IONTOPHORESIS CHARGE,9410271,LOCAL,97033,CPT,,,,,GP,Outpatient,,,115.06,75,United Health ,United Health Medicare Advantage,17.64,,,,,,,Fee Schedule,17.64,47.26,
97033 IONTOPHORESIS EA 15 MIN CHARGES,9640077,LOCAL,97033,CPT,,,,,GP,Outpatient,,,115.06,75,United Health ,United Health Medicare Advantage,17.64,,,,,,,Fee Schedule,17.64,47.26,
97033 OT IONTOPHORESIS,9850073,LOCAL,97033,CPT,,,,,GO,Outpatient,,,115.06,75,United Health ,United Health Medicare Advantage,17.64,,,,,,,Fee Schedule,17.64,47.26,
97033 OT IONTOPHORESIS 15 MIN APPL CHARGE,9860073,LOCAL,97033,CPT,,,,,GO|CO,Outpatient,,,115.06,75,United Health ,United Health Medicare Advantage,17.64,,,,,,,Fee Schedule,17.64,47.26,
97033 PT IONTOPHORESIS,9650077,LOCAL,97033,CPT,,,,,GP|CQ,Outpatient,,,115.06,75,United Health ,United Health Medicare Advantage,17.64,,,,,,,Fee Schedule,17.64,47.26,
Iontophoresis Charges,1366374,LOCAL,97033,CPT,,,,,GO,Outpatient,,,115.06,75,United Health ,United Health Medicare Advantage,17.64,,,,,,,Fee Schedule,17.64,47.26,
Iontophoresis Charges,7895927,LOCAL,97033,CPT,,,,,GP,Outpatient,,,115.06,75,United Health ,United Health Medicare Advantage,17.64,,,,,,,Fee Schedule,17.64,47.26,
OT Iontophoresis Assistant Units,1366374,LOCAL,97033,CPT,,,,,CQ,Outpatient,,,115.06,75,United Health ,United Health Medicare Advantage,17.64,,,,,,,Fee Schedule,17.64,47.26,
OT Iontophoresis Assistant Units,1373443,LOCAL,97033,CPT,,,,,CQ,Outpatient,,,115.06,75,United Health ,United Health Medicare Advantage,17.64,,,,,,,Fee Schedule,17.64,47.26,
OT Iontophoresis Charges,1366374,LOCAL,97033,CPT,,,,,GO,Outpatient,,,115.06,75,United Health ,United Health Medicare Advantage,17.64,,,,,,,Fee Schedule,17.64,47.26,
OT Iontophoresis Units,1373443,LOCAL,97033,CPT,,,,,GO,Outpatient,,,115.06,75,United Health ,United Health Medicare Advantage,17.64,,,,,,,Fee Schedule,17.64,47.26,
PT Iontophoresis Assistant Units,9390424,LOCAL,97033,CPT,,,,,CQ,Outpatient,,,115.06,75,United Health ,United Health Medicare Advantage,17.64,,,,,,,Fee Schedule,17.64,47.26,
Allergy Panel13 Stinging Insect Grp QSTC,9063178,LOCAL,86003,CPT,,,,,,Outpatient,,,115.65,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Honey Bee (I1) IgE QST,12866524,LOCAL,86003,CPT,,,,,,Outpatient,,,115.65,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Peanut Component Panel QSTC,8764809,LOCAL,86008,CPT,,,,,,Outpatient,,,115.65,21.52,United Health ,United Health Medicare Advantage,17.93,,,,,,,Fee Schedule,15.29,17.93,
RT CHARGE Chest Physiotherapy -> PEP Therapy Initial,8699752,LOCAL,94668,CPT,,,,,,Outpatient,,,115.89,75,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,76.09,117.85,
"Chlamydia Trachomatis RNA, TMA QST",12762527,LOCAL,87491,CPT,,,,,,Outpatient,,,117,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Mycoplasma Genitalium, rRNA QST",12762530,LOCAL,87563,CPT,,,,,,Outpatient,,,117,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",12762531,LOCAL,87591,CPT,,,,,,Outpatient,,,117,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
Trichomonas Vaginalis RNA QST,12762534,LOCAL,87661,CPT,,,,,,Outpatient,,,117,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
Ferritin,1628893,LOCAL,82728,CPT,,,,,,Outpatient,,,117.5,16.36,United Health ,United Health Medicare Advantage,50.83,,,,,,,Fee Schedule,17.73,50.82956044,
97750 - Physical performance test or measurement,9640058,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,United Health ,United Health Medicare Advantage,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 FCE-FUNCTIONAL CAPACITY EVAL 1 CHARGE,9640050,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,United Health ,United Health Medicare Advantage,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 OT PERF TEST MEAS 15 MIN CHARGE,9850061,LOCAL,97750,CPT,,,,,GO,Outpatient,,,118.17,77,United Health ,United Health Medicare Advantage,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 OT Strapping Shoulder Assistant Units,9860061,LOCAL,97750,CPT,,,,,GO|CO,Outpatient,,,118.17,77,United Health ,United Health Medicare Advantage,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 PRE WORK SCREEN CHARGE,9650058,LOCAL,97750,CPT,,,,,GP|CQ,Outpatient,,,118.17,77,United Health ,United Health Medicare Advantage,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 PT ISOKINETIC TEST 15 MIN,9640053,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,United Health ,United Health Medicare Advantage,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 PT ISOKINETIC TEST 15 MIN ASST,9650053,LOCAL,97750,CPT,,,,,GP|CQ,Outpatient,,,118.17,77,United Health ,United Health Medicare Advantage,31.29,,,,,,,Fee Schedule,31.29,56.44,
97750 PT PHYSICAL PERFORMANCE TEST CHARGE,9650050,LOCAL,97750,CPT,,,,,GP|CQ,Outpatient,,,118.17,77,United Health ,United Health Medicare Advantage,31.29,,,,,,,Fee Schedule,31.29,56.44,
97761 (PROSTHETIC TRAINING CAWC),9650033,LOCAL,97761,CPT,,,,,GP|CQ,Outpatient,,,118.17,77,United Health ,United Health Medicare Advantage,37.35,,,,,,,Fee Schedule,37.35,56.44,
97761 PROSTHETIC TRAINING 15 MINS,9640033,LOCAL,97761,CPT,,,,,GP,Outpatient,,,118.17,77,United Health ,United Health Medicare Advantage,37.35,,,,,,,Fee Schedule,37.35,56.44,
97761 PT PROSTHETIC TRAINING CHARGE,9410181,LOCAL,97761,CPT,,,,,GP,Outpatient,,,118.17,77,United Health ,United Health Medicare Advantage,37.35,,,,,,,Fee Schedule,37.35,56.44,
Functional Capacity Eval Charge,7895967,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,United Health ,United Health Medicare Advantage,31.29,,,,,,,Fee Schedule,31.29,56.44,
OT Physical Performance Test Assistant Units,7895284,LOCAL,97750,CPT,,,,,CQ,Outpatient,,,118.17,77,United Health ,United Health Medicare Advantage,31.29,,,,,,,Fee Schedule,31.29,56.44,
OT Physical Performance Test Charges,7895284,LOCAL,97750,CPT,,,,,GO,Outpatient,,,118.17,77,United Health ,United Health Medicare Advantage,31.29,,,,,,,Fee Schedule,31.29,56.44,
OT Physical Performance Test Units,7897702,LOCAL,97750,CPT,,,,,GO,Outpatient,,,118.17,77,United Health ,United Health Medicare Advantage,31.29,,,,,,,Fee Schedule,31.29,56.44,
Prosthetic Training Charges,7895930,LOCAL,97761,CPT,,,,,GP,Outpatient,,,118.17,77,United Health ,United Health Medicare Advantage,37.35,,,,,,,Fee Schedule,37.35,56.44,
PT Physical Performance Assistant Test,9390432,LOCAL,97750,CPT,,,,,CQ,Outpatient,,,118.17,77,United Health ,United Health Medicare Advantage,31.29,,,,,,,Fee Schedule,31.29,56.44,
PT Physical Performance Test Charges,7895980,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,United Health ,United Health Medicare Advantage,31.29,,,,,,,Fee Schedule,31.29,56.44,
"PT Prosthetic Management, Train Assistant Units",9390460,LOCAL,97761,CPT,,,,,CQ,Outpatient,,,118.17,77,United Health ,United Health Medicare Advantage,37.35,,,,,,,Fee Schedule,37.35,56.44,
"29125 Application of short arm splint (forearm to hand); static, right",8584933,LOCAL,29125,CPT,,,,,,Outpatient,,,120,129,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,63.51,863,
"Chlamydia Trachomatis RNA, TMA QST",14747186,LOCAL,87491,CPT,,,,,,Outpatient,,,120,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
Cortisol Baseline,7974014,LOCAL,80400,CPT,,,,,,Outpatient,,,120,39.14,United Health ,United Health Medicare Advantage,75.99,,,,,,,Fee Schedule,18.43,75.985,
Cyt Clinical Info QST,14754292,LOCAL,88104,CPT,,,,,,Outpatient,,,120,,United Health ,United Health Medicare Advantage,35.88,,,,,,,Fee Schedule,14.07,35.88,
Cyt Pathologist QST,14754294,LOCAL,88172,CPT,,,,,,Outpatient,,,120,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,58.01,156.67,
Cyt Report Notes QST,14754295,LOCAL,88173,CPT,,,,,,Outpatient,,,120,,United Health ,United Health Medicare Advantage,48.85,,,,,,,Fee Schedule,48.85,53.82,
Cyt Report Type QST,14754291,LOCAL,88121,CPT,,,,,,Outpatient,,,120,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,58.01,156.67,
Cyt Screener QST,14754293,LOCAL,87207,CPT,,,,,,Outpatient,,,120,7.19,United Health ,United Health Medicare Advantage,5.99,,,,,,,Fee Schedule,5.99,10.57,
"Mycoplasma Genitalium, rRNA QST",14747189,LOCAL,87563,CPT,,,,,,Outpatient,,,120,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",14747187,LOCAL,87591,CPT,,,,,,Outpatient,,,120,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
Tissue 1A Source QST,14754297,LOCAL,88108,CPT,,,,,,Outpatient,,,120,,United Health ,United Health Medicare Advantage,35.88,,,,,,,Fee Schedule,14.07,35.88,
Tissue 1B Source QST,14754303,LOCAL,88108,CPT,,,,,,Outpatient,,,120,,United Health ,United Health Medicare Advantage,35.88,,,,,,,Fee Schedule,14.07,35.88,
Tissue 1C Source QST,14754321,LOCAL,88108,CPT,,,,,,Outpatient,,,120,,United Health ,United Health Medicare Advantage,35.88,,,,,,,Fee Schedule,14.07,35.88,
Tissue A Clinical Impression QST,14754296,LOCAL,88160,CPT,,,,,,Outpatient,,,120,,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue A Comment QST,14754301,LOCAL,88161,CPT,,,,,,Outpatient,,,120,,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue A Diagnosis QST,14754300,LOCAL,88162,CPT,,,,,,Outpatient,,,120,,United Health ,United Health Medicare Advantage,48.85,,,,,,,Fee Schedule,48.85,58.01,
Tissue A Gross Description QST,14754299,LOCAL,88305,CPT,,,,,,Outpatient,,,120,,United Health ,United Health Medicare Advantage,48.85,,,,,,,Fee Schedule,48.85,59.06,
Tissue B Comment QST,14754307,LOCAL,88161,CPT,,,,,,Outpatient,,,120,,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue B Diagnosis QST,14754306,LOCAL,88162,CPT,,,,,,Outpatient,,,120,,United Health ,United Health Medicare Advantage,48.85,,,,,,,Fee Schedule,48.85,58.01,
Tissue B Gross Description QST,14754305,LOCAL,88305,CPT,,,,,,Outpatient,,,120,,United Health ,United Health Medicare Advantage,48.85,,,,,,,Fee Schedule,48.85,59.06,
Tissue C Clinical Impression QST,14754320,LOCAL,88160,CPT,,,,,,Outpatient,,,120,,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue C Comment QST,14754325,LOCAL,88161,CPT,,,,,,Outpatient,,,120,,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,14.07,22.39,
Tissue C Diagnosis QST,14754324,LOCAL,88162,CPT,,,,,,Outpatient,,,120,,United Health ,United Health Medicare Advantage,48.85,,,,,,,Fee Schedule,48.85,58.01,
Tissue C Gross Description QST,14754323,LOCAL,88305,CPT,,,,,,Outpatient,,,120,,United Health ,United Health Medicare Advantage,48.85,,,,,,,Fee Schedule,48.85,59.06,
Trichomonas Vaginalis RNA QST,14747188,LOCAL,87661,CPT,,,,,,Outpatient,,,120,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
naloxone 1 mg/mL injectable solution 2 mL [CULL],11202975,LOCAL,J2312,CPT,,,,,,Outpatient,2,ML,120.384,,United Health ,United Health Medicare Advantage,0.07,,,,,,,Fee Schedule,0.065,0.065,
T. candidus QSTC,9010450,LOCAL,86606,CPT,,,,,,Outpatient,,,120.75,18.06,United Health ,United Health Medicare Advantage,15.05,,,,,,,Fee Schedule,15.05,15.29,
T. vulgaris QSTC,9010456,LOCAL,86609,CPT,,,,,,Outpatient,,,120.75,15.46,United Health ,United Health Medicare Advantage,12.88,,,,,,,Fee Schedule,12.88,15.29,
Trichoderma viride IgG QSTC,9010474,LOCAL,86001,CPT,,,,,,Outpatient,,,120.75,9.38,United Health ,United Health Medicare Advantage,7.82,,,,,,,Fee Schedule,7.82,15.29,
L3925 Fo pip dip jnt/sprng pre ots,9856100,LOCAL,,,L3925,HCPCS,,,,Outpatient,,,121.05,79,United Health ,United Health Medicare Advantage,59.39,,,,,,,Fee Schedule,59.39,59.39,
"Fecal Lipids, Total QSTC",8972795,LOCAL,82710,CPT,,,,,,Outpatient,,,121.19,20.16,United Health ,United Health Medicare Advantage,16.8,,,,,,,Fee Schedule,16.8,17.73,
Oxcarbazepine Metabolite QSTC,8764758,LOCAL,80183,CPT,,,,,,Outpatient,,,121.5,15.9,United Health ,United Health Medicare Advantage,13.25,,,,,,,Fee Schedule,13.25,15.38,
Lactated Ringers Injection 1000 mL [CULL],11281275,LOCAL,J7120,CPT,,,,,,Outpatient,1000,ML,121.6,,United Health ,United Health Medicare Advantage,0.54,,,,,,,Fee Schedule,0.543820225,0.543820225,
97110  SB OT Thera Exer,9850027,LOCAL,97110,CPT,,,,,GO,Outpatient,,,122.28,79,United Health ,United Health Medicare Advantage,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110  SB PT Thera Exer,9650027,LOCAL,97110,CPT,,,,,GP|CQ,Outpatient,,,122.28,79,United Health ,United Health Medicare Advantage,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 EXERCISE 1/MORE AREAS CHARGE,9410136,LOCAL,97110,CPT,,,,,GP,Outpatient,,,122.28,79,United Health ,United Health Medicare Advantage,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 OT Therapeutic Exercise Assistant Units,9860027,LOCAL,97110,CPT,,,,,GO|CO,Outpatient,,,122.28,79,United Health ,United Health Medicare Advantage,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 PT THERAPEUTIC EXERCISE,9640054,LOCAL,97110,CPT,,,,,GP,Outpatient,,,122.28,79,United Health ,United Health Medicare Advantage,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 PT Therapeutic Exercise Assistant Units,9650054,LOCAL,97110,CPT,,,,,GP|CQ,Outpatient,,,122.28,79,United Health ,United Health Medicare Advantage,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
97110 THERAPEUTIC EXER 15 MIN CHARGES,9640027,LOCAL,97110,CPT,,,,,GP,Outpatient,,,122.28,79,United Health ,United Health Medicare Advantage,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
OT Therapeutic Exercise Assistant Units,750901,LOCAL,97110,CPT,,,,,CQ,Outpatient,,,122.28,79,United Health ,United Health Medicare Advantage,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
OT Therapeutic Exercise Charges,750901,LOCAL,97110,CPT,,,,,GO,Outpatient,,,122.28,79,United Health ,United Health Medicare Advantage,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
OT Therapeutic Exercise Rehab Units,7897696,LOCAL,97110,CPT,,,,,GO,Outpatient,,,122.28,79,United Health ,United Health Medicare Advantage,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
PT Therapeutic Exercise Assistant Units,9390430,LOCAL,97110,CPT,,,,,CQ,Outpatient,,,122.28,79,United Health ,United Health Medicare Advantage,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
Therapeutic Exercise Charges,750901,LOCAL,97110,CPT,,,,,GO,Outpatient,,,122.28,79,United Health ,United Health Medicare Advantage,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
Therapeutic Exercise Charges,7895934,LOCAL,97110,CPT,,,,,GP,Outpatient,,,122.28,79,United Health ,United Health Medicare Advantage,36.6,,,,,,,Fee Schedule,36.59637931,56.44,
Creatine Kinase,633712,LOCAL,82550,CPT,,,,,,Outpatient,,,122.4,7.81,United Health ,United Health Medicare Advantage,23.74,,,,,,,Fee Schedule,7.16,23.7373913,
Genital Culture,633894,LOCAL,87070,CPT,,,,,,Outpatient,,,122.4,10.34,United Health ,United Health Medicare Advantage,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Respiratory Culture,4123062,LOCAL,87070,CPT,,,,,,Outpatient,,,122.4,10.34,United Health ,United Health Medicare Advantage,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Sputum Culture,7909553,LOCAL,87070,CPT,,,,,,Outpatient,,,122.4,10.34,United Health ,United Health Medicare Advantage,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Blood Culture,4122800,LOCAL,87040,CPT,,,,,,Outpatient,,,123.22,12.38,United Health ,United Health Medicare Advantage,19.45,,,,,,,Fee Schedule,10.57,19.45393258,
Blood Unit Culture,7967813,LOCAL,87040,CPT,,,,,,Outpatient,,,123.22,12.38,United Health ,United Health Medicare Advantage,19.45,,,,,,,Fee Schedule,10.57,19.45393258,
Folate Level,1628894,LOCAL,82746,CPT,,,,,,Outpatient,,,123.62,17.64,United Health ,United Health Medicare Advantage,48.81,,,,,,,Fee Schedule,17.73,48.81056075,
Troponin-I,1634892,LOCAL,84484,CPT,,,,,,Outpatient,,,124.52,14.96,United Health ,United Health Medicare Advantage,0.89,,,,,,,Fee Schedule,0.887987013,17.73,
influenza vaccine (Flucelvax PF) vaccine 2025-2026 [CULL],11292050,LOCAL,90661,CPT,,,,,,Outpatient,0.5,ML,124.60032,,United Health ,United Health Medicare Advantage,52.02,,,,,,,Fee Schedule,39.58,52.0225,
methylPREDNISolone 1 g Pow,11201957,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,124.8,,United Health ,United Health Medicare Advantage,0.21,,,,,,,Fee Schedule,0.21,0.21,
29584 PT APPLICATION OF MULTI-LAYER COMPRESSION SYSTEM,9109668,LOCAL,29584,CPT,,,,,GP,Outpatient,,,125,81,United Health ,United Health Medicare Advantage,144.26,,,,,,,Fee Schedule,63.51,863,
PT MultiLayer Compress Below Knee Charge,7896004,LOCAL,29584,CPT,,,,,GP,Outpatient,,,125,81,United Health ,United Health Medicare Advantage,144.26,,,,,,,Fee Schedule,63.51,863,
XR TMJ Open and Closed Left,9514710,LOCAL,70328,CPT,,,,,LT,Outpatient,,,125,66.83,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR TMJ Open and Closed Right,9514712,LOCAL,70328,CPT,,,,,RT,Outpatient,,,125,66.83,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
Liver Kidney Microsomal LKM1 Ab IgG QSTC,8764790,LOCAL,86376,CPT,,,,,,Outpatient,,,125.19,17.46,United Health ,United Health Medicare Advantage,25.09,,,,,,,Fee Schedule,15.29,25.085,
Medium Cam Walking Boot,9400074,LOCAL,,,L4387,HCPCS,,,,Outpatient,,,125.35,67,United Health ,United Health Medicare Advantage,195.89,,,,,,,Fee Schedule,195.89,195.89,
PTH-Related Protein (PTH-RP) QSTC,8764743,LOCAL,83519,CPT,,,,,,Outpatient,,,126,22.08,United Health ,United Health Medicare Advantage,72.02,,,,,,,Fee Schedule,17.73,72.02,
REF DAT IgG,7939268,LOCAL,86880,CPT,,,,,,Outpatient,,,126,6.47,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,6.29,54.31,
Computer Crossmatch Interp -> Computer XM OK,8142426,LOCAL,86923,CPT,,,,,,Outpatient,,,126.02,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
Serological Immediate Spin -> Compatible,8014366,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
Serological Immediate Spin -> Corrected,10125801,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
Serological Immediate Spin -> Incompatible,9527535,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Gel Interp -> Compatible,8013754,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Gel Interp -> Incompatible,8013753,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Gel Interp -> Least Incompatible,8013752,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Tube Interp -> Compatible,8014220,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Tube Interp -> Incompatible,8014219,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
XM AHG Tube Interp -> Least Incompatible,8014218,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
Alanine aminotransferase,633632,LOCAL,84460,CPT,,,,,,Outpatient,,,126.07,6.36,United Health ,United Health Medicare Advantage,5.3,,,,,,,Fee Schedule,5.3,7.16,
Erythrocyte Sedimentation Rate (ESR),7909828,LOCAL,85652,CPT,,,,,,Outpatient,,,126.07,3.24,United Health ,United Health Medicare Advantage,43.68,,,,,,,Fee Schedule,8.21,43.67975976,
97112 BAL ACT EA 15 MIN CHARGES,9640028,LOCAL,97112,CPT,,,,,GP,Outpatient,,,127.2,83,United Health ,United Health Medicare Advantage,30.63,,,,,,,Fee Schedule,30.63,56.44,
97112 NEUROMUSCULAR RE-EDUCATION CHARGE,9410141,LOCAL,97112,CPT,,,,,GP,Outpatient,,,127.2,83,United Health ,United Health Medicare Advantage,30.63,,,,,,,Fee Schedule,30.63,56.44,
97112 OT NEURO MUSCULAR RE ED EA 15 MIN,9850028,LOCAL,97112,CPT,,,,,GO,Outpatient,,,127.2,83,United Health ,United Health Medicare Advantage,30.63,,,,,,,Fee Schedule,30.63,56.44,
97112 OT Neuromusc Re-education Assistant Units,9860028,LOCAL,97112,CPT,,,,,GO|CO,Outpatient,,,127.2,83,United Health ,United Health Medicare Advantage,30.63,,,,,,,Fee Schedule,30.63,56.44,
97112 PT Neuromuscular Re-Ed Assistant Units,9650028,LOCAL,97112,CPT,,,,,GP|CQ,Outpatient,,,127.2,83,United Health ,United Health Medicare Advantage,30.63,,,,,,,Fee Schedule,30.63,56.44,
Neuromuscular Reeducation Charges,750905,LOCAL,97112,CPT,,,,,GO,Outpatient,,,127.2,83,United Health ,United Health Medicare Advantage,30.63,,,,,,,Fee Schedule,30.63,56.44,
Neuromuscular Reeducation Charges,7895932,LOCAL,97112,CPT,,,,,GP,Outpatient,,,127.2,83,United Health ,United Health Medicare Advantage,30.63,,,,,,,Fee Schedule,30.63,56.44,
OT Neuromuscular Reeducation Assistant Units,750905,LOCAL,97112,CPT,,,,,CQ,Outpatient,,,127.2,83,United Health ,United Health Medicare Advantage,30.63,,,,,,,Fee Schedule,30.63,56.44,
OT Neuromuscular Reeducation Charges,750905,LOCAL,97112,CPT,,,,,GO,Outpatient,,,127.2,83,United Health ,United Health Medicare Advantage,30.63,,,,,,,Fee Schedule,30.63,56.44,
OT Neuromuscular Reeducation Rehab Units,7897697,LOCAL,97112,CPT,,,,,GO,Outpatient,,,127.2,83,United Health ,United Health Medicare Advantage,30.63,,,,,,,Fee Schedule,30.63,56.44,
PT Neuromuscular Reeducation Assistant Units,9390444,LOCAL,97112,CPT,,,,,CQ,Outpatient,,,127.2,83,United Health ,United Health Medicare Advantage,30.63,,,,,,,Fee Schedule,30.63,56.44,
Culture Fungus Smear not Hr Skn Bld QST,10217136,LOCAL,87102,CPT,,,,,,Outpatient,,,127.3,10.09,United Health ,United Health Medicare Advantage,53.14,,,,,,,Fee Schedule,10.57,53.14428571,
Alcohol Level,1503765,LOCAL,,,G0480,HCPCS,,,,Outpatient,,,129.74,84,United Health ,United Health Medicare Advantage,114.43,,,,,,,Fee Schedule,46.74,114.43,
CBC w/ Differential,633683,LOCAL,85025,CPT,,,,,,Outpatient,,,129.74,9.32,United Health ,United Health Medicare Advantage,31.46,,,,,,,Fee Schedule,8.21,31.45666667,
Na Citrate Platelet Count,9472554,LOCAL,85049,CPT,,,,,,Outpatient,,,129.74,5.38,United Health ,United Health Medicare Advantage,33.54,,,,,,,Fee Schedule,8.21,33.535,
Platelet Count,2182297,LOCAL,85049,CPT,,,,,,Outpatient,,,129.74,5.38,United Health ,United Health Medicare Advantage,33.54,,,,,,,Fee Schedule,8.21,33.535,
Platelet Count Manual,7974157,LOCAL,85049,CPT,,,,,,Outpatient,,,129.74,5.38,United Health ,United Health Medicare Advantage,33.54,,,,,,,Fee Schedule,8.21,33.535,
iron dextran 50 mg/mL injectable solution 2 mL [CULL],11205256,LOCAL,J1750,CPT,,,,,,Outpatient,2,ML,129.85728,,United Health ,United Health Medicare Advantage,18.11,,,,,,,Fee Schedule,18.11,122.4,
70030 X-RAY EYE FOR FOREIGN BODY,8658473,LOCAL,70030,CPT,,,,,,Outpatient,,,130,72.6,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Foreign Body Localization Eye,8658473,LOCAL,70030,CPT,,,,,,Outpatient,,,130,72.6,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
TSI(Thyroid Stimulating Immunoglob) QSTC,8764795,LOCAL,84445,CPT,,,,,,Outpatient,,,130.05,61.03,United Health ,United Health Medicare Advantage,89.95,,,,,,,Fee Schedule,47.35,89.95,
Glucose Fasting GTT,8238854,LOCAL,82951,CPT,,,,,,Outpatient,,,130.97,15.44,United Health ,United Health Medicare Advantage,12.87,,,,,,,Fee Schedule,12.87,17.73,
Small Cam Walking Boot,9400073,LOCAL,,,L4387,HCPCS,,,,Outpatient,,,131.56,67,United Health ,United Health Medicare Advantage,195.89,,,,,,,Fee Schedule,195.89,195.89,
L3908 Comfort cool thumb/wrist CMC orthosis,9800210,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,131.58,86,United Health ,United Health Medicare Advantage,67.37,,,,,,,Fee Schedule,67.37,67.37,
L3908 OT WRIST HAND ORTHOSIS,9800211,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,131.58,86,United Health ,United Health Medicare Advantage,67.37,,,,,,,Fee Schedule,67.37,67.37,
Large Cam Walking Boot,9400070,LOCAL,,,L4387,HCPCS,,,,Outpatient,,,131.67,67,United Health ,United Health Medicare Advantage,195.89,,,,,,,Fee Schedule,195.89,195.89,
97535  SB PT Act of Liv 15 m,9640035,LOCAL,97535,CPT,,,,,GP,Outpatient,,,132.09,86,United Health ,United Health Medicare Advantage,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97535 OT HOME MAKING ACTIVITY CHARGE,9820191,LOCAL,97535,CPT,,,,,GO,Outpatient,,,132.09,86,United Health ,United Health Medicare Advantage,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97535 OT SELF CARE/HOME MGMT/ADL 15 MIN,9860191,LOCAL,97535,CPT,,,,,GO|CO,Outpatient,,,132.09,86,United Health ,United Health Medicare Advantage,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97535 PT ADL Training/Self Care Assistant Units,9650035,LOCAL,97535,CPT,,,,,GP|CQ,Outpatient,,,132.09,86,United Health ,United Health Medicare Advantage,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97535 SELF CARE/HOME MGMT-ADL'S CHARGE,9410191,LOCAL,97535,CPT,,,,,GP,Outpatient,,,132.09,86,United Health ,United Health Medicare Advantage,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
ADL Training Charge,7895959,LOCAL,97535,CPT,,,,,GP,Outpatient,,,132.09,86,United Health ,United Health Medicare Advantage,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
ADL Training Charges,1366372,LOCAL,97535,CPT,,,,,GO,Outpatient,,,132.09,86,United Health ,United Health Medicare Advantage,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
OT ADL Training Charges,1366372,LOCAL,97535,CPT,,,,,GO,Outpatient,,,132.09,86,United Health ,United Health Medicare Advantage,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
"OT Self Care, Home Management Units",1373569,LOCAL,97535,CPT,,,,,GO,Outpatient,,,132.09,86,United Health ,United Health Medicare Advantage,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
"OT Self Care, Home Mgmt Assistant Units",1373569,LOCAL,97535,CPT,,,,,CQ,Outpatient,,,132.09,86,United Health ,United Health Medicare Advantage,14.7,,,,,,,Fee Schedule,14.70452962,47.26,
97530  SB OT Thera Act 15,9850032,LOCAL,97530,CPT,,,,,GO,Outpatient,,,133.15,87,United Health ,United Health Medicare Advantage,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
97530 ACTIVITIES EACH 15 MIN CHARGE,9410270,LOCAL,97530,CPT,,,,,GP,Outpatient,,,133.15,87,United Health ,United Health Medicare Advantage,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
97530 OT Therapeutic Activities Assistant Units,9860032,LOCAL,97530,CPT,,,,,GO|CO,Outpatient,,,133.15,87,United Health ,United Health Medicare Advantage,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
97530 PT MAT\BED ACTIVITIES CHARGE,9640034,LOCAL,97530,CPT,,,,,GP,Outpatient,,,133.15,87,United Health ,United Health Medicare Advantage,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
97530 PT Theraputic Activities Assistant Units,9650034,LOCAL,97530,CPT,,,,,GP|CQ,Outpatient,,,133.15,87,United Health ,United Health Medicare Advantage,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
OT Therapeutic Activities Assistant Units,750903,LOCAL,97530,CPT,,,,,CQ,Outpatient,,,133.15,87,United Health ,United Health Medicare Advantage,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
OT Therapeutic Activities Charges,750903,LOCAL,97530,CPT,,,,,GO,Outpatient,,,133.15,87,United Health ,United Health Medicare Advantage,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
OT Therapeutic Activities Rehab Units,7897699,LOCAL,97530,CPT,,,,,GO,Outpatient,,,133.15,87,United Health ,United Health Medicare Advantage,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
PT Therapeutic Activity Assistant Units,9390442,LOCAL,97530,CPT,,,,,CQ,Outpatient,,,133.15,87,United Health ,United Health Medicare Advantage,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
Therapeutic Activities Charge,7895929,LOCAL,97530,CPT,,,,,GP,Outpatient,,,133.15,87,United Health ,United Health Medicare Advantage,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
Therapeutic Activities Charges,750903,LOCAL,97530,CPT,,,,,GO,Outpatient,,,133.15,87,United Health ,United Health Medicare Advantage,78.32,,,,,,,Fee Schedule,56.44,78.32022727,
amiodarone 150 mg/100 mL-D5% intravenous solution 100 mL [CULL],11200044,LOCAL,J0283,CPT,,,,,,Outpatient,100,ML,133.2106667,,United Health ,United Health Medicare Advantage,2.53,,,,,,,Fee Schedule,2.529,2.529,
BB CROSSMATCH (AHG),6413027,LOCAL,86922,CPT,,,,,,Outpatient,,,133.82,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
BB CROSSMATCH (XMG INSTRUMENT),6413070,LOCAL,86922,CPT,,,,,,Outpatient,,,133.82,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
Urine Culture,4126493,LOCAL,87086,CPT,,,,,,Outpatient,,,134.64,9.68,United Health ,United Health Medicare Advantage,31.43,,,,,,,Fee Schedule,10.57,31.43235995,
.dRVVT 1:1 Mix QSTC,6230328,LOCAL,85613,CPT,,,,,,Outpatient,,,135,11.5,United Health ,United Health Medicare Advantage,9.58,,,,,,,Fee Schedule,5.42,9.58,
Glomerular Basement Memb. Ab (IgG) QSTC,8853257,LOCAL,83520,CPT,,,,,,Outpatient,,,135,20.72,United Health ,United Health Medicare Advantage,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Glutamic Acid Decarboxylase-65 Ab QSTC,8764746,LOCAL,86341,CPT,,,,,,Outpatient,,,135,28.28,United Health ,United Health Medicare Advantage,23.57,,,,,,,Fee Schedule,15.29,23.57,
Quad Screen QSTC,8972927,LOCAL,81511,CPT,,,,,,Outpatient,,,135,184.2,United Health ,United Health Medicare Advantage,153.5,,,,,,,Fee Schedule,153.5,173.68,
Ribosomal P Antibody QSTC,8853260,LOCAL,83516,CPT,,,,,,Outpatient,,,135,13.84,United Health ,United Health Medicare Advantage,11.53,,,,,,,Fee Schedule,11.53,17.73,
"Rickettsia RMSF IgG,IgM w rfx Titer QSTC",8764764,LOCAL,86757,CPT,,,,,,Outpatient,,,135,23.22,United Health ,United Health Medicare Advantage,19.35,,,,,,,Fee Schedule,15.29,19.35,
Tryptase QSTC,8764744,LOCAL,83520,CPT,,,,,,Outpatient,,,135,20.72,United Health ,United Health Medicare Advantage,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
96523 Port Flush,14892040,LOCAL,96523,CPT,,,,,59,Outpatient,,,136,153,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,54.31,64.56,
OLANZapine 10 mg VL [CULL],11240752,LOCAL,J2358,CPT,,,,,,Outpatient,1,EA,136.096,,United Health ,United Health Medicare Advantage,2.92,,,,,,,Fee Schedule,2.92,2.92,
.Endomysial Ab Titer QSTC,8853243,LOCAL,86231,CPT,,,,,,Outpatient,,,136.17,14.51,United Health ,United Health Medicare Advantage,106.94,,,,,,,Fee Schedule,15.29,106.935,
Endomysial (IgG) Antibody Screen and Titer QSTC,10146198,LOCAL,86231,CPT,,,,,,Outpatient,,,136.17,14.51,United Health ,United Health Medicare Advantage,106.94,,,,,,,Fee Schedule,15.29,106.935,
L3808 OT SPLINT - DORSAL HAND SPLINT CHARGE,9856068,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,137.3,89,United Health ,United Health Medicare Advantage,375.59,,,,,,,Fee Schedule,375.59,375.59,
"L3808 WHFO, RIGID W/O JOINTS CHARGE",9856097,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,137.3,89,United Health ,United Health Medicare Advantage,375.59,,,,,,,Fee Schedule,375.59,375.59,
"96361- Hydration, each additional hour",1928298,LOCAL,96361,CPT,,,,,,Outpatient,,,137.66,89,United Health ,United Health Medicare Advantage,42.18,,,,,,,Fee Schedule,42.18,749.76,
96361 IV INFUSION HYDRATION ADDL HR Charge,8049102,LOCAL,96361,CPT,,,,,,Outpatient,,,137.66,89,United Health ,United Health Medicare Advantage,42.18,,,,,,,Fee Schedule,42.18,749.76,
90472 PO IMMUNIZATION ADM EA ADDTL VAC CHARGE,9279753,LOCAL,90472,CPT,,,,,,Outpatient,,,137.77,90,United Health ,United Health Medicare Advantage,14.55,,,,,,,Fee Schedule,14.55,56.18,
Phenytoin Lvl Total,7973985,LOCAL,80185,CPT,,,,,,Outpatient,,,138,15.9,United Health ,United Health Medicare Advantage,75.5,,,,,,,Fee Schedule,15.38,75.495,
aztreonam 1 g injection [CULL],11201222,LOCAL,J0457,CPT,,,,,,Outpatient,1,EA,138.5472,,United Health ,United Health Medicare Advantage,2.23,,,,,,,Fee Schedule,2.233,2.233,
"Allergy Panel 19, Seafood QSTC",13864480,LOCAL,86003,CPT,,,,,,Outpatient,,,138.78,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Crystal Examination Body Fluid,3454316,LOCAL,89060,CPT,,,,,,Outpatient,,,139,8.8,United Health ,United Health Medicare Advantage,21.53,,,,,,,Fee Schedule,14.07,21.53,
Bill Cyto Path Cell Enhance Tech,8489561,LOCAL,88112,CPT,,,,,,Outpatient,,,139.94,,United Health ,United Health Medicare Advantage,48.85,,,,,,,Fee Schedule,42.2,48.85,
Bill FNA Eval Interp & Rpt,8489566,LOCAL,88173,CPT,,,,,,Outpatient,,,139.94,,United Health ,United Health Medicare Advantage,48.85,,,,,,,Fee Schedule,48.85,53.82,
Bill IHC Antibody Additional,14048006,LOCAL,88341,CPT,,,,,,Outpatient,,,139.94,,United Health ,United Health Medicare Advantage,59.04,,,,,,,Fee Schedule,59.04,59.06,
Bill Tissue Exam Level 3,14047998,LOCAL,88304,CPT,,,,,,Outpatient,,,139.94,,United Health ,United Health Medicare Advantage,48.85,,,,,,,Fee Schedule,32.32,48.85,
Bill Tissue Exam Level 4,14036169,LOCAL,88305,CPT,,,,,,Outpatient,,,139.94,,United Health ,United Health Medicare Advantage,48.85,,,,,,,Fee Schedule,48.85,59.06,
70250 X-RAY EXAM OF SKULL,8658523,LOCAL,70250,CPT,,,,,,Outpatient,,,140,286.28,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
hepatitis A pediatric vaccine 25 units/0.5 mL intramuscular suspension 0.5 mL [CULL],11202555,LOCAL,90632,CPT,,,,,,Outpatient,0.5,ML,140.288,,United Health ,United Health Medicare Advantage,73.54,,,,,,,Fee Schedule,39.58,73.542,
medroxyPROGESTERone 150 mg/mL intramuscular suspension 1 mL [CULL],11204480,LOCAL,J1050,CPT,,,,,,Outpatient,1,ML,140.704,,United Health ,United Health Medicare Advantage,50.14,,,,,,,Fee Schedule,50.14,50.14,
"West Nile Ab IgG, CSF QSTC",13872975,LOCAL,86789,CPT,,,,,,Outpatient,,,141.3,17.27,United Health ,United Health Medicare Advantage,14.39,,,,,,,Fee Schedule,14.39,15.29,
"West Nile Ab IgG, Serum QSTC",9010233,LOCAL,86789,CPT,,,,,,Outpatient,,,141.3,17.27,United Health ,United Health Medicare Advantage,14.39,,,,,,,Fee Schedule,14.39,15.29,
"West Nile Ab IgM, CSF QSTC",13872978,LOCAL,86788,CPT,,,,,,Outpatient,,,141.3,20.22,United Health ,United Health Medicare Advantage,16.85,,,,,,,Fee Schedule,15.29,16.85,
"West Nile Ab IgM, Serum QSTC",9010236,LOCAL,86788,CPT,,,,,,Outpatient,,,141.3,20.22,United Health ,United Health Medicare Advantage,16.85,,,,,,,Fee Schedule,15.29,16.85,
"Chlamydia Trachomatis RNA, TMA QST",14718353,LOCAL,87491,CPT,,,,,,Outpatient,,,142,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
HPV MRNA E6/E7 QSTA,14718356,LOCAL,87624,CPT,,,,,,Outpatient,,,142,42.11,United Health ,United Health Medicare Advantage,67.2,,,,,,,Fee Schedule,40.19,67.195,
Thinprep Review Cytotechnologist: QST,14718368,LOCAL,88175,CPT,,,,,,Outpatient,,,142,31.93,United Health ,United Health Medicare Advantage,26.61,,,,,,,Fee Schedule,25.25,26.61,
"Trichomonas vaginalis, Ql TMA, Pap QST",14718355,LOCAL,87661,CPT,,,,,,Outpatient,,,142,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Cardio IQ(R) Lipoprotein Fraction, Ion Mobility QSTC",9039426,LOCAL,83704,CPT,,,,,,Outpatient,,,142.38,41.03,United Health ,United Health Medicare Advantage,34.19,,,,,,,Fee Schedule,34.19,46.74,
Parathyroid Hormone Intact,3455483,LOCAL,83970,CPT,,,,,,Outpatient,,,143,49.54,United Health ,United Health Medicare Advantage,92.84,,,,,,,Fee Schedule,47.35,92.84111111,
"Factor VIII Activity, Clotting QSTC",9039263,LOCAL,85240,CPT,,,,,,Outpatient,,,144,21.48,United Health ,United Health Medicare Advantage,17.9,,,,,,,Fee Schedule,5.42,17.9,
"Sirolimus, LC/MS/MS QSTC",8764819,LOCAL,80195,CPT,,,,,,Outpatient,,,144,16.48,United Health ,United Health Medicare Advantage,13.73,,,,,,,Fee Schedule,13.73,15.38,
97760 ORTHOTICS FIT/TRAIN EA 15MN CHARGE,9410176,LOCAL,97760,CPT,,,,,GP,Outpatient,,,144.44,94,United Health ,United Health Medicare Advantage,42.32,,,,,,,Fee Schedule,42.32,56.44,
97760 ORTHOTICS FITTING & TRAINING CHARGE,9850030,LOCAL,97760,CPT,,,,,GO,Outpatient,,,144.44,94,United Health ,United Health Medicare Advantage,42.32,,,,,,,Fee Schedule,42.32,56.44,
97760 OT Orthotic Mgmt/Train Initial Charge Assistant Units,9860030,LOCAL,97760,CPT,,,,,GO|CO,Outpatient,,,144.44,94,United Health ,United Health Medicare Advantage,42.32,,,,,,,Fee Schedule,42.32,56.44,
97760 PO ORTHOTIC EVALUATION CHARGE,9640032,LOCAL,97760,CPT,,,,,GP,Outpatient,,,144.44,94,United Health ,United Health Medicare Advantage,42.32,,,,,,,Fee Schedule,42.32,56.44,
97760 PO ORTHOTIC FOLLOW UP CHARGE,9650032,LOCAL,97760,CPT,,,,,GP|CQ,Outpatient,,,144.44,94,United Health ,United Health Medicare Advantage,42.32,,,,,,,Fee Schedule,42.32,56.44,
Orthotic Mgmt and Training Charges,7895275,LOCAL,97760,CPT,,,,,GO,Outpatient,,,144.44,94,United Health ,United Health Medicare Advantage,42.32,,,,,,,Fee Schedule,42.32,56.44,
Orthotic Mgmt and Training Charges,7895953,LOCAL,97760,CPT,,,,,GP,Outpatient,,,144.44,94,United Health ,United Health Medicare Advantage,42.32,,,,,,,Fee Schedule,42.32,56.44,
"OT Orthotic Management, Train Assistant Units",1373573,LOCAL,97760,CPT,,,,,CQ,Outpatient,,,144.44,94,United Health ,United Health Medicare Advantage,42.32,,,,,,,Fee Schedule,42.32,56.44,
"OT Orthotic Management, Train Units",1373573,LOCAL,97760,CPT,,,,,GO,Outpatient,,,144.44,94,United Health ,United Health Medicare Advantage,42.32,,,,,,,Fee Schedule,42.32,56.44,
"PT Orthotic Management, Train Assistant Units",9390458,LOCAL,97760,CPT,,,,,CQ,Outpatient,,,144.44,94,United Health ,United Health Medicare Advantage,42.32,,,,,,,Fee Schedule,42.32,56.44,
Urinary Catheter Type:; -> Straight/Intermittent,4610954,LOCAL,51701,CPT,,,,,,Outpatient,,,144.74,94,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,105.27,863,
EVENT MONITOR RECORDING ONLY,8200120,LOCAL,93270,CPT,,,,,,Outpatient,,,145.04,94,United Health ,United Health Medicare Advantage,34.09,,,,,,,Fee Schedule,34.09,99.86,
desmopressin 4 mcg/mL injectable solution 1 mL [CULL],11201582,LOCAL,J2597,CPT,,,,,,Outpatient,1,ML,145.92,,United Health ,United Health Medicare Advantage,3.52,,,,,,,Fee Schedule,3.52,233.26,
% CD3 (Mature T Cells) QSTC,13873423,LOCAL,86359,CPT,,,,,,Outpatient,,,146.25,45.28,United Health ,United Health Medicare Advantage,37.73,,,,,,,Fee Schedule,15.29,37.73,
CD4/CD8 Ratio QSTC,13873439,LOCAL,86360,CPT,,,,,,Outpatient,,,146.25,56.38,United Health ,United Health Medicare Advantage,46.98,,,,,,,Fee Schedule,44.29,46.98,
Beta hCG Qualitative,633663,LOCAL,84703,CPT,,,,,,Outpatient,,,146.88,9.02,United Health ,United Health Medicare Advantage,7.52,,,,,,,Fee Schedule,7.16,7.52,
Serum Pregnancy Qual POCT,10461706,LOCAL,84703,CPT,,,,,,Outpatient,,,146.88,9.02,United Health ,United Health Medicare Advantage,7.52,,,,,,,Fee Schedule,7.16,7.52,
Serum Pregnancy Test Qualitative,7909775,LOCAL,84703,CPT,,,,,,Outpatient,,,146.88,9.02,United Health ,United Health Medicare Advantage,7.52,,,,,,,Fee Schedule,7.16,7.52,
Serum Pregnancy Test Qualitative w/ Reflex,9384303,LOCAL,84703,CPT,,,,,,Outpatient,,,146.88,9.02,United Health ,United Health Medicare Advantage,7.52,,,,,,,Fee Schedule,7.16,7.52,
Urine Pregnancy POCT,8373784,LOCAL,81025,CPT,,,,,,Outpatient,,,146.88,10.33,United Health ,United Health Medicare Advantage,13.38,,,,,,,Fee Schedule,4.02,13.375,
Urine Pregnancy Test Qualitative,7909798,LOCAL,81025,CPT,,,,,,Outpatient,,,146.88,10.33,United Health ,United Health Medicare Advantage,13.38,,,,,,,Fee Schedule,4.02,13.375,
cefTRIAXone 1 g injection [CULL],11201426,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,147.0368,,United Health ,United Health Medicare Advantage,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
"IgA, Serum QSTC",13873298,LOCAL,82787,CPT,,,,,,Outpatient,,,147.38,9.62,United Health ,United Health Medicare Advantage,8.02,,,,,,,Fee Schedule,7.16,8.02,
IgA1 QSTC,13873292,LOCAL,82784,CPT,,,,,,Outpatient,,,147.38,11.16,United Health ,United Health Medicare Advantage,34.96,,,,,,,Fee Schedule,7.16,34.958,
Tobramycin Level,1634888,LOCAL,80200,CPT,,,,,,Outpatient,,,148.1,19.36,United Health ,United Health Medicare Advantage,16.13,,,,,,,Fee Schedule,15.38,16.13,
Blood Gas Arterial RT,8172944,LOCAL,36600,CPT,,,,,,Outpatient,,,148.2,96,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,85.79,863,
Blood Gas Draw Type -> Arterial (Puncture),5230102,LOCAL,36600,CPT,,,,,,Outpatient,,,148.2,96,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,85.79,863,
RT Arterial Puncture CHARGE,8143881,LOCAL,36600,CPT,,,,,,Outpatient,,,148.2,96,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,85.79,863,
"RT CHARGE PFT -> Maximum breathing capacity, Maximal voluntary ventilation (M",5267133,LOCAL,94200,CPT,,,,,,Outpatient,,,148.2,96,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,54.31,76.09,
XR TMJ Open and Closed Bilateral,1170502,LOCAL,70330,CPT,,,,,,Outpatient,,,150,80.85,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
Diphtheria Antitoxoid QSTC,14129477,LOCAL,86648,CPT,,,,,,Outpatient,,,151,18.25,United Health ,United Health Medicare Advantage,15.21,,,,,,,Fee Schedule,15.21,15.29,
Tetanus Antitoxoid QSTC,14129478,LOCAL,86774,CPT,,,,,,Outpatient,,,151,17.76,United Health ,United Health Medicare Advantage,14.8,,,,,,,Fee Schedule,14.8,15.29,
Hepatic Function Panel,633744,LOCAL,80076,CPT,,,,,,Outpatient,,,151.78,9.8,United Health ,United Health Medicare Advantage,58.59,,,,,,,Fee Schedule,12.14,58.58814815,
Hepatic Panel,633744,LOCAL,80076,CPT,,,,,,Outpatient,,,151.78,9.8,United Health ,United Health Medicare Advantage,58.59,,,,,,,Fee Schedule,12.14,58.58814815,
Dihydrotestosterone QSTC,8853275,LOCAL,82642,CPT,,,,,,Outpatient,,,151.88,35.14,United Health ,United Health Medicare Advantage,29.28,,,,,,,Fee Schedule,18.43,29.28,
36430 BLOOD TRANSFUSION CHARGE,9284603,LOCAL,36430,CPT,,,,,,Outpatient,,,151.98,99,United Health ,United Health Medicare Advantage,399.7,,,,,,,Fee Schedule,399.7,863,
BLOOD ADMINISTRATION Charge,5240125,LOCAL,36430,CPT,,,,,,Outpatient,,,151.98,99,United Health ,United Health Medicare Advantage,399.7,,,,,,,Fee Schedule,399.7,863,
92608 ST EX FOR SPEECH DEVICE RX EACH 30 MIN ADDL TIM,9636007,LOCAL,92608,CPT,,,,,GN,Outpatient,,,152.72,99,United Health ,United Health Medicare Advantage,44.72,,,,,,,Fee Schedule,44.72,337.75,
SLP Speech AAC Eval Addl Half Hour Units,1373854,LOCAL,92608,CPT,,,,,GN,Outpatient,,,152.72,99,United Health ,United Health Medicare Advantage,44.72,,,,,,,Fee Schedule,44.72,337.75,
Speech Generating Device Eval Additional 30 Min,1373854,LOCAL,92608,CPT,,,,,GN,Outpatient,,,152.72,99,United Health ,United Health Medicare Advantage,44.72,,,,,,,Fee Schedule,44.72,337.75,
Bill Only REF Splitting,13514968,LOCAL,86985,CPT,,,,,,Outpatient,,,153,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.88,156.67,
"Quantiferon(R)-TB Gold Plus, 1 Tube QST",9384402,LOCAL,86480,CPT,,,,,,Outpatient,,,153,74.38,United Health ,United Health Medicare Advantage,65.24,,,,,,,Fee Schedule,44.29,65.24390244,
"Quantiferon(R)-TB Gold Plus, 1 Tube QSTC",8983765,LOCAL,86480,CPT,,,,,,Outpatient,,,153,74.38,United Health ,United Health Medicare Advantage,65.24,,,,,,,Fee Schedule,44.29,65.24390244,
97113 AQUATIC THERAPY 15 MINS,9650029,LOCAL,97113,CPT,,,,,GP|CQ,Outpatient,,,153.55,100,United Health ,United Health Medicare Advantage,34.34,,,,,,,Fee Schedule,34.34,56.44,
97113 AQUATIC THERAPY 15 MINS OT,9860051,LOCAL,97113,CPT,,,,,GO|CO,Outpatient,,,153.55,100,United Health ,United Health Medicare Advantage,34.34,,,,,,,Fee Schedule,34.34,56.44,
97113 Occupational Therapy Aquatic charge,9850051,LOCAL,97113,CPT,,,,,GO,Outpatient,,,153.55,100,United Health ,United Health Medicare Advantage,34.34,,,,,,,Fee Schedule,34.34,56.44,
97113 OT AQUATIC THERAPY CHARGE,9640029,LOCAL,97113,CPT,,,,,GP,Outpatient,,,153.55,100,United Health ,United Health Medicare Advantage,34.34,,,,,,,Fee Schedule,34.34,56.44,
Aquatic Charge,7895272,LOCAL,97113,CPT,,,,,GO,Outpatient,,,153.55,100,United Health ,United Health Medicare Advantage,34.34,,,,,,,Fee Schedule,34.34,56.44,
Aquatic Therapy Charges,7895958,LOCAL,97113,CPT,,,,,GP,Outpatient,,,153.55,100,United Health ,United Health Medicare Advantage,34.34,,,,,,,Fee Schedule,34.34,56.44,
OT Aquatic Exercise Assistant Units,7895272,LOCAL,97113,CPT,,,,,CQ,Outpatient,,,153.55,100,United Health ,United Health Medicare Advantage,34.34,,,,,,,Fee Schedule,34.34,56.44,
OT Aquatic Exercise Assistant Units,7898597,LOCAL,97113,CPT,,,,,CQ,Outpatient,,,153.55,100,United Health ,United Health Medicare Advantage,34.34,,,,,,,Fee Schedule,34.34,56.44,
OT Aquatic Exercise Units,7897709,LOCAL,97113,CPT,,,,,GO,Outpatient,,,153.55,100,United Health ,United Health Medicare Advantage,34.34,,,,,,,Fee Schedule,34.34,56.44,
OT Aquatic Exercise Units,7898597,LOCAL,97113,CPT,,,,,GO,Outpatient,,,153.55,100,United Health ,United Health Medicare Advantage,34.34,,,,,,,Fee Schedule,34.34,56.44,
PT Aquatic Assistant Units,9390434,LOCAL,97113,CPT,,,,,CQ,Outpatient,,,153.55,100,United Health ,United Health Medicare Advantage,34.34,,,,,,,Fee Schedule,34.34,56.44,
G0237 PULM REHAB EA 15 MIN,10470027,LOCAL,,,G0237,HCPCS,,,59,Outpatient,,,154.78,101,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,22.39,51.98,
G0239 PULMONARY EXERCISE,10470025,LOCAL,,,G0239,HCPCS,,,,Outpatient,,,154.78,101,United Health ,United Health Medicare Advantage,35.88,,,,,,,Fee Schedule,35.88,51.98,
Calcium Oxalate QSTC,8997193,LOCAL,82340,CPT,,,,,,Outpatient,,,155,7.24,United Health ,United Health Medicare Advantage,22.62,,,,,,,Fee Schedule,7.16,22.61833333,
Sodium Urate QSTC,8997195,LOCAL,84300,CPT,,,,,,Outpatient,,,155,6.07,United Health ,United Health Medicare Advantage,9.74,,,,,,,Fee Schedule,7.16,9.74,
Uric Acid QSTC,8997197,LOCAL,84560,CPT,,,,,,Outpatient,,,155,6.1,United Health ,United Health Medicare Advantage,19.49,,,,,,,Fee Schedule,7.16,19.49,
"LD, Pericardial Fluid QSTC",13864442,LOCAL,83615,CPT,,,,,,Outpatient,,,155.39,7.25,United Health ,United Health Medicare Advantage,21.68,,,,,,,Fee Schedule,7.16,21.675,
"16000 Initial treatment, first degree burn, when no more than local treatment required",9400038,LOCAL,16000,CPT,,,,,,Outpatient,,,155.91,101,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
Diphtheria Antitoxoid QST,13824476,LOCAL,86648,CPT,,,,,,Outpatient,,,156,18.25,United Health ,United Health Medicare Advantage,15.21,,,,,,,Fee Schedule,15.21,15.29,
Tetanus Antitoxoid QST,13824477,LOCAL,86774,CPT,,,,,,Outpatient,,,156,17.76,United Health ,United Health Medicare Advantage,14.8,,,,,,,Fee Schedule,14.8,15.29,
Transferrin,633851,LOCAL,84466,CPT,,,,,,Outpatient,,,156.67,15.31,United Health ,United Health Medicare Advantage,29.64,,,,,,,Fee Schedule,17.73,29.64248366,
CANDIDA GLABRATA QST,12439000,LOCAL,87481,CPT,,,,,,Outpatient,,,157,42.11,United Health ,United Health Medicare Advantage,478.17,,,,,,,Fee Schedule,40.19,478.165,
CANDIDA SPECIES QST,12438999,LOCAL,87481,CPT,,,,,,Outpatient,,,157,42.11,United Health ,United Health Medicare Advantage,478.17,,,,,,,Fee Schedule,40.19,478.165,
"Chlamydia Trachomatis RNA, TMA QST",12439002,LOCAL,87591,CPT,,,,,,Outpatient,,,157,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",12439003,LOCAL,87491,CPT,,,,,,Outpatient,,,157,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
SURESWAB(R) ADV BV QST,12438998,LOCAL,81513,CPT,,,,,,Outpatient,,,157,171.16,United Health ,United Health Medicare Advantage,142.63,,,,,,,Fee Schedule,63.34,142.63,
"TRICHOMONAS VAGINALIS (TV), TMA QST",12439001,LOCAL,87661,CPT,,,,,,Outpatient,,,157,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
CANDIDA GLABRATA QST,12433969,LOCAL,87481,CPT,,,,,,Outpatient,,,157.5,42.11,United Health ,United Health Medicare Advantage,478.17,,,,,,,Fee Schedule,40.19,478.165,
CANDIDA SPECIES QST,12433968,LOCAL,87481,CPT,,,,,,Outpatient,,,157.5,42.11,United Health ,United Health Medicare Advantage,478.17,,,,,,,Fee Schedule,40.19,478.165,
"CRYPTOSPORIDIUM ANTIGEN, EIA QSTC",12500635,LOCAL,87328,CPT,,,,,,Outpatient,,,157.5,16.58,United Health ,United Health Medicare Advantage,13.82,,,,,,,Fee Schedule,10.57,13.82,
"Kappa/LambdaLt Chains,Freew/Ratio,S QSTC",8853285,LOCAL,83521,CPT,,,,,,Outpatient,,,157.5,20.72,United Health ,United Health Medicare Advantage,87.22,,,,,,,Fee Schedule,17.73,87.215,
XR Bone Age Studies,1170014,LOCAL,77072,CPT,,,,,,Outpatient,,,157.72,84.98,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
BB REF ABO DISCREP (RH),6432002,LOCAL,86901,CPT,,,,,,Outpatient,,,159.75,3.59,United Health ,United Health Medicare Advantage,35.88,,,,,,,Fee Schedule,6.29,35.88,
REF ABO/Rh Discrep,13484121,LOCAL,86900,CPT,,,,,,Outpatient,,,159.75,3.59,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,6.29,117.85,
"Ammonia, Plasma",7974187,LOCAL,82140,CPT,,,,,,Outpatient,,,160.34,17.48,United Health ,United Health Medicare Advantage,22.63,,,,,,,Fee Schedule,17.73,22.62909091,
97164 CIS Prgm PT Re-Evaluation 20 min,9650016,LOCAL,97164,CPT,,,,,GP|CQ,Outpatient,,,160.46,104,United Health ,United Health Medicare Advantage,62.94,,,,,,,Fee Schedule,62.94,349.89,
97164 RE-EVALUATION CHARGE,9410061,LOCAL,97164,CPT,,,,,GP,Outpatient,,,160.46,104,United Health ,United Health Medicare Advantage,62.94,,,,,,,Fee Schedule,62.94,349.89,
97164 RE-EVALUATION PT CHARGES,9640016,LOCAL,97164,CPT,,,,,GP,Outpatient,,,160.46,104,United Health ,United Health Medicare Advantage,62.94,,,,,,,Fee Schedule,62.94,349.89,
PT ReEval Time,7896016,LOCAL,97164,CPT,,,,,GP,Outpatient,,,160.46,104,United Health ,United Health Medicare Advantage,62.94,,,,,,,Fee Schedule,62.94,349.89,
Tobramycin Level Peak,1634889,LOCAL,80200,CPT,,,,,,Outpatient,,,163.2,19.36,United Health ,United Health Medicare Advantage,16.13,,,,,,,Fee Schedule,15.38,16.13,
Tobramycin Level Trough,1634890,LOCAL,80200,CPT,,,,,,Outpatient,,,163.2,19.36,United Health ,United Health Medicare Advantage,16.13,,,,,,,Fee Schedule,15.38,16.13,
11719 TRIM NAIL(S) ANY NUMBER WC CHARGE,8726774,LOCAL,11719,CPT,,,,,,Outpatient,,,163.39,106,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,54.31,863,
.C-ANCA Titer QSTC,8764786,LOCAL,86037,CPT,,,,,,Outpatient,,,163.67,14.46,United Health ,United Health Medicare Advantage,12.05,,,,,,,Fee Schedule,12.05,15.29,
.P-ANCA Titer QSTC,6225794,LOCAL,86037,CPT,,,,,,Outpatient,,,163.67,14.46,United Health ,United Health Medicare Advantage,12.05,,,,,,,Fee Schedule,12.05,15.29,
"Methicillin Resistant Staphylococcus aureus,PCR QSTC",9630594,LOCAL,87641,CPT,,,,,,Outpatient,,,164.16,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
phytonadione 10 mg/mL injectable solution 1 mL [CULL],11212150,LOCAL,J3430,CPT,,,,,,Outpatient,1,ML,164.224,,United Health ,United Health Medicare Advantage,2.81,,,,,,,Fee Schedule,2.808,2.808,
Bill Manual Tumor IM Histochem,14049347,LOCAL,88360,CPT,,,,,,Outpatient,,,164.92,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,59.06,156.67,
Bill SB Consult 1st TB w FS SGL SP,14048002,LOCAL,88331,CPT,,,,,,Outpatient,,,164.92,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,53.82,156.67,
Bill IHC Initial Antibody,14049345,LOCAL,88342,CPT,,,,,,Outpatient,,,164.98,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,59.06,156.67,
29105 - Long Arm Splint,9322359,LOCAL,29105,CPT,,,,,,Outpatient,,,165,158,United Health ,United Health Medicare Advantage,144.26,,,,,,,Fee Schedule,63.51,863,
Toxocara Ab (IgG) QSTC,13864452,LOCAL,86682,CPT,,,,,,Outpatient,,,165.38,15.61,United Health ,United Health Medicare Advantage,13.01,,,,,,,Fee Schedule,13.01,15.29,
Tissue Culture,633906,LOCAL,87070,CPT,,,,,,Outpatient,,,166.46,10.34,United Health ,United Health Medicare Advantage,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
acetaZOLAMIDE 500 mg intravenous injection [CULL],11200001,LOCAL,J1120,CPT,,,,,,Outpatient,1,EA,168.8,,United Health ,United Health Medicare Advantage,25.59,,,,,,,Fee Schedule,25.594,25.594,
97763 OT Orthotic Mgmt/Train Establish Charge,9650038,LOCAL,97763,CPT,,,,,GP|CQ,Outpatient,,,168.9,110,United Health ,United Health Medicare Advantage,45.74,,,,,,,Fee Schedule,45.74,56.44,
97763 OT Orthotic Mgmt/Train Established Assistant Units,9820206,LOCAL,97763,CPT,,,,,GO,Outpatient,,,168.9,110,United Health ,United Health Medicare Advantage,45.74,,,,,,,Fee Schedule,45.74,56.44,
97763 OT Orthotic/Prosthetic Mgmt/Training - each 15 min,9860206,LOCAL,97763,CPT,,,,,GO|CO,Outpatient,,,168.9,110,United Health ,United Health Medicare Advantage,45.74,,,,,,,Fee Schedule,45.74,56.44,
97763 PT ORTHO/PROST MNG/TRAIN EA 15,9410206,LOCAL,97763,CPT,,,,,GP,Outpatient,,,168.9,110,United Health ,United Health Medicare Advantage,45.74,,,,,,,Fee Schedule,45.74,56.44,
97763 PT Orthotic Mgmt/Train Establish Charge,9640038,LOCAL,97763,CPT,,,,,GP,Outpatient,,,168.9,110,United Health ,United Health Medicare Advantage,45.74,,,,,,,Fee Schedule,45.74,56.44,
OT Orthotic Mgmt/Train Est. Assit Units,7965332,LOCAL,97763,CPT,,,,,CQ,Outpatient,,,168.9,110,United Health ,United Health Medicare Advantage,45.74,,,,,,,Fee Schedule,45.74,56.44,
OT Orthotic Mgmt/Train Establish Charge,7965332,LOCAL,97763,CPT,,,,,GO,Outpatient,,,168.9,110,United Health ,United Health Medicare Advantage,45.74,,,,,,,Fee Schedule,45.74,56.44,
OT Orthotic Mgmt/Train Establish Rehab Units,7964942,LOCAL,97763,CPT,,,,,GO,Outpatient,,,168.9,110,United Health ,United Health Medicare Advantage,45.74,,,,,,,Fee Schedule,45.74,56.44,
PT Orthotic Mgmt/Train Establish Charge,7965252,LOCAL,97763,CPT,,,,,GP,Outpatient,,,168.9,110,United Health ,United Health Medicare Advantage,45.74,,,,,,,Fee Schedule,45.74,56.44,
"PT Orthotic/Prosthetic Manage,Train Assistant Units",9390462,LOCAL,97763,CPT,,,,,CQ,Outpatient,,,168.9,110,United Health ,United Health Medicare Advantage,45.74,,,,,,,Fee Schedule,45.74,56.44,
Total Glutathione QST,14799054,LOCAL,82978,CPT,,,,,,Outpatient,,,169,18.54,United Health ,United Health Medicare Advantage,15.45,,,,,,,Fee Schedule,15.45,17.73,
epoetin alfa-epbx 4000 units/mL preservative-free injectable solution 1 mL [CULL],11202396,LOCAL,Q5106,CPT,,,,,,Outpatient,1,ML,169.4208,,United Health ,United Health Medicare Advantage,7.85,,,,,,,Fee Schedule,7.85,525.49,
CT Heart Calcium Scoring,2424782,LOCAL,75571,CPT,,,,,,Outpatient,,,170,90.75,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,170.53,
"Cortisol, LC/MS, Saliva QSTC",8853249,LOCAL,82530,CPT,,,,,,Outpatient,,,171,20.05,United Health ,United Health Medicare Advantage,29.79,,,,,,,Fee Schedule,17.73,29.79,
Factor V (Leiden) Mutation Analysis QSTC,8764652,LOCAL,81241,CPT,,,,,,Outpatient,,,171,88.04,United Health ,United Health Medicare Advantage,73.37,,,,,,,Fee Schedule,63.34,73.37,
"Lyme Disease Ab (IgM), Blot QSTC",8849718,LOCAL,86617,CPT,,,,,,Outpatient,,,171,18.59,United Health ,United Health Medicare Advantage,15.49,,,,,,,Fee Schedule,15.29,15.49,
"Lyme Disease Ab(IgG),Blot QSTC",8849707,LOCAL,86617,CPT,,,,,,Outpatient,,,171,18.59,United Health ,United Health Medicare Advantage,15.49,,,,,,,Fee Schedule,15.29,15.49,
Prothrombin Gene Analysis QSTC,8764653,LOCAL,81240,CPT,,,,,,Outpatient,,,171,78.83,United Health ,United Health Medicare Advantage,65.69,,,,,,,Fee Schedule,63.34,65.69,
Cholesterol HDL,3170344,LOCAL,83718,CPT,,,,,,Outpatient,,,172,9.83,United Health ,United Health Medicare Advantage,8.19,,,,,,,Fee Schedule,7.16,8.19,
Glucagon QSTC,13864528,LOCAL,82943,CPT,,,,,,Outpatient,,,173.7,17.15,United Health ,United Health Medicare Advantage,14.29,,,,,,,Fee Schedule,14.29,18.43,
fondaparinux 2.5 mg/0.5 mL subcutaneous solution 0.5 mL [CULL],11260583,LOCAL,J1652,CPT,,,,,,Outpatient,0.5,ML,174.8864,,United Health ,United Health Medicare Advantage,0.88,,,,,,,Fee Schedule,0.877,0.877,
CULL MG Wire Loc Needle,13721990,LOCAL,10035,CPT,A4648,HCPCS,,,,Outpatient,,,174.99,114,United Health ,United Health Medicare Advantage,643.26,,,,,,,Fee Schedule,643.26,1291,
90912 - Bfb training 1st 15 min.,9442435,LOCAL,90912,CPT,,,,,,Outpatient,,,175,114,United Health ,United Health Medicare Advantage,35.97,,,,,,,Fee Schedule,35.97,233.61,
97129 Cognition Ther Intervent First 15 min,9850048,LOCAL,97129,CPT,,,,,GO,Outpatient,,,175,114,United Health ,United Health Medicare Advantage,18.94,,,,,,,Fee Schedule,18.94,56.44,
97129 Cognition Ther Intervent First 15 min Assistant Units,9860048,LOCAL,97129,CPT,,,,,GO|CO,Outpatient,,,175,114,United Health ,United Health Medicare Advantage,18.94,,,,,,,Fee Schedule,18.94,56.44,
97130 Cognition Ther Intervent Addlt 15 min,9850049,LOCAL,97130,CPT,,,,,GO,Outpatient,,,175,114,United Health ,United Health Medicare Advantage,18.08,,,,,,,Fee Schedule,18.08,56.44,
97130 Cognition Ther Intervent Addlt 15 min Assistant Units,9860049,LOCAL,97130,CPT,,,,,GO|CO,Outpatient,,,175,114,United Health ,United Health Medicare Advantage,18.08,,,,,,,Fee Schedule,18.08,56.44,
"OT Cog Ther Intervent, Addl 15 Min Asst",9401146,LOCAL,97130,CPT,,,,,CQ,Outpatient,,,175,114,United Health ,United Health Medicare Advantage,18.08,,,,,,,Fee Schedule,18.08,56.44,
"OT Cog Ther Intervent, Addl 15 Min Units",9401146,LOCAL,97130,CPT,,,,,GO,Outpatient,,,175,114,United Health ,United Health Medicare Advantage,18.08,,,,,,,Fee Schedule,18.08,56.44,
"OT Cog Ther Intervent, First 15 Min Asst",9401140,LOCAL,97129,CPT,,,,,CQ,Outpatient,,,175,114,United Health ,United Health Medicare Advantage,18.94,,,,,,,Fee Schedule,18.94,56.44,
"OT Cog Ther Intervent,First 15 Min Units",9401140,LOCAL,97129,CPT,,,,,GO,Outpatient,,,175,114,United Health ,United Health Medicare Advantage,18.94,,,,,,,Fee Schedule,18.94,56.44,
Bill Only Pheno Non-Rh EA/Ag,13517193,LOCAL,86905,CPT,,,,,,Outpatient,,,175.5,4.6,United Health ,United Health Medicare Advantage,328.88,,,,,,,Fee Schedule,6.29,328.88,
Bill Only REF Thawing,13514966,LOCAL,86927,CPT,,,,,,Outpatient,,,175.5,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.88,156.67,
Ref Hgb S,9527497,LOCAL,85660,CPT,,,,,,Outpatient,,,175.5,6.61,United Health ,United Health Medicare Advantage,5.51,,,,,,,Fee Schedule,5.51,8.21,
Basic Metabolic Panel,633628,LOCAL,80048,CPT,,,,,,Outpatient,,,176.26,10.15,United Health ,United Health Medicare Advantage,37.17,,,,,,,Fee Schedule,12.14,37.17170492,
gemcitabine 1 g injection [CULL],11292094,LOCAL,J9201,CPT,,,,,,Outpatient,1,EA,176.384,,United Health ,United Health Medicare Advantage,3.59,,,,,,,Fee Schedule,3.59,3.59,
RT CHARGE PFT -> Diffusion (DLCO),5267130,LOCAL,94729,CPT,,,,,,Outpatient,,,176.44,115,United Health ,United Health Medicare Advantage,47.24,,,,,,,Fee Schedule,47.24,76.09,
E0773 Thawed FFP CPD,7267127,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,United Health ,United Health Medicare Advantage,84.29,,,,,,,Fee Schedule,84.29,217.45,
E1237 Thawed Aph FFP ACDA,7267133,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,United Health ,United Health Medicare Advantage,84.29,,,,,,,Fee Schedule,84.29,217.45,
E2701 Thawed Plasma CPD <24h,7267161,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,United Health ,United Health Medicare Advantage,84.29,,,,,,,Fee Schedule,84.29,217.45,
E2737 Thawed Plasma CP2D <24h,7267171,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,United Health ,United Health Medicare Advantage,84.29,,,,,,,Fee Schedule,84.29,217.45,
E4713 Thawed Aph FFP ACDA 1,7267173,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,United Health ,United Health Medicare Advantage,84.29,,,,,,,Fee Schedule,84.29,217.45,
E4717 Thawed Aph FFP ACDA 2,7267174,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,United Health ,United Health Medicare Advantage,84.29,,,,,,,Fee Schedule,84.29,217.45,
E4721 Thawed Aph FFP ACDA 3,7267175,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,United Health ,United Health Medicare Advantage,84.29,,,,,,,Fee Schedule,84.29,217.45,
amiodarone 360 mg/200 mL-D5% intravenous solution 200 mL [CULL],11200046,LOCAL,J0283,CPT,,,,,,Outpatient,200,ML,177.1776,,United Health ,United Health Medicare Advantage,2.53,,,,,,,Fee Schedule,2.529,2.529,
protamine 10 mg/mL injectable solution 25 mL [CULL],11211130,LOCAL,J2720,CPT,,,,,,Outpatient,25,ML,178.208,,United Health ,United Health Medicare Advantage,1.57,,,,,,,Fee Schedule,1.571,1.571,
Anti-Mullerian Hormone (AMH) Female QSTC,8972886,LOCAL,82166,CPT,,,,,,Outpatient,,,180,46.34,United Health ,United Health Medicare Advantage,38.62,,,,,,,Fee Schedule,17.73,38.62,
"Chlamydia Trachomatis RNA, TMA QST",14718336,LOCAL,87491,CPT,,,,,,Outpatient,,,180,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Chromogranin A, LC/MS/MS QSTC",10319690,LOCAL,86316,CPT,,,,,,Outpatient,,,180,24.97,United Health ,United Health Medicare Advantage,100.2,,,,,,,Fee Schedule,15.29,100.2,
"Estriol, Serum QSTC",9039351,LOCAL,82677,CPT,,,,,,Outpatient,,,180,29.02,United Health ,United Health Medicare Advantage,24.18,,,,,,,Fee Schedule,18.43,24.18,
H. pylori Urea Breath Test QSTC,8764622,LOCAL,83013,CPT,,,,,,Outpatient,,,180,80.83,United Health ,United Health Medicare Advantage,123.01,,,,,,,Fee Schedule,46.74,123.01,
"Metanephrines, Fract Free LCMSMS, P QSTC",8764672,LOCAL,83835,CPT,,,,,,Outpatient,,,180,20.33,United Health ,United Health Medicare Advantage,98.31,,,,,,,Fee Schedule,18.43,98.305,
Mycophenolic Acid QSTC,9039269,LOCAL,80180,CPT,,,,,,Outpatient,,,180,21.66,United Health ,United Health Medicare Advantage,98.85,,,,,,,Fee Schedule,15.38,98.845,
"Neisseria Gonorrhoeae RNA, TMA QST",14718337,LOCAL,87591,CPT,,,,,,Outpatient,,,180,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
Thinprep Review Cytotechnologist: QST,14718350,LOCAL,88175,CPT,,,,,,Outpatient,,,180,31.93,United Health ,United Health Medicare Advantage,26.61,,,,,,,Fee Schedule,25.25,26.61,
"Trichomonas vaginalis, Ql TMA, Pap QST",14718338,LOCAL,87661,CPT,,,,,,Outpatient,,,180,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Galactose-Alpha-1,3-Galactose IgE QSTC",8764840,LOCAL,86008,CPT,,,,,,Outpatient,,,180.09,21.52,United Health ,United Health Medicare Advantage,17.93,,,,,,,Fee Schedule,15.29,17.93,
HOLTER MONITOR  24H,8200090,LOCAL,93225,CPT,,,,,,Outpatient,,,182,198,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,99.86,117.85,
DRAIN TRU-CLOSE 500CC (BUY BY EACH-10/CS,6800045,LOCAL,,,A7048,HCPCS,,,,Outpatient,,,183.26,88,United Health ,United Health Medicare Advantage,60.63,,,,,,,Fee Schedule,60.63,60.63,
FLUORO CENTRAL LINE PLACEMENT,8201221,LOCAL,77001,CPT,,,,,,Outpatient,,,184.82,177.38,United Health ,United Health Medicare Advantage,70.92,,,,,,,Fee Schedule,70.92,262.79,
Vitamin B12 Level,633871,LOCAL,82607,CPT,,,,,,Outpatient,,,184.82,18.1,United Health ,United Health Medicare Advantage,82.43,,,,,,,Fee Schedule,18.43,82.43266533,
XR Port Placement,10460170,LOCAL,77001,CPT,,,,,,Outpatient,,,184.82,177.38,United Health ,United Health Medicare Advantage,70.92,,,,,,,Fee Schedule,70.92,262.79,
RT CHARGE Chest Physiotherapy -> PEP Therapy Subsequent,8699751,LOCAL,94667,CPT,,,,,,Outpatient,,,184.89,120,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,76.09,117.85,
RT CHARGE Mechanical Oscillation -> Yes,10417130,LOCAL,94667,CPT,,,,,,Outpatient,,,184.89,120,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,76.09,117.85,
"Streptococcus pneumoniae Ag, Ur QSTC",13864418,LOCAL,87899,CPT,,,,,,Outpatient,,,185.22,19.28,United Health ,United Health Medicare Advantage,16.07,,,,,,,Fee Schedule,10.57,16.07,
"FVIII Act, Clotting QSTC",13873492,LOCAL,85240,CPT,,,,,,Outpatient,,,186.96,21.48,United Health ,United Health Medicare Advantage,17.9,,,,,,,Fee Schedule,5.42,17.9,
"PTT, Activated QSTC",13873491,LOCAL,85730,CPT,,,,,,Outpatient,,,186.96,7.21,United Health ,United Health Medicare Advantage,1.65,,,,,,,Fee Schedule,1.648553055,5.42,
Ristocetin Cofactor QSTC,13873494,LOCAL,85245,CPT,,,,,,Outpatient,,,186.96,27.53,United Health ,United Health Medicare Advantage,22.94,,,,,,,Fee Schedule,5.42,22.94,
von Willebrand Factor Ag QSTC,13873493,LOCAL,85246,CPT,,,,,,Outpatient,,,186.96,27.53,United Health ,United Health Medicare Advantage,22.94,,,,,,,Fee Schedule,5.42,22.94,
"vWf Ag, Multimeric QSTC",13873495,LOCAL,85247,CPT,,,,,,Outpatient,,,186.96,27.53,United Health ,United Health Medicare Advantage,22.94,,,,,,,Fee Schedule,5.42,22.94,
benztropine 1 mg/mL injectable solution 2 mL [CULL],11202065,LOCAL,J0515,CPT,,,,,,Outpatient,2,ML,188,,United Health ,United Health Medicare Advantage,13.82,,,,,,,Fee Schedule,13.815,13.815,
.T. pallidum Ab QSTC,13864522,LOCAL,86780,CPT,,,,,,Outpatient,,,189,15.89,United Health ,United Health Medicare Advantage,13.24,,,,,,,Fee Schedule,13.24,15.29,
Syphilis Antibody Cascading Reflex QSTC,8972904,LOCAL,86780,CPT,,,,,,Outpatient,,,189,15.89,United Health ,United Health Medicare Advantage,13.24,,,,,,,Fee Schedule,13.24,15.29,
L3923 HFO W/O JOINTS PRE CST CHARGE,9646078,LOCAL,,,L3923,HCPCS,,,,Outpatient,,,191.03,124,United Health ,United Health Medicare Advantage,97.81,,,,,,,Fee Schedule,97.81,97.81,
"MAG-SGPG Ab IgM, EIA QSTC",13864465,LOCAL,83520,CPT,,,,,,Outpatient,,,191.75,20.72,United Health ,United Health Medicare Advantage,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
amphotericin B 50 mg Pow [CULL],J0285,CPT,,,,,,,,Outpatient,50,ML,192,,United Health ,United Health Medicare Advantage,43.29,,,,,,,Fee Schedule,43.29,43.29,
"96366 IV INFUSION, MEDICATIONS, ADDITIONAL",7904532,LOCAL,96366,CPT,,,,,,Outpatient,,,193,125,United Health ,United Health Medicare Advantage,42.18,,,,,,,Fee Schedule,42.18,749.76,
"96366- IV tx, each additional hour",1928300,LOCAL,96366,CPT,,,,,,Outpatient,,,193,125,United Health ,United Health Medicare Advantage,42.18,,,,,,,Fee Schedule,42.18,749.76,
"96367 IV INFUSION, SEQUENTIAL, NEW OR DIFF",7904533,LOCAL,96367,CPT,,,,,,Outpatient,,,193,125,United Health ,United Health Medicare Advantage,65.07,,,,,,,Fee Schedule,65.07,442.94,
"96367- IV tx, sequential infusion",1928301,LOCAL,96367,CPT,,,,,,Outpatient,,,193,125,United Health ,United Health Medicare Advantage,65.07,,,,,,,Fee Schedule,65.07,442.94,
"96374- IV Injection, single/initial",1928305,LOCAL,96374,CPT,,,,,59,Outpatient,,,193,125,United Health ,United Health Medicare Advantage,192.63,,,,,,,Fee Schedule,64.56,192.63,
96374 IV PUSH MEDS INIT INJ 15 MIN OR LESS,7904536,LOCAL,96374,CPT,,,,,59,Outpatient,,,193,125,United Health ,United Health Medicare Advantage,192.63,,,,,,,Fee Schedule,64.56,192.63,
"96375- IV Injection, add new drug",1928306,LOCAL,96375,CPT,,,,,59,Outpatient,,,193,125,United Health ,United Health Medicare Advantage,42.18,,,,,,,Fee Schedule,42.18,64.56,
"96375 IV PUSH INJECTION ADD, NEW OR DIFF",7904537,LOCAL,96375,CPT,,,,,59,Outpatient,,,193,125,United Health ,United Health Medicare Advantage,42.18,,,,,,,Fee Schedule,42.18,64.56,
INJ IV PUSH THER/PROPH SUBSTANCE INTIAL,8210021,LOCAL,96374,CPT,,,,,59,Outpatient,,,193,125,United Health ,United Health Medicare Advantage,192.63,,,,,,,Fee Schedule,64.56,192.63,
"Beryllium, Serum/Plasma QSTC",10704808,LOCAL,83018,CPT,,,,,,Outpatient,,,194.5,26.35,United Health ,United Health Medicare Advantage,21.96,,,,,,,Fee Schedule,16.07,21.96,
9581626 EEG AWAKE/DROWSY PRO FEE CHARGES,8795941,LOCAL,95816,CPT,,,,,26,Outpatient,,,195,533,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,284.7,466.96,
95819 EEG AWAKE AND ASLEEP PRO-FEE CHARGE,13508139,LOCAL,95819,CPT,,,,,26,Outpatient,,,195,599,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,284.7,466.96,
95822 EEG COMA or SLEEP ONLY PRO,10049176,LOCAL,95822,CPT,,,,,26,Outpatient,,,195,499,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,284.7,466.96,
Vitamin B3 QSTC,8972908,LOCAL,84591,CPT,,,,,,Outpatient,,,195.75,20.47,United Health ,United Health Medicare Advantage,17.06,,,,,,,Fee Schedule,17.06,17.73,
Thyroid Stimulating Hormone,633844,LOCAL,84443,CPT,,,,,,Outpatient,,,195.84,20.16,United Health ,United Health Medicare Advantage,87.64,,,,,,,Fee Schedule,18.43,87.63697303,
TSH with Reflex to FT4,7948309,LOCAL,84439,CPT,,,,,,Outpatient,,,195.84,10.82,United Health ,United Health Medicare Advantage,28.58,,,,,,,Fee Schedule,18.43,28.58065455,
"Mumps Virus Ab IgG, IgM, Diagnostic QSTC",13864479,LOCAL,86735,CPT,,,,,,Outpatient,,,196.07,15.66,United Health ,United Health Medicare Advantage,13.05,,,,,,,Fee Schedule,13.05,15.29,
Deoxycorticosterone QSTC,13864487,LOCAL,82633,CPT,,,,,,Outpatient,,,196.2,37.18,United Health ,United Health Medicare Advantage,30.98,,,,,,,Fee Schedule,18.43,30.98,
Q Fever Ab IgG IgM w/rfx Titers QSTC,13864460,LOCAL,86638,CPT,,,,,,Outpatient,,,196.56,14.54,United Health ,United Health Medicare Advantage,12.12,,,,,,,Fee Schedule,12.12,15.29,
G0108 Diabetes Management Treatment 30 Minutes CHARGE,10255367,LOCAL,,,G0108,HCPCS,,,,Outpatient,,,196.8,128,United Health ,United Health Medicare Advantage,52.41,,,,,,,Fee Schedule,52.41,95.93,
94799 Pulm Function Screen Charge,10440012,LOCAL,94799,CPT,,,,,,Outpatient,,,198.38,129,United Health ,United Health Medicare Advantage,143.05,,,,,,,Fee Schedule,76.09,143.05,
97168 CIS Prgm OT Re-Evaluation 30 min,9850016,LOCAL,97168,CPT,,,,,GO,Outpatient,,,200.91,131,United Health ,United Health Medicare Advantage,63.82,,,,,,,Fee Schedule,63.82,269.95,
97168 RE-EVALUATION CHARGE,9860016,LOCAL,97168,CPT,,,,,GO|CO,Outpatient,,,200.91,131,United Health ,United Health Medicare Advantage,63.82,,,,,,,Fee Schedule,63.82,269.95,
OT ReEval Units,7895298,LOCAL,97168,CPT,,,,,GO,Outpatient,,,200.91,131,United Health ,United Health Medicare Advantage,63.82,,,,,,,Fee Schedule,63.82,269.95,
OT ReEvaluation Units,7897819,LOCAL,97168,CPT,,,,,GO,Outpatient,,,200.91,131,United Health ,United Health Medicare Advantage,63.82,,,,,,,Fee Schedule,63.82,269.95,
Gabapentin QSTC,8764562,LOCAL,80171,CPT,,,,,,Outpatient,,,202.5,26,United Health ,United Health Medicare Advantage,111.87,,,,,,,Fee Schedule,15.38,111.87,
TRAb (TSH Receptor Binding Ab) QSTC,8764674,LOCAL,83520,CPT,,,,,,Outpatient,,,202.5,20.72,United Health ,United Health Medicare Advantage,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
"Coccidioides Ab, CF w/ ID, CSF QSTC",13864531,LOCAL,86635,CPT,,,,,,Outpatient,,,203.04,13.76,United Health ,United Health Medicare Advantage,11.47,,,,,,,Fee Schedule,11.47,15.29,
Body Fluid Culture,4122803,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,United Health ,United Health Medicare Advantage,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Ear Culture,633890,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,United Health ,United Health Medicare Advantage,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Eye Culture,633892,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,United Health ,United Health Medicare Advantage,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Medical Device Culture,633898,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,United Health ,United Health Medicare Advantage,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Nasal Culture,633900,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,United Health ,United Health Medicare Advantage,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
"Porphyrins, Fract, Quant, Random Ur QSTC",13864457,LOCAL,84120,CPT,,,,,,Outpatient,,,203.18,17.65,United Health ,United Health Medicare Advantage,14.71,,,,,,,Fee Schedule,14.71,17.73,
Stool Culture,633904,LOCAL,87045,CPT,,,,,,Outpatient,,,203.18,11.33,United Health ,United Health Medicare Advantage,79.67,,,,,,,Fee Schedule,10.57,79.665,
Throat Culture,633905,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,United Health ,United Health Medicare Advantage,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Wound Culture,633908,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,United Health ,United Health Medicare Advantage,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
Wound Culture Deep,8395521,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,United Health ,United Health Medicare Advantage,67.61,,,,,,,Fee Schedule,10.57,67.60639535,
micafungin 100 mg intravenous injection [CULL],11220353,LOCAL,J2248,CPT,,,,,,Outpatient,1,EA,203.7888,,United Health ,United Health Medicare Advantage,0.25,,,,,,,Fee Schedule,0.249,122.4,
Vitamin K QSTC,8972880,LOCAL,84597,CPT,,,,,,Outpatient,,,203.9,16.46,United Health ,United Health Medicare Advantage,13.72,,,,,,,Fee Schedule,13.72,17.73,
PSA Diagnostic,1634882,LOCAL,84153,CPT,,,,,,Outpatient,,,206.86,22.07,United Health ,United Health Medicare Advantage,104.84,,,,,,,Fee Schedule,17.73,104.8447059,
PSA Screening,4123035,LOCAL,,,G0103,HCPCS,,,,Outpatient,,,206.86,134,United Health ,United Health Medicare Advantage,19.31,,,,,,,Fee Schedule,15.29,19.31,
Chromatin (Nucleosomal) Antibody QSTC,10148609,LOCAL,86235,CPT,,,,,,Outpatient,,,206.91,21.52,United Health ,United Health Medicare Advantage,37.57,,,,,,,Fee Schedule,15.29,37.56575758,
94640 UDN SPECIAL MED 2 CHARGE,13515633,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,185.95,
94640 UDN SPECIAL MED CHARGE,13522003,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE Aerosol Therapy -> Subsequent,5397112,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE EZPAP -> Initial,9429159,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE EZPAP -> Subsequent,9429160,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE MDI -> Initial,12111660,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE MDI -> Subsequent,12111659,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT CHARGE Suction -> BBG/Nasopharyngeal,6690655,LOCAL,31720,CPT,,,,,,Outpatient,,,208.54,136,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,863,
RT Continuous Neb Subsequent CHARGE,8144096,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT IPV Subsequent CHARGE,8144062,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> Cough,13657418,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> ET tube,13657417,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> Medication aerosol,8846461,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> Nasal aspirate,13650046,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,185.95,
Sputum Collection Method -> Nasal wash,13650044,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,185.95,
L3912 HFO FLEXION,9856101,LOCAL,,,L3912,HCPCS,,,,Outpatient,,,211.05,137,United Health ,United Health Medicare Advantage,108.07,,,,,,,Fee Schedule,108.07,108.07,
"penicillin G potassium 20,000,000 units injection [CULL]",11211080,LOCAL,J2540,CPT,,,,,,Outpatient,1,EA,211.2,,United Health ,United Health Medicare Advantage,0.78,,,,,,,Fee Schedule,0.78,0.78,
REF Antibody Screen,7939320,LOCAL,86850,CPT,,,,,,Outpatient,,,211.5,11.72,United Health ,United Health Medicare Advantage,48.85,,,,,,,Fee Schedule,6.29,48.85,
US Unlisted Procedure,8733482,LOCAL,76999,CPT,,,,,,Outpatient,,,212.54,113.85,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,161.71,
%CDT QSTC,13864781,LOCAL,82373,CPT,,,,,,Outpatient,,,213.75,21.67,United Health ,United Health Medicare Advantage,18.06,,,,,,,Fee Schedule,17.73,18.06,
Transferrin - QSTC,13864778,LOCAL,84466,CPT,,,,,,Outpatient,,,213.75,15.31,United Health ,United Health Medicare Advantage,29.64,,,,,,,Fee Schedule,17.73,29.64248366,
hyaluronidase 150 units/mL injectable solution 1 mL [CULL],11282257,LOCAL,J3470,CPT,,,,,,Outpatient,1,ML,214.272,,United Health ,United Health Medicare Advantage,31.81,,,,,,,Fee Schedule,31.807,122.4,
"96372 INJECTIONS (IM, SC) OP",7904535,LOCAL,96372,CPT,,,,,59,Outpatient,,,214.42,139,United Health ,United Health Medicare Advantage,65.07,,,,,,,Fee Schedule,64.56,65.07,
96372- Subq/IM Injection,1928303,LOCAL,96372,CPT,,,,,59,Outpatient,,,214.42,139,United Health ,United Health Medicare Advantage,65.07,,,,,,,Fee Schedule,64.56,65.07,
RT CHARGE PFT -> Lung Volume,9004829,LOCAL,94727,CPT,,,,,,Outpatient,,,215.73,140,United Health ,United Health Medicare Advantage,143.05,,,,,,,Fee Schedule,76.09,143.05,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,90471,CPT,G0010,HCPCS,,,,Outpatient,,,216.15,140,United Health ,United Health Medicare Advantage,42.18,,,,,,,Fee Schedule,42.18,65.07,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,G0010,CPT,,,,,,Outpatient,,,216.15,,United Health ,United Health Medicare Advantage,42.18,,,,,,,Fee Schedule,42.18,65.07,
CATH LAB US INTRAOPERATIVE,8200550,LOCAL,76998,CPT,,,,,,Outpatient,,,216.65,116.33,United Health ,United Health Medicare Advantage,36.73,,,,,,,Fee Schedule,36.73,165.47,
Bladder Scan,649589,LOCAL,51798,CPT,,,,,,Outpatient,,,216.87,59,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,54.31,863,
DOPP LOWER EXT ARTERIAL/ABI,8200450,LOCAL,93922,CPT,,,,,,Outpatient,,,218,265,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,117.85,161.71,
69209 REM IMPACT CERUMEN REQ IRRIGAT CHARGE,8020086,LOCAL,69209,CPT,,,,,,Outpatient,,,219.69,143,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,54.31,863,
97550 CAREGIVER TRAINING 1ST 30 MIN,14015178,LOCAL,97550,CPT,,,,,,Outpatient,,,220,,United Health ,United Health Medicare Advantage,38.85,,,,,,,Fee Schedule,38.85,95.93,
97550 OT Caregiver Training Init 30 Mins,13649811,LOCAL,97550,CPT,,,,,,Outpatient,,,220,,United Health ,United Health Medicare Advantage,38.85,,,,,,,Fee Schedule,38.85,95.93,
97550 ST Caregiver Training 1st 30 min,14013233,LOCAL,97550,CPT,,,,,,Outpatient,,,220,,United Health ,United Health Medicare Advantage,38.85,,,,,,,Fee Schedule,38.85,95.93,
"SLP Caregiver Training, First 30 Min Time",14466884,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,220,,United Health ,United Health Medicare Advantage,50.79,,,,,,,Fee Schedule,50.79,95.93,
Bill Only ABSC,7936968,LOCAL,86850,CPT,,,,,,Outpatient,,,220.5,11.72,United Health ,United Health Medicare Advantage,48.85,,,,,,,Fee Schedule,6.29,48.85,
"Platelet Antibody Screen, Serum QSTC",10736090,LOCAL,86022,CPT,,,,,,Outpatient,,,220.5,22.04,United Health ,United Health Medicare Advantage,18.37,,,,,,,Fee Schedule,15.29,18.37,
92524 BEHAVIORAL AND QUALITATIVE ANALYSIS OF VOICE AND RESONANCE,9630059,LOCAL,92524,CPT,,,,,GN,Outpatient,,,222.2,144,United Health ,United Health Medicare Advantage,103.27,,,,,,,Fee Schedule,103.27,337.75,
Behav/Qual Analysis of Voice and Resonance Charge,7897211,LOCAL,92524,CPT,,,,,GN,Outpatient,,,222.2,144,United Health ,United Health Medicare Advantage,103.27,,,,,,,Fee Schedule,103.27,337.75,
SLP Analysis of Voice & Resonance Units,7897212,LOCAL,92524,CPT,,,,,GN,Outpatient,,,222.2,144,United Health ,United Health Medicare Advantage,103.27,,,,,,,Fee Schedule,103.27,337.75,
92597 EVAL FOR USE AND/OR FITTING OF VOICE PROSTHETIC TO SUPPLEMENT ORAL SPEECH,9630068,LOCAL,92597,CPT,,,,,GN,Outpatient,,,223.9,146,United Health ,United Health Medicare Advantage,67.18,,,,,,,Fee Schedule,67.18,337.75,
Eval for Use/Fitting of Voice Prosthetic Dvc Chg,1373846,LOCAL,92597,CPT,,,,,GN,Outpatient,,,223.9,146,United Health ,United Health Medicare Advantage,67.18,,,,,,,Fee Schedule,67.18,337.75,
"SLP Use,Fit Speech Prosthetic Eval Units",1373846,LOCAL,92597,CPT,,,,,GN,Outpatient,,,223.9,146,United Health ,United Health Medicare Advantage,67.18,,,,,,,Fee Schedule,67.18,337.75,
64418- Suprascapular nerve block,10452404,LOCAL,64418,CPT,,,,,,Outpatient,,,225,693,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
75809 SHUNTOGRAM PREV PLCMNT INDWELLING NONVASC SHUNT,13650394,LOCAL,75809,CPT,,,,,,Outpatient,,,225,87.45,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,176.48,
"Hantavirus Antibody IgG,IgM QSTC",13864534,LOCAL,86790,CPT,,,,,,Outpatient,,,225,15.46,United Health ,United Health Medicare Advantage,12.88,,,,,,,Fee Schedule,12.88,15.29,
"Histoplasma Quantitative Antigen, EIA QSTC",9752803,LOCAL,87385,CPT,,,,,,Outpatient,,,225,15.9,United Health ,United Health Medicare Advantage,13.25,,,,,,,Fee Schedule,10.57,13.25,
"Potassium w/o Creatinine, Random Ur QSTC",9039260,LOCAL,84133,CPT,,,,,,Outpatient,,,225,5.68,United Health ,United Health Medicare Advantage,19.32,,,,,,,Fee Schedule,7.16,19.32,
Soluble Transferrin Receptor QSTC,9777250,LOCAL,84238,CPT,,,,,,Outpatient,,,225,43.88,United Health ,United Health Medicare Advantage,36.57,,,,,,,Fee Schedule,36.57,46.74,
XR Shunt Series,13650394,LOCAL,75809,CPT,,,,,,Outpatient,,,225,87.45,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,176.48,
Dengue Fever Ab (IgG) QSTC,13873177,LOCAL,86790,CPT,,,,,,Outpatient,,,228,15.46,United Health ,United Health Medicare Advantage,12.88,,,,,,,Fee Schedule,12.88,15.29,
Dengue Fever Ab (IgM) QSTC,13873183,LOCAL,86790,CPT,,,,,,Outpatient,,,228,15.46,United Health ,United Health Medicare Advantage,12.88,,,,,,,Fee Schedule,12.88,15.29,
"Mycoplasma pneumoniae Ab (IgG, IgM) QSTC",8972832,LOCAL,86738,CPT,,,,,,Outpatient,,,228.83,15.89,United Health ,United Health Medicare Advantage,13.24,,,,,,,Fee Schedule,13.24,15.29,
REF DAT Polyspecific,7939270,LOCAL,86880,CPT,,,,,,Outpatient,,,229.5,6.47,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,6.29,54.31,
voriconazole 200 mg intravenous injection [CULL],11211371,LOCAL,J3465,CPT,,,,,,Outpatient,1,EA,230.4,,United Health ,United Health Medicare Advantage,0.75,,,,,,,Fee Schedule,0.751,0.751,
92610  Bedside Swallowing Eval,9630082,LOCAL,92610,CPT,,,,,GN,Outpatient,,,231.76,151,United Health ,United Health Medicare Advantage,55.89,,,,,,,Fee Schedule,55.89,337.75,
Eval of Oral and Pharyngeal Swallowing Fx Chg  nd Pharyngeal Swallowing Fx Chg,7896918,LOCAL,92610,CPT,,,,,GN,Outpatient,,,231.76,151,United Health ,United Health Medicare Advantage,55.89,,,,,,,Fee Schedule,55.89,337.75,
Eval of Oral and Pharyngeal Swallowing Fx Chg  nd Pharyngeal Swallowing Fx Chg -> Yes,7896918,LOCAL,92610,CPT,,,,,GN,Outpatient,,,231.76,151,United Health ,United Health Medicare Advantage,55.89,,,,,,,Fee Schedule,55.89,337.75,
SLP Pharyngeal Swallow Eval Units,1373843,LOCAL,92610,CPT,,,,,GN,Outpatient,,,231.76,151,United Health ,United Health Medicare Advantage,55.89,,,,,,,Fee Schedule,55.89,337.75,
"Caregiver / patient demonstrates understanding of substance abuse, triggers, treatment",4517330,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,235,,United Health ,United Health Medicare Advantage,50.79,,,,,,,Fee Schedule,50.79,95.93,
"Caregiver / patient demonstrates understanding of substance abuse, triggers, treatment",4517330,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,235,,United Health ,United Health Medicare Advantage,50.79,,,,,,,Fee Schedule,50.79,95.93,
PT CAREGIVER TRAINING INT 30 MIN,4517330,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,235,,United Health ,United Health Medicare Advantage,50.79,,,,,,,Fee Schedule,50.79,95.93,
96523 FLUSH VAD CHARGE,8213318,LOCAL,96523,CPT,,,,,,Outpatient,,,235.66,153,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,54.31,64.56,
Follicle Stimulating Hormone Level,3170314,LOCAL,83001,CPT,,,,,,Outpatient,,,238.68,22.3,United Health ,United Health Medicare Advantage,98.8,,,,,,,Fee Schedule,18.43,98.80384615,
Antibody ID,634330,LOCAL,86870,CPT,,,,,,Outpatient,,,238.76,,United Health ,United Health Medicare Advantage,328.88,,,,,,,Fee Schedule,38.27,328.88,
BB THAW FFP,6413062,LOCAL,86931,CPT,,,,,,Outpatient,,,238.76,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.88,156.67,
Bill IHC Multiplex Antibody,14048007,LOCAL,88344,CPT,,,,,,Outpatient,,,238.76,,United Health ,United Health Medicare Advantage,328.88,,,,,,,Fee Schedule,59.06,328.88,
"Bill Only Antigen Type, Patient",8872565,LOCAL,86905,CPT,,,,,,Outpatient,,,238.76,4.6,United Health ,United Health Medicare Advantage,328.88,,,,,,,Fee Schedule,6.29,328.88,
"Bill Only Antigen Type, Product",8872566,LOCAL,86902,CPT,,,,,,Outpatient,,,238.76,7.62,United Health ,United Health Medicare Advantage,328.88,,,,,,,Fee Schedule,6.29,328.88,
Bill Tissue Exam Level 5,14049344,LOCAL,88307,CPT,,,,,,Outpatient,,,238.76,,United Health ,United Health Medicare Advantage,328.88,,,,,,,Fee Schedule,59.06,328.88,
11732 AVULSION OF EACH ADDITIONAL NAIL PLATE,13029593,LOCAL,11732,CPT,,,,,,Outpatient,,,239.9,156,United Health ,United Health Medicare Advantage,14.39,,,,,,,Fee Schedule,14.39,863,
93463 Pharmacologic Agent Administration,8230065,LOCAL,93463,CPT,,,,,,Outpatient,,,240,156,United Health ,United Health Medicare Advantage,79.18,,,,,,,Fee Schedule,64.56,863,
36591 COLLECT BLOOD FROM IMPL VEN DEVICE CHARGE,10451346,LOCAL,36591,CPT,,,,,,Outpatient,,,241.46,157,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,85.79,863,
Central Line Activity. -> Blood drawn,12856467,LOCAL,36592,CPT,,,,,,Outpatient,,,241.46,157,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,85.79,863,
Anaerobic Culture,4122782,LOCAL,87075,CPT,,,,,,Outpatient,,,242.35,11.36,United Health ,United Health Medicare Advantage,50.33,,,,,,,Fee Schedule,10.57,50.328,
Bill Only ABID Panel,7936969,LOCAL,86870,CPT,,,,,,Outpatient,,,243,,United Health ,United Health Medicare Advantage,328.88,,,,,,,Fee Schedule,38.27,328.88,
US OB Greater Than 14 Weeks,1169850,LOCAL,76805,CPT,,,,,,Outpatient,,,243,130.35,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,148.61,
US OB Greater Than 14 Weeks,1169851,LOCAL,76805,CPT,,,,,,Outpatient,,,243,130.35,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,148.61,
FLUOROSCOPY <1 HOUR,8210790,LOCAL,76000,CPT,,,,,,Outpatient,,,246.02,380.33,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,176.48,220.99,
.Hep C Viral RNA Quant RealTime PCR QSTC,8764584,LOCAL,87522,CPT,,,,,,Outpatient,,,247.5,51.41,United Health ,United Health Medicare Advantage,144.75,,,,,,,Fee Schedule,40.19,144.745,
HCV RNA Quan Progress to Genotyping QSTC,9039270,LOCAL,87522,CPT,,,,,,Outpatient,,,247.5,51.41,United Health ,United Health Medicare Advantage,144.75,,,,,,,Fee Schedule,40.19,144.745,
"Hepatitis C, RNA, Quantitative, PCR QSTC",8764755,LOCAL,87522,CPT,,,,,,Outpatient,,,247.5,51.41,United Health ,United Health Medicare Advantage,144.75,,,,,,,Fee Schedule,40.19,144.745,
"HSV Type 1&2 DNA, Qual RT PCR QSTC",8873562,LOCAL,87529,CPT,,,,,,Outpatient,,,247.5,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
Pancreatic Elastase-1 QSTC,8764835,LOCAL,82653,CPT,,,,,,Outpatient,,,247.5,27.56,United Health ,United Health Medicare Advantage,22.97,,,,,,,Fee Schedule,17.73,22.97,
REF PLT Screening,13475613,LOCAL,86022,CPT,,,,,,Outpatient,,,247.5,22.04,United Health ,United Health Medicare Advantage,18.37,,,,,,,Fee Schedule,15.29,18.37,
RT CHARGE Aerosol Therapy -> Initial,12502774,LOCAL,94640,CPT,,,,,,Outpatient,,,247.86,136,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT Continuous Neb Initial CHARGE,8144200,LOCAL,94640,CPT,,,,,,Outpatient,,,247.86,136,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,185.95,
RT IPV Initial CHARGE,8144187,LOCAL,94640,CPT,,,,,,Outpatient,,,247.86,136,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,76.09,185.95,
96415 CHEMO IV INFUSION EA ADDL HR INF CHARGE,9665726,LOCAL,96415,CPT,,,,,,Outpatient,,,248.22,161,United Health ,United Health Medicare Advantage,65.07,,,,,,,Fee Schedule,65.07,749.76,
aztreonam 2 g injection [CULL],11201229,LOCAL,J0457,CPT,,,,,,Outpatient,1,EA,249.6,,United Health ,United Health Medicare Advantage,2.23,,,,,,,Fee Schedule,2.233,2.233,
"Clobazam and Metabolite, Serum/Plasma QSTC",8764736,LOCAL,80299,CPT,,,,,,Outpatient,,,249.75,22.37,United Health ,United Health Medicare Advantage,18.64,,,,,,,Fee Schedule,15.38,18.64,
95977 - device analysis and complex programming,14685299,LOCAL,95977,CPT,,,,,,Outpatient,,,250,92,United Health ,United Health Medicare Advantage,83.92,,,,,,,Fee Schedule,83.92,214.22,
Hep Acute Pnl,633756,LOCAL,80074,CPT,,,,,,Outpatient,,,250,57.16,United Health ,United Health Medicare Advantage,59.34,,,,,,,Fee Schedule,12.14,59.336,
Hep Acute Pnl Post Exposure,9517262,LOCAL,80074,CPT,,,,,,Outpatient,,,250,57.16,United Health ,United Health Medicare Advantage,59.34,,,,,,,Fee Schedule,12.14,59.336,
COLLAR HARD PED 8 -11,6000015,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,250.75,223,United Health ,United Health Medicare Advantage,175.72,,,,,,,Fee Schedule,175.72,175.72,
Albumin Level,1620877,LOCAL,82040,CPT,,,,,,Outpatient,,,250.92,5.94,United Health ,United Health Medicare Advantage,127.89,,,,,,,Fee Schedule,7.16,127.89,
Luteinizing Hormone,4240834,LOCAL,83002,CPT,,,,,,Outpatient,,,250.92,22.22,United Health ,United Health Medicare Advantage,18.52,,,,,,,Fee Schedule,18.43,18.52,
Rufinamide QSTC,13864436,LOCAL,80210,CPT,,,,,,Outpatient,,,251.6,32.53,United Health ,United Health Medicare Advantage,27.11,,,,,,,Fee Schedule,15.38,27.11,
XR Hand 2 Views Left,1170215,LOCAL,73120,CPT,,,,,LT,Outpatient,,,253.04,135.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Hand 2 Views Right,1170217,LOCAL,73120,CPT,,,,,RT,Outpatient,,,253.04,135.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Lower Extremity Infant 2 Views Bilat,8455866,LOCAL,73592,CPT,,,,,,Outpatient,,,253.13,136.13,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Lower Extremity Infant 2 Views Left,8455869,LOCAL,73592,CPT,,,,,LT,Outpatient,,,253.13,136.13,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Lower Extremity Infant 2 Views Right,8455872,LOCAL,73592,CPT,,,,,RT,Outpatient,,,253.13,136.13,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
hepatitis B adult vaccine 20 mcg/mL intramuscular suspension 1 mL [CULL],11202558,LOCAL,90746,CPT,,,,,,Outpatient,1,ML,253.80864,,United Health ,United Health Medicare Advantage,75.15,,,,,,,Fee Schedule,39.58,75.145,
XR Chest 1 View,8132832,LOCAL,71045,CPT,,,,,,Outpatient,,,253.82,136.13,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Elbow 1 View Left,13554981,LOCAL,73070,CPT,,,,,52|LT,Outpatient,,,254.32,136.13,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Elbow 1 View Right,13554984,LOCAL,73070,CPT,,,,,52|RT,Outpatient,,,254.32,136.13,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
69210 REM IMPACT CERUMEN REQ INSTRU CHARGE,8020194,LOCAL,69210,CPT,,,,,,Outpatient,,,255.9,166,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,54.31,863,
Bill Only Computer Search EA/Ag,13517192,LOCAL,86902,CPT,,,,,,Outpatient,,,256.5,7.62,United Health ,United Health Medicare Advantage,328.88,,,,,,,Fee Schedule,6.29,328.88,
Bill Only Fresh Unit (<5 Days Old),13517198,LOCAL,86999,CPT,,,,,,Outpatient,,,256.5,,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,6.29,22.39,
US Pelvic Ltd,8206967,LOCAL,76857,CPT,,,,,,Outpatient,,,257.05,137.78,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
RT CHARGE PFT -> Spirometry,5274349,LOCAL,94010,CPT,,,,,,Outpatient,,,258.58,168,United Health ,United Health Medicare Advantage,143.05,,,,,,,Fee Schedule,76.09,143.05,
97161  SB PT Eval Low Comp,9640014,LOCAL,97161,CPT,,,,,GP,Outpatient,,,262.16,170,United Health ,United Health Medicare Advantage,46.04,,,,,,,Fee Schedule,46.04162662,349.89,
97161 EVAL - LOW COMPLEXITY CHARGE,9410054,LOCAL,97161,CPT,,,,,GP,Outpatient,,,262.16,170,United Health ,United Health Medicare Advantage,46.04,,,,,,,Fee Schedule,46.04162662,349.89,
97161 PHYSICAL THERAPY EVALUATION CHARGE,9650014,LOCAL,97161,CPT,,,,,GP|CQ,Outpatient,,,262.16,170,United Health ,United Health Medicare Advantage,46.04,,,,,,,Fee Schedule,46.04162662,349.89,
PT Low Complex Units,7896010,LOCAL,97161,CPT,,,,,GP,Outpatient,,,262.16,170,United Health ,United Health Medicare Advantage,46.04,,,,,,,Fee Schedule,46.04162662,349.89,
"Lactoferrin, QL, Stool QSTC",9039266,LOCAL,83630,CPT,,,,,,Outpatient,,,263.25,23.64,United Health ,United Health Medicare Advantage,19.7,,,,,,,Fee Schedule,17.73,19.7,
"92521 EVALUATION OF SPEECH FLUENCY (STUTTERING, CLUTTERING)",9630056,LOCAL,92521,CPT,,,,,GN,Outpatient,,,263.99,172,United Health ,United Health Medicare Advantage,125.86,,,,,,,Fee Schedule,125.86,337.75,
SLP Speech Fluency Eval Units,7897205,LOCAL,92521,CPT,,,,,GN,Outpatient,,,263.99,172,United Health ,United Health Medicare Advantage,125.86,,,,,,,Fee Schedule,125.86,337.75,
Speech Fluency Eval Charge,7897205,LOCAL,92521,CPT,,,,,GN,Outpatient,,,263.99,172,United Health ,United Health Medicare Advantage,125.86,,,,,,,Fee Schedule,125.86,337.75,
methylPREDNISolone 1 g preservative-free Pow,11287452,LOCAL,J2919,CPT,,,,,,Outpatient,1,UN,264.6528,,United Health ,United Health Medicare Advantage,0.21,,,,,,,Fee Schedule,0.21,5685.74,
92526  Treatment of Swallow,9630083,LOCAL,92526,CPT,,,,,GN,Outpatient,,,265.2,172,United Health ,United Health Medicare Advantage,85.25,,,,,,,Fee Schedule,56.44,85.2525,
dihydroergotamine 1 mg/mL injectable solution 1 mL [CULL],11202330,LOCAL,J1110,CPT,,,,,,Outpatient,1,ML,265.2,,United Health ,United Health Medicare Advantage,57.08,,,,,,,Fee Schedule,57.082,57.082,
SLP Swallow Dysfunction Oral Feed Units,1373842,LOCAL,92526,CPT,,,,,GN,Outpatient,,,265.2,172,United Health ,United Health Medicare Advantage,85.25,,,,,,,Fee Schedule,56.44,85.2525,
Treatment of Swallowing Dysfunction Charge,7896917,LOCAL,92526,CPT,,,,,GN,Outpatient,,,265.2,172,United Health ,United Health Medicare Advantage,85.25,,,,,,,Fee Schedule,56.44,85.2525,
Treatment of Swallowing Dysfunction Charge -> Yes,7896917,LOCAL,92526,CPT,,,,,GN,Outpatient,,,265.2,172,United Health ,United Health Medicare Advantage,85.25,,,,,,,Fee Schedule,56.44,85.2525,
RNA Polymerase III Antibody QSTC,10067478,LOCAL,83516,CPT,,,,,,Outpatient,,,265.5,13.84,United Health ,United Health Medicare Advantage,11.53,,,,,,,Fee Schedule,11.53,17.73,
XR Sinuses Paranasal < 3 Views,1170432,LOCAL,70210,CPT,,,,,,Outpatient,,,266.27,142.73,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Pelvis 1 or 2 Views,1170351,LOCAL,72170,CPT,,,,,,Outpatient,,,266.62,142.73,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
Zonisamide QSTC,8764609,LOCAL,80203,CPT,,,,,,Outpatient,,,267.53,15.9,United Health ,United Health Medicare Advantage,13.25,,,,,,,Fee Schedule,13.25,15.38,
"Iodine, U24 QSTC",13864440,LOCAL,82542,CPT,,,,,,Outpatient,,,267.8,28.91,United Health ,United Health Medicare Advantage,24.09,,,,,,,Fee Schedule,17.73,24.09,
.Atypical P-ANCA Titer QSTC,8764788,LOCAL,86037,CPT,,,,,,Outpatient,,,270,14.46,United Health ,United Health Medicare Advantage,12.05,,,,,,,Fee Schedule,12.05,15.29,
"Acylcarnitine, Plasma QSTC",9215425,LOCAL,82017,CPT,,,,,,Outpatient,,,270,20.24,United Health ,United Health Medicare Advantage,16.87,,,,,,,Fee Schedule,16.87,17.73,
C. difficile Toxin B Qual PCR QSTC,13864437,LOCAL,87493,CPT,,,,,,Outpatient,,,270,44.72,United Health ,United Health Medicare Advantage,37.27,,,,,,,Fee Schedule,37.27,40.19,
"Cytomegalovirus DNA, QN, Real-T PCR QSTC",8764608,LOCAL,87497,CPT,,,,,,Outpatient,,,270,51.41,United Health ,United Health Medicare Advantage,42.84,,,,,,,Fee Schedule,40.19,42.84,
"Kappa/Lambda Lght Chn, Free w Rat U QSTC",9039383,LOCAL,83883,CPT,,,,,,Outpatient,,,270,16.32,United Health ,United Health Medicare Advantage,13.6,,,,,,,Fee Schedule,13.6,15.29,
"Kappa/Lambda Light Chains, Tot Ur QSTC",9039383,LOCAL,83883,CPT,,,,,,Outpatient,,,270,16.32,United Health ,United Health Medicare Advantage,13.6,,,,,,,Fee Schedule,13.6,15.29,
"Mycoplasma Genitalium,R-T PCR QST",9773947,LOCAL,87624,CPT,,,,,,Outpatient,,,270,42.11,United Health ,United Health Medicare Advantage,67.2,,,,,,,Fee Schedule,40.19,67.195,
Reference Lab Crossmatch -> Compatible,8185614,LOCAL,86920,CPT,,,,,,Outpatient,,,270,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
Reference Lab Crossmatch -> Incompatible,8185613,LOCAL,86920,CPT,,,,,,Outpatient,,,270,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
Reference Lab Crossmatch -> Least Incompatible,8185612,LOCAL,86920,CPT,,,,,,Outpatient,,,270,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
von Willebrand Factor Ag QSTC,8764731,LOCAL,85246,CPT,,,,,,Outpatient,,,270,27.53,United Health ,United Health Medicare Advantage,22.94,,,,,,,Fee Schedule,5.42,22.94,
99281 Emergency Department Visit. Level 1,2644297,LOCAL,99281,CPT,,,,,25,Outpatient,,,272.36,177,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,80.5,
XR Finger(s) 1 View Left,13554987,LOCAL,73140,CPT,,,,,52|LT,Outpatient,,,272.62,146.03,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Finger(s) 1 View Right,13554990,LOCAL,73140,CPT,,,,,52|RT,Outpatient,,,272.62,146.03,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
Electrocardiogram 12 Lead.,9696149,LOCAL,93005,CPT,,,,,,Outpatient,,,273.98,178,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,38.53,54.31,
93242 Holter 3 to 7 Days Recording,90820010,LOCAL,93242,CPT,,,,,,Outpatient,,,275,179,United Health ,United Health Medicare Advantage,35.88,,,,,,,Fee Schedule,35.88,99.86,
Prolactin Level,3170316,LOCAL,84146,CPT,,,,,,Outpatient,,,275.4,23.26,United Health ,United Health Medicare Advantage,19.38,,,,,,,Fee Schedule,18.43,19.38,
XR Elbow 2 Views Left,1170121,LOCAL,73070,CPT,,,,,LT,Outpatient,,,275.53,136.13,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Elbow 2 Views Right,1170123,LOCAL,73070,CPT,,,,,RT,Outpatient,,,275.53,136.13,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
.TR Interpretation,1173781,LOCAL,86078,CPT,,,,,,Outpatient,,,277.85,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.88,156.67,
BB REF LAB PHYSICIAN INTERP,6413086,LOCAL,86077,CPT,,,,,,Outpatient,,,279,,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,22.39,38.88,
Bill Only Crossmatch IS,8419033,LOCAL,86920,CPT,,,,,,Outpatient,,,279,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
hepatitis B immune globulin intramuscular solution 0.5 mL [CULL],11202561,LOCAL,J1571,CPT,,,,,,Outpatient,0.5,ML,280.064,,United Health ,United Health Medicare Advantage,66.64,,,,,,,Fee Schedule,66.64,771.25,
XR Spine 1 View Specify Level,8058789,LOCAL,72020,CPT,,,,,,Outpatient,,,281.44,150.98,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Knee 1 View Standing AP Bilateral,1170291,LOCAL,73565,CPT,,,,,,Outpatient,,,283.03,151.8,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
Iodine QSTC,13864439,LOCAL,82542,CPT,,,,,,Outpatient,,,283.32,28.91,United Health ,United Health Medicare Advantage,24.09,,,,,,,Fee Schedule,17.73,24.09,
XR Neck Soft Tissue,1170331,LOCAL,70360,CPT,,,,,,Outpatient,,,284.4,152.63,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
97162  SB PT Eval Mod Comp,9640015,LOCAL,97162,CPT,,,,,GP,Outpatient,,,287.16,187,United Health ,United Health Medicare Advantage,42.69,,,,,,,Fee Schedule,42.68861429,349.89,
97162 EVAL - MODERATE COMPLEXITY CHARGE,9410055,LOCAL,97162,CPT,,,,,GP,Outpatient,,,287.16,187,United Health ,United Health Medicare Advantage,42.69,,,,,,,Fee Schedule,42.68861429,349.89,
97162 PT EVAL MOD COMPLEX CHARGES,9650015,LOCAL,97162,CPT,,,,,GP|CQ,Outpatient,,,287.16,187,United Health ,United Health Medicare Advantage,42.69,,,,,,,Fee Schedule,42.68861429,349.89,
PT Moderate Complex Units,7896012,LOCAL,97162,CPT,,,,,GP,Outpatient,,,287.16,187,United Health ,United Health Medicare Advantage,42.69,,,,,,,Fee Schedule,42.68861429,349.89,
Soluble Liver Antigen (SLA) Autoantibody QSTC,10148492,LOCAL,83520,CPT,,,,,,Outpatient,,,288,20.72,United Health ,United Health Medicare Advantage,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
XR Shoulder 1 View Left,1170409,LOCAL,73020,CPT,,,,,LT,Outpatient,,,289.86,155.1,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Shoulder 1 View Right,1170411,LOCAL,73020,CPT,,,,,RT,Outpatient,,,289.86,155.1,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR AC Joints Bilateral,1169922,LOCAL,73050,CPT,,,,,,Outpatient,,,289.94,155.1,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Calcaneus Limited Left,13554972,LOCAL,73650,CPT,,,,,52|LT,Outpatient,,,290.55,174.9,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Calcaneus Limited Right,13554975,LOCAL,73650,CPT,,,,,52|RT,Outpatient,,,290.55,174.9,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
BD Bone Density DEXA Vert Fracture Assmt,8206345,LOCAL,77086,CPT,,,,,,Outpatient,,,291.16,155.93,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,116.02,
XR Foreign Body Localization Child 1 Vw,1170207,LOCAL,76010,CPT,,,,,,Outpatient,,,291.16,155.93,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
cefTRIAXone 2 g injection [CULL],11202189,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,292.1824,,United Health ,United Health Medicare Advantage,5.16,,,,,,,Fee Schedule,5.161428571,5.161428571,
"Cytomegalovirus DNA, QL R-T PCR QSTC",9777223,LOCAL,87496,CPT,,,,,,Outpatient,,,292.5,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Factor IX Activity,Clotting [352X]  QSTC",12534660,LOCAL,85250,CPT,,,,,,Outpatient,,,292.5,22.85,United Health ,United Health Medicare Advantage,19.04,,,,,,,Fee Schedule,5.42,19.04,
"HIV-1 RNA, QN, Real-Time PCR QSTC",8764763,LOCAL,87536,CPT,,,,,,Outpatient,,,292.5,102.12,United Health ,United Health Medicare Advantage,85.1,,,,,,,Fee Schedule,85.1,158.39,
XR Chest Decubitus,1170049,LOCAL,71046,CPT,,,,,,Outpatient,,,292.6,212.85,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
"Factor VIII Inhibitor, EIA QSTC",13873092,LOCAL,85335,CPT,,,,,,Outpatient,,,294.75,15.44,United Health ,United Health Medicare Advantage,12.87,,,,,,,Fee Schedule,5.42,12.87,
"FVIII Act, Clotting QSTC",13873093,LOCAL,85240,CPT,,,,,,Outpatient,,,294.75,21.48,United Health ,United Health Medicare Advantage,17.9,,,,,,,Fee Schedule,5.42,17.9,
XR Upper Extremity Infant 2 Views Left,8455878,LOCAL,73092,CPT,,,,,LT,Outpatient,,,296.99,159.23,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Upper Extremity Infant 2 Views Right,8455881,LOCAL,73092,CPT,,,,,RT,Outpatient,,,296.99,159.23,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
Ref Rh Phenotyping,9527485,LOCAL,86906,CPT,,,,,,Outpatient,,,297,9.3,United Health ,United Health Medicare Advantage,35.88,,,,,,,Fee Schedule,6.29,35.88,
92611 ST VIDEOFLUOR SWALLOW CHARGE,9630067,LOCAL,92611,CPT,,,,,GN,Outpatient,,,297.49,193,United Health ,United Health Medicare Advantage,189.99,,,,,,,Fee Schedule,176.48,189.9866667,
Fluoroscopic Evaluation of Swallow Function Charge,7896919,LOCAL,92611,CPT,,,,,GN,Outpatient,,,297.49,193,United Health ,United Health Medicare Advantage,189.99,,,,,,,Fee Schedule,176.48,189.9866667,
SLP Fluoroscopic Evaluation Units,1373839,LOCAL,92611,CPT,,,,,GN,Outpatient,,,297.49,193,United Health ,United Health Medicare Advantage,189.99,,,,,,,Fee Schedule,176.48,189.9866667,
97165 EVAL -  LOW COMPLEXITY CHARGE,9850014,LOCAL,97165,CPT,,,,,GO,Outpatient,,,297.74,194,United Health ,United Health Medicare Advantage,94.3,,,,,,,Fee Schedule,94.3,269.95,
97165 OT Evaluation Low Complexity 30 min,9860014,LOCAL,97165,CPT,,,,,GO|CO,Outpatient,,,297.74,194,United Health ,United Health Medicare Advantage,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Evaluation Low Complexity Units,7897807,LOCAL,97165,CPT,,,,,GO,Outpatient,,,297.74,194,United Health ,United Health Medicare Advantage,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Low Complex Units,7895291,LOCAL,97165,CPT,,,,,GO,Outpatient,,,297.74,194,United Health ,United Health Medicare Advantage,94.3,,,,,,,Fee Schedule,94.3,269.95,
"Aspergillus Antigen, EIA, Serum QSTC",9777227,LOCAL,87305,CPT,,,,,,Outpatient,,,298,14.38,United Health ,United Health Medicare Advantage,11.98,,,,,,,Fee Schedule,10.57,11.98,
29581 PT Lower Extremity Application of Strapping,9640079,LOCAL,29581,CPT,,,,,GP,Outpatient,,,300,195,United Health ,United Health Medicare Advantage,144.26,,,,,,,Fee Schedule,144.26,863,
PT Lymphedema Wrap below Knee Charge,7895901,LOCAL,29581,CPT,,,,,GP,Outpatient,,,300,195,United Health ,United Health Medicare Advantage,144.26,,,,,,,Fee Schedule,144.26,863,
Lacosamide QSTC,8764635,LOCAL,80235,CPT,,,,,,Outpatient,,,301.5,32.53,United Health ,United Health Medicare Advantage,27.11,,,,,,,Fee Schedule,15.38,27.11,
tetanus/diphth/pertussis (Tdap) adult/adol 5 units-2 units-15.5 mcg/0.5 mL intramuscular suspension 0.5 mL [CULL],11202346,LOCAL,90714,CPT,,,,,,Outpatient,0.5,ML,301.632,,United Health ,United Health Medicare Advantage,14.45,,,,,,,Fee Schedule,14.45070423,39.58,
XR Toe(s) 2 PLUS Views Right,1170522,LOCAL,73660,CPT,,,,,RT,Outpatient,,,301.78,161.7,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Toe(s) 2+ Views Left,1170520,LOCAL,73660,CPT,,,,,LT,Outpatient,,,301.78,161.7,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
influenza vaccine (Fluzone HD) vaccine 2025-2026 [CULL],11292055,LOCAL,90662,CPT,,,,,,Outpatient,0.5,ML,303.5392,,United Health ,United Health Medicare Advantage,86.13,,,,,,,Fee Schedule,39.58,86.13,
Large Humeral Fracture Brace,9400080,LOCAL,,,L3982,HCPCS,,,,Outpatient,,,303.88,,United Health ,United Health Medicare Advantage,429.48,,,,,,,Fee Schedule,429.48,429.48,
Medium Humeral Fracture Brace,9400079,LOCAL,,,L3982,HCPCS,,,,Outpatient,,,303.88,,United Health ,United Health Medicare Advantage,429.48,,,,,,,Fee Schedule,429.48,429.48,
CV Holter Monitor Recording up to 48 Hrs,8230053,LOCAL,93225,CPT,,,,,,Outpatient,,,304,198,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,99.86,117.85,
Holter Monitor 48 Hr,8230053,LOCAL,93225,CPT,,,,,,Outpatient,,,304,198,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,99.86,117.85,
Bill Only Rh Phenotyping,7936966,LOCAL,86906,CPT,,,,,,Outpatient,,,306,9.3,United Health ,United Health Medicare Advantage,35.88,,,,,,,Fee Schedule,6.29,35.88,
COV19/Flu/RSV (GeneXpert Plus),10791321,LOCAL,87637,CPT,,,,,,Outpatient,,,306,171.16,United Health ,United Health Medicare Advantage,69.48,,,,,,,Fee Schedule,40.19,69.4761107,
US OB Less Than 14 Weeks,8206952,LOCAL,76801,CPT,,,,,,Outpatient,,,307,165,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,148.61,
Chlamydia/Chlamydophila Ab 2 IgM QSTC,13864537,LOCAL,86632,CPT,,,,,,Outpatient,,,307.13,15.22,United Health ,United Health Medicare Advantage,12.68,,,,,,,Fee Schedule,12.68,15.29,
EPINEPHrine 8 mg/250 mL-NaCl 0.9% Sol [CULL],11200040,LOCAL,J0165,CPT,,,,,,Outpatient,250,ML,307.2,,United Health ,United Health Medicare Advantage,0.43,,,,,,,Fee Schedule,0.433,0.433,
Comprehensive Metabolic Panel,633709,LOCAL,80053,CPT,,,,,,Outpatient,,,307.22,12.67,United Health ,United Health Medicare Advantage,82.76,,,,,,,Fee Schedule,12.14,82.75523053,
XR Ankle 1 View Left,13554963,LOCAL,73600,CPT,,,,,52|LT,Outpatient,,,307.85,165,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ankle 1 View Right,13554966,LOCAL,73600,CPT,,,,,52|RT,Outpatient,,,307.85,165,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Foot 2 Views Left,1170185,LOCAL,73620,CPT,,,,,LT,Outpatient,,,309.19,165.83,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Foot 2 Views Right,1170187,LOCAL,73620,CPT,,,,,RT,Outpatient,,,309.19,165.83,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
"Bill Only ABID Panel, Enzyme (Ab)",13517190,LOCAL,86870,CPT,,,,,,Outpatient,,,310.5,,United Health ,United Health Medicare Advantage,328.88,,,,,,,Fee Schedule,38.27,328.88,
"Bill Only ABID Panel, Enzyme (Ezym)",13517194,LOCAL,86971,CPT,,,,,,Outpatient,,,310.5,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.88,156.67,
Insulin Autoantibody QSTC,8764818,LOCAL,86337,CPT,,,,,,Outpatient,,,310.5,25.69,United Health ,United Health Medicare Advantage,21.41,,,,,,,Fee Schedule,15.29,21.41,
XR Finger(s) 2 Plus Views Left,1170151,LOCAL,73140,CPT,,,,,LT,Outpatient,,,311.14,146.03,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Finger(s) 2 Plus Views Right,1170153,LOCAL,73140,CPT,,,,,RT,Outpatient,,,311.14,146.03,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
97163  SB PT Eval High Comp,9640017,LOCAL,97163,CPT,,,,,GP,Outpatient,,,312.16,203,United Health ,United Health Medicare Advantage,92.25,,,,,,,Fee Schedule,92.25,349.89,
97163 EVAL - HIGH COMPLEXITY CHARGE,9410062,LOCAL,97163,CPT,,,,,GP,Outpatient,,,312.16,203,United Health ,United Health Medicare Advantage,92.25,,,,,,,Fee Schedule,92.25,349.89,
97163 IND EDUCATION EVAL CHARGE,9650017,LOCAL,97163,CPT,,,,,GP|CQ,Outpatient,,,312.16,203,United Health ,United Health Medicare Advantage,92.25,,,,,,,Fee Schedule,92.25,349.89,
PT High Complex Units,7896014,LOCAL,97163,CPT,,,,,GP,Outpatient,,,312.16,203,United Health ,United Health Medicare Advantage,92.25,,,,,,,Fee Schedule,92.25,349.89,
Factor II Activity QSTC,8972859,LOCAL,85210,CPT,,,,,,Outpatient,,,312.8,15.58,United Health ,United Health Medicare Advantage,12.98,,,,,,,Fee Schedule,5.42,12.98,
MG Mammo Implant Screening Lt w/ Tomo.,8146654,LOCAL,77067,CPT,,,,,LT,Outpatient,,,313.11,363,United Health ,United Health Medicare Advantage,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Implant Screening Rt w/ Tomo.,8146657,LOCAL,77067,CPT,,,,,RT,Outpatient,,,313.11,363,United Health ,United Health Medicare Advantage,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Screening Left w/ Tomo.,8146660,LOCAL,77067,CPT,,,,,LT,Outpatient,,,313.11,363,United Health ,United Health Medicare Advantage,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Screening Right w/ Tomo.,8146663,LOCAL,77067,CPT,,,,,RT,Outpatient,,,313.11,363,United Health ,United Health Medicare Advantage,79.68,,,,,,,Fee Schedule,74,79.68,
92609 ST USE OF SPEECH DEVICE SERVICES,9636008,LOCAL,92609,CPT,,,,,GN,Outpatient,,,314.48,204,United Health ,United Health Medicare Advantage,95.88,,,,,,,Fee Schedule,56.44,95.88,
SLP Speech-Gen Dev Prog and Mod,7896913,LOCAL,92609,CPT,,,,,GN,Outpatient,,,314.48,204,United Health ,United Health Medicare Advantage,95.88,,,,,,,Fee Schedule,56.44,95.88,
SLP Speech-Gen Dev Prog and Mod Time,1373849,LOCAL,92609,CPT,,,,,GN,Outpatient,,,314.48,204,United Health ,United Health Medicare Advantage,95.88,,,,,,,Fee Schedule,56.44,95.88,
SLP Tx Generating Device Units,1373849,LOCAL,92609,CPT,,,,,GN,Outpatient,,,314.48,204,United Health ,United Health Medicare Advantage,95.88,,,,,,,Fee Schedule,56.44,95.88,
"Factor V Activity, Clotting QSTC",9777239,LOCAL,85220,CPT,,,,,,Outpatient,,,315,21.18,United Health ,United Health Medicare Advantage,17.65,,,,,,,Fee Schedule,5.42,17.65,
Hepatitis B Virus DNA Qnt RT PCR QSTC,8764549,LOCAL,87517,CPT,,,,,,Outpatient,,,315,51.41,United Health ,United Health Medicare Advantage,178.5,,,,,,,Fee Schedule,40.19,178.495,
Inhibin A QSTC,8972775,LOCAL,86336,CPT,,,,,,Outpatient,,,315,18.71,United Health ,United Health Medicare Advantage,15.59,,,,,,,Fee Schedule,15.29,15.59,
"Viral Respiratory, Rapid Culture with Reflex QST",12126195,LOCAL,87140,CPT,,,,,,Outpatient,,,315,6.68,United Health ,United Health Medicare Advantage,5.57,,,,,,,Fee Schedule,5.57,10.57,
"Porphyrins, Total QSTC",13864419,LOCAL,82542,CPT,,,,,,Outpatient,,,315.9,28.91,United Health ,United Health Medicare Advantage,24.09,,,,,,,Fee Schedule,17.73,24.09,
"73040 Radiologic examination, shoulder, arthrography: AddOn",14917589,LOCAL,73040,CPT,,,,,,Outpatient,,,316.12,777.98,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Forearm 1 View Left,13554993,LOCAL,73090,CPT,,,,,52|LT,Outpatient,,,318.62,170.78,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Forearm 1 View Right,13554996,LOCAL,73090,CPT,,,,,52|RT,Outpatient,,,318.62,170.78,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ankle 2 Views Left,1169936,LOCAL,73600,CPT,,,,,LT,Outpatient,,,318.65,165,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ankle 2 Views Right,1169938,LOCAL,73600,CPT,,,,,RT,Outpatient,,,318.65,165,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
tobramycin 1.2 g injection [CULL],11211303,LOCAL,J3260,CPT,,,,,,Outpatient,1,EA,320,,United Health ,United Health Medicare Advantage,2.07,,,,,,,Fee Schedule,2.071,2.071,
Complement Component C1q QSTC,8972752,LOCAL,86160,CPT,,,,,,Outpatient,,,322.65,14.4,United Health ,United Health Medicare Advantage,36.91,,,,,,,Fee Schedule,15.29,36.909,
97166  SB OT Eval Mod Comp,9860015,LOCAL,97166,CPT,,,,,GO|CO,Outpatient,,,322.74,210,United Health ,United Health Medicare Advantage,94.3,,,,,,,Fee Schedule,94.3,269.95,
97166 EVAL -  MODERATE COMPLEXITY CHARGE,9850015,LOCAL,97166,CPT,,,,,GO,Outpatient,,,322.74,210,United Health ,United Health Medicare Advantage,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Evaluation Moderate Complexity Units,7897808,LOCAL,97166,CPT,,,,,GO,Outpatient,,,322.74,210,United Health ,United Health Medicare Advantage,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Moderate Complex Units,7895293,LOCAL,97166,CPT,,,,,GO,Outpatient,,,322.74,210,United Health ,United Health Medicare Advantage,94.3,,,,,,,Fee Schedule,94.3,269.95,
XR Calcaneus Left,1170032,LOCAL,73650,CPT,,,,,LT,Outpatient,,,325.42,174.9,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Calcaneus Right,1170034,LOCAL,73650,CPT,,,,,RT,Outpatient,,,325.42,174.9,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
94618 PULM STRESS TEST - 6 MIN WALK CHARGE,10470023,LOCAL,94618,CPT,,,,,59,Outpatient,,,326.86,212,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,76.09,117.85,
94618 PULMONARY STRESS TEST CHARGE,10470022,LOCAL,94618,CPT,,,,,,Outpatient,,,326.86,212,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,76.09,117.85,
XR Hips 2 Views w/AP Pelvis Bilat,7520609,LOCAL,73521,CPT,,,,,,Outpatient,,,327.27,175.73,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
"Neutrophil Funct, Oxidative Burst QSTC",13864519,LOCAL,82657,CPT,,,,,,Outpatient,,,327.6,26.6,United Health ,United Health Medicare Advantage,22.17,,,,,,,Fee Schedule,17.73,22.17,
XR Clavicle Limited Left,13554978,LOCAL,73000,CPT,,,,,52|LT,Outpatient,,,330.84,198.83,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Clavicle Limited Right,13575896,LOCAL,73000,CPT,,,,,52|RT,Outpatient,,,330.84,198.83,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR CV Line Injection,10153535,LOCAL,77001,CPT,,,,,,Outpatient,,,330.88,177.38,United Health ,United Health Medicare Advantage,70.92,,,,,,,Fee Schedule,70.92,262.79,
XR Portogram,8602535,LOCAL,36598,CPT,,,,,,Outpatient,,,330.88,587,United Health ,United Health Medicare Advantage,192.63,,,,,,,Fee Schedule,192.63,863,
"Neuron Specific Enolase, CSF QSTC",13864472,LOCAL,86316,CPT,,,,,,Outpatient,,,335.25,24.97,United Health ,United Health Medicare Advantage,100.2,,,,,,,Fee Schedule,15.29,100.2,
XR Sternum 2+ Views,1170496,LOCAL,71120,CPT,,,,,,Outpatient,,,335.51,179.85,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
"Borrelia species DNA, QL RT PCR QSTC",13864432,LOCAL,87801,CPT,,,,,,Outpatient,,,337.5,84.24,United Health ,United Health Medicare Advantage,70.2,,,,,,,Fee Schedule,40.19,70.2,
"Calprotectin, Stool QSTC",8764641,LOCAL,83993,CPT,,,,,,Outpatient,,,337.5,23.56,United Health ,United Health Medicare Advantage,19.63,,,,,,,Fee Schedule,17.73,19.63,
"Factor VII Activity, Clotting QSTC",12530023,LOCAL,85230,CPT,,,,,,Outpatient,,,337.5,21.48,United Health ,United Health Medicare Advantage,17.9,,,,,,,Fee Schedule,5.42,17.9,
"Rheumatoid Factor (IgA, IgG, IgM) QSTC",9743436,LOCAL,83520,CPT,,,,,,Outpatient,,,337.5,20.72,United Health ,United Health Medicare Advantage,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
SURESWAB(R) ADV BV QST,12432150,LOCAL,81513,CPT,,,,,,Outpatient,,,338,171.16,United Health ,United Health Medicare Advantage,142.63,,,,,,,Fee Schedule,63.34,142.63,
"Estrogens, Fractionated, LC/MS QSTC",8972883,LOCAL,82671,CPT,,,,,,Outpatient,,,340.29,38.76,United Health ,United Health Medicare Advantage,185.98,,,,,,,Fee Schedule,18.43,185.975,
"86617-Lyme Disease Abs (IgG, IgM) IBL CSF QSTC",14825580,LOCAL,86617,CPT,,,,,,Outpatient,,,342,18.59,United Health ,United Health Medicare Advantage,15.49,,,,,,,Fee Schedule,15.29,15.49,
"BK Virus DNA, Quant, RT PCR QSTC",8853280,LOCAL,87799,CPT,,,,,,Outpatient,,,342,51.41,United Health ,United Health Medicare Advantage,42.84,,,,,,,Fee Schedule,40.19,42.84,
"Lyme Disease Ab Rfx Blot IgG, IgM QSTC",8764732,LOCAL,86618,CPT,,,,,,Outpatient,,,342,20.44,United Health ,United Health Medicare Advantage,17.03,,,,,,,Fee Schedule,15.29,17.03,
"Lyme Disease Abs (IgG, IgM) IBL CSF QSTC",14114578,LOCAL,86617,CPT,,,,,,Outpatient,,,342,18.59,United Health ,United Health Medicare Advantage,15.49,,,,,,,Fee Schedule,15.29,15.49,
"Lyme Disease Antibodies (IgG, IgM), Immunoblot, CSF QST",6232109,LOCAL,86617,CPT,,,,,,Outpatient,,,342,18.59,United Health ,United Health Medicare Advantage,15.49,,,,,,,Fee Schedule,15.29,15.49,
sodium thiosulfate 25% intravenous solution 50 mL [CULL],11260081,LOCAL,J0208,CPT,,,,,,Outpatient,50,ML,342.4,,United Health ,United Health Medicare Advantage,95.11,,,,,,,Fee Schedule,95.11,7537.07,
Chlamydia/Chlamydophila Ab 1 IgG QSTC,13864536,LOCAL,86631,CPT,,,,,,Outpatient,,,342.9,14.18,United Health ,United Health Medicare Advantage,11.82,,,,,,,Fee Schedule,11.82,15.29,
"TRICHOMONAS VAGINALIS (TV), TMA QST",12432301,LOCAL,87661,CPT,,,,,,Outpatient,,,343.11,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
CANDIDA GLABRATA QST,12432300,LOCAL,87481,CPT,,,,,,Outpatient,,,343.13,42.11,United Health ,United Health Medicare Advantage,478.17,,,,,,,Fee Schedule,40.19,478.165,
CANDIDA SPECIES QST,12432293,LOCAL,87481,CPT,,,,,,Outpatient,,,343.13,42.11,United Health ,United Health Medicare Advantage,478.17,,,,,,,Fee Schedule,40.19,478.165,
CANDIDA SPECIES QST,12432299,LOCAL,87481,CPT,,,,,,Outpatient,,,343.13,42.11,United Health ,United Health Medicare Advantage,478.17,,,,,,,Fee Schedule,40.19,478.165,
SURESWAB(R) ADV BV QST,12432298,LOCAL,81513,CPT,,,,,,Outpatient,,,343.13,171.16,United Health ,United Health Medicare Advantage,142.63,,,,,,,Fee Schedule,63.34,142.63,
"EBV DNA, QN PCR QSTC",8764620,LOCAL,87799,CPT,,,,,,Outpatient,,,344.25,51.41,United Health ,United Health Medicare Advantage,42.84,,,,,,,Fee Schedule,40.19,42.84,
XR Wrist 2 Views Left,1170606,LOCAL,73100,CPT,,,,,LT,Outpatient,,,344.56,184.8,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Wrist 2 Views Right,1170608,LOCAL,73100,CPT,,,,,RT,Outpatient,,,344.56,184.8,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
REF LAB IAT CROSSMATCH,13797753,LOCAL,86922,CPT,,,,,,Outpatient,,,347,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
XR Forearm 2 Views Left,1170197,LOCAL,73090,CPT,,,,,LT,Outpatient,,,347.3,170.78,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Forearm 2 Views Right,1170199,LOCAL,73090,CPT,,,,,RT,Outpatient,,,347.3,170.78,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
97167 EVAL -  HIGH COMPLEXITY CHARGE,9850017,LOCAL,97167,CPT,,,,,GO,Outpatient,,,347.74,226,United Health ,United Health Medicare Advantage,94.3,,,,,,,Fee Schedule,94.3,269.95,
97167 IND EDUCATION EVAL CHARGE,9860017,LOCAL,97167,CPT,,,,,GO|CO,Outpatient,,,347.74,226,United Health ,United Health Medicare Advantage,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT Evaluation High Complexity Units,7897809,LOCAL,97167,CPT,,,,,GO,Outpatient,,,347.74,226,United Health ,United Health Medicare Advantage,94.3,,,,,,,Fee Schedule,94.3,269.95,
OT High Complex Units,7895295,LOCAL,97167,CPT,,,,,GO,Outpatient,,,347.74,226,United Health ,United Health Medicare Advantage,94.3,,,,,,,Fee Schedule,94.3,269.95,
99211 LEVEL I VISIT CHARGE,9319019,LOCAL,99211,CPT,,,,,,Outpatient,,,348.41,226,United Health ,United Health Medicare Advantage,7.37,,,,,,,Fee Schedule,7.37,7.37,
99211 Office Visit Established Pt. Level 1,10168485,LOCAL,99211,CPT,,,,,,Outpatient,,,348.41,226,United Health ,United Health Medicare Advantage,7.37,,,,,,,Fee Schedule,7.37,7.37,
XR Scapula Left,1170401,LOCAL,73010,CPT,,,,,LT,Outpatient,,,348.57,187.28,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Scapula Right,1170403,LOCAL,73010,CPT,,,,,RT,Outpatient,,,348.57,187.28,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
Mycobacterium Slow Grower MIC QST,13864520,LOCAL,87186,CPT,,,,,,Outpatient,,,348.75,10.38,United Health ,United Health Medicare Advantage,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
Mycobacterium Slow Grower MIC QSTC,13864520,LOCAL,87186,CPT,,,,,,Outpatient,,,348.75,10.38,United Health ,United Health Medicare Advantage,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
CPAP Charge -> Subsequent,8365858,LOCAL,94660,CPT,,,,,,Outpatient,,,348.84,279,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,181.37,185.95,
17110 CRYOSURGERY REMOVAL OF LESIONS CHARGE,9038957,LOCAL,17110,CPT,,,,,,Outpatient,,,350,228,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
94625 PHY/QHP OP PULM RHB W/O MNTR,10470028,LOCAL,94625,CPT,,,,,,Outpatient,,,350,407,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,51.98,54.31,
11730 AVULSION OF NAIL PLATE SINGLE,8715870,LOCAL,11730,CPT,,,,,,Outpatient,,,350.01,228,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,95.93,863,
94618 PULMONARY STRESS TEST 6 MINUTE WALK,10440014,LOCAL,94618,CPT,,,,,,Outpatient,,,351.07,212,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,76.09,117.85,
linezolid 2 mg/mL-D5% intravenous solution 300 mL [CULL],11201931,LOCAL,J2020,CPT,,,,,,Outpatient,300,ML,352,,United Health ,United Health Medicare Advantage,2.74,,,,,,,Fee Schedule,2.742,2.742,
RT CHARGE PFT -> Bedside Spirometry,8860673,LOCAL,94060,CPT,,,,,,Outpatient,,,353.43,230,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,149.57,284.7,
RT CHARGE PFT -> Spirometry before & after,5267139,LOCAL,94060,CPT,,,,,,Outpatient,,,353.43,230,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,149.57,284.7,
Alpha Subunit QSTC,9849271,LOCAL,83520,CPT,,,,,,Outpatient,,,354.33,20.72,United Health ,United Health Medicare Advantage,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
XR Spine Thoracic 2 Views,1170484,LOCAL,72070,CPT,,,,,,Outpatient,,,358.33,192.23,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
micafungin 50 mg intravenous injection [CULL],11220352,LOCAL,J2248,CPT,,,,,,Outpatient,1,EA,359.232,,United Health ,United Health Medicare Advantage,0.25,,,,,,,Fee Schedule,0.249,122.4,
Acetylcholine Recept. Modulating Ab QSTC,13864533,LOCAL,86043,CPT,,,,,,Outpatient,,,360,14.46,United Health ,United Health Medicare Advantage,12.05,,,,,,,Fee Schedule,12.05,15.29,
Adenovirus DNA Qual RT PCR QSTC,10100374,LOCAL,87798,CPT,,,,,,Outpatient,,,360,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
"B.pertussis/para DNA,Ql Rl-Time PCR QSTC",8873570,LOCAL,87798,CPT,,,,,,Outpatient,,,360,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Bartonella Sp Ab IgG,IgM w/rf Titer QSTC",9777261,LOCAL,86611,CPT,,,,,,Outpatient,,,360,12.22,United Health ,United Health Medicare Advantage,10.18,,,,,,,Fee Schedule,10.18,15.29,
Copeptin QSTC,9039409,LOCAL,86255,CPT,,,,,,Outpatient,,,360,14.46,United Health ,United Health Medicare Advantage,12.05,,,,,,,Fee Schedule,12.05,15.29,
Hepatitis C Viral RNA Genotype LiPA QSTC,8764578,LOCAL,87902,CPT,,,,,,Outpatient,,,360,308.94,United Health ,United Health Medicare Advantage,257.45,,,,,,,Fee Schedule,158.39,257.45,
Histamine QSTC,13864456,LOCAL,83088,CPT,,,,,,Outpatient,,,360,35.44,United Health ,United Health Medicare Advantage,29.53,,,,,,,Fee Schedule,17.73,29.53,
HSV 1 QST,9775428,LOCAL,87529,CPT,,,,,,Outpatient,,,360,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
HSV 2 QST,9775429,LOCAL,87529,CPT,,,,,,Outpatient,,,360,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
Mycobacterium Avium Complex MIC QST,13344174,LOCAL,87186,CPT,,,,,,Outpatient,,,360,10.38,United Health ,United Health Medicare Advantage,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
methylPREDNISolone sodium succinate 2 g injection [CULL],11201958,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,361.92,,United Health ,United Health Medicare Advantage,0.21,,,,,,,Fee Schedule,0.21,0.21,
XR Mandible Less Than 4 Views,1170303,LOCAL,70100,CPT,,,,,,Outpatient,,,362.58,194.7,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
Babesia microti Ab (IgG) QSTC,13872991,LOCAL,86753,CPT,,,,,,Outpatient,,,367.5,14.87,United Health ,United Health Medicare Advantage,12.39,,,,,,,Fee Schedule,12.39,15.29,
Ehrlichia chaffeensis Ab IgG QSTC,13872999,LOCAL,86753,CPT,,,,,,Outpatient,,,367.5,14.87,United Health ,United Health Medicare Advantage,12.39,,,,,,,Fee Schedule,12.39,15.29,
Lyme Ab Screen QSTC,13872998,LOCAL,86618,CPT,,,,,,Outpatient,,,367.5,20.44,United Health ,United Health Medicare Advantage,17.03,,,,,,,Fee Schedule,15.29,17.03,
XR Clavicle Left,1170075,LOCAL,73000,CPT,,,,,LT,Outpatient,,,370.53,198.83,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Clavicle Right,1170077,LOCAL,73000,CPT,,,,,RT,Outpatient,,,370.53,198.83,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Humerus Limited Left,13554999,LOCAL,73060,CPT,,,,,52|LT,Outpatient,,,372.34,223.58,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Humerus Limited Right,13555002,LOCAL,73060,CPT,,,,,52|RT,Outpatient,,,372.34,223.58,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
Reptilase Clotting Time QSTC,13864513,LOCAL,85635,CPT,,,,,,Outpatient,,,372.42,11.82,United Health ,United Health Medicare Advantage,9.85,,,,,,,Fee Schedule,8.21,9.85,
XR Tibia/Fibula Left,1170516,LOCAL,73590,CPT,,,,,LT,Outpatient,,,373.27,200.48,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Tibia/Fibula Right,1170518,LOCAL,73590,CPT,,,,,RT,Outpatient,,,373.27,200.48,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
27095 INJ PROC FOR HIP ARTHROGRAPHY W/ ANESTH,5661071,LOCAL,27095,CPT,,,,,,Outpatient,,,373.99,,United Health ,United Health Medicare Advantage,64.91,,,,,,,Fee Schedule,64.91,863,
"64454 - Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imagin",12897048,LOCAL,64454,CPT,,,,,,Outpatient,,,375,244,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
"64454 Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging",9520502,LOCAL,64454,CPT,,,,,,Outpatient,,,375,244,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
caspofungin 50 mg intravenous injection [CULL],11201273,LOCAL,J0637,CPT,,,,,,Outpatient,1,EA,376,,United Health ,United Health Medicare Advantage,3.82,,,,,,,Fee Schedule,3.818,3.818,
"Bill Only Adsorption (Pheno, Rest, Wrm)",13517195,LOCAL,86978,CPT,,,,,,Outpatient,,,378,,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,38.88,54.31,
"Bill Only Rare Unit, Outside Search",13517199,LOCAL,86999,CPT,,,,,,Outpatient,,,378,,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,6.29,22.39,
tuberculin purified protein derivative 5 tuberculin units/0.1 mL intradermal solution 1 mL [CULL],11200764,LOCAL,86580,CPT,,,,,,Outpatient,1,ML,379.84,,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,15.29,22.39,
"SureSwab(R) Trich. Vag. RNA,QL TMA QSTC",8853247,LOCAL,87661,CPT,,,,,,Outpatient,,,382.5,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Trichomonas Vaginalis RNA, Ql, TMA QST",8853247,LOCAL,87661,CPT,,,,,,Outpatient,,,382.5,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
XR Femur 1 View Left,7520564,LOCAL,73551,CPT,,,,,LT,Outpatient,,,382.59,205.43,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Femur 1 View Right,7520567,LOCAL,73551,CPT,,,,,RT,Outpatient,,,382.59,205.43,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
Hereditary Hemochroma DNA Mut Analy QSTC,8764601,LOCAL,81256,CPT,,,,,,Outpatient,,,387,78.43,United Health ,United Health Medicare Advantage,65.36,,,,,,,Fee Schedule,63.34,65.36,
Bill Only Absorption,7967780,LOCAL,86978,CPT,,,,,,Outpatient,,,391.5,,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,38.88,54.31,
Food and Tree Nut Allergy Panel QSTC,14884175,LOCAL,86003,CPT,,,,,,Outpatient,,,393.21,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
99282 - Level 2,2644298,LOCAL,99282,CPT,,,,,25,Outpatient,,,393.64,256,United Health ,United Health Medicare Advantage,144.78,,,,,,,Fee Schedule,144.78,144.78,
BRACE COOL X-ACT DON-JOY (USE),4852073,LOCAL,,,L1833,HCPCS,,,,Outpatient,,,394.02,994,United Health ,United Health Medicare Advantage,556.31,,,,,,,Fee Schedule,556.31,556.31,
93797 Cardiac Rehab without ECG monitoring,10411210,LOCAL,93797,CPT,,,,,,Outpatient,,,394.32,256,United Health ,United Health Medicare Advantage,115.11,,,,,,,Fee Schedule,115.11,219.28,
93798 Cardiac Rehab Phase II,10411000,LOCAL,93798,CPT,,,,,,Outpatient,,,394.32,256,United Health ,United Health Medicare Advantage,115.11,,,,,,,Fee Schedule,115.11,219.28,
DUP ARTERIAL & VENOUS MAPPING UNI,8200502,LOCAL,93986,CPT,,,,,,Outpatient,,,395.6,257,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Vein Mapping Lower Extremity Left,12175098,LOCAL,93986,CPT,,,,,LT,Outpatient,,,395.6,257,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Vein Mapping Lower Extremity Right,12175101,LOCAL,93986,CPT,,,,,RT,Outpatient,,,395.6,257,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Vein Mapping Upper Extremity Left,12175107,LOCAL,93986,CPT,,,,,LT,Outpatient,,,395.6,257,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Vein Mapping Upper Extremity Right,12175110,LOCAL,93986,CPT,,,,,RT,Outpatient,,,395.6,257,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
caspofungin 70 mg intravenous injection [CULL],11201274,LOCAL,J0637,CPT,,,,,,Outpatient,1,EA,396,,United Health ,United Health Medicare Advantage,3.82,,,,,,,Fee Schedule,3.818,3.818,
71046 XR Chest 2 Views: AddOn,13632841,LOCAL,71046,CPT,,,,,,Outpatient,,,397.38,212.85,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Chest 2 Views,689607,LOCAL,71046,CPT,,,,,,Outpatient,,,397.38,212.85,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
Heparin Anti-Xa QSTC,8972922,LOCAL,85520,CPT,,,,,,Outpatient,,,400.5,15.71,United Health ,United Health Medicare Advantage,13.09,,,,,,,Fee Schedule,5.42,13.09,
XR Abdomen KUB 1 View,1169926,LOCAL,74018,CPT,,,,,,Outpatient,,,401.12,215.33,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Knee 1 or 2 Views Left,1170263,LOCAL,73560,CPT,,,,,LT,Outpatient,,,401.12,215.33,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Knee 1 or 2 Views Right,1170265,LOCAL,73560,CPT,,,,,RT,Outpatient,,,401.12,215.33,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
21- Hydroxylase Antibody QSTC,9708927,LOCAL,83516,CPT,,,,,,Outpatient,,,402.53,13.84,United Health ,United Health Medicare Advantage,11.53,,,,,,,Fee Schedule,11.53,17.73,
"96360 - Hydration, first hour",1928297,LOCAL,96360,CPT,,,,,,Outpatient,,,403.29,262,United Health ,United Health Medicare Advantage,192.63,,,,,,,Fee Schedule,192.63,442.94,
"96360 IV HYDRATION, INITIAL 31-90 MINS",7904529,LOCAL,96360,CPT,,,,,,Outpatient,,,403.29,262,United Health ,United Health Medicare Advantage,192.63,,,,,,,Fee Schedule,192.63,442.94,
Inhibin B QSTC,6210082,LOCAL,83520,CPT,,,,,,Outpatient,,,405,20.72,United Health ,United Health Medicare Advantage,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Rituxan Sensitivity (CD20) QSTC,13864421,LOCAL,86356,CPT,,,,,,Outpatient,,,405,32.14,United Health ,United Health Medicare Advantage,26.78,,,,,,,Fee Schedule,15.29,26.78,
XR Hip 1 View Left,1170225,LOCAL,73501,CPT,,,,,LT,Outpatient,,,407.12,218.63,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 1 View Right,1170227,LOCAL,73501,CPT,,,,,RT,Outpatient,,,407.12,218.63,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
A. phagocytophilum Ab IgG IgM QSTC,13864527,LOCAL,86666,CPT,,,,,,Outpatient,,,407.25,12.22,United Health ,United Health Medicare Advantage,10.18,,,,,,,Fee Schedule,10.18,15.29,
XR Bone Length Studies Scanograms,1170016,LOCAL,77073,CPT,,,,,,Outpatient,,,407.59,218.63,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
DOP ABI-ANKLE BRACHIAL INDEX,8230017,LOCAL,93922,CPT,,,,,,Outpatient,,,408.25,265,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,117.85,161.71,
US ABI,8206802,LOCAL,93922,CPT,,,,,,Outpatient,,,408.25,265,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,117.85,161.71,
US Segmental Pressures LE 1-2 Lvls Bilat,1169757,LOCAL,93922,CPT,,,,,,Outpatient,,,408.25,265,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,117.85,161.71,
XR Sacrum/Coccyx 2+ Views,1170391,LOCAL,72220,CPT,,,,,,Outpatient,,,408.83,219.45,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Sniff Test,8602547,LOCAL,71046,CPT,,,,,,Outpatient,,,409.11,212.85,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Sternoclavicular Joint(s),1170494,LOCAL,71130,CPT,,,,,,Outpatient,,,411.41,220.28,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
Bill Only Antigen Type Group 1,13517191,LOCAL,86902,CPT,,,,,,Outpatient,,,414,7.62,United Health ,United Health Medicare Advantage,328.88,,,,,,,Fee Schedule,6.29,328.88,
Proinsulin QSTC,8972777,LOCAL,84206,CPT,,,,,,Outpatient,,,414,32.03,United Health ,United Health Medicare Advantage,26.69,,,,,,,Fee Schedule,18.43,26.69,
XR Elbow Complete 3+ Views Left,1170127,LOCAL,73080,CPT,,,,,LT,Outpatient,,,414.29,221.93,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Elbow Complete 3+ Views Right,1170129,LOCAL,73080,CPT,,,,,RT,Outpatient,,,414.29,221.93,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
DOPP ART EXT BIL MULTIPLE,8200300,LOCAL,93923,CPT,,,,,,Outpatient,,,414.94,401,United Health ,United Health Medicare Advantage,143.05,,,,,,,Fee Schedule,143.05,244.97,
DOPP ART EXT BIL W/EXERCISE,8200310,LOCAL,93924,CPT,,,,,,Outpatient,,,414.94,302,United Health ,United Health Medicare Advantage,143.05,,,,,,,Fee Schedule,143.05,161.71,
XR Shoulder Complete 2 Plus Views Left,1170415,LOCAL,73030,CPT,,,,,LT,Outpatient,,,416.12,222.75,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Shoulder Complete 2 Plus Views Right,1170417,LOCAL,73030,CPT,,,,,RT,Outpatient,,,416.12,222.75,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Femur 2 Views Left,7520570,LOCAL,73552,CPT,,,,,LT,Outpatient,,,417.02,223.58,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Femur 2 Views Right,7520573,LOCAL,73552,CPT,,,,,RT,Outpatient,,,417.02,223.58,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Humerus Left,1170245,LOCAL,73060,CPT,,,,,LT,Outpatient,,,417.02,223.58,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Humerus Right,1170247,LOCAL,73060,CPT,,,,,RT,Outpatient,,,417.02,223.58,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 1 View w/ AP Pelvis Left,7520576,LOCAL,73501,CPT,,,,,LT,Outpatient,,,418.32,218.63,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 1 View w/ AP Pelvis Right,7520579,LOCAL,73501,CPT,,,,,RT,Outpatient,,,418.32,218.63,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
15272 APP SKN SUB GRFT TAL 100 SQ CM ADDT FAC CHARGE,12831013,LOCAL,15272,CPT,,,,,,Outpatient,,,419.53,273,United Health ,United Health Medicare Advantage,13.68,,,,,,,Fee Schedule,13.68,2862.92,
"epoetin alfa-epbx 10,000 units/mL preservative-free injectable solution 1 mL [CULL]",11202387,LOCAL,Q5105,CPT,,,,,,Outpatient,1,ML,423.552,,United Health ,United Health Medicare Advantage,0.79,,,,,,,Fee Schedule,0.79,233.26,
"11055 BENIGN LESION PARING/CUTTING, SINGLE",13043366,LOCAL,11055,CPT,,,,,,Outpatient,,,426.97,278,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
"Enterovirus RNA, QL Real-Time PCR QSTC",8873564,LOCAL,87498,CPT,,,,,,Outpatient,,,427.5,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
CULL US Echo Dop w/ Spectr Ltd,13734793,LOCAL,93321,CPT,,,,,,Outpatient,,,428.24,278,United Health ,United Health Medicare Advantage,15.78,,,,,,,Fee Schedule,15.78,678.38,
ECHO DOP W/SPECTR LTD,8200175,LOCAL,93321,CPT,,,,,,Outpatient,,,428.24,278,United Health ,United Health Medicare Advantage,15.78,,,,,,,Fee Schedule,15.78,678.38,
CPAP Charge -> Initial,8365859,LOCAL,94660,CPT,,,,,,Outpatient,,,429.93,279,United Health ,United Health Medicare Advantage,185.95,,,,,,,Fee Schedule,181.37,185.95,
"S. pneumoniae Ab (IgG), MAID QSTC",13864418,LOCAL,87899,CPT,,,,,,Outpatient,,,431.1,19.28,United Health ,United Health Medicare Advantage,16.07,,,,,,,Fee Schedule,10.57,16.07,
XR Foot Complete 3 Plus Views Left,1170191,LOCAL,73630,CPT,,,,,LT,Outpatient,,,431.43,231,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Foot Complete 3 plus Views Right,1170193,LOCAL,73630,CPT,,,,,RT,Outpatient,,,431.43,231,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
ER US VASCULAR ACCESS GUIDANCE,8200565,LOCAL,76937,CPT,,,,,,Outpatient,,,431.69,231.83,United Health ,United Health Medicare Advantage,23.28,,,,,,,Fee Schedule,23.28,165.47,
US VASCULAR ACCESS GUIDANCE,8200560,LOCAL,76937,CPT,,,,,,Outpatient,,,431.69,231.83,United Health ,United Health Medicare Advantage,23.28,,,,,,,Fee Schedule,23.28,165.47,
E0181 RBC CPD 500 LR,7266548,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,United Health ,United Health Medicare Advantage,182,,,,,,,Fee Schedule,182,217.45,
E0226 RBC CPDA1 500 LR,7266556,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,United Health ,United Health Medicare Advantage,182,,,,,,,Fee Schedule,182,217.45,
E0366 RBC CP2D AS3 500,7266579,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,United Health ,United Health Medicare Advantage,182,,,,,,,Fee Schedule,182,217.45,
E0382 RBC CP2D AS3 500 LR,7266659,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,United Health ,United Health Medicare Advantage,182,,,,,,,Fee Schedule,182,217.45,
E0424 RBC CPD AS5 500 LR,7266667,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,United Health ,United Health Medicare Advantage,182,,,,,,,Fee Schedule,182,217.45,
E4531 Aph RBC ACDA AS1 LR,7266601,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,United Health ,United Health Medicare Advantage,182,,,,,,,Fee Schedule,182,217.45,
E4532 Aph RBC ACDA AS1 LR 1,7266602,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,United Health ,United Health Medicare Advantage,182,,,,,,,Fee Schedule,182,217.45,
E4533 Aph RBC ACDA AS1 LR 2,7266603,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,United Health ,United Health Medicare Advantage,182,,,,,,,Fee Schedule,182,217.45,
E4543 Aph RBC ACDA AS3 LR,7266613,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,United Health ,United Health Medicare Advantage,182,,,,,,,Fee Schedule,182,217.45,
E4544 Aph RBC ACDA AS3 LR 1,7266614,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,United Health ,United Health Medicare Advantage,182,,,,,,,Fee Schedule,182,217.45,
E4545 Aph RBC ACDA AS3 LR 2,7266615,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,United Health ,United Health Medicare Advantage,182,,,,,,,Fee Schedule,182,217.45,
E5157 RBC CPD AS1 LR LV,8069011,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,United Health ,United Health Medicare Advantage,182,,,,,,,Fee Schedule,182,217.45,
XR Hip 2-3 Views Left,7520582,LOCAL,73502,CPT,,,,,LT,Outpatient,,,434.37,232.65,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 2-3 Views Right,7520585,LOCAL,73502,CPT,,,,,RT,Outpatient,,,434.37,232.65,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
fondaparinux 7.5 mg/0.6 mL subcutaneous solution 0.6 mL [CULL],11260585,LOCAL,J1652,CPT,,,,,,Outpatient,0.6,ML,434.56,,United Health ,United Health Medicare Advantage,0.88,,,,,,,Fee Schedule,0.877,0.877,
XR Ankle Complete 3 Plus Views Left,1169942,LOCAL,73610,CPT,,,,,LT,Outpatient,,,434.8,233.48,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ankle Complete 3 Plus Views Right,1169944,LOCAL,73610,CPT,,,,,RT,Outpatient,,,434.8,233.48,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hand Complete 3 Plus Views Right,1170223,LOCAL,73130,CPT,,,,,RT,Outpatient,,,438.91,235.13,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hand Complete 3 Views Left,1170221,LOCAL,73130,CPT,,,,,LT,Outpatient,,,438.91,235.13,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
E0336 RBC CPD AS1 500 LR,7266574,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,439,282,United Health ,United Health Medicare Advantage,182,,,,,,,Fee Schedule,182,217.45,
11056 BENIGN LESION PARING(2-4),13029575,LOCAL,11056,CPT,,,,,,Outpatient,,,439.05,285,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
11103 TANGENTIAL BIOP EA ADDT CHARGE,9322081,LOCAL,11103,CPT,,,,,,Outpatient,,,439.05,285,United Health ,United Health Medicare Advantage,16.62,,,,,,,Fee Schedule,16.62,863,
11721 DEBRIDE NAIL 6 OR MORE WC CHARGE,8726776,LOCAL,11721,CPT,,,,,,Outpatient,,,439.05,285,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,54.31,863,
97602 DEBRIDE MAGGOT THERAPY NON-EXC,11633062,LOCAL,97602,CPT,,,,,,Outpatient,,,439.05,285,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,549.61,
97605 Wound VAC <=50 sq cm,10015643,LOCAL,97605,CPT,,,,,,Outpatient,,,439.05,285,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,273.27,
XR Sacroiliac Joints 3+ Views,1170387,LOCAL,72202,CPT,,,,,,Outpatient,,,440.26,235.95,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
BD Bone Density DEXA Axial w/Frac Assess,5017920,LOCAL,77085,CPT,,,,,,Outpatient,,,442.63,237.6,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,116.02,
US PSEUDOANEURYSM COMPRESSION,8200520,LOCAL,76936,CPT,,,,,,Outpatient,,,443.14,237.6,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,262.79,284.7,
US Pseudoaneurysm Compression Repair,7936316,LOCAL,76936,CPT,,,,,,Outpatient,,,443.14,237.6,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,262.79,284.7,
XR Sinuses Paranasal Complete,1170434,LOCAL,70220,CPT,,,,,,Outpatient,,,445.06,238.43,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
92523 SPEECH SOUND LANGUAGE COMPREHENS CHARGE,9630058,LOCAL,92523,CPT,,,,,GN,Outpatient,,,445.57,290,United Health ,United Health Medicare Advantage,214.08,,,,,,,Fee Schedule,214.08,337.75,
SLP Analysis of Voice & Resonance Minutes,7897211,LOCAL,92523,CPT,,,,,GN,Outpatient,,,445.57,290,United Health ,United Health Medicare Advantage,214.08,,,,,,,Fee Schedule,103.27,337.75,
SLP Sound Prod w/ Lang Comp Eval Units,7897209,LOCAL,92523,CPT,,,,,GN,Outpatient,,,445.57,290,United Health ,United Health Medicare Advantage,214.08,,,,,,,Fee Schedule,214.08,337.75,
Speech Sound Prod w/ Language Charge,7896929,LOCAL,92523,CPT,,,,,GN,Outpatient,,,445.57,290,United Health ,United Health Medicare Advantage,214.08,,,,,,,Fee Schedule,214.08,337.75,
XR Hip 2-3 Views w/AP Pelvis Left,7520588,LOCAL,73502,CPT,,,,,LT,Outpatient,,,446.32,232.65,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Hip 2-3 Views w/AP Pelvis Right,7520591,LOCAL,73502,CPT,,,,,RT,Outpatient,,,446.32,232.65,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
L3931 Forearm based radial nerve orthosis,9646083,LOCAL,,,L3931,HCPCS,,,GP,Outpatient,,,447.23,291,United Health ,United Health Medicare Advantage,229.01,,,,,,,Fee Schedule,229.01,229.01,
L3931 OT WRIST HAND FINGER ORTHOSIS,9856104,LOCAL,,,L3931,HCPCS,,,,Outpatient,,,447.23,291,United Health ,United Health Medicare Advantage,229.01,,,,,,,Fee Schedule,229.01,229.01,
L3931 Wrst/thmb Spic Spnt,9800062,LOCAL,,,L3931,HCPCS,,,,Outpatient,,,447.23,291,United Health ,United Health Medicare Advantage,229.01,,,,,,,Fee Schedule,229.01,229.01,
US Breast Limited Left.,8068444,LOCAL,76642,CPT,,,,,LT,Outpatient,,,449.55,240.9,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,161.71,
US Breast Limited Right.,8068447,LOCAL,76642,CPT,,,,,RT,Outpatient,,,449.55,240.9,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,161.71,
pneumococcal 23-polyvalent vaccine injectable solution 0.5 mL [CULL],11212160,LOCAL,90732,CPT,,,,,,Outpatient,0.5,ML,449.59104,,United Health ,United Health Medicare Advantage,133.47,,,,,,,Fee Schedule,39.58,133.472,
Adalimumab Level for IBD QSTC,13864453,LOCAL,80145,CPT,,,,,,Outpatient,,,450,46.28,United Health ,United Health Medicare Advantage,38.57,,,,,,,Fee Schedule,15.38,38.57,
"Amino Acid Analysis, Plasma QSTC",9039235,LOCAL,82139,CPT,,,,,,Outpatient,,,450,20.24,United Health ,United Health Medicare Advantage,16.87,,,,,,,Fee Schedule,16.87,17.73,
"BK Virus DNA, Quant, RT PCR, Ur QSTC",8764640,LOCAL,87799,CPT,,,,,,Outpatient,,,450,51.41,United Health ,United Health Medicare Advantage,42.84,,,,,,,Fee Schedule,40.19,42.84,
CULL CV Nurse MRI Monitoring,14671862,LOCAL,76018,CPT,,,,,,Outpatient,,,450,75.9,United Health ,United Health Medicare Advantage,83.92,,,,,,,Fee Schedule,83.92,83.92,
Histamine Release Chronic Urticaria QSTC,8764646,LOCAL,86343,CPT,,,,,,Outpatient,,,450,14.95,United Health ,United Health Medicare Advantage,12.46,,,,,,,Fee Schedule,12.46,15.29,
Infliximab Anti-drug Antibody for IBD QSTC,12552286,LOCAL,83520,CPT,,,,,,Outpatient,,,450,20.72,United Health ,United Health Medicare Advantage,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Infliximab Level for IBD QSTC,13864454,LOCAL,80230,CPT,,,,,,Outpatient,,,450,46.28,United Health ,United Health Medicare Advantage,38.57,,,,,,,Fee Schedule,15.38,38.57,
"Interleukin-6 (IL-6), Serum QSTC",9708918,LOCAL,83529,CPT,,,,,,Outpatient,,,450,20.72,United Health ,United Health Medicare Advantage,17.27,,,,,,,Fee Schedule,17.27,17.73,
SJMC 76018 MR Safety Implant Electronics Preparation,14671862,LOCAL,76018,CPT,,,,,,Outpatient,,,450,75.9,United Health ,United Health Medicare Advantage,83.92,,,,,,,Fee Schedule,83.92,83.92,
"VZV DNA, QL RT PCR QSTC",9777241,LOCAL,87798,CPT,,,,,,Outpatient,,,450,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
"99202 LEVEL II INITIAL VISIT, FAC CHARGE",12832515,LOCAL,99202,CPT,,,,,,Outpatient,,,452.19,294,United Health ,United Health Medicare Advantage,39.11,,,,,,,Fee Schedule,39.11,39.11,
99202 Office Visit New Pt. Level 2,10168481,LOCAL,99202,CPT,,,,,,Outpatient,,,452.19,294,United Health ,United Health Medicare Advantage,39.11,,,,,,,Fee Schedule,39.11,39.11,
99212 LEVEL II VISIT CHARGE,9319021,LOCAL,99212,CPT,,,,,,Outpatient,,,452.19,294,United Health ,United Health Medicare Advantage,29.48,,,,,,,Fee Schedule,29.48,29.48,
99212 Office Visit Established Pt. Level 2,10168486,LOCAL,99212,CPT,,,,,,Outpatient,,,452.19,294,United Health ,United Health Medicare Advantage,29.48,,,,,,,Fee Schedule,29.48,29.48,
12001 SIMPLE REPAIR OF WOUND TRUNK,13029607,LOCAL,12001,CPT,,,,,,Outpatient,,,454.38,295,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
FIRST HOUR DIRECT OBSERVATION CHARGE,8566355,LOCAL,,,G0379,HCPCS,,,25,Outpatient,,,457.38,297,United Health ,United Health Medicare Advantage,560.53,,,,,,,Fee Schedule,560.53,560.53,
CHOLANGIO W EXIST CATH S&I,8210339,LOCAL,47531,CPT,,,,,,Outpatient,,,458,298,United Health ,United Health Medicare Advantage,3226.48,,,,,,,Fee Schedule,2599,3226.48,
esmolol 10 mg/mL-sterile water Sol 250 mL [CULL],11201727,LOCAL,J1806,CPT,,,,,,Outpatient,250,ML,458.88,,United Health ,United Health Medicare Advantage,0.41,,,,,,,Fee Schedule,0.41,0.41,
Pregabalin QSTC,8853245,LOCAL,80299,CPT,,,,,,Outpatient,,,459,22.37,United Health ,United Health Medicare Advantage,18.64,,,,,,,Fee Schedule,15.38,18.64,
29580 Application of a Paste Boot (Bilateral),12642335,LOCAL,29580,CPT,,,,,,Outpatient,,,462.53,301,United Health ,United Health Medicare Advantage,144.26,,,,,,,Fee Schedule,144.26,863,
29580 PT UNNA BOOT APPL,9410275,LOCAL,29580,CPT,,,,,GP,Outpatient,,,462.53,301,United Health ,United Health Medicare Advantage,144.26,,,,,,,Fee Schedule,144.26,863,
US EXT NONVASC COMPLETE,8230013,LOCAL,76881,CPT,,,,,,Outpatient,,,462.67,248.33,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US EXT NONVASC LIMITED ANATOMIC SPEC,8230014,LOCAL,76882,CPT,,,,,,Outpatient,,,462.67,248.33,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
Bill Only Elution,7967778,LOCAL,86860,CPT,,,,,,Outpatient,,,463.5,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.27,156.67,
XR Pelvis Complete 3+ Views,1170353,LOCAL,72190,CPT,,,,,,Outpatient,,,463.51,248.33,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
DOP ART - LEA W/ TREADMILL,8230021,LOCAL,93924,CPT,,,,,,Outpatient,,,465.08,302,United Health ,United Health Medicare Advantage,143.05,,,,,,,Fee Schedule,143.05,161.71,
US Lower Ext Doppler w/ Stress Test,1169765,LOCAL,93924,CPT,,,,,,Outpatient,,,465.08,302,United Health ,United Health Medicare Advantage,143.05,,,,,,,Fee Schedule,143.05,161.71,
XR Osseous Survey Infant,1170020,LOCAL,77076,CPT,,,,,,Outpatient,,,466.03,249.98,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Facial Bones < 3 Views,1170139,LOCAL,70140,CPT,,,,,,Outpatient,,,471.62,253.28,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Orbits Limited,13555005,LOCAL,70140,CPT,,,,,,Outpatient,,,471.62,253.28,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
US Hips Infant Limited/Static,8206871,LOCAL,76886,CPT,,,,,,Outpatient,,,472.34,253.28,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,161.71,
US Spinal Canal,1169879,LOCAL,76800,CPT,,,,,,Outpatient,,,472.34,253.28,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
Bill Only Rare Donor Fee,13517197,LOCAL,86999,CPT,,,,,,Outpatient,,,472.5,,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,6.29,22.39,
96373- Intra-Arterial Injection,1928304,LOCAL,96373,CPT,,,,,59,Outpatient,,,473.98,308,United Health ,United Health Medicare Advantage,192.63,,,,,,,Fee Schedule,64.56,192.63,
96373 S-INJ NON CHEMO IA CHARGE,8049127,LOCAL,96373,CPT,,,,,59,Outpatient,,,473.98,308,United Health ,United Health Medicare Advantage,192.63,,,,,,,Fee Schedule,64.56,192.63,
DOP VENOUS LOWER EXT UNILATERAL,8200430,LOCAL,93971,CPT,,,,,,Outpatient,,,476.32,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
DOP VENOUS UPPER EXT UNI OR LTD,8200431,LOCAL,93971,CPT,,,,,,Outpatient,,,476.32,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUP AO IVC ILIAC LIMITED,8200531,LOCAL,93979,CPT,,,,,,Outpatient,,,476.32,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Aorta IVC Iliac Duplex Limited,1169579,LOCAL,93979,CPT,,,,,,Outpatient,,,476.32,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Venous Duplex Left,1169771,LOCAL,93971,CPT,,,,,LT,Outpatient,,,476.32,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Venous Duplex Right,1169773,LOCAL,93971,CPT,,,,,RT,Outpatient,,,476.32,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Upper Ext Venous Duplex Left,1169903,LOCAL,93971,CPT,,,,,LT,Outpatient,,,476.32,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Upper Ext Venous Duplex Right,1169905,LOCAL,93971,CPT,,,,,RT,Outpatient,,,476.32,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUP AV FISTULA OR DIALYSIS GRAFT,8200500,LOCAL,93990,CPT,,,,,,Outpatient,,,476.33,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUPLEX ARTERAL UPPER EXT UNI OR LTD,8200490,LOCAL,93931,CPT,,,,,,Outpatient,,,476.33,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUPLEX ARTERIAL LOWER EXT UNI OR LTD,8200470,LOCAL,93926,CPT,,,,,,Outpatient,,,476.33,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Hemodialysis Duplex Access Lt,8206865,LOCAL,93990,CPT,,,,,,Outpatient,,,476.33,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Hemodialysis Duplex Access Rt,8206868,LOCAL,93990,CPT,,,,,RT,Outpatient,,,476.33,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Arterial Duplex Left,1169761,LOCAL,93926,CPT,,,,,LT,Outpatient,,,476.33,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Arterial Duplex Right,1169763,LOCAL,93926,CPT,,,,,RT,Outpatient,,,476.33,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Upper Ext Arterial Duplex Left,1169897,LOCAL,93931,CPT,,,,,LT,Outpatient,,,476.33,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Upper Ext Arterial Duplex Right,1169899,LOCAL,93931,CPT,,,,,RT,Outpatient,,,476.33,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
DAPTOmycin 500 mg intravenous injection [CULL],11210536,LOCAL,J0878,CPT,,,,,,Outpatient,1,EA,480,480,United Health ,United Health Medicare Advantage,0.03,,,,,,,Fee Schedule,0.01,122.4,
CULL MG Needle/Wire Loc Breast,13720943,LOCAL,19281,CPT,,,,,,Outpatient,,,481.51,313,United Health ,United Health Medicare Advantage,1481.32,,,,,,,Fee Schedule,1200.99,1496,
MG Mammo Guided Needle Loc Left,8206592,LOCAL,19281,CPT,,,,,LT,Outpatient,,,481.51,313,United Health ,United Health Medicare Advantage,1481.32,,,,,,,Fee Schedule,1200.99,1496,
MG Mammo Guided Needle Loc Right,8206595,LOCAL,19281,CPT,,,,,RT,Outpatient,,,481.51,313,United Health ,United Health Medicare Advantage,1481.32,,,,,,,Fee Schedule,1200.99,1496,
Bill Tissue Exam Level 6,14048000,LOCAL,88309,CPT,,,,,,Outpatient,,,485.96,,United Health ,United Health Medicare Advantage,746.86,,,,,,,Fee Schedule,59.06,746.86,
IA-2 Antibody QSTC,9039410,LOCAL,86341,CPT,,,,,,Outpatient,,,486,28.28,United Health ,United Health Medicare Advantage,23.57,,,,,,,Fee Schedule,15.29,23.57,
Low LSO,9400072,LOCAL,,,L0642,HCPCS,,,,Outpatient,,,486.86,,United Health ,United Health Medicare Advantage,319.33,,,,,,,Fee Schedule,319.33,319.33,
96422 CHEMO ARTERIAL INFUS UP TO 1HR CHARGE,9404492,LOCAL,96422,CPT,,,,,,Outpatient,,,488.94,318,United Health ,United Health Medicare Advantage,303.25,,,,,,,Fee Schedule,303.25,442.94,
L3933 OT FINGER ORTHOSIS,9856060,LOCAL,,,L3933,HCPCS,,,,Outpatient,,,488.97,318,United Health ,United Health Medicare Advantage,239.92,,,,,,,Fee Schedule,239.92,239.92,
Bill Only Reticulocyte Separation,8629513,LOCAL,86972,CPT,,,,,,Outpatient,,,490.5,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.88,156.67,
"11105 Punch Biopsy of Skin, Ea Separate/Additional CRRH_GA",13243078,LOCAL,11105,CPT,,,,,,Outpatient,,,491.38,319,United Health ,United Health Medicare Advantage,19.82,,,,,,,Fee Schedule,19.82,863,
A. phagocytophilum/E chaffeensis Ab QSTC,13864420,LOCAL,86666,CPT,,,,,,Outpatient,,,492.75,12.22,United Health ,United Health Medicare Advantage,10.18,,,,,,,Fee Schedule,10.18,15.29,
XR Spine Cervical 2 or 3 Views,1170452,LOCAL,72040,CPT,,,,,,Outpatient,,,496.68,266.48,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
96125 ST-COGNITIVE TEST PER 1HR,9630086,LOCAL,96125,CPT,,,,,GN,Outpatient,,,497.34,323,United Health ,United Health Medicare Advantage,96.7,,,,,,,Fee Schedule,96.7,846.56,
SLP Cognitive Test Units,7897180,LOCAL,96125,CPT,,,,,GN,Outpatient,,,497.34,323,United Health ,United Health Medicare Advantage,96.7,,,,,,,Fee Schedule,96.7,846.56,
Standardized Cognitive Eval Charge,7897180,LOCAL,96125,CPT,,,,,GN,Outpatient,,,497.34,323,United Health ,United Health Medicare Advantage,96.7,,,,,,,Fee Schedule,96.7,846.56,
"45300 PROCTOSIGMOIDOSCOPY, RIGID, DIAGNOSTIC, W OR W/O COLLECTION BY BRUSHING OR WASHING",8934255,LOCAL,45300,CPT,,,,,,Outpatient,,,498,129,United Health ,United Health Medicare Advantage,833.54,,,,,,,Fee Schedule,833.54,1419.32,
BD Bone Density DEXA Axial Skeleton,1167839,LOCAL,77080,CPT,,,,,,Outpatient,,,499.09,267.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,116.02,
OASIS MATRIX WOUND 3X3.5,13962593,LOCAL,,,Q4102,HCPCS,,,,Outpatient,,,501.86,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
G0463 CR REHAB ASSESSMENT CHARGE,10470016,LOCAL,,,G0463,HCPCS,,,,Outpatient,,,502.12,326,United Health ,United Health Medicare Advantage,117.82,,,,,,,Fee Schedule,117.82,117.82,
G0463 HOSPITAL OP CLINIC VISIT W PROC MCR ONLY,13436347,LOCAL,,,G0463,HCPCS,,,25,Outpatient,,,502.12,326,United Health ,United Health Medicare Advantage,117.82,,,,,,,Fee Schedule,117.82,117.82,
G0463 HOSPITAL OUTPATIENT VISIT CHARGE,10470015,LOCAL,,,G0463,HCPCS,,,25,Outpatient,,,502.12,326,United Health ,United Health Medicare Advantage,117.82,,,,,,,Fee Schedule,117.82,117.82,
G0463 OUTPATIENT CLINIC VISIT,13043743,LOCAL,,,G0463,HCPCS,,,25,Outpatient,,,502.12,326,United Health ,United Health Medicare Advantage,117.82,,,,,,,Fee Schedule,117.82,117.82,
IVUS ADDL VESSEL,8230049,LOCAL,92979,CPT,,,,,,Outpatient,,,506,329,United Health ,United Health Medicare Advantage,130.59,,,,,,,Fee Schedule,130.59,863,
"Susceptibility Aerobic Bacteria,MIC QSTC",9039459,LOCAL,87186,CPT,,,,,,Outpatient,,,506.25,10.38,United Health ,United Health Medicare Advantage,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
"Susceptibility, Aerobic Bacterium QST",8389539,LOCAL,87186,CPT,,,,,,Outpatient,,,506.25,10.38,United Health ,United Health Medicare Advantage,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
Administration of Blood (Bridge),8019084,LOCAL,36430,CPT,,,,,,Outpatient,,,509,99,United Health ,United Health Medicare Advantage,399.7,,,,,,,Fee Schedule,399.7,863,
TRANSFUSE Fresh Frozen Plasma (Bridge),8482691,LOCAL,36430,CPT,,,,,,Outpatient,,,509,99,United Health ,United Health Medicare Advantage,399.7,,,,,,,Fee Schedule,399.7,863,
TRANSFUSE Platelet Product (Bridge),8482692,LOCAL,36430,CPT,,,,,,Outpatient,,,509,99,United Health ,United Health Medicare Advantage,399.7,,,,,,,Fee Schedule,399.7,863,
TRANSFUSE Red Blood Cells Leukoreduced (Bridge),8482690,LOCAL,36430,CPT,,,,,,Outpatient,,,509,99,United Health ,United Health Medicare Advantage,399.7,,,,,,,Fee Schedule,399.7,863,
XR Nasal Bones 3+ Views,1170329,LOCAL,70160,CPT,,,,,,Outpatient,,,510.81,273.9,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
"Bill Only RBC Pretreatment, Chemicals",8629511,LOCAL,86970,CPT,,,,,,Outpatient,,,513,,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,38.88,54.31,
"Bill Only RBC Pretreatment, Enyzme",8629512,LOCAL,86971,CPT,,,,,,Outpatient,,,513,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.88,156.67,
XR Arthrogram Injection Ankle Left,1169950,LOCAL,20605,CPT,,,,,LT,Outpatient,,,517.48,336,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrogram Injection Ankle Right,1169952,LOCAL,20605,CPT,,,,,RT,Outpatient,,,517.48,336,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrogram Injection Elbow Right,1169958,LOCAL,20605,CPT,,,,,RT,Outpatient,,,517.48,336,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrogram Injection Wrist Left,1169996,LOCAL,20605,CPT,,,,,LT,Outpatient,,,517.48,336,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrogram Injection Wrist Right,1169998,LOCAL,20605,CPT,,,,,RT,Outpatient,,,517.48,336,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
IMPLANT ALLODERM 1/2,13962573,LOCAL,,,Q4116,HCPCS,,,,Outpatient,,,517.5,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
ECHO DOP COLOR FLOW MAPPING,8200220,LOCAL,93325,CPT,,,,,,Outpatient,,,517.63,336,United Health ,United Health Medicare Advantage,17.83,,,,,,,Fee Schedule,17.83,161.71,
XR Spine Lumbosacral 2 or 3 Views,1170470,LOCAL,72100,CPT,,,,,,Outpatient,,,520.24,278.85,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
"G0399 HOME SLEEP STUDY, CHARGE",8303751,LOCAL,,,G0399,HCPCS,,,,Outpatient,,,523.26,340,United Health ,United Health Medicare Advantage,143.05,,,,,,,Fee Schedule,143.05,206.62,
11057 BENIGN LESION PARING(4+),13029576,LOCAL,11057,CPT,,,,,,Outpatient,,,523.3,340,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
16030 Dressing/Debridement Large More than one ext or >10% total body,9400041,LOCAL,16030,CPT,,,,,,Outpatient,,,523.3,863,United Health ,United Health Medicare Advantage,365.27,,,,,,,Fee Schedule,365.27,863,
15276 APPL-HC SKSB GRT F/N/H/G-AD 25CM CHARGE,9709030,LOCAL,15276,CPT,,,,,,Outpatient,,,526.26,342,United Health ,United Health Medicare Advantage,20.61,,,,,,,Fee Schedule,20.61,2862.92,
XR Knee 3 Views Left,1170269,LOCAL,73562,CPT,,,,,LT,Outpatient,,,527.77,282.98,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Knee 3 Views Right,1170271,LOCAL,73562,CPT,,,,,RT,Outpatient,,,527.77,282.98,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Barium Swallow,9756897,LOCAL,74220,CPT,,,,,,Outpatient,,,527.78,282.98,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,83.69,162.76,
XR Swallowing Function w/ Speech,1170500,LOCAL,74230,CPT,,,,,,Outpatient,,,527.78,282.98,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,176.48,
RT CHARGE PFT -> Bronchoprovocation,5267129,LOCAL,94070,CPT,,,,,,Outpatient,,,530,345,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,149.57,284.7,
Ertapenem Sodium 1 gram intravenous injection [CULL],11201820,LOCAL,J1335,CPT,,,,,,Outpatient,1,EA,532.992,,United Health ,United Health Medicare Advantage,9.16,,,,,,,Fee Schedule,9.16,9.16,
XR Mandible Complete 4+ Views,1170301,LOCAL,70110,CPT,,,,,,Outpatient,,,533.23,286.28,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Facial Bones 3+ Views,1170141,LOCAL,70150,CPT,,,,,,Outpatient,,,533.25,286.28,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Skull < 4 Views,1170436,LOCAL,70250,CPT,,,,,,Outpatient,,,533.25,286.28,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Hips 3-4 Views Bilat,7520612,LOCAL,73522,CPT,,,,,,Outpatient,,,534.2,286.28,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Hips 3-4 Views w/AP Pelvis Bilat,7520615,LOCAL,73522,CPT,,,,,,Outpatient,,,534.2,286.28,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
93799 INPATIENT TEACH CARDIAC REHAB CHARGE,8230066,LOCAL,93799,CPT,,,,,,Outpatient,,,535.14,348,United Health ,United Health Medicare Advantage,143.05,,,,,,,Fee Schedule,38.53,863,
XR Wrist Complete 3 Plus Views Right,1170614,LOCAL,73110,CPT,,,,,RT,Outpatient,,,538.7,288.75,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Wrist Complete 3+ Views Left,1170612,LOCAL,73110,CPT,,,,,LT,Outpatient,,,538.7,288.75,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
"COVID-19, Respiratory Panel 2.1(Biofire)",9624028,LOCAL,0202U,CPT,,,,,,Outpatient,,,540,500.14,United Health ,United Health Medicare Advantage,443.38,,,,,,,Fee Schedule,173.68,443.38,
Bill Only Antigen Type Group 2,10312940,LOCAL,86902,CPT,,,,,,Outpatient,,,544.5,7.62,United Health ,United Health Medicare Advantage,328.88,,,,,,,Fee Schedule,6.29,328.88,
XR Abdomen 2 Views,8132826,LOCAL,74019,CPT,,,,,,Outpatient,,,546.49,292.88,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
L3807 Tko Splint,9646038,LOCAL,,,L3807,HCPCS,,,,Outpatient,,,549.15,357,United Health ,United Health Medicare Advantage,281.19,,,,,,,Fee Schedule,281.19,281.19,
96132 NEUROPSYCH TESTING EVAL; FIRST HOUR CHARGE,9496220,LOCAL,96132,CPT,,,,,,Outpatient,,,549.45,357,United Health ,United Health Medicare Advantage,485.11,,,,,,,Fee Schedule,485.11,846.56,
XR Spine Cervical 4 or 5 Views,1170454,LOCAL,72050,CPT,,,,,,Outpatient,,,552.95,296.18,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
albumin human 25% intravenous solution 100 mL [CULL],11281015,LOCAL,P9047,CPT,,,,,,Outpatient,100,ML,552.96,,United Health ,United Health Medicare Advantage,53.08,,,,,,,Fee Schedule,53.077,217.45,
G0277 HBO Full Body 30 Min Interval,10015694,LOCAL,,,G0277,HCPCS,,,,Outpatient,,,553.52,360,United Health ,United Health Medicare Advantage,126.08,,,,,,,Fee Schedule,126.08,549.61,
XR Knee Complete 4 Plus Views Left,1170287,LOCAL,73564,CPT,,,,,LT,Outpatient,,,554.16,297,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Knee Complete 4 Plus Views Right,1170289,LOCAL,73564,CPT,,,,,RT,Outpatient,,,554.16,297,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
"penicillin G benzathine 600,000 units/mL intramuscular suspension 1 mL [CULL]",11202082,LOCAL,J0561,CPT,,,,,,Outpatient,1,ML,558.848,,United Health ,United Health Medicare Advantage,30.01,,,,,,,Fee Schedule,30.01,122.4,
ADAMTS13 Activity w/Rfx Inhibitor QSTC,9777262,LOCAL,85397,CPT,,,,,,Outpatient,,,562.5,37.03,United Health ,United Health Medicare Advantage,30.86,,,,,,,Fee Schedule,26.47,30.86,
"Chromosome Analysis, Blood QSTC",8848485,LOCAL,88262,CPT,,,,,,Outpatient,,,562.5,150.59,United Health ,United Health Medicare Advantage,125.49,,,,,,,Fee Schedule,63.34,125.49,
Clinical Indication: QSTC,8848484,LOCAL,88230,CPT,,,,,,Outpatient,,,562.5,139.79,United Health ,United Health Medicare Advantage,116.49,,,,,,,Fee Schedule,58.01,116.49,
Kleihauer-Betke Stain QSTC,9956031,LOCAL,85460,CPT,,,,,,Outpatient,,,562.5,9.28,United Health ,United Health Medicare Advantage,7.73,,,,,,,Fee Schedule,7.73,8.21,
Respirat. Allergy Profile Region VI QSTC,9039268,LOCAL,86003,CPT,,,,,,Outpatient,,,564.39,6.26,United Health ,United Health Medicare Advantage,5.22,,,,,,,Fee Schedule,5.22,15.29,
Respirat. Allergy Profile Region VI QSTC,9041102,LOCAL,82785,CPT,,,,,,Outpatient,,,564.39,19.75,United Health ,United Health Medicare Advantage,203.96,,,,,,,Fee Schedule,17.73,203.9616667,
Respiratory Allergy Panel Region VI with Reflexes QSTC,14884176,LOCAL,82785,CPT,,,,,,Outpatient,,,564.39,19.75,United Health ,United Health Medicare Advantage,203.96,,,,,,,Fee Schedule,17.73,203.9616667,
XR Spine Thoracic 3 Views,1170486,LOCAL,72072,CPT,,,,,,Outpatient,,,567.43,304.43,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Ribs 2 Views Left,1170371,LOCAL,71100,CPT,,,,,LT,Outpatient,,,567.44,304.43,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Ribs 2 Views Right,1170373,LOCAL,71100,CPT,,,,,RT,Outpatient,,,567.44,304.43,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
US Breast ABUS Left,8746657,LOCAL,76641,CPT,,,,,LT,Outpatient,,,571.63,306.9,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Breast ABUS Left.,8567804,LOCAL,76641,CPT,,,,,LT,Outpatient,,,571.63,306.9,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Breast ABUS Right.,8567807,LOCAL,76641,CPT,,,,,RT,Outpatient,,,571.63,306.9,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Breast Complete Left.,8068438,LOCAL,76641,CPT,,,,,LT,Outpatient,,,571.63,306.9,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Breast Complete Right.,8068441,LOCAL,76641,CPT,,,,,RT,Outpatient,,,571.63,306.9,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
Electrocardiogram 12 Lead,2322786,LOCAL,93005,CPT,,,,,,Outpatient,,,573,178,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,38.53,54.31,
99283 - Level 3,2644299,LOCAL,99283,CPT,,,,,25,Outpatient,,,578.6,376,United Health ,United Health Medicare Advantage,253.15,,,,,,,Fee Schedule,253.15,253.15,
pneumococcal 21-valent conjugate vaccine (cvx 327) - Sus [CULL],11200021,LOCAL,90684,CPT,,,,,,Outpatient,0.5,ML,579.792,,United Health ,United Health Medicare Advantage,344.25,,,,,,,Fee Schedule,160.4,344.252,
29581 APPL MULTLAY COMPRS LWR LEG,9739188,LOCAL,29581,CPT,,,,,,Outpatient,,,580.2,195,United Health ,United Health Medicare Advantage,144.26,,,,,,,Fee Schedule,144.26,863,
XR Ribs 3 Views Bilateral,1170375,LOCAL,71110,CPT,,,,,,Outpatient,,,580.49,311.03,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Spine Thoracic 4+ Views,1170488,LOCAL,72074,CPT,,,,,,Outpatient,,,581.11,311.85,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Sinus Tract SI,2425614,LOCAL,76080,CPT,,,,,,Outpatient,,,583.56,312.68,United Health ,United Health Medicare Advantage,501.29,,,,,,,Fee Schedule,176.48,501.29,
Bill Only Rare Unit,8196052,LOCAL,86999,CPT,,,,,,Outpatient,,,585,,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,6.29,22.39,
Oviduct chromotubation 58350,9093091,LOCAL,58350,CPT,,,,,,Outpatient,,,585,4936,United Health ,United Health Medicare Advantage,4513.2,,,,,,,Fee Schedule,2599,4513.2,
ER ECHOCARDIOGRAM 2D LIMITED,8200203,LOCAL,93308,CPT,,,,,,Outpatient,,,586,564,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,678.38,
TRANSPAC REUSABLE CABLE 42661-03,8200204,LOCAL,93308,CPT,,,,,,Outpatient,,,586,564,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,678.38,
64445 NERV BLOCK SCIATIC,5661029,LOCAL,64445,CPT,,,,,,Outpatient,,,587.24,382,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
"FISH, Chromosome Specific 1 Pr QSTC",13864683,LOCAL,88271,CPT,,,,,,Outpatient,,,587.34,25.7,United Health ,United Health Medicare Advantage,21.42,,,,,,,Fee Schedule,21.42,63.34,
Specimen Source: FISH Chrom Pr x1 QSTC,13864676,LOCAL,88273,CPT,,,,,,Outpatient,,,587.34,41.77,United Health ,United Health Medicare Advantage,34.81,,,,,,,Fee Schedule,34.81,63.34,
rifAMPin 600 mg intravenous injection [CULL],11211144,LOCAL,J2804,CPT,,,,,,Outpatient,1,EA,587.52,,United Health ,United Health Medicare Advantage,0.15,,,,,,,Fee Schedule,0.153,0.153,
REF Antibody ID,7032173,LOCAL,86870,CPT,,,,,,Outpatient,,,589.5,,United Health ,United Health Medicare Advantage,328.88,,,,,,,Fee Schedule,38.27,328.88,
US Head Newborn,8206862,LOCAL,76506,CPT,,,,,,Outpatient,,,590.44,316.8,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
Very Long Chain Fatty Acids QSTC,8764801,LOCAL,82726,CPT,,,,,,Outpatient,,,590.63,23.7,United Health ,United Health Medicare Advantage,19.75,,,,,,,Fee Schedule,17.73,19.75,
US Fetal Biophysical Profile w/ Non-Str,1169687,LOCAL,76818,CPT,,,,,,Outpatient,,,591.07,316.8,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,148.61,
99203  New Patient-Detailed,12642291,LOCAL,99203,CPT,,,,,,Outpatient,,,595.04,387,United Health ,United Health Medicare Advantage,67.57,,,,,,,Fee Schedule,67.57,67.57,
99203 Office Visit New Pt. Level 3,10168482,LOCAL,99203,CPT,,,,,,Outpatient,,,595.04,387,United Health ,United Health Medicare Advantage,67.57,,,,,,,Fee Schedule,67.57,67.57,
99203 Office Visit New Pt. Level 3,10168482,LOCAL,99203,CPT,,,,,,Outpatient,,,595.04,387,United Health ,United Health Medicare Advantage,67.57,,,,,,,Fee Schedule,67.57,67.57,
99213 Established patient visit- level 3,7947777,LOCAL,99213,CPT,,,,,,Outpatient,,,595.04,387,United Health ,United Health Medicare Advantage,54.77,,,,,,,Fee Schedule,54.77,54.77,
99213 Established patient visit- level 3,7947777,LOCAL,99213,CPT,,,,,,Outpatient,,,595.04,387,United Health ,United Health Medicare Advantage,54.77,,,,,,,Fee Schedule,54.77,54.77,
99213 LEVEL III VISIT CHARGE,9319022,LOCAL,99213,CPT,,,,,,Outpatient,,,595.04,387,United Health ,United Health Medicare Advantage,54.77,,,,,,,Fee Schedule,54.77,54.77,
99213 Office Visit Established Pt. Level 3,10168487,LOCAL,99213,CPT,,,,,,Outpatient,,,595.04,387,United Health ,United Health Medicare Advantage,54.77,,,,,,,Fee Schedule,54.77,54.77,
LENS #SA60AT,4832535,LOCAL,,,V2632,HCPCS,,,,Outpatient,,,599.5,392,United Health ,United Health Medicare Advantage,145.73,,,,,,,Fee Schedule,145.73,145.73,
"Creatinine, Random, Ur QSTC",13873086,LOCAL,82570,CPT,,,,,,Outpatient,,,599.63,6.22,United Health ,United Health Medicare Advantage,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"N-Methylhistamine, Random, Ur QSTC",13873083,LOCAL,82542,CPT,,,,,,Outpatient,,,599.63,28.91,United Health ,United Health Medicare Advantage,24.09,,,,,,,Fee Schedule,17.73,24.09,
XR Ribs w/ PA Chest Bilateral,1170377,LOCAL,71111,CPT,,,,,,Outpatient,,,601.59,322.58,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
36010 INTRO CATH SUP/INF VENA CAVA,8266890,LOCAL,36010,CPT,,,,,,Outpatient,,,604.59,393,United Health ,United Health Medicare Advantage,87.95,,,,,,,Fee Schedule,87.95,929.12,
INTRO CATH VENA CAVA,8267101,LOCAL,36010,CPT,,,,,,Outpatient,,,604.59,393,United Health ,United Health Medicare Advantage,87.95,,,,,,,Fee Schedule,87.95,929.12,
Antenatal Testing Type -> Contraction stress test,10446024,LOCAL,59020,CPT,,,,,,Outpatient,,,607.55,94,United Health ,United Health Medicare Advantage,183.92,,,,,,,Fee Schedule,183.92,863,
97597 ACTIVE WOUND CARE MANAGEMENT FIRST 20 CM,13048047,LOCAL,97597,CPT,,,,,59,Outpatient,,,608.25,395,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
97597 DEBRIDE SCISSOR/SCAPEL 20SQ CM,9410251,LOCAL,97597,CPT,,,,,GP,Outpatient,,,608.25,395,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
97597 DEBRIDEMENT,9866113,LOCAL,97597,CPT,,,,,GO|CO,Outpatient,,,608.25,395,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
97597 OT SELECT DEBRIDE ME CHARGE,9856113,LOCAL,97597,CPT,,,,,GO,Outpatient,,,608.25,395,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
97598 Debrid Open wound > 20 sq cm charge,12511973,LOCAL,97598,CPT,,,,,,Outpatient,,,608.25,395,United Health ,United Health Medicare Advantage,20.42,,,,,,,Fee Schedule,20.42,1466.58,
OT Removal Devitalized Tissue < 20 cm Units,7897756,LOCAL,97597,CPT,,,,,GO,Outpatient,,,608.25,395,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
OT Removal Tissue <20 Assist Units,7897756,LOCAL,97597,CPT,,,,,CQ,Outpatient,,,608.25,395,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
OT Selective Debridement Charge,7895252,LOCAL,97597,CPT,,,,,GO,Outpatient,,,608.25,395,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
Selective Debridement Charge,7895942,LOCAL,97597,CPT,,,,,GP,Outpatient,,,608.25,395,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
"Selective Debridement Charge -> Yes, total wound surface area, first 20 sq cm or less",8968080,LOCAL,97597,CPT,,,,,GP,Outpatient,,,608.25,395,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
XR Cystogram Limited,13703435,LOCAL,74430,CPT,,,,,52,Outpatient,,,612.55,554.4,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,176.48,326.51,
US Chest,1169635,LOCAL,76604,CPT,,,,,,Outpatient,,,612.93,328.35,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
XR Ribs w/ PA Chest Left,1170379,LOCAL,71101,CPT,,,,,LT,Outpatient,,,615.08,330,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Ribs w/ PA Chest Right,1170381,LOCAL,71101,CPT,,,,,RT,Outpatient,,,615.08,330,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
Strep Pneumoniae Ab IgG 23 Serotypes QST,10217037,LOCAL,86581,CPT,,,,,,Outpatient,,,615.83,,United Health ,United Health Medicare Advantage,92.03,,,,,,,Fee Schedule,44.29,92.03,
"Strep pneumoniae IgG Abs, 23 Serotypes QST",14006318,LOCAL,86581,CPT,,,,,,Outpatient,,,615.83,,United Health ,United Health Medicare Advantage,92.03,,,,,,,Fee Schedule,44.29,92.03,
DUP ARTERIAL & VENOUS MAPPING BIL,8200501,LOCAL,93985,CPT,,,,,,Outpatient,,,616.92,401,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Vein Mapping Lower Extremity Bilat,12175095,LOCAL,93985,CPT,,,,,,Outpatient,,,616.92,401,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Vein Mapping Upper Extremity Bilat,12175104,LOCAL,93985,CPT,,,,,,Outpatient,,,616.92,401,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Vessel Mapping for Hemo Access Bilat,10216429,LOCAL,93985,CPT,,,,,,Outpatient,,,616.92,401,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,161.71,220.99,
DOP ART-LEA WITH ABI SEG PRESSURES,8230018,LOCAL,93923,CPT,,,,,,Outpatient,,,617.64,401,United Health ,United Health Medicare Advantage,143.05,,,,,,,Fee Schedule,143.05,244.97,
DOP ART-UEA W/ PRESSURES UPPER,8230064,LOCAL,93923,CPT,,,,,,Outpatient,,,617.64,401,United Health ,United Health Medicare Advantage,143.05,,,,,,,Fee Schedule,143.05,244.97,
US Segmental Pressures LE 3+ Lvls Bilat,1169755,LOCAL,93923,CPT,,,,,,Outpatient,,,617.64,401,United Health ,United Health Medicare Advantage,143.05,,,,,,,Fee Schedule,143.05,244.97,
US Segmental Pressures UE 3+ Lvls Bilat,9759154,LOCAL,93923,CPT,,,,,,Outpatient,,,617.64,401,United Health ,United Health Medicare Advantage,143.05,,,,,,,Fee Schedule,143.05,244.97,
L3913 Hand finger orthosis (HFO) without joints may include soft interface straps custom fabricated,9856095,LOCAL,,,L3913,HCPCS,,,,Outpatient,,,620.7,403,United Health ,United Health Medicare Advantage,304.58,,,,,,,Fee Schedule,304.58,304.58,
L3913 HFO W/O JOINTS CF CHARGE,9856102,LOCAL,,,L3913,HCPCS,,,,Outpatient,,,620.7,403,United Health ,United Health Medicare Advantage,304.58,,,,,,,Fee Schedule,304.58,304.58,
MG Mammo Diagnostic Left w/ Tomo.,8058649,LOCAL,77065,CPT,,,,,LT,Outpatient,,,623.77,334.13,United Health ,United Health Medicare Advantage,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Diagnostic Right w/ Tomo.,8058652,LOCAL,77065,CPT,,,,,RT,Outpatient,,,623.77,334.13,United Health ,United Health Medicare Advantage,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Digital Diagnostic Left.,7918560,LOCAL,77065,CPT,,,,,LT,Outpatient,,,623.77,334.13,United Health ,United Health Medicare Advantage,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Digital Diagnostic Right.,7918563,LOCAL,77065,CPT,,,,,RT,Outpatient,,,623.77,334.13,United Health ,United Health Medicare Advantage,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Implant Diag Left w/ Tomo.,8058658,LOCAL,77065,CPT,,,,,LT,Outpatient,,,623.77,334.13,United Health ,United Health Medicare Advantage,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Implant Diag Right w/ Tomo.,8058661,LOCAL,77065,CPT,,,,,RT,Outpatient,,,623.77,334.13,United Health ,United Health Medicare Advantage,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Implant Digital Diag Left.,8058667,LOCAL,77065,CPT,,,,,LT,Outpatient,,,623.77,334.13,United Health ,United Health Medicare Advantage,75.3,,,,,,,Fee Schedule,74,75.3,
MG Mammo Implant Digital Diag Right.,8058670,LOCAL,77065,CPT,,,,,RT,Outpatient,,,623.77,334.13,United Health ,United Health Medicare Advantage,75.3,,,,,,,Fee Schedule,74,75.3,
XR Osseous Survey Limited,1170022,LOCAL,77074,CPT,,,,,,Outpatient,,,626.27,335.78,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
94625 OUTPATIENT PULMONARY REHAB W/O CONTINIOUS MONITORING,10470029,LOCAL,94625,CPT,,,,,,Outpatient,,,626.86,407,United Health ,United Health Medicare Advantage,54.31,,,,,,,Fee Schedule,51.98,54.31,
Newborn Screen,8165282,LOCAL,84035,CPT,,,,,,Outpatient,,,629.03,4.78,United Health ,United Health Medicare Advantage,3.98,,,,,,,Fee Schedule,3.98,7.16,
"Phenylketonuria, Blood SO",9565050,LOCAL,84030,CPT,,,,,,Outpatient,,,629.03,6.6,United Health ,United Health Medicare Advantage,5.5,,,,,,,Fee Schedule,5.5,7.16,
"Susceptibility, Yeast, Comp. Panel QSTC",6250013,LOCAL,87186,CPT,,,,,,Outpatient,,,630,10.38,United Health ,United Health Medicare Advantage,35.67,,,,,,,Fee Schedule,10.57,35.67132075,
US OB Limited,1169856,LOCAL,76815,CPT,,,,,,Outpatient,,,632.6,339.08,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,148.61,
"L3702 Elbow orthosis, without joints, may include soft interface, straps, custom fabricated",9646073,LOCAL,,,L3702,HCPCS,,,,Outpatient,,,634.13,412,United Health ,United Health Medicare Advantage,324.72,,,,,,,Fee Schedule,324.72,324.72,
L3702 ELBOW SPLINT,9856096,LOCAL,,,L3702,HCPCS,,,,Outpatient,,,634.13,412,United Health ,United Health Medicare Advantage,324.72,,,,,,,Fee Schedule,324.72,324.72,
CULL US Echo Dop w/ Spectral Complete,13736513,LOCAL,93320,CPT,,,,,,Outpatient,,,636.3,414,United Health ,United Health Medicare Advantage,29.71,,,,,,,Fee Schedule,29.71,678.38,
ECHO DOP W/SPECTRAL COMPLETE,8200180,LOCAL,93320,CPT,,,,,,Outpatient,,,636.3,414,United Health ,United Health Medicare Advantage,29.71,,,,,,,Fee Schedule,29.71,678.38,
"epoetin alfa 10,000 units/mL preservative-free Sol 1 mL [CULL]",11202387,LOCAL,J0885,CPT,,,,,,Outpatient,1,ML,636.672,,United Health ,United Health Medicare Advantage,8.54,,,,,,,Fee Schedule,0.79,233.26,
74248 XR Small Bowel Follow Thru: AddOn,13626886,LOCAL,74248,CPT,,,,,,Outpatient,,,636.99,341.55,United Health ,United Health Medicare Advantage,41.4,,,,,,,Fee Schedule,41.4,176.48,
CULL XR Small Bowel Follow Thru,13626886,LOCAL,74248,CPT,,,,,,Outpatient,,,636.99,341.55,United Health ,United Health Medicare Advantage,41.4,,,,,,,Fee Schedule,41.4,176.48,
64486 TAP BLOCK UNILATERAL BY INJECTION(S),5661023,LOCAL,64486,CPT,,,,,,Outpatient,,,637.75,415,United Health ,United Health Medicare Advantage,46.33,,,,,,,Fee Schedule,46.33,863,
INTRO CATH RT HEART PA,8267102,LOCAL,36013,CPT,,,,,,Outpatient,,,638.52,415,United Health ,United Health Medicare Advantage,104.34,,,,,,,Fee Schedule,104.34,929.12,
alteplase 2 mg injection [CULL],11201047,LOCAL,J2997,CPT,,,,,,Outpatient,1,EA,644.928,,United Health ,United Health Medicare Advantage,94.45,,,,,,,Fee Schedule,94.45,122.4,
"Supersaturation, U24 SO",13938669,LOCAL,83945,CPT,,,,,,Outpatient,,,645.39,17.34,United Health ,United Health Medicare Advantage,24.09,,,,,,,Fee Schedule,17.73,24.085,
10060 DRAINAGE OF SKIN ABSCESS CHARGE,9704026,LOCAL,10060,CPT,,,,,,Outpatient,,,646.72,420,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
10061 I & D COMPLEX,13048116,LOCAL,10061,CPT,,,,,,Outpatient,,,646.72,420,United Health ,United Health Medicare Advantage,365.27,,,,,,,Fee Schedule,239.03,863,
Bill Prostate Biopsy,14048008,LOCAL,,,G0416,HCPCS,,,,Outpatient,,,646.83,,United Health ,United Health Medicare Advantage,328.88,,,,,,,Fee Schedule,59.06,328.88,
XR Spine Thoracolumbar 2 Views,1170490,LOCAL,72080,CPT,,,,,,Outpatient,,,651.93,349.8,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
High LSO,9400071,LOCAL,,,L0648,HCPCS,,,,Outpatient,,,655.66,,United Health ,United Health Medicare Advantage,797.49,,,,,,,Fee Schedule,797.49,797.49,
"11102 Tangential Biopsy of Skin, 1 lesion",9620037,LOCAL,11102,CPT,,,,,,Outpatient,,,656.43,427,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
16020 BURN DEBRIDEMENT/DRESSING INITIAL OR SUB,13043448,LOCAL,16020,CPT,,,,,,Outpatient,,,656.43,427,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
16020 Chemical Canterizaiton,9400039,LOCAL,16020,CPT,,,,,,Outpatient,,,656.43,427,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
17250 CAUTERY OF WOUND (ELECTRICAL),13033473,LOCAL,17250,CPT,,,,,,Outpatient,,,656.43,427,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
97606 Wound VAC >50 sq cm HBO,10015644,LOCAL,97606,CPT,,,,,,Outpatient,,,656.43,427,United Health ,United Health Medicare Advantage,365.27,,,,,,,Fee Schedule,365.27,549.61,
REF ABO Discrep (ABSC),13481254,LOCAL,86850,CPT,,,,,,Outpatient,,,657,11.72,United Health ,United Health Medicare Advantage,48.85,,,,,,,Fee Schedule,6.29,48.85,
TELEMETRY DAILY CHARGE,9341351,LOCAL,93229,CPT,,,,,,Outpatient,,,659,311,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,99.86,284.7,
13133 >  Each additional 5 cm or less (List separately in addition to primary procedure),12788295,LOCAL,13133,CPT,,,,,,Outpatient,,,660,,United Health ,United Health Medicare Advantage,95.58,,,,,,,Fee Schedule,95.58,863,
"13133-Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; e",14746903,LOCAL,13133,CPT,,,,,,Outpatient,,,660,,United Health ,United Health Medicare Advantage,95.58,,,,,,,Fee Schedule,95.58,863,
82570 QST,14798876,LOCAL,82570,CPT,,,,,,Outpatient,,,662,6.22,United Health ,United Health Medicare Advantage,40.98,,,,,,,Fee Schedule,7.16,40.97514925,
"Leukotriene E4, Random, Urine QST",14798876,LOCAL,82542,CPT,,,,,,Outpatient,,,662.05,28.91,United Health ,United Health Medicare Advantage,24.09,,,,,,,Fee Schedule,7.16,40.97514925,
Bill Only Antigen Type Group 3,10312933,LOCAL,86902,CPT,,,,,,Outpatient,,,666,7.62,United Health ,United Health Medicare Advantage,328.88,,,,,,,Fee Schedule,6.29,328.88,
"JC Polyoma Virus DNA, Qual PCR CSF QSTC",10170129,LOCAL,87798,CPT,,,,,,Outpatient,,,666,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
XR Skull Complete,1170438,LOCAL,70260,CPT,,,,,,Outpatient,,,672.73,360.53,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
Bill Only REF Washing,13514969,LOCAL,86999,CPT,,,,,,Outpatient,,,675,,United Health ,United Health Medicare Advantage,22.39,,,,,,,Fee Schedule,6.29,22.39,
US AAA Screening,8058767,LOCAL,76706,CPT,,,,,,Outpatient,,,675.12,362.18,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Abdomen Limited,1169569,LOCAL,76705,CPT,,,,,,Outpatient,,,675.12,362.18,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Renal,7936319,LOCAL,76770,CPT,,,,,,Outpatient,,,675.12,362.18,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,245.49,
US Retroperitoneal Complete,1169867,LOCAL,76770,CPT,,,,,,Outpatient,,,675.12,362.18,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,245.49,
MG Mammo Digital Screening Bilateral.,7918566,LOCAL,77067,CPT,,,,,,Outpatient,,,676.43,363,United Health ,United Health Medicare Advantage,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Digital Screening Left.,7949062,LOCAL,77067,CPT,,,,,52|LT,Outpatient,,,676.43,363,United Health ,United Health Medicare Advantage,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Digital Screening Right.,7949065,LOCAL,77067,CPT,,,,,52|RT,Outpatient,,,676.43,363,United Health ,United Health Medicare Advantage,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Implant Digital Screening Bil.,8058673,LOCAL,77067,CPT,,,,,,Outpatient,,,676.43,363,United Health ,United Health Medicare Advantage,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Implant Screening Bil w/ Tomo.,8058682,LOCAL,77067,CPT,,,,,,Outpatient,,,676.43,363,United Health ,United Health Medicare Advantage,79.68,,,,,,,Fee Schedule,74,79.68,
MG Mammo Screening Bilateral w/ Tomo.,8058685,LOCAL,77067,CPT,,,,,,Outpatient,,,676.43,363,United Health ,United Health Medicare Advantage,79.68,,,,,,,Fee Schedule,74,79.68,
64450 INJECTION PERIPHERAL NERVE OR BRANCH,5661030,LOCAL,64450,CPT,,,,,,Outpatient,,,680,1613,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
57105 - BIOPSY VAGINAL MUCOSA EXTENSIVE,14749499,LOCAL,57105,CPT,,,,,,Outpatient,,,685,3180,United Health ,United Health Medicare Advantage,2906.92,,,,,,,Fee Schedule,2315,3558.77,
adenosine 3 mg/mL intravenous solution 30 mL [CULL],11201017,LOCAL,J0153,CPT,,,,,,Outpatient,30,ML,686.4,,United Health ,United Health Medicare Advantage,0.53,,,,,,,Fee Schedule,0.529,0.529,
"Immunoglobulins Panel, CSF QSTC",13864507,LOCAL,82784,CPT,,,,,,Outpatient,,,687.2,11.16,United Health ,United Health Medicare Advantage,34.96,,,,,,,Fee Schedule,7.16,34.958,
LENS PRELOADED #PCB00,4851541,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,687.5,410,United Health ,United Health Medicare Advantage,145.73,,,,,,,Fee Schedule,145.73,145.73,
LENS PRELOADED DCB00,4855985,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,687.5,410,United Health ,United Health Medicare Advantage,145.73,,,,,,,Fee Schedule,145.73,145.73,
US Fetal Biophysical Profile w/o N-Str,1169689,LOCAL,76819,CPT,,,,,,Outpatient,,,688.53,369.6,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,148.61,
"FISH, Prenatal Scr Interp QSTC",13864670,LOCAL,88274,CPT,,,,,,Outpatient,,,690.75,50.86,United Health ,United Health Medicare Advantage,42.38,,,,,,,Fee Schedule,42.38,63.34,
"FISH, Prenatal Screen QSTC",13864673,LOCAL,88271,CPT,,,,,,Outpatient,,,690.75,25.7,United Health ,United Health Medicare Advantage,21.42,,,,,,,Fee Schedule,21.42,63.34,
zoledronic acid 4 mg/100 mL intravenous solution 100 mL [CULL],11211397,LOCAL,J3489,CPT,,,,,,Outpatient,100,ML,691.2,,United Health ,United Health Medicare Advantage,5.08,,,,,,,Fee Schedule,5.082,5.082,
11104 Punch Biopsy,10017193,LOCAL,11104,CPT,,,,,,Outpatient,,,691.38,449,United Health ,United Health Medicare Advantage,365.27,,,,,,,Fee Schedule,365.27,863,
XR Abdomen Series Chest 1 View,1169932,LOCAL,74022,CPT,,,,,,Outpatient,,,691.86,53.63,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Osseous Survey Complete,1170018,LOCAL,77075,CPT,,,,,,Outpatient,,,694.85,372.9,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,176.48,
XR Spine Cervical 6+ Views,1170461,LOCAL,72052,CPT,,,,,,Outpatient,,,701.96,376.2,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
"96365 IV INFUSION, MEDS, INITIAL 16-90 MINS",7904531,LOCAL,96365,CPT,,,,,,Outpatient,,,702.66,457,United Health ,United Health Medicare Advantage,192.63,,,,,,,Fee Schedule,192.63,442.94,
"96365- IV tx, first hour",1928299,LOCAL,96365,CPT,,,,,,Outpatient,,,702.66,457,United Health ,United Health Medicare Advantage,192.63,,,,,,,Fee Schedule,192.63,442.94,
US Aorta,7936256,LOCAL,76775,CPT,,,,,,Outpatient,,,702.79,377.03,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Retroperitoneal Limited,1169869,LOCAL,76775,CPT,,,,,,Outpatient,,,702.79,377.03,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
F/U EMBOLIZATION/INFUSION,8210730,LOCAL,75898,CPT,,,,,,Outpatient,,,707.78,379.5,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,1231.66,2877.63,
US Extremity Nonvascular Limited Left,2425338,LOCAL,76882,CPT,,,,,LT,Outpatient,,,708.51,248.33,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Extremity Nonvascular Limited Right,2425341,LOCAL,76882,CPT,,,,,RT,Outpatient,,,708.51,248.33,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Head/Neck Soft Tissue,1169729,LOCAL,76536,CPT,,,,,,Outpatient,,,708.51,380.33,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
76000 XR Fluoroscopy Under 1 Hour: AddOn,13658083,LOCAL,76000,CPT,,,,,,Outpatient,,,709.31,380.33,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,176.48,220.99,
64495 - INJ PARAVERT F JNT L/S 3 LEV,5661079,LOCAL,64495,CPT,,,,,,Outpatient,,,710.23,462,United Health ,United Health Medicare Advantage,42.72,,,,,,,Fee Schedule,42.72,1250.53,
INTRO CAROTID VERTEBRAL ARTERY,8267188,LOCAL,36100,CPT,,,,,,Outpatient,,,710.94,462,United Health ,United Health Medicare Advantage,122.25,,,,,,,Fee Schedule,122.25,929.12,
XR Urography Retrograde,10454609,LOCAL,74420,CPT,,,,,,Outpatient,,,714.75,383.63,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,176.48,326.51,
97607 Disp NP Wound Tx <=50 Sq Cm.,10017200,LOCAL,97607,CPT,,,,,,Outpatient,,,716.42,466,United Health ,United Health Medicare Advantage,365.27,,,,,,,Fee Schedule,365.27,549.61,
".Thyroglobulin, LC/MS/MS QSTC",13864486,LOCAL,84432,CPT,,,,,,Outpatient,,,720,19.27,United Health ,United Health Medicare Advantage,46.24,,,,,,,Fee Schedule,18.43,46.235,
93017 CARDIAC STRESS TEST CHARGE,7938407,LOCAL,93017,CPT,,,,,,Outpatient,,,721.43,469,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,244.97,284.7,
CARDIAC STRESS W/TRACING,8200041,LOCAL,93017,CPT,,,,,,Outpatient,,,721.43,469,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,244.97,284.7,
NM Stress Test Trace,2426005,LOCAL,93017,CPT,,,,,,Outpatient,,,721.43,469,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,244.97,284.7,
64405 Occipital Nerve Block Unilateral,5661077,LOCAL,64405,CPT,,,,,,Outpatient,,,724.33,879,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
MRI 3D Reconstruction w/o Workstation,8108472,LOCAL,76376,CPT,,,,,,Outpatient,,,730.14,391.88,United Health ,United Health Medicare Advantage,13.93,,,,,,,Fee Schedule,13.93,13.93,
Bill Only REF Thawing & Washing RBC,13514967,LOCAL,86931,CPT,,,,,,Outpatient,,,733.5,,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,38.88,156.67,
L3808 Forearm based orthosis w/o dynamic,9856093,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,733.5,89,United Health ,United Health Medicare Advantage,375.59,,,,,,,Fee Schedule,375.59,375.59,
OT CARPAL TUNNEL SPLINTS,9646074,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,733.5,89,United Health ,United Health Medicare Advantage,375.59,,,,,,,Fee Schedule,375.59,375.59,
REF HLA ABSC,13484120,LOCAL,86829,CPT,,,,,,Outpatient,,,733.5,77.03,United Health ,United Health Medicare Advantage,64.19,,,,,,,Fee Schedule,6.29,64.19,
REF HPA-1 Typing,13481256,LOCAL,81105,CPT,,,,,,Outpatient,,,733.5,146.66,United Health ,United Health Medicare Advantage,122.22,,,,,,,Fee Schedule,63.34,122.22,
93571 Cor Flow Wire 1st Measure,8230055,LOCAL,93571,CPT,,,,,,Outpatient,,,734.27,477,United Health ,United Health Medicare Advantage,143.66,,,,,,,Fee Schedule,143.66,2669.67,
LENS #ACU0T0,4853561,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,737,410,United Health ,United Health Medicare Advantage,145.73,,,,,,,Fee Schedule,145.73,145.73,
LENS #SN60WF,4891100,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,737,410,United Health ,United Health Medicare Advantage,145.73,,,,,,,Fee Schedule,145.73,145.73,
XR Arthrocentesis Asp/Inj Intmed Jt Lt,14807134,LOCAL,20605,CPT,,,,,LT,Outpatient,,,740,336,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Intmed Jt Rt,14807137,LOCAL,20605,CPT,,,,,RT,Outpatient,,,740,336,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Major Jt Bilat,14807140,LOCAL,20610,CPT,,,,,50,Outpatient,,,740,650,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Major Jt Lt,14807143,LOCAL,20610,CPT,,,,,LT,Outpatient,,,740,650,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Major Jt Rt,14807146,LOCAL,20610,CPT,,,,,RT,Outpatient,,,740,650,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Small Jt Lt,14807149,LOCAL,20600,CPT,,,,,LT,Outpatient,,,740,295,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
XR Arthrocentesis Asp/Inj Small Jt Rt,14807152,LOCAL,20600,CPT,,,,,RT,Outpatient,,,740,295,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
XR Colon Barium Enema,9427624,LOCAL,74270,CPT,,,,,,Outpatient,,,740.46,396.83,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,176.48,
DOP VENOUS LOWER EXT BILATERAL,8200420,LOCAL,93970,CPT,,,,,,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
DOP VENOUS UPPER EXT BIL,8200421,LOCAL,93970,CPT,,,,,,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP AO IVC ILIAC COMPLETE,8200530,LOCAL,93978,CPT,,,,,,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP CAROTID BILATERAL,8200370,LOCAL,93880,CPT,,,,,,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP CAROTID UNI,8200380,LOCAL,93882,CPT,,,,,,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
DUP HEPATOPORTAL INFLOW/OUTFLOW COMP,8200434,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP MESENTERIC/CELIAC ARTERY IN/OUT COMP,8200433,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP RENAL ARTERIES INFLOW/OUTFLOW COMP,8200432,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUPLEX ARTERIAL LOWER EXT BIL,8200460,LOCAL,93925,CPT,,,,,,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUPLEX ARTERIAL UPPER EXT BIL,8200480,LOCAL,93930,CPT,,,,,,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Abdomen Vascular Limited,8206811,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Aorta IVC Iliac Duplex Complete,1169577,LOCAL,93978,CPT,,,,,,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Art/Vein Abd/Pelvis/Scrotal Complete,1169581,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Carotid Duplex Bilateral,1169631,LOCAL,93880,CPT,,,,,,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Carotid Duplex Left,8814383,LOCAL,93882,CPT,,,,,LT,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Carotid Duplex Right,8814386,LOCAL,93882,CPT,,,,,RT,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US Lower Ext Arterial Duplex Bilateral,1169759,LOCAL,93925,CPT,,,,,,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Lower Ext Venous Duplex Bilateral,1169769,LOCAL,93970,CPT,,,,,,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Renal Artery Duplex Bilateral,4246822,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
US Upper Ext Arterial Duplex Bilateral,1169895,LOCAL,93930,CPT,,,,,,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,161.71,220.99,
US Upper Ext Venous Duplex Bilateral,1169901,LOCAL,93970,CPT,,,,,,Outpatient,,,742.12,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
DUP RENAL ARTERIES UNI,8200585,LOCAL,93976,CPT,,,,,,Outpatient,,,742.13,482,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,245.49,
US Renal Artery Duplex Left,4246828,LOCAL,93976,CPT,,,,,LT,Outpatient,,,742.13,482,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,245.49,
US Renal Artery Duplex Right,4246843,LOCAL,93976,CPT,,,,,RT,Outpatient,,,742.13,482,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,245.49,
Acetylcholine Receptor Binding Ab QSTC,8853232,LOCAL,86041,CPT,,,,,,Outpatient,,,743,22.08,United Health ,United Health Medicare Advantage,18.4,,,,,,,Fee Schedule,15.29,18.4,
XR Small Bowel Series,12908279,LOCAL,74250,CPT,,,,,,Outpatient,,,748.74,401.78,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,176.48,
Chlamydophila pneumoniae QSTC,9727429,LOCAL,87486,CPT,,,,,,Outpatient,,,750,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
Human RSV A QSTC,9727398,LOCAL,87633,CPT,,,,,,Outpatient,,,750,500.14,United Health ,United Health Medicare Advantage,610.31,,,,,,,Fee Schedule,158.39,610.305625,
Mycoplasma pneumoniae QSTC,9727431,LOCAL,87581,CPT,,,,,,Outpatient,,,750,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
REF Antibody Titer,7943112,LOCAL,86886,CPT,,,,,,Outpatient,,,756,6.22,United Health ,United Health Medicare Advantage,156.67,,,,,,,Fee Schedule,6.29,156.67,
64494 - INJ PARAVERT F JNT L/S 2 LEV,5661036,LOCAL,64494,CPT,,,,,,Outpatient,,,761,495,United Health ,United Health Medicare Advantage,41.55,,,,,,,Fee Schedule,41.55,1250.53,
REF HLA PLT ABSC,13479160,LOCAL,86829,CPT,,,,,,Outpatient,,,767.25,77.03,United Health ,United Health Medicare Advantage,64.19,,,,,,,Fee Schedule,6.29,64.19,
REF PLT ABSC,13484122,LOCAL,86022,CPT,,,,,,Outpatient,,,767.25,22.04,United Health ,United Health Medicare Advantage,18.37,,,,,,,Fee Schedule,15.29,18.37,
95822 EEG COMA OR SLEEP ONLY CHARGE,8687098,LOCAL,95822,CPT,,,,,,Outpatient,,,768.44,499,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,284.7,466.96,
EEG EXTENDED 41-60 MINUTES CHARGE,13515636,LOCAL,95812,CPT,,,,,,Outpatient,,,768.44,499,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,284.7,740.58,
MG Mammo Diagnostic Bilateral w/ Tomo.,8058646,LOCAL,77066,CPT,,,,,,Outpatient,,,770.81,413.33,United Health ,United Health Medicare Advantage,96.53,,,,,,,Fee Schedule,74,96.53,
MG Mammo Digital Diagnostic Bilat.,7918557,LOCAL,77066,CPT,,,,,,Outpatient,,,770.81,413.33,United Health ,United Health Medicare Advantage,96.53,,,,,,,Fee Schedule,74,96.53,
MG Mammo Implant Diag Bilateral w/ Tomo.,8058655,LOCAL,77066,CPT,,,,,,Outpatient,,,770.81,413.33,United Health ,United Health Medicare Advantage,96.53,,,,,,,Fee Schedule,11.11,96.53,
MG Mammo Implant Diag Bilateral w/ Tomo.,8058655,LOCAL,G0279,CPT,,,,,,Outpatient,,,770.81,,United Health ,United Health Medicare Advantage,11.11,,,,,,,Fee Schedule,11.11,96.53,
MG Mammo Implant Digital Diag Bilateral.,8058664,LOCAL,77066,CPT,,,,,,Outpatient,,,770.81,413.33,United Health ,United Health Medicare Advantage,96.53,,,,,,,Fee Schedule,74,96.53,
Pen G Benz/Proc (Bicillin CR) [CULL],11202075,LOCAL,J0558,CPT,,,,,,Outpatient,2,ML,771.5488,,United Health ,United Health Medicare Advantage,19.52,,,,,,,Fee Schedule,19.52,122.4,
97608 Disp NP Wound Tx >50 Sq Cm.,10017187,LOCAL,97608,CPT,,,,,,Outpatient,,,777.46,505,United Health ,United Health Medicare Advantage,365.27,,,,,,,Fee Schedule,365.27,549.61,
Bill Only Antigen Type Group 4,10312939,LOCAL,86902,CPT,,,,,,Outpatient,,,778.5,7.62,United Health ,United Health Medicare Advantage,328.88,,,,,,,Fee Schedule,6.29,328.88,
64491 INJ PARAVER CERV/THOR 2ND LEVEL,5661064,LOCAL,64491,CPT,,,,,,Outpatient,,,782.44,509,United Health ,United Health Medicare Advantage,48.01,,,,,,,Fee Schedule,48.01,1250.53,
64492 FACET CERV/THOR 3RD ADDTL LEVEL CHARGE,5661080,LOCAL,64492,CPT,,,,,,Outpatient,,,782.44,509,United Health ,United Health Medicare Advantage,48.5,,,,,,,Fee Schedule,48.5,1250.53,
"FISH, Locus Specific X2 100 QSTC",13864693,LOCAL,88271,CPT,,,,,,Outpatient,,,787.5,25.7,United Health ,United Health Medicare Advantage,21.42,,,,,,,Fee Schedule,21.42,63.34,
KERECIS OMEGA 3 - DISK 14MM 2,13962583,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,787.5,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
"Liver Fibrosis, Fibro-ActiTest Pnl QSTC",8764813,LOCAL,81596,CPT,,,,,,Outpatient,,,787.5,86.63,United Health ,United Health Medicare Advantage,429.13,,,,,,,Fee Schedule,63.34,429.125,
Specimen Source: FISH Locus Pr x2 QSTC,13864687,LOCAL,88275,CPT,,,,,,Outpatient,,,787.5,61.43,United Health ,United Health Medicare Advantage,51.19,,,,,,,Fee Schedule,51.19,63.34,
ICD DFT TESTING,8231015,LOCAL,93641,CPT,,,,,,Outpatient,,,788,512,United Health ,United Health Medicare Advantage,205.74,,,,,,,Fee Schedule,205.74,9059.73,
99204 New patient-level 4 specialty clinic,13538609,LOCAL,,,G0463,HCPCS,,,,Outpatient,,,788.5,326,United Health ,United Health Medicare Advantage,117.82,,,,,,,Fee Schedule,117.82,117.82,
99204 Office Visit New Pt. Level 4,10168483,LOCAL,99204,CPT,,,,,,Outpatient,,,788.5,513,United Health ,United Health Medicare Advantage,110.67,,,,,,,Fee Schedule,110.67,110.67,
99204 Office Visit New Pt. Level 4,10168483,LOCAL,99204,CPT,,,,,,Outpatient,,,788.5,513,United Health ,United Health Medicare Advantage,110.67,,,,,,,Fee Schedule,110.67,110.67,
99214 LEVEL IV VISIT CHARGE,9319023,LOCAL,99214,CPT,,,,,,Outpatient,,,788.5,513,United Health ,United Health Medicare Advantage,80.51,,,,,,,Fee Schedule,80.51,80.51,
99214 Office Visit Established Pt. Level 4,10168488,LOCAL,99214,CPT,,,,,,Outpatient,,,788.5,513,United Health ,United Health Medicare Advantage,80.51,,,,,,,Fee Schedule,80.51,80.51,
New Patient Level 4,13436278,LOCAL,99204,CPT,,,,,25,Outpatient,,,788.5,513,United Health ,United Health Medicare Advantage,110.67,,,,,,,Fee Schedule,110.67,117.82,
New Patient Level 4,13436278,LOCAL,G0463,CPT,,,,,25,Outpatient,,,788.5,326,United Health ,United Health Medicare Advantage,117.82,,,,,,,Fee Schedule,110.67,117.82,
36593 DECLOT IMPLANT DEVICE/CATHETER CHARGE,8700839,LOCAL,36593,CPT,,,,,,Outpatient,,,794.92,517,United Health ,United Health Medicare Advantage,303.25,,,,,,,Fee Schedule,303.25,863,
64590  Insertion or replacement of peripheral or gastric neurostimulator pulse generator,8529396,LOCAL,64590,CPT,,,,,,Outpatient,,,798,519,United Health ,United Health Medicare Advantage,19605.75,,,,,,,Fee Schedule,9233,30196.67,
US Transvaginal Non-OB,1169889,LOCAL,76830,CPT,,,,,,Outpatient,,,798,428.18,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
JAK2 V617F Mutation Analysis QSTC,9039438,LOCAL,81270,CPT,,,,,,Outpatient,,,810,109.99,United Health ,United Health Medicare Advantage,449.92,,,,,,,Fee Schedule,63.34,449.915,
TPMT Genotype QSTC,10168397,LOCAL,81335,CPT,,,,,,Outpatient,,,810,209.77,United Health ,United Health Medicare Advantage,174.81,,,,,,,Fee Schedule,173.68,174.81,
LENS CLAREON CCA0T0,4802028,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,819.5,410,United Health ,United Health Medicare Advantage,145.73,,,,,,,Fee Schedule,145.73,145.73,
LENS CLAREON CNA0T0,4890000,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,819.5,410,United Health ,United Health Medicare Advantage,145.73,,,,,,,Fee Schedule,145.73,145.73,
95816 EEG AWAKE AND DROWSY CHARGE,8303772,LOCAL,95816,CPT,,,,,,Outpatient,,,820.05,533,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,284.7,466.96,
ADD'L ART 2ND/3RD ABD,8267115,LOCAL,36248,CPT,,,,,,Outpatient,,,820.1,533,United Health ,United Health Medicare Advantage,39.09,,,,,,,Fee Schedule,39.09,929.12,
XR Spine Lumbosacral 4 Plus Views,1170476,LOCAL,72110,CPT,,,,,,Outpatient,,,823.1,441.38,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
"GAD65, IA-2 and Insulin Autoantibody QSTC",14105691,LOCAL,86337,CPT,,,,,,Outpatient,,,823.5,25.69,United Health ,United Health Medicare Advantage,21.41,,,,,,,Fee Schedule,15.29,21.41,
"GAD65, IA-2 and Insulin Autoantibody QSTC.",14621959,LOCAL,86337,CPT,,,,,,Outpatient,,,823.5,25.69,United Health ,United Health Medicare Advantage,21.41,,,,,,,Fee Schedule,15.29,21.41,
LENS #DIB00,4803761,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,825,410,United Health ,United Health Medicare Advantage,145.73,,,,,,,Fee Schedule,145.73,145.73,
92978 Cath IVUS First Vessel,8230048,LOCAL,92978,CPT,,,,,,Outpatient,,,828.2,538,United Health ,United Health Medicare Advantage,164.22,,,,,,,Fee Schedule,164.22,863,
"Rho D Immune Globulin, Human, full dose, 300 micrograms, INJ",90620010,LOCAL,J2790,CPT,,,,,,Outpatient,,,829.08,,United Health ,United Health Medicare Advantage,80.53,,,,,,,Fee Schedule,80.532,122.4,
XR Arthrogram Knee SI Left,2425410,LOCAL,73580,CPT,,,,,LT,Outpatient,,,834.05,447.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Arthrogram Knee SI Right,2425413,LOCAL,73580,CPT,,,,,RT,Outpatient,,,834.05,447.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,176.48,326.51,
Abeta 40 - QST,13874686,LOCAL,82233,CPT,,,,,,Outpatient,,,844,,United Health ,United Health Medicare Advantage,128.92,,,,,,,Fee Schedule,128.92,173.68,
Abeta 42 - QST,13874685,LOCAL,82234,CPT,,,,,,Outpatient,,,844,,United Health ,United Health Medicare Advantage,128.92,,,,,,,Fee Schedule,128.92,173.68,
PASSY-MUIR PMV2001- 703-2001,8800100,LOCAL,,,L8501,HCPCS,,,,Outpatient,,,846.95,,United Health ,United Health Medicare Advantage,179.42,,,,,,,Fee Schedule,179.42,179.42,
"epoetin alfa-epbx 20,000 units/mL injectable solution 1 mL [CULL]",11202388,LOCAL,Q5106,CPT,,,,,,Outpatient,1,ML,847.104,,United Health ,United Health Medicare Advantage,7.85,,,,,,,Fee Schedule,7.85,525.49,
36005 Venogram Injection,8212037,LOCAL,36005,CPT,,,,,,Outpatient,,,847.39,551,United Health ,United Health Medicare Advantage,38.76,,,,,,,Fee Schedule,38.76,929.12,
levothyroxine 40 mcg (0.04 mg)/mL intravenous solution 5 mL [CULL],11202740,LOCAL,J0650,CPT,,,,,,Outpatient,5,ML,851.392,,United Health ,United Health Medicare Advantage,5.98,,,,,,,Fee Schedule,5.983,122.4,
XR Upper GI w/ Air Contrast,1170566,LOCAL,74246,CPT,,,,,,Outpatient,,,862.77,492.53,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,176.48,
XR Upper GI w/ Air w/ Small Bowel,1170570,LOCAL,74246,CPT,,,,,,Outpatient,,,862.77,492.53,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,176.48,
EPINEPHrine 1 mg/mL injectable solution 30 mL [CULL],11202381,LOCAL,J0165,CPT,,,,,,Outpatient,30,ML,864,,United Health ,United Health Medicare Advantage,0.43,,,,,,,Fee Schedule,0.433,0.433,
US Scrotum (Contents),8206982,LOCAL,76870,CPT,,,,,,Outpatient,,,864.82,463.65,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
US OB Transvaginal,1169861,LOCAL,76817,CPT,,,,,,Outpatient,,,865.47,464.48,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,148.61,
93308 LMTD STUDENT ECHOCARDIOGRAM CHARGE,6011002,LOCAL,93308,CPT,,,,,,Outpatient,,,867.64,564,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,678.38,
ECHO 2D LTD,8200150,LOCAL,93308,CPT,,,,,,Outpatient,,,867.64,564,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,678.38,
US Echo 2D Limited,8071400,LOCAL,93308,CPT,,,,,,Outpatient,,,867.64,564,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,678.38,
Pneumonia Panel (Biofire),9594219,LOCAL,87633,CPT,,,,,,Outpatient,,,868.73,500.14,United Health ,United Health Medicare Advantage,610.31,,,,,,,Fee Schedule,158.39,610.305625,
tbo-filgrastim 300 mcg/0.5 mL subcutaneous solution 0.5 mL [CULL],11202449,LOCAL,J1447,CPT,,,,,,Outpatient,0.5,ML,872.2368,,United Health ,United Health Medicare Advantage,0.28,,,,,,,Fee Schedule,0.28,525.49,
XR Colon Barium Enema w/ Air Contrast,9427627,LOCAL,74280,CPT,,,,,,Outpatient,,,872.33,467.78,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,176.48,
CARDIAC THROMBOLYTICS IV,8267127,LOCAL,92977,CPT,,,,,,Outpatient,,,874.14,568,United Health ,United Health Medicare Advantage,303.25,,,,,,,Fee Schedule,303.25,863,
NM Thyroid Imaging,2426008,LOCAL,78013,CPT,A9512,HCPCS,,,,Outpatient,,,879.12,471.08,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,560.96,
92612 - ENDOSCOPY SWALLOW TST (FEES),9636010,LOCAL,92612,CPT,,,,,GN,Outpatient,,,884,575,United Health ,United Health Medicare Advantage,52.01,,,,,,,Fee Schedule,52.01,162.41,
92612 Fiber Endo Eval Swallow Video Charge,9410192,LOCAL,92612,CPT,,,,,GN,Outpatient,,,884,575,United Health ,United Health Medicare Advantage,52.01,,,,,,,Fee Schedule,52.01,162.41,
SLP Fiberoptic Swallow Eval Units,1373844,LOCAL,92612,CPT,,,,,GN,Outpatient,,,884,575,United Health ,United Health Medicare Advantage,52.01,,,,,,,Fee Schedule,52.01,162.41,
Speech Fiberoptic Swallow Eval Charge,1373844,LOCAL,92612,CPT,,,,,GN,Outpatient,,,884,575,United Health ,United Health Medicare Advantage,52.01,,,,,,,Fee Schedule,52.01,162.41,
99284 - Level 4,2644300,LOCAL,99284,CPT,,,,,25,Outpatient,,,886.65,576,United Health ,United Health Medicare Advantage,389.31,,,,,,,Fee Schedule,389.31,389.31,
3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase (HMGCR) Antibody (IgG) QSTC,13864471,LOCAL,83520,CPT,,,,,,Outpatient,,,888.75,20.72,United Health ,United Health Medicare Advantage,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
XR Hips 5+ Views Bilat,7520618,LOCAL,73523,CPT,,,,,,Outpatient,,,890.34,477.68,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Hips 5+ Views w/AP Pelvis Bilat,7520621,LOCAL,73523,CPT,,,,,,Outpatient,,,890.34,477.68,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR Barium Swallow w/ Upper GI + KUB,8912828,LOCAL,74240,CPT,,,,,,Outpatient,,,891.48,477.68,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,176.48,
XR Upper GI,1170562,LOCAL,74240,CPT,,,,,,Outpatient,,,891.48,477.68,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,176.48,
XR Upper GI w/ Small Bowel,1170574,LOCAL,74240,CPT,,,,,,Outpatient,,,891.48,477.68,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,176.48,
ceftaroline 600 mg intravenous injection [CULL],11201425,LOCAL,J0712,CPT,,,,,,Outpatient,1,EA,896.73216,,United Health ,United Health Medicare Advantage,4.23,,,,,,,Fee Schedule,4.23,233.26,
"ANNA3 Ab, IFA, CSF QSTC",13873554,LOCAL,86255,CPT,,,,,,Outpatient,,,900,14.46,United Health ,United Health Medicare Advantage,12.05,,,,,,,Fee Schedule,12.05,15.29,
"GAD65 Ab, IFA, CSF QSTC",13873575,LOCAL,86341,CPT,,,,,,Outpatient,,,900,28.28,United Health ,United Health Medicare Advantage,23.57,,,,,,,Fee Schedule,15.29,23.57,
TPMT Activity QSTC,8764663,LOCAL,84433,CPT,,,,,,Outpatient,,,900,26.6,United Health ,United Health Medicare Advantage,22.17,,,,,,,Fee Schedule,17.73,22.17,
CATH PL 1ST ORDER VENOUS,8267186,LOCAL,36011,CPT,,,,,,Outpatient,,,908.34,590,United Health ,United Health Medicare Advantage,126.74,,,,,,,Fee Schedule,126.74,929.12,
VENOGRAM INJ BILATERAL,8267755,LOCAL,36005,CPT,,,,,,Outpatient,,,914.51,551,United Health ,United Health Medicare Advantage,38.76,,,,,,,Fee Schedule,38.76,929.12,
XR Barium Swallow w/ Upper GI w/ Air,13554969,LOCAL,74246,CPT,,,,,,Outpatient,,,918.22,492.53,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,176.48,
95819 EEG AWAKE & ASLEEP CHARGE,8704890,LOCAL,95819,CPT,,,,,,Outpatient,,,922.13,599,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,284.7,466.96,
US Biopsy Abdomen/Retroperitoneal Mass,8565247,LOCAL,76942,CPT,,,,,,Outpatient,,,927.16,497.48,United Health ,United Health Medicare Advantage,28.54,,,,,,,Fee Schedule,28.54,165.47,
US Biopsy Liver,1169599,LOCAL,76942,CPT,,,,,,Outpatient,,,927.16,497.48,United Health ,United Health Medicare Advantage,28.54,,,,,,,Fee Schedule,28.54,165.47,
US Breast Needle Loc Left,7936259,LOCAL,19285,CPT,,,,,LT,Outpatient,,,927.16,603,United Health ,United Health Medicare Advantage,643.26,,,,,,,Fee Schedule,643.26,1291,
US Breast Needle Loc Right,7936262,LOCAL,19285,CPT,,,,,RT,Outpatient,,,927.16,603,United Health ,United Health Medicare Advantage,643.26,,,,,,,Fee Schedule,643.26,1291,
US NEEDLE PLACEMENT CVS,8200510,LOCAL,76942,CPT,,,,,,Outpatient,,,927.16,497.48,United Health ,United Health Medicare Advantage,28.54,,,,,,,Fee Schedule,28.54,165.47,
XR Cholangiogram T-Tube Check,8207012,LOCAL,47531,CPT,,,,,,Outpatient,,,927.38,298,United Health ,United Health Medicare Advantage,3226.48,,,,,,,Fee Schedule,2599,3226.48,
KERECIS OMEGA 3 - DISK 16MM 2,13962585,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,929.25,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
XR Arthrogram Elbow SI Left,2425398,LOCAL,73085,CPT,,,,,LT,Outpatient,,,934.13,500.78,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Arthrogram Elbow SI Right,2425401,LOCAL,73085,CPT,,,,,RT,Outpatient,,,934.13,500.78,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,176.48,326.51,
"Bartonella DNA, Qual, RT PCR QSTC",13864512,LOCAL,87471,CPT,,,,,,Outpatient,,,940.5,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
BiPAP Charge -> Subsequent,2678299,LOCAL,94003,CPT,,,,,,Outpatient,,,943.5,613,United Health ,United Health Medicare Advantage,604.42,,,,,,,Fee Schedule,604.42,941,
NM Lung Perfusion Imaging,1169328,LOCAL,78580,CPT,A9540,HCPCS,,,,Outpatient,,,948.45,508.2,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,1409.71,
64999 PERI-INFILTRATION HARDWARE,5661083,LOCAL,64999,CPT,,,,,,Outpatient,,,953.35,620,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
L3806 OT WRIST HAND FINGER ORTHOSIS,9856094,LOCAL,,,L3806,HCPCS,,,,Outpatient,,,966.78,628,United Health ,United Health Medicare Advantage,510.8,,,,,,,Fee Schedule,510.8,510.8,
"penicillin G benzathine 1,200,000 units/2 mL intramuscular suspension 2 mL [CULL]",11202076,LOCAL,J0561,CPT,,,,,,Outpatient,2,ML,967.8944,,United Health ,United Health Medicare Advantage,30.01,,,,,,,Fee Schedule,30.01,122.4,
ADD'L ART 2ND/3RD THORAC,8267111,LOCAL,36218,CPT,,,,,,Outpatient,,,970.36,631,United Health ,United Health Medicare Advantage,42.55,,,,,,,Fee Schedule,42.55,929.12,
CATH PLACE SEG SUBSEG PA,8267104,LOCAL,36015,CPT,,,,,,Outpatient,,,980.22,637,United Health ,United Health Medicare Advantage,139.57,,,,,,,Fee Schedule,139.57,929.12,
US Abdomen Complete,1169567,LOCAL,76700,CPT,,,,,,Outpatient,,,984.47,528,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,245.49,
BiPAP Charge -> Initial,2678300,LOCAL,94002,CPT,,,,,,Outpatient,,,990,663,United Health ,United Health Medicare Advantage,604.42,,,,,,,Fee Schedule,604.42,941,
BiPAP/CPAP Mode -> NIMV,2678300,LOCAL,94002,CPT,,,,,,Outpatient,,,990,663,United Health ,United Health Medicare Advantage,604.42,,,,,,,Fee Schedule,604.42,941,
ECHOCARDIOGRAM 2D W/STRESS,8200440,LOCAL,93350,CPT,,,,,,Outpatient,,,990,644,United Health ,United Health Medicare Advantage,501.29,,,,,,,Fee Schedule,501.29,678.38,
16025 DRESS AN/OR DEBMT BURN INI MED CHARGE,8020080,LOCAL,16025,CPT,,,,,,Outpatient,,,991.5,644,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
CT Angio Heart/Coronary Arteries,9515210,LOCAL,75574,CPT,,,,,,Outpatient,,,992.21,532.13,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,565.59,
20610 INJECT MAJOR JOINT,5661087,LOCAL,20610,CPT,,,,,,Outpatient,,,1000,650,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
methylene blue 5 mg/mL intravenous solution 10 mL [CULL],11202913,LOCAL,Q9968,CPT,,,,,,Outpatient,10,ML,1000.0512,,United Health ,United Health Medicare Advantage,8.73,,,,,,,Fee Schedule,8.73,8.73,
OASIS MATRIX WOUND 3 X 7 CM,13962592,LOCAL,,,Q4102,HCPCS,,,,Outpatient,,,1003.01,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
NM Parathyroid Imaging w/ Spect Inj/Scan,2425984,LOCAL,78071,CPT,A9500,HCPCS,,,,Outpatient,,,1004.58,331.65,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,560.96,
XR Arthrogram Hip SI Left,2425404,LOCAL,73525,CPT,,,,,LT,Outpatient,,,1004.84,538.73,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Arthrogram Hip SI Right,2425407,LOCAL,73525,CPT,,,,,RT,Outpatient,,,1004.84,538.73,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,176.48,326.51,
INTRO EXTREMITY ARTERY,8267105,LOCAL,36140,CPT,,,,,,Outpatient,,,1022.12,664,United Health ,United Health Medicare Advantage,72.34,,,,,,,Fee Schedule,72.34,929.12,
PERC CHANGE TUBE OR DRAINAGE CATH S&I,8210742,LOCAL,75984,CPT,,,,,,Outpatient,,,1029.19,551.93,United Health ,United Health Medicare Advantage,49.58,,,,,,,Fee Schedule,49.58,262.79,
XR Drainage Perc Cath Replace,9343679,LOCAL,75984,CPT,,,,,,Outpatient,,,1029.19,551.93,United Health ,United Health Medicare Advantage,49.58,,,,,,,Fee Schedule,49.58,262.79,
11107 INCAL BX SKN EA SEP/ADDL CHARGE,9704096,LOCAL,11107,CPT,,,,,,Outpatient,,,1030.62,670,United Health ,United Health Medicare Advantage,23.51,,,,,,,Fee Schedule,23.51,863,
CYSTOGRAM S&I,8211185,LOCAL,74430,CPT,,,,,,Outpatient,,,1033.41,554.4,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Cystogram,4126362,LOCAL,74430,CPT,,,,,,Outpatient,,,1033.41,554.4,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,176.48,326.51,
US Joint/Bursa Lw Int Arth/Asp/Inj Left,3148332,LOCAL,20606,CPT,,,,,LT,Outpatient,,,1035.43,673,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
US Joint/Bursa Lw Int Arth/Asp/Inj Right,3148335,LOCAL,20606,CPT,,,,,RT,Outpatient,,,1035.43,673,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
US Joint/Bursa Lw Maj Arth/Asp/Inj Left,3148338,LOCAL,20611,CPT,,,,,LT,Outpatient,,,1035.43,673,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Lw Maj Arth/Asp/Inj Right,3148341,LOCAL,20611,CPT,,,,,RT,Outpatient,,,1035.43,673,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Lw Sm Arth/Asp/Inj Left,6130396,LOCAL,20604,CPT,,,,,LT,Outpatient,,,1035.43,673,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Lw Sm Arth/Asp/Inj Right,6130399,LOCAL,20604,CPT,,,,,RT,Outpatient,,,1035.43,673,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Up Int Arth/Asp/Inj Left,2425353,LOCAL,20606,CPT,,,,,LT,Outpatient,,,1035.43,673,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
US Joint/Bursa Up Int Arth/Asp/Inj Right,2425356,LOCAL,20606,CPT,,,,,RT,Outpatient,,,1035.43,673,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
US Joint/Bursa Up Maj Arth/Asp/Inj Left,2425359,LOCAL,20611,CPT,,,,,LT,Outpatient,,,1035.43,673,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Up Maj Arth/Asp/Inj Right,2425362,LOCAL,20611,CPT,,,,,RT,Outpatient,,,1035.43,673,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Up Sm Arth/Asp/Inj Left,6130402,LOCAL,20604,CPT,,,,,LT,Outpatient,,,1035.43,673,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
US Joint/Bursa Up Sm Arth/Asp/Inj Right,6130405,LOCAL,20604,CPT,,,,,RT,Outpatient,,,1035.43,673,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
GASTRO-JEJUNOSTOMY TUBE REPLACEMENT,8200254,LOCAL,49452,CPT,,,,,,Outpatient,,,1040.53,676,United Health ,United Health Medicare Advantage,857.17,,,,,,,Fee Schedule,857.17,1496,
"Chikungunya Virus RNA, Qual RT PCR QSTC",13864475,LOCAL,87798,CPT,,,,,,Outpatient,,,1050.75,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
ARTERIAL LINE PLACEMENT,8210320,LOCAL,36620,CPT,,,,,,Outpatient,,,1052.64,684,United Health ,United Health Medicare Advantage,38.92,,,,,,,Fee Schedule,38.92,929.12,
NM Hepatobiliary Imaging,2425957,LOCAL,78226,CPT,,,,,,Outpatient,,,1059,567.6,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,560.96,
DART FIRE EDGE SCREW,4810328,LOCAL,,,C1716,HCPCS,,,,Outpatient,,,1062.93,,United Health ,United Health Medicare Advantage,868.33,,,,,,,Fee Schedule,612.6,868.33,
NEPHROSTOGRAM S&I,8212039,LOCAL,74425,CPT,,,,,,Outpatient,,,1072.47,575.03,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,176.48,326.51,
glucagon 1 mg injection [CULL],11282210,LOCAL,J1610,CPT,,,,,,Outpatient,1,EA,1075.2,,United Health ,United Health Medicare Advantage,182.45,,,,,,,Fee Schedule,182.45,233.26,
99205 LEVEL V INITIAL VISIT FAC CHARGE,12832503,LOCAL,99205,CPT,,,,,,Outpatient,,,1078.84,701,United Health ,United Health Medicare Advantage,151.18,,,,,,,Fee Schedule,151.18,151.18,
99205 New patient-level 5 specialty clinic,13538610,LOCAL,,,G0463,HCPCS,,,,Outpatient,,,1078.84,326,United Health ,United Health Medicare Advantage,117.82,,,,,,,Fee Schedule,117.82,117.82,
99205 Office Visit New Pt. Level 5,10168484,LOCAL,99205,CPT,,,,,,Outpatient,,,1078.84,701,United Health ,United Health Medicare Advantage,151.18,,,,,,,Fee Schedule,151.18,151.18,
99205 Office Visit New Pt. Level 5,10168484,LOCAL,99205,CPT,,,,,,Outpatient,,,1078.84,701,United Health ,United Health Medicare Advantage,151.18,,,,,,,Fee Schedule,151.18,151.18,
99215 LEVEL V VISIT CHARGE,9322144,LOCAL,99215,CPT,,,,,,Outpatient,,,1078.84,701,United Health ,United Health Medicare Advantage,119.41,,,,,,,Fee Schedule,119.41,119.41,
99215 Office Visit Established Pt. Level 5,10168489,LOCAL,99215,CPT,,,,,,Outpatient,,,1078.84,701,United Health ,United Health Medicare Advantage,119.41,,,,,,,Fee Schedule,119.41,119.41,
"Leptospira DNA, Qual RT PCR QSTC",13864445,LOCAL,87798,CPT,,,,,,Outpatient,,,1096.88,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
"Fungal Sequencing, ITS Region QSTC",13864438,LOCAL,87153,CPT,,,,,,Outpatient,,,1102.5,138.43,United Health ,United Health Medicare Advantage,115.36,,,,,,,Fee Schedule,115.36,158.39,
"Cortisol, Free, LC/MS, Serum QSTC",8972878,LOCAL,82530,CPT,,,,,,Outpatient,,,1104.43,20.05,United Health ,United Health Medicare Advantage,29.79,,,,,,,Fee Schedule,17.73,29.79,
acetylcysteine 20% intravenous solution 30 mL [CULL],11200013,LOCAL,J0132,CPT,,,,,,Outpatient,30,ML,1120.00032,,United Health ,United Health Medicare Advantage,0.37,,,,,,,Fee Schedule,0.367,0.367,
"Pneumocystis jirovecii,Qual Real-Time PCR QSTC",9215420,LOCAL,87798,CPT,,,,,,Outpatient,,,1120.91,42.11,United Health ,United Health Medicare Advantage,35.09,,,,,,,Fee Schedule,35.09,40.19,
CATH PL 2ND ORDER VENOUS,8267187,LOCAL,36012,CPT,,,,,,Outpatient,,,1122.44,730,United Health ,United Health Medicare Advantage,142.32,,,,,,,Fee Schedule,142.32,929.12,
NM Gastrointestinal Blood Loss Imaging,1169242,LOCAL,78278,CPT,A9512,HCPCS,,,,Outpatient,,,1123.93,603.08,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,1409.71,
Bird Fancier's Precipitin Panel I QSTC,13864443,LOCAL,86331,CPT,,,,,,Outpatient,,,1133.1,14.38,United Health ,United Health Medicare Advantage,11.98,,,,,,,Fee Schedule,11.98,15.29,
99285 - Level 5,2644301,LOCAL,99285,CPT,,,,,25,Outpatient,,,1135.13,738,United Health ,United Health Medicare Advantage,560.53,,,,,,,Fee Schedule,560.53,560.53,
chlorothiazide 0.5 g intravenous injection [CULL],11240810,LOCAL,J1205,CPT,,,,,,Outpatient,1,EA,1143.168,,United Health ,United Health Medicare Advantage,58.13,,,,,,,Fee Schedule,58.126,58.126,
US Breast ABUS Bilateral.,13939856,LOCAL,76641,CPT,,,,,50,Outpatient,,,1143.26,306.9,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
XR ERCP Biliary,8649296,LOCAL,74328,CPT,,,,,,Outpatient,,,1143.36,612.98,United Health ,United Health Medicare Advantage,121.3,,,,,,,Fee Schedule,121.3,262.79,
XR ERCP Pancreatic,8649299,LOCAL,74329,CPT,,,,,,Outpatient,,,1143.36,612.98,United Health ,United Health Medicare Advantage,23.05,,,,,,,Fee Schedule,23.05,262.79,
amphotericin B liposomal 50 mg intravenous injection [CULL],11202015,LOCAL,J0289,CPT,,,,,,Outpatient,1,EA,1152.16,,United Health ,United Health Medicare Advantage,21.48,,,,,,,Fee Schedule,21.48,1293.51,
GUIDED PERC DRAIN W CATH S&I,8210333,LOCAL,75989,CPT,,,,,,Outpatient,,,1153.62,618.75,United Health ,United Health Medicare Advantage,50.75,,,,,,,Fee Schedule,50.75,262.79,
US Pelvic Comp,8206964,LOCAL,76856,CPT,,,,,,Outpatient,,,1159.45,622.05,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,245.49,
29445 APPL RIGID LEG CAST,9739196,LOCAL,29445,CPT,,,,,,Outpatient,,,1160.76,266,United Health ,United Health Medicare Advantage,242.81,,,,,,,Fee Schedule,242.81,863,
NM Hyperthyroid Therapy,8567789,LOCAL,79005,CPT,A9517,HCPCS,,,,Outpatient,,,1161.71,622.88,United Health ,United Health Medicare Advantage,23.13,,,,,,,Fee Schedule,23.13,456.65,
XR Spine Scoliosis 1 View,7520627,LOCAL,72081,CPT,,,,,,Outpatient,,,1170.74,627.83,United Health ,United Health Medicare Advantage,80.5,,,,,,,Fee Schedule,80.5,83.69,
XR Arthrogram Wrist SI Left,2425422,LOCAL,73115,CPT,,,,,LT,Outpatient,,,1176.56,631.13,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,176.48,326.51,
XR Arthrogram Wrist SI Right,2425425,LOCAL,73115,CPT,,,,,RT,Outpatient,,,1176.56,631.13,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,176.48,326.51,
E3077 Aph Plt ACDA LR,7266775,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,United Health ,United Health Medicare Advantage,487.1,,,,,,,Fee Schedule,487.1,546.55,
E3087 Aph Plt ACDA LR 1,7266780,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,United Health ,United Health Medicare Advantage,487.1,,,,,,,Fee Schedule,487.1,546.55,
E3088 Aph Plt ACDA LR 2,7266781,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,United Health ,United Health Medicare Advantage,487.1,,,,,,,Fee Schedule,487.1,546.55,
E3089 Aph Plt ACDA LR 3,7266782,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,United Health ,United Health Medicare Advantage,487.1,,,,,,,Fee Schedule,487.1,546.55,
E4643 Aph Plt ACDA LR <3E11,7266909,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,United Health ,United Health Medicare Advantage,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5030 Aph Plt ACDA LR BM,8058823,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,United Health ,United Health Medicare Advantage,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5032 Aph Plt ACDA LR BM 2,8029134,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,United Health ,United Health Medicare Advantage,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5033 Aph Plt ACDA LR BM 3,8058812,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,United Health ,United Health Medicare Advantage,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5036 Aph Plt ACDA LR Irr BM 2,8029108,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,United Health ,United Health Medicare Advantage,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5075 Aph Plt ACDA LR <3E11 BM,8058809,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,United Health ,United Health Medicare Advantage,487.1,,,,,,,Fee Schedule,487.1,546.55,
E9232 Aph Plt ACDA LR BT6,10074919,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,United Health ,United Health Medicare Advantage,487.1,,,,,,,Fee Schedule,487.1,546.55,
E5031  Aph Plt ACDA LR BM 1,8029138,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1188,768,United Health ,United Health Medicare Advantage,487.1,,,,,,,Fee Schedule,487.1,546.55,
64480 CERVICAL THORACIC TRANSFORAMINAL EACH AD,5661052,LOCAL,64480,CPT,,,,,,Outpatient,,,1193.14,776,United Health ,United Health Medicare Advantage,50.22,,,,,,,Fee Schedule,50.22,1250.53,
95824 EEG CEREBRAL DEATH EVALUATION ONLY CHARGE,9646722,LOCAL,95824,CPT,,,,,,Outpatient,,,1194.07,776,United Health ,United Health Medicare Advantage,485.11,,,,,,,Fee Schedule,466.96,485.11,
BREAST SIZER SMOOTH ROUND HIGH 565CC,4850931,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,1210,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE 505HP,4840154,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,1210,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
"RT CHARGE Ventilator Restart, Ongoing -> Yes",12109384,LOCAL,94003,CPT,,,,,,Outpatient,,,1224,613,United Health ,United Health Medicare Advantage,604.42,,,,,,,Fee Schedule,604.42,941,
KERECIS OMEGA 3 - 1.75 X 1.75CM,13962575,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,1228.5,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
"Prostaglandin D2 (Pg D2), Urine QST",12667576,LOCAL,84150,CPT,,,,,,Outpatient,,,1230,50.12,United Health ,United Health Medicare Advantage,41.77,,,,,,,Fee Schedule,41.77,47.35,
15274 App Skin Sub Graft (TWSA>100cm2) t/s/l ; add 100 cm 2,12642329,LOCAL,15274,CPT,,,,,,Outpatient,,,1230.36,800,United Health ,United Health Medicare Advantage,35.4,,,,,,,Fee Schedule,35.4,2862.92,
15278 APPL-HC SKSB GRT F/N/H/G-KD A100 CHARGE,9709036,LOCAL,15278,CPT,,,,,,Outpatient,,,1230.36,800,United Health ,United Health Medicare Advantage,44.7,,,,,,,Fee Schedule,44.7,2862.92,
11106 INCAL BX SKN SINGLE LES CHARGE,9704095,LOCAL,11106,CPT,,,,,,Outpatient,,,1230.62,800,United Health ,United Health Medicare Advantage,559.65,,,,,,,Fee Schedule,559.65,1291,
"Aquaporin-4 (AQP4) (NMO-IgG) Antibody with Reflex to Titer, Serum QSTC",10041610,LOCAL,86052,CPT,,,,,,Outpatient,,,1237.5,14.46,United Health ,United Health Medicare Advantage,12.05,,,,,,,Fee Schedule,12.05,15.29,
"JC Polyoma Virus DNA, Qnt PCR, Serum QSTC",10274092,LOCAL,87799,CPT,,,,,,Outpatient,,,1237.5,51.41,United Health ,United Health Medicare Advantage,42.84,,,,,,,Fee Schedule,40.19,42.84,
"NMO Spectrum Eval (AQP4 w/Rflx toMOG), Serum QSTC",10274088,LOCAL,86052,CPT,,,,,,Outpatient,,,1237.5,14.46,United Health ,United Health Medicare Advantage,12.05,,,,,,,Fee Schedule,12.05,15.29,
"64520 Injection Lumbar or Thoracic, Paravertebral Sympathetic",5661043,LOCAL,64520,CPT,,,,,,Outpatient,,,1239.7,806,United Health ,United Health Medicare Advantage,813.96,,,,,,,Fee Schedule,813.96,1291,
96413 CHEMO IV INFUSION 1ST HR INF CHARGE,9665725,LOCAL,96413,CPT,,,,,,Outpatient,,,1244.66,809,United Health ,United Health Medicare Advantage,303.25,,,,,,,Fee Schedule,303.25,442.94,
REF Genetic RBC Phenotyping,13481257,LOCAL,81403,CPT,,,,,,Outpatient,,,1246.5,222.24,United Health ,United Health Medicare Advantage,185.2,,,,,,,Fee Schedule,173.68,185.2,
NM Liver/Spleen Imaging Injection/Scan,1169286,LOCAL,78215,CPT,A9541,HCPCS,,,,Outpatient,,,1248.36,669.08,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,1409.71,
"CBFB/MYH11 inv(16), Quant RT PCR QSTC",13864502,LOCAL,81401,CPT,,,,,,Outpatient,,,1260,164.4,United Health ,United Health Medicare Advantage,137,,,,,,,Fee Schedule,63.34,137,
REF PLT Crossmatch,13481259,LOCAL,86022,CPT,,,,,,Outpatient,,,1269,22.04,United Health ,United Health Medicare Advantage,18.37,,,,,,,Fee Schedule,15.29,18.37,
epoetin alfa 20000 units/mL Sol 1 mL [CULL],11202388,LOCAL,J0885,CPT,,,,,,Outpatient,1,ML,1273.344,,United Health ,United Health Medicare Advantage,8.54,,,,,,,Fee Schedule,7.85,525.49,
Admark Phospho Tau/Ttl Ab42 Comments QST,13877904,LOCAL,83520,CPT,,,,,,Outpatient,,,1277.25,20.72,United Health ,United Health Medicare Advantage,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Admark Phospho Tau/Ttl Ab42 Interp QST,13877902,LOCAL,83520,CPT,,,,,,Outpatient,,,1277.25,20.72,United Health ,United Health Medicare Advantage,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
Admark Phospho Tau/Ttl Ab42 Methods QST,13877905,LOCAL,83520,CPT,,,,,,Outpatient,,,1277.25,20.72,United Health ,United Health Medicare Advantage,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
62320 Cervical/Thoracic Epidural without Fluor,5661014,LOCAL,62320,CPT,,,,,,Outpatient,,,1284.42,835,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
11042 DEB SQ TISSUE-1ST 20SQCM/< CHARGE,9704056,LOCAL,11042,CPT,,,,,,Outpatient,,,1286.64,836,United Health ,United Health Medicare Advantage,365.27,,,,,,,Fee Schedule,365.27,863,
11043 DEB MUS/FASCIA-1ST 20SQCM/< CHARGE,9704059,LOCAL,11043,CPT,,,,,,Outpatient,,,1286.64,836,United Health ,United Health Medicare Advantage,559.65,,,,,,,Fee Schedule,549.61,863,
11045 Debrid bone 1st 20 sq cm charge,12510099,LOCAL,11045,CPT,,,,,,Outpatient,,,1286.64,836,United Health ,United Health Medicare Advantage,20.61,,,,,,,Fee Schedule,20.61,1466.58,
11045 Debrid Sub Tissue > 20 sq cm charge,12511974,LOCAL,11045,CPT,,,,,,Outpatient,,,1286.64,836,United Health ,United Health Medicare Advantage,20.61,,,,,,,Fee Schedule,20.61,1466.58,
11046 DEB MUS/FASCIA-EA ADDL 20SQCM CHARGE,9704068,LOCAL,11046,CPT,,,,,,Outpatient,,,1286.64,836,United Health ,United Health Medicare Advantage,44.01,,,,,,,Fee Schedule,44.01,1466.58,
XR Urethrocystography Retrograde,1170578,LOCAL,74450,CPT,,,,,,Outpatient,,,1300.84,697.95,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,176.48,220.99,
MTB Complex Rifampin Resist PCR Sput QSTC,8873578,LOCAL,87801,CPT,,,,,,Outpatient,,,1316.25,84.24,United Health ,United Health Medicare Advantage,70.2,,,,,,,Fee Schedule,40.19,70.2,
US OB Greater Than 14 Weeks Single,8583651,LOCAL,76805,CPT,,,,,,Outpatient,,,1319.46,130.35,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,148.61,
NM Parathyroid Imaging Injection/Scan,1169316,LOCAL,78070,CPT,A9500,HCPCS,,,,Outpatient,,,1324.92,710.33,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,1409.71,
NM Bone Marrow Imaging Whole Body,1169186,LOCAL,78104,CPT,A9541,HCPCS,,,,Outpatient,,,1327.01,711.98,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,560.96,
16030 DRESS AN/OR DEBMT BURN INI LG CHARGE,8020081,LOCAL,16030,CPT,,,,,,Outpatient,,,1328,863,United Health ,United Health Medicare Advantage,365.27,,,,,,,Fee Schedule,365.27,863,
93660 STRESS TILT TABLE CHARGE,8200435,LOCAL,93660,CPT,,,,,,Outpatient,,,1338.01,870,United Health ,United Health Medicare Advantage,485.11,,,,,,,Fee Schedule,244.97,863,
JEJUNOSTOMY PERC,8200251,LOCAL,49441,CPT,,,,,,Outpatient,,,1339,870,United Health ,United Health Medicare Advantage,1734.34,,,,,,,Fee Schedule,983.02,1734.34,
Bacterial 16S rDNA Sequencing QSTC,8873571,LOCAL,87153,CPT,,,,,,Outpatient,,,1344.6,138.43,United Health ,United Health Medicare Advantage,115.36,,,,,,,Fee Schedule,115.36,158.39,
64620 DESTR INTERCOSTAL NERVE,5661066,LOCAL,64620,CPT,,,,,,Outpatient,,,1345.12,874,United Health ,United Health Medicare Advantage,813.96,,,,,,,Fee Schedule,813.96,1695.82,
64634 DESTR FACET CRV/THR EA ADL LVL,5661058,LOCAL,64634,CPT,,,,,,Outpatient,,,1345.12,874,United Health ,United Health Medicare Advantage,54.71,,,,,,,Fee Schedule,54.71,1250.53,
15002 SITE PREP -100 SQCM(TAL),12625535,LOCAL,15002,CPT,,,,,,Outpatient,,,1348.68,877,United Health ,United Health Medicare Advantage,1672.39,,,,,,,Fee Schedule,1466.58,1672.39,
64405 OCCIPITAL - BILATERAL CHARGE,5661078,LOCAL,64405,CPT,,,,,,Outpatient,,,1352.9,879,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
conjugated estrogens 25 mg injection [CULL],11201516,LOCAL,J1410,CPT,,,,,,Outpatient,1,EA,1372.1472,,United Health ,United Health Medicare Advantage,392.06,,,,,,,Fee Schedule,233.26,392.06,
10120 Incision & removal of Foreign Body Simple,9620024,LOCAL,10120,CPT,,,,,,Outpatient,,,1373.45,893,United Health ,United Health Medicare Advantage,365.27,,,,,,,Fee Schedule,239.03,863,
62321 CERVICAL THORACIC EPIDURAL,5661016,LOCAL,62321,CPT,,,,,,Outpatient,,,1375.34,894,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
64520 LUMBAR OR THORACIC Sympathetic Charge,5661033,LOCAL,64520,CPT,,,,,,Outpatient,,,1375.34,806,United Health ,United Health Medicare Advantage,813.96,,,,,,,Fee Schedule,813.96,1291,
64490 INJ PARAVER CERV/THOR 1ST LEVEL,5661063,LOCAL,64490,CPT,,,,,,Outpatient,,,1376.78,895,United Health ,United Health Medicare Advantage,813.96,,,,,,,Fee Schedule,813.96,1291,
INTRO CATH AORTA,8267107,LOCAL,36200,CPT,,,,,,Outpatient,,,1379.82,897,United Health ,United Health Medicare Advantage,112.42,,,,,,,Fee Schedule,112.42,929.12,
tbo-filgrastim 480 mcg/0.8 mL subcutaneous solution 0.8 mL [CULL],11202451,LOCAL,J1447,CPT,,,,,,Outpatient,0.8,ML,1395.9776,,United Health ,United Health Medicare Advantage,0.28,,,,,,,Fee Schedule,0.28,525.49,
64479 CERVICAL THORACIC TRANSFORAMINAL EPIDRL,5661051,LOCAL,64479,CPT,,,,,,Outpatient,,,1397.93,909,United Health ,United Health Medicare Advantage,813.96,,,,,,,Fee Schedule,813.96,1291,
BUPivacaine liposome 1.3% (13.3 mg/mL) injectable suspension 20 mL [CULL],11202119,LOCAL,J0666,CPT,,,,,,Outpatient,20,ML,1402.224,,United Health ,United Health Medicare Advantage,1.34,,,,,,,Fee Schedule,1.34,1.34,
62323 LUMBAR OR CAUDAL EPIDURAL,5661015,LOCAL,62323,CPT,,,,,,Outpatient,,,1408.03,915,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
PERC ASPIRATION DISC,8230054,LOCAL,62267,CPT,,,,,,Outpatient,,,1409.73,916,United Health ,United Health Medicare Advantage,643.26,,,,,,,Fee Schedule,643.26,1291,
EPIFIX SKIN SUBSTITUTE 14MM,13962560,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,1410.75,1755,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
64510 NERV BLK STELLATE GANGLION,5661032,LOCAL,64510,CPT,,,,,,Outpatient,,,1418.86,922,United Health ,United Health Medicare Advantage,813.96,,,,,,,Fee Schedule,813.96,1695.82,
"64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when per",9520503,LOCAL,64624,CPT,,,,,,Outpatient,,,1425,926,United Health ,United Health Medicare Advantage,1785.34,,,,,,,Fee Schedule,1695.82,2315,
64640 DESTR OTH PERIPHERAL NERVE/BRCH,5661065,LOCAL,64640,CPT,,,,,,Outpatient,,,1425.83,927,United Health ,United Health Medicare Advantage,813.96,,,,,,,Fee Schedule,813.96,1695.82,
62290 INJ DISKOGRAPH LUMBAR EA LVL,5661062,LOCAL,62290,CPT,,,,,,Outpatient,,,1432.9,931,United Health ,United Health Medicare Advantage,134.34,,,,,,,Fee Schedule,134.34,863,
11400 EXC BENIGN LES-T/A/L 0.5CM OR < CHARGE FACILITY,9704107,LOCAL,11400,CPT,,,,,,Outpatient,,,1438,935,United Health ,United Health Medicare Advantage,643.26,,,,,,,Fee Schedule,643.26,1291,
PLACE ART 2ND ABD & BELOW,8267113,LOCAL,36246,CPT,,,,,,Outpatient,,,1441.95,937,United Health ,United Health Medicare Advantage,203.35,,,,,,,Fee Schedule,203.35,929.12,
NM Kidney Imaging Single w/ Pharm,1169262,LOCAL,78708,CPT,A9562,HCPCS,,,,Outpatient,,,1446.62,775.5,United Health ,United Health Medicare Advantage,492.12,,,,,,,Fee Schedule,492.12,560.96,
"92950 Cardiopulmonary resuscitation (eg, in cardiac arrest)",7968980,LOCAL,92950,CPT,,,,,,Outpatient,,,1448.28,941,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,284.7,1328.28,
92950 Cardiopulmonary Resuscitation Cath Lab,8212013,LOCAL,92950,CPT,,,,,,Outpatient,,,1448.28,941,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,284.7,1328.28,
92950 CARDIOPULMONARY RESUSCITATION CHARGE,8207219,LOCAL,92950,CPT,,,,,,Outpatient,,,1448.28,941,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,284.7,1328.28,
RT CHARGE Ventilator Initiate -> Yes,12109383,LOCAL,94002,CPT,,,,,,Outpatient,,,1453.5,663,United Health ,United Health Medicare Advantage,604.42,,,,,,,Fee Schedule,604.42,941,
NM Inflammation Loc Limited,1226092,LOCAL,78800,CPT,,,,,,Outpatient,,,1461.78,783.75,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,1409.71,
NM Inflammation Loc Limited - Ceretec,1169144,LOCAL,78800,CPT,A9521,HCPCS,,,,Outpatient,,,1461.78,783.75,United Health ,United Health Medicare Advantage,802.34,,,,,,,Fee Schedule,802.34,1409.71,
11402 EXC BENIGN LES-T/A/L 1.1-2.0 CM CHARGE,9704151,LOCAL,11402,CPT,,,,,,Outpatient,,,1481.17,963,United Health ,United Health Medicare Advantage,643.26,,,,,,,Fee Schedule,643.26,1291,
62273 BLOOD PATCH,5661017,LOCAL,62273,CPT,,,,,,Outpatient,,,1494.18,971,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
"13131-Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1",14749500,LOCAL,13131,CPT,,,,,,Outpatient,,,1505,400,United Health ,United Health Medicare Advantage,365.27,,,,,,,Fee Schedule,365.27,863,
MRI Fingers w/ Contrast Left,9343664,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Fingers w/ Contrast Right,9343667,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Forearm w/ Contrast Left,8206725,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Forearm w/ Contrast Right,8206727,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hand w/ Contrast Left,1168924,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hand w/ Contrast Right,1168926,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Humerus w/ Contrast Left,8206756,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Humerus w/ Contrast Right,8206758,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Scapula w/ Contrast Left,12912778,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Scapula w/ Contrast Right,12912781,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
NM Intestine Imaging Meckels,1169254,LOCAL,78290,CPT,A9512,HCPCS,,,,Outpatient,,,1535.86,823.35,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,560.96,
XR Spine Scoliosis 2-3 Views,7520630,LOCAL,72082,CPT,,,,,,Outpatient,,,1542.91,827.48,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
XR ERCP Biliary and Pancreatic,8207021,LOCAL,74330,CPT,,,,,,Outpatient,,,1543.36,827.48,United Health ,United Health Medicare Advantage,151.62,,,,,,,Fee Schedule,151.62,262.79,
XR IVP,1170251,LOCAL,74400,CPT,,,,,,Outpatient,,,1550,831.6,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,176.48,
64493 - INJ PARAVERT F JNT L/S 1 LEV,5661035,LOCAL,64493,CPT,,,,,,Outpatient,,,1563.68,1016,United Health ,United Health Medicare Advantage,813.96,,,,,,,Fee Schedule,813.96,1291,
G0260 INJ SACRO JNT ARTHR ANEST/STER,8132863,LOCAL,G0260,CPT,,,,,,Outpatient,,,1564.95,1017,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
NM Bone Imaging Limited Injection,1169176,LOCAL,78300,CPT,,,,,,Outpatient,,,1566.92,839.85,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,560.96,
"62272 SPINAL PUNC, THERAP",5661019,LOCAL,62272,CPT,,,,,,Outpatient,,,1587.32,693,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
64425 NERV BLK ILIOINGUINAL,5661024,LOCAL,64425,CPT,,,,,,Outpatient,,,1587.32,1032,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
64483 TRANS INJ LUMB/SACR-UNILATERAL CHARGE,5661053,LOCAL,64483,CPT,,,,,,Outpatient,,,1587.72,1812,United Health ,United Health Medicare Advantage,813.96,,,,,,,Fee Schedule,813.96,1291,
64484 TRANS INJ LUMB/SACR EA ADD UIL CHARGE,5661054,LOCAL,64484,CPT,,,,,,Outpatient,,,1587.72,1812,United Health ,United Health Medicare Advantage,41.55,,,,,,,Fee Schedule,41.55,1250.53,
ECHO COMPLETE W/ DOPPLER,8200137,LOCAL,93306,CPT,,,,,,Outpatient,,,1593.2,1036,United Health ,United Health Medicare Advantage,501.29,,,,,,,Fee Schedule,501.29,678.38,
ECHOCARDIOGRAM 2D COMPLETE,8200140,LOCAL,93307,CPT,,,,,,Outpatient,,,1593.2,1036,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,678.38,
US Echo Doppler Complete,7936277,LOCAL,93306,CPT,,,,,,Outpatient,,,1593.2,1036,United Health ,United Health Medicare Advantage,501.29,,,,,,,Fee Schedule,501.29,678.38,
XR Spine Scoliosis 4-5 Views,7520624,LOCAL,72083,CPT,,,,,,Outpatient,,,1597.41,856.35,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
phentolamine 5 mg injection [CULL],11211090,LOCAL,J2760,CPT,,,,,,Outpatient,1,EA,1605.12,,United Health ,United Health Medicare Advantage,432.02,,,,,,,Fee Schedule,122.4,432.02,
TLSO,9400067,LOCAL,,,L0648,HCPCS,,,,Outpatient,,,1611.78,,United Health ,United Health Medicare Advantage,797.49,,,,,,,Fee Schedule,797.49,797.49,
64636 DESTR FACET LUM/SAC EA ADL LVL,5661056,LOCAL,64636,CPT,,,,,,Outpatient,,,1614.14,1049,United Health ,United Health Medicare Advantage,48.01,,,,,,,Fee Schedule,48.01,1250.53,
"12020 SIMP CLOSURE, SUPERF WOUND CHARGE",9303466,LOCAL,12020,CPT,,,,,,Outpatient,,,1615.12,1050,United Health ,United Health Medicare Advantage,559.65,,,,,,,Fee Schedule,549.61,863,
"rabies vaccine, human diploid cell 2.5 intl units intramuscular injection [CULL]",11212261,LOCAL,90675,CPT,,,,,,Outpatient,1,EA,1633.664,328,United Health ,United Health Medicare Advantage,313.68,,,,,,,Fee Schedule,160.4,313.68,
BAL Fluid Count with Differential,12449847,LOCAL,0202U,CPT,,,,,,Outpatient,,,1642.5,500.14,United Health ,United Health Medicare Advantage,443.38,,,,,,,Fee Schedule,173.68,443.38,
XR Spine Scoliosis 6+ Views,7520633,LOCAL,72084,CPT,,,,,,Outpatient,,,1651.91,886.05,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,83.69,97.22,
NM Non-Cardiac Vascular Flow Imaging,1169314,LOCAL,78445,CPT,,,,,,Outpatient,,,1652.88,886.05,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,560.96,
63650 IMPLANT NEURSTIM ELEC EPIDURAL,10283945,LOCAL,63650,CPT,,,,,,Outpatient,,,1660,6563,United Health ,United Health Medicare Advantage,6000.2,,,,,,,Fee Schedule,5787,8672.71,
63650 IMPLANT NEURSTIM ELEC EPIDURAL,8132877,LOCAL,63650,CPT,,,,,,Outpatient,,,1660,6563,United Health ,United Health Medicare Advantage,6000.2,,,,,,,Fee Schedule,5787,8672.71,
63650-IMPLANT NEURSTIM ELEC EPIDURAL,8132877,LOCAL,63650,CPT,,,,,,Outpatient,,,1660,6563,United Health ,United Health Medicare Advantage,6000.2,,,,,,,Fee Schedule,5787,8672.71,
"rabies vaccine, human diploid cell 2.5 intl units Pow [CULL]",11212261,LOCAL,90675,CPT,,,,,,Outpatient,1,EA,1665.824,328,United Health ,United Health Medicare Advantage,313.68,,,,,,,Fee Schedule,160.4,313.68,
XR Nephrostogram,8115644,LOCAL,50430,CPT,,,,,,Outpatient,,,1670,1389,United Health ,United Health Medicare Advantage,610.24,,,,,,,Fee Schedule,555.55,1291,
XR Nephrostogram Existing Access,10454588,LOCAL,50431,CPT,,,,,,Outpatient,,,1670,1389,United Health ,United Health Medicare Advantage,610.24,,,,,,,Fee Schedule,555.55,1291,
36568 INTRO CATH VENA CAVA PICC CHARGE,13709100,LOCAL,36568,CPT,,,,,,Outpatient,,,1678,1091,United Health ,United Health Medicare Advantage,1420.25,,,,,,,Fee Schedule,1291,1644.1,
REPOSITION CVL UNDER FLUORO,8210300,LOCAL,36597,CPT,,,,,,Outpatient,,,1678,1091,United Health ,United Health Medicare Advantage,1420.25,,,,,,,Fee Schedule,1068.64,1420.25,
omadacycline 100 mg injection [CULL],11290183,LOCAL,J0121,CPT,,,,,,Outpatient,1,EA,1678.2144,,United Health ,United Health Medicare Advantage,4.02,,,,,,,Fee Schedule,4.02,2110.36,
15271 APP SKN SUB GRFT T/A/L 100 SQ CM FAC CHARGE,12831012,LOCAL,15271,CPT,,,,,,Outpatient,,,1680.09,1092,United Health ,United Health Medicare Advantage,1672.39,,,,,,,Fee Schedule,1496,2862.92,
"15275 App Skin Sub Graft (TWSA<100cm2) f/a/h-ft/aig; 1""25 sp cm",12641291,LOCAL,15275,CPT,,,,,,Outpatient,,,1680.09,1092,United Health ,United Health Medicare Advantage,1672.39,,,,,,,Fee Schedule,1496,2862.92,
"Zika Virus RNA, Qual TMA QSTC",13864496,LOCAL,87662,CPT,,,,,,Outpatient,,,1687.5,61.57,United Health ,United Health Medicare Advantage,51.31,,,,,,,Fee Schedule,40.19,51.31,
CATH LAB STRESS ECHO,8200161,LOCAL,93351,CPT,,,,,,Outpatient,,,1697.74,1104,United Health ,United Health Medicare Advantage,501.29,,,,,,,Fee Schedule,501.29,678.38,
US Stress Echo,7936322,LOCAL,93351,CPT,,,,,,Outpatient,,,1697.74,1104,United Health ,United Health Medicare Advantage,501.29,,,,,,,Fee Schedule,501.29,678.38,
64581 Incision for implantation of neurostimulator electrode array; sacral nerve,8603595,LOCAL,64581,CPT,,,,,,Outpatient,,,1704,1108,United Health ,United Health Medicare Advantage,6000.2,,,,,,,Fee Schedule,6000.2,8672.71,
CASPR2 Ab QSTC,13864490,LOCAL,86255,CPT,,,,,,Outpatient,,,1704.38,14.46,United Health ,United Health Medicare Advantage,12.05,,,,,,,Fee Schedule,12.05,15.29,
IMPLANT 625CC 350-1695,4802349,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,1710.5,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
"KIT D816, Mutation Analysis  QSTC",13864489,LOCAL,81273,CPT,,,,,,Outpatient,,,1721.25,149.84,United Health ,United Health Medicare Advantage,124.87,,,,,,,Fee Schedule,63.34,124.87,
Ganglioside Ab Panel 6 QSTC,13864481,LOCAL,83520,CPT,,,,,,Outpatient,,,1734.26,20.72,United Health ,United Health Medicare Advantage,117.38,,,,,,,Fee Schedule,17.73,117.3767568,
64418 - suprascapular nerve block,10452404,LOCAL,64418,CPT,,,,,,Outpatient,,,1735,693,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
64420 NERV BLK INTERCSTL NERV SNGL,5661025,LOCAL,64420,CPT,,,,,,Outpatient,,,1735,693,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
64454 Genicular block,13776911,LOCAL,64454,CPT,,,,,,Outpatient,,,1735,244,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
64461 THORACIC PARAVERTEBRAL BLOCK,13786726,LOCAL,64461,CPT,,,,,,Outpatient,,,1735,50,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
Injection Blood Patch Epidural,7633812,LOCAL,62273,CPT,,,,,,Outpatient,,,1735,971,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
LGI1 Ab QSTC,13864491,LOCAL,86255,CPT,,,,,,Outpatient,,,1738.13,14.46,United Health ,United Health Medicare Advantage,12.05,,,,,,,Fee Schedule,12.05,15.29,
PULM ANGIO DURING CORONARIES,8230012,LOCAL,93568,CPT,,,,,,Outpatient,,,1744,1134,United Health ,United Health Medicare Advantage,37.1,,,,,,,Fee Schedule,37.1,863,
92960 ELEC CARDIOVERSION/DEFIBRILATION OP Tech Fee,7969852,LOCAL,92960,CPT,,,,,,Outpatient,,,1759.91,1144,United Health ,United Health Medicare Advantage,598.27,,,,,,,Fee Schedule,598.27,1291,
Perc Cor Stent-Drug Eluding LD,4221012,LOCAL,92960,CPT,,,,,,Outpatient,,,1759.91,1144,United Health ,United Health Medicare Advantage,598.27,,,,,,,Fee Schedule,598.27,1291,
10030 FLUID DRAIN SOFT TIS PERC GUID,8266849,LOCAL,10030,CPT,,,,,,Outpatient,,,1760,704,United Health ,United Health Medicare Advantage,643.26,,,,,,,Fee Schedule,643.26,1605.05,
NM Thyroid Uptake Single/Multi,2426011,LOCAL,78014,CPT,,,,,,Outpatient,,,1775.09,952.05,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,560.96,
NM Thyroid w/ Uptake Single,12109219,LOCAL,78014,CPT,A9516,HCPCS,,,,Outpatient,,,1775.09,952.05,United Health ,United Health Medicare Advantage,482.33,,,,,,,Fee Schedule,482.3325,560.96,
NUSHIELD 1.6CM DISC,13962586,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,1777.5,1155,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
MG Surgical Specimen,9437784,LOCAL,76098,CPT,,,,,,Outpatient,,,1778.77,953.7,United Health ,United Health Medicare Advantage,501.29,,,,,,,Fee Schedule,176.48,501.29,
GASTROSTOMY TUBE REPLACEMENT,8200253,LOCAL,49450,CPT,,,,,,Outpatient,,,1793.73,1166,United Health ,United Health Medicare Advantage,857.17,,,,,,,Fee Schedule,857.17,1496,
JEJUNOSTOMY REPLACEMENT PERC,8200252,LOCAL,49451,CPT,,,,,,Outpatient,,,1793.73,1166,United Health ,United Health Medicare Advantage,857.17,,,,,,,Fee Schedule,857.17,1496,
Critical Care Ill/Injured Patient Init 30-74 Min 99291,2389455,LOCAL,99291,CPT,,,,,25,Outpatient,,,1816.43,1181,United Health ,United Health Medicare Advantage,770.36,,,,,,,Fee Schedule,770.36,770.36,
"13132 -Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet;",14751269,LOCAL,13132,CPT,,,,,,Outpatient,,,1830,612,United Health ,United Health Medicare Advantage,559.65,,,,,,,Fee Schedule,559.65,863,
NM Myocardial Planar Single Study,2425978,LOCAL,78481,CPT,A9500,HCPCS,,,,Outpatient,,,1832.02,982.58,United Health ,United Health Medicare Advantage,492.12,,,,,,,Fee Schedule,492.12,560.96,
MRI Breast w/o Contrast Left.,9386272,LOCAL,77046,CPT,,,,,LT,Outpatient,,,1833.89,983.4,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Breast w/o Contrast Right.,9386275,LOCAL,77046,CPT,,,,,RT,Outpatient,,,1833.89,983.4,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
CULL US OB Greater Than 14 Wks Add'l Gest,13579115,LOCAL,76810,CPT,,,,,,Outpatient,,,1847.31,990.83,United Health ,United Health Medicare Advantage,36.14,,,,,,,Fee Schedule,36.14,148.61,
US OB Greater Than 14 Weeks Multi,8108499,LOCAL,76810,CPT,,,,,,Outpatient,,,1847.31,990.83,United Health ,United Health Medicare Advantage,36.14,,,,,,,Fee Schedule,36.14,148.61,
NM Tumor Loc Limited,1169410,LOCAL,78800,CPT,,,,,,Outpatient,,,1850.54,783.75,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,1409.71,
NM Tumor Loc Multiple Areas,1169412,LOCAL,78801,CPT,,,,,,Outpatient,,,1850.54,2895.75,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,1409.71,
PARACENTESIS ABDOMINAL WITH IMAGING,8267134,LOCAL,49083,CPT,,,,,,Outpatient,,,1857.81,1208,United Health ,United Health Medicare Advantage,857.17,,,,,,,Fee Schedule,857.17,1496,
NM Cardiac MUGA,1169208,LOCAL,78472,CPT,A9512,HCPCS,,,,Outpatient,,,1861.6,998.25,United Health ,United Health Medicare Advantage,1118.05,,,,,,,Fee Schedule,560.96,1118.045,
Meningitis Panel (BioFire),7909558,LOCAL,87483,CPT,,,,,,Outpatient,,,1875.71,500.14,United Health ,United Health Medicare Advantage,416.78,,,,,,,Fee Schedule,158.39,416.78,
PLACE ART 1ST ABD & BELOW,8267112,LOCAL,36245,CPT,,,,,,Outpatient,,,1882.73,1224,United Health ,United Health Medicare Advantage,191.24,,,,,,,Fee Schedule,191.24,929.12,
GRAFIX PRIME 16MM,13962570,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,1883.25,3671,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
PLACE ART 1ST THORAC/BRAC,8267108,LOCAL,36215,CPT,,,,,,Outpatient,,,1917.07,1246,United Health ,United Health Medicare Advantage,175.13,,,,,,,Fee Schedule,175.13,929.12,
PLACE ART 2ND THORAC/BRAC,8267109,LOCAL,36216,CPT,,,,,,Outpatient,,,1917.07,1246,United Health ,United Health Medicare Advantage,222.85,,,,,,,Fee Schedule,222.85,929.12,
PLACE ART 3RD THORAC/BRAC,8267110,LOCAL,36217,CPT,,,,,,Outpatient,,,1917.07,1246,United Health ,United Health Medicare Advantage,273.71,,,,,,,Fee Schedule,273.71,929.12,
NM Lung Vent/Perf Imaging,2425966,LOCAL,78582,CPT,A9540,HCPCS,,,,Outpatient,,,1919.6,1029.6,United Health ,United Health Medicare Advantage,492.12,,,,,,,Fee Schedule,492.12,1409.71,
PLACE ART 3RD ABD & BELOW,8267114,LOCAL,36247,CPT,,,,,,Outpatient,,,1927.08,1253,United Health ,United Health Medicare Advantage,240.87,,,,,,,Fee Schedule,240.87,929.12,
NM Lymphoscintigraphy Injection/Scan,1169292,LOCAL,78195,CPT,,,,,,Outpatient,,,1928.84,1034.55,United Health ,United Health Medicare Advantage,492.12,,,,,,,Fee Schedule,492.12,1409.71,
Alpha-Globin Gene Deletion/Dupl. QSTC,13864435,LOCAL,81269,CPT,,,,,,Outpatient,,,1940.63,242.88,United Health ,United Health Medicare Advantage,202.4,,,,,,,Fee Schedule,173.68,202.4,
NM Kidney Imaging Single w/o Pharm,1169264,LOCAL,78707,CPT,A9562,HCPCS,,,,Outpatient,,,1959.43,1051.05,United Health ,United Health Medicare Advantage,492.12,,,,,,,Fee Schedule,492.12,560.96,
REF HLA Antibody ID,13479161,LOCAL,86830,CPT,,,,,,Outpatient,,,1962,114.62,United Health ,United Health Medicare Advantage,95.52,,,,,,,Fee Schedule,38.27,95.52,
PERICARDIOCENTESIS INITIAL,8230050,LOCAL,33016,CPT,,,,,,Outpatient,,,1966.67,1278,United Health ,United Health Medicare Advantage,1420.25,,,,,,,Fee Schedule,1291,1420.25,
REMOVAL BILIARY DRAIN CATH,8200538,LOCAL,47537,CPT,,,,,,Outpatient,,,1966.67,1278,United Health ,United Health Medicare Advantage,857.17,,,,,,,Fee Schedule,291.97,1496,
"Apolipoprotein E Isoform, CSF QST",12677744,LOCAL,82542,CPT,,,,,,Outpatient,,,1975.5,28.91,United Health ,United Health Medicare Advantage,24.09,,,,,,,Fee Schedule,17.73,24.09,
KERECIS OMEGA 3 - DISK 14MM,13962582,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,1975.5,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
CULL Selective Add'l Vessel S&I,13635231,LOCAL,75774,CPT,,,,,,Outpatient,,,1975.99,1059.3,United Health ,United Health Medicare Advantage,44.32,,,,,,,Fee Schedule,44.32,6018.68,
SELECTIVE ADD'L VESSEL S&I,8210640,LOCAL,75774,CPT,,,,,,Outpatient,,,1975.99,1059.3,United Health ,United Health Medicare Advantage,44.32,,,,,,,Fee Schedule,44.32,6018.68,
CATH PLACE LT RT PA,8267103,LOCAL,36014,CPT,,,,,,Outpatient,,,1986.67,1291,United Health ,United Health Medicare Advantage,121.59,,,,,,,Fee Schedule,121.59,929.12,
remdesivir 100 mg Injection [CULL],11201128,LOCAL,J0248,CPT,,,,,,Outpatient,1,EA,1996.8,,United Health ,United Health Medicare Advantage,6.73,,,,,,,Fee Schedule,6.73,771.25,
ECHO LIMITED WITH CONTRAST,8200178,LOCAL,,,C8924,HCPCS,,,,Outpatient,,,2022.58,1315,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,678.38,
US Echo 2D Limited w/ Contrast,7936274,LOCAL,93308,CPT,C8924,HCPCS,,,,Outpatient,,,2022.58,564,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,678.38,
".MOG Ab, CBA, Serum QSTC",10274091,LOCAL,86362,CPT,,,,,,Outpatient,,,2025,14.46,United Health ,United Health Medicare Advantage,12.05,,,,,,,Fee Schedule,12.05,15.29,
"Myelin Oligodendrocyte Glycoprotein w/Rfx Titer, Serum QSTC",12613098,LOCAL,86362,CPT,,,,,,Outpatient,,,2025,14.46,United Health ,United Health Medicare Advantage,12.05,,,,,,,Fee Schedule,12.05,15.29,
PURAPLY AM COMMERCIAL 1.6CM DISC,13962603,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,2025,3861,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
36589 - Removal of tunneled central venous catheter,12431092,LOCAL,36589,CPT,,,,,,Outpatient,,,2025.12,1316,United Health ,United Health Medicare Advantage,565.25,,,,,,,Fee Schedule,565.25,1291,
37253 Invasc US Each Addl Vessel,8230057,LOCAL,37253,CPT,,,,,,Outpatient,,,2035,1323,United Health ,United Health Medicare Advantage,57.61,,,,,,,Fee Schedule,57.61,2669.67,
"64449 N BLOCK INJ, LUMBAR PLEXUS",8882246,LOCAL,64449,CPT,,,,,,Outpatient,,,2035,890,United Health ,United Health Medicare Advantage,813.96,,,,,,,Fee Schedule,813.96,1695.82,
"CRMP5/CV2 Ab, LB QSTC",13873513,LOCAL,84182,CPT,,,,,,Outpatient,,,2036.25,35.05,United Health ,United Health Medicare Advantage,29.21,,,,,,,Fee Schedule,15.29,29.21,
"GAD65 Ab, LB QSTC",13873519,LOCAL,86341,CPT,,,,,,Outpatient,,,2036.25,28.28,United Health ,United Health Medicare Advantage,23.57,,,,,,,Fee Schedule,15.29,23.57,
tocilizumab 20 mg/mL Sol 4 mL [CULL],11260558,LOCAL,J3262,CPT,,,,,,Outpatient,4,ML,2039.6544,,United Health ,United Health Medicare Advantage,5.71,,,,,,,Fee Schedule,5.71,1641.22,
92953 TRANSCUTANEOUS PACING TechFee,8057710,LOCAL,92953,CPT,,,,,,Outpatient,,,2060.2,1339,United Health ,United Health Medicare Advantage,598.27,,,,,,,Fee Schedule,598.27,1291,
92953-Temp transcutaneous pacing Charge,8212036,LOCAL,92953,CPT,,,,,,Outpatient,,,2060.2,1339,United Health ,United Health Medicare Advantage,598.27,,,,,,,Fee Schedule,598.27,1291,
EXTERNAL PACER,4221033,LOCAL,92953,CPT,,,,,,Outpatient,,,2060.2,1339,United Health ,United Health Medicare Advantage,598.27,,,,,,,Fee Schedule,598.27,1291,
NM Testicular Imaging w/ Vasc Flow,8733473,LOCAL,78761,CPT,A9512,HCPCS,,,,Outpatient,,,2063.03,1106.33,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,560.96,
11750 EXCISION NAIL MATRIX PERMANENT CHARGE,9303447,LOCAL,11750,CPT,,,,,,Outpatient,,,2064.41,1342,United Health ,United Health Medicare Advantage,365.27,,,,,,,Fee Schedule,365.27,863,
33967 Insertion Intra-aortic Percutaneous Device Charge,8211150,LOCAL,33967,CPT,,,,,,Outpatient,,,2102.51,1367,United Health ,United Health Medicare Advantage,205.15,,,,,,,Fee Schedule,205.15,12132.94,
KERECIS OMEGA 3 - 3 X 3.5CM,13962577,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,2106,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
ibutilide 0.1 mg/mL intravenous solution 10 mL [CULL],11201842,LOCAL,J1742,CPT,,,,,,Outpatient,10,ML,2107.584,,United Health ,United Health Medicare Advantage,172.31,,,,,,,Fee Schedule,172.31,233.26,
NM Hepatobiliary Imaging w/ Drug,2425957,LOCAL,78226,CPT,A9537,HCPCS,,,,Outpatient,,,2134.97,567.6,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,560.96,
NM Hepatobiliary Imaging w/ EF,12894248,LOCAL,78227,CPT,A9537,HCPCS,,,,Outpatient,,,2134.97,1145.1,United Health ,United Health Medicare Advantage,1384.56,,,,,,,Fee Schedule,560.96,1384.5568,
VENOGRAM BILATERAL EXT S&I,8211110,LOCAL,75822,CPT,,,,,,Outpatient,,,2159,1157.48,United Health ,United Health Medicare Advantage,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
XR Venogram Extremity Bilateral,13085158,LOCAL,75822,CPT,,,,,,Outpatient,,,2159,1157.48,United Health ,United Health Medicare Advantage,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
NUSHIELD 1.6CM DISC,10510071,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,2172.5,1155,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
64633 DESTR FACET CERV/THOR SNG LVL,5661057,LOCAL,64633,CPT,,,,,,Outpatient,,,2179,1416,United Health ,United Health Medicare Advantage,1785.34,,,,,,,Fee Schedule,1250.53,2315,
64635 DESTR FACET LUM/SAC SINGLE LVL,5661055,LOCAL,64635,CPT,,,,,,Outpatient,,,2179,1416,United Health ,United Health Medicare Advantage,1785.34,,,,,,,Fee Schedule,1250.53,2315,
93567 Inj Supra Aortography,8230011,LOCAL,93567,CPT,,,,,,Outpatient,,,2187.66,1422,United Health ,United Health Medicare Advantage,29.54,,,,,,,Fee Schedule,29.54,863,
NM Gastric Emptying Study,1169236,LOCAL,78264,CPT,,,,,,Outpatient,,,2193.29,1176.45,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,560.96,
NM Bone Spect,1169188,LOCAL,78803,CPT,,,,,,Outpatient,,,2202.35,1181.4,United Health ,United Health Medicare Advantage,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
APPLY SKIN SUB 1ST 255Q CM LEG UP TO 100,13531303,LOCAL,15271,CPT,,,,,25,Outpatient,,,2221.65,1092,United Health ,United Health Medicare Advantage,1672.39,,,,,,,Fee Schedule,1496,2862.92,
CT Ankle w/o Contrast Left,1167903,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Ankle w/o Contrast Right,1167905,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Clavicle w/o Contrast Left,12885310,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Clavicle w/o Contrast Right,12885313,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Elbow w/o Contrast Left,1168002,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Elbow w/o Contrast Right,1168004,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Femur w/o Contrast Left,8202922,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Femur w/o Contrast Right,8202924,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Foot w/o Contrast Left,1168040,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Foot w/o Contrast Right,1168042,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Forearm w/o Contrast Left,8202950,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Forearm w/o Contrast Right,8202952,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Hand w/o Contrast Left,1168086,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Hand w/o Contrast Right,1168088,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Hip w/o Contrast Left,1168116,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Hip w/o Contrast Right,1168118,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Humerus w/o Contrast Left,8202997,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Humerus w/o Contrast Right,8202999,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Knee w/o Contrast Left,1168158,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Knee w/o Contrast Right,1168160,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Shoulder w/o Contrast Left,1168220,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Shoulder w/o Contrast Right,1168222,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Tibia/Fibula w/o Contrast Left,8203045,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Tibia/Fibula w/o Contrast Right,8203047,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Wrist w/o Contrast Left,1168341,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Wrist w/o Contrast Right,1168343,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Angio Abdomen Aorta + Iliofemoral,1167851,LOCAL,75635,CPT,,,,,,Outpatient,,,2242.64,1202.85,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,565.59,
37252 Invasc US Initial Vessel,8230056,LOCAL,37252,CPT,,,,,,Outpatient,,,2252.25,1464,United Health ,United Health Medicare Advantage,72.79,,,,,,,Fee Schedule,72.79,2669.67,
15277 App Skin Sub Graft(TWSA>100cm2 f/a/h-ft diag add 100 cm2,12635466,LOCAL,15277,CPT,,,,,,Outpatient,,,2263.33,1471,United Health ,United Health Medicare Advantage,1672.39,,,,,,,Fee Schedule,1496,2862.92,
93312 TEE 2D MM COMPLETE WO CHARGE,8200160,LOCAL,93312,CPT,,,,,,Outpatient,,,2279.37,1482,United Health ,United Health Medicare Advantage,501.29,,,,,,,Fee Schedule,501.29,678.38,
US Echo Transesophageal,7936283,LOCAL,93312,CPT,,,,,,Outpatient,,,2279.37,1482,United Health ,United Health Medicare Advantage,501.29,,,,,,,Fee Schedule,501.29,678.38,
G0278-CL ILIAC/FEM ANGIO FOR CLOSURE Charge,8212025,LOCAL,,,G0278,HCPCS,,,,Outpatient,,,2301.79,1496,United Health ,United Health Medicare Advantage,10.66,,,,,,,Fee Schedule,10.66,6018.68,
NM Gastric Emptying w/ SB,10110882,LOCAL,78265,CPT,,,,,,Outpatient,,,2302.29,1234.2,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,560.96,
onabotulinumtoxinA 100 units injection [CULL],11212323,LOCAL,J0585,CPT,,,,,,Outpatient,1,EA,2307.84,,United Health ,United Health Medicare Advantage,6.5,,,,,,,Fee Schedule,6.5,771.25,
MRI Brachial Plexus w/o Contrast Lt,8784911,LOCAL,73221,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Brachial Plexus w/o Contrast Rt,8784914,LOCAL,73221,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Clavicle w/o Contrast Left,9647312,LOCAL,71550,CPT,,,,,LT,Outpatient,,,2317.56,1765.5,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Clavicle w/o Contrast Right,9647315,LOCAL,71550,CPT,,,,,RT,Outpatient,,,2317.56,1765.5,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Fingers w/o Contrast Left,8513078,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Fingers w/o Contrast Right,8513081,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Forearm w/o Contrast Lt,8058719,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Forearm w/o Contrast Rt,8058722,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Hand w/o Contrast Left,1168930,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Hand w/o Contrast Right,1168932,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Humerus w/o Contrast Left,8203080,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Humerus w/o Contrast Right,8203082,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Scapula w/o Contrast Left,9647339,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Scapula w/o Contrast Right,9647342,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRA Neck w/o Contrast,1168683,LOCAL,70547,CPT,,,,,,Outpatient,,,2317.57,1242.45,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,729.93,
KERECIS OMEGA 3 - DISK 16MM,13962584,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,2331,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRA Pelvis w/o Contrast,1168691,LOCAL,72198,CPT,,,,,,Outpatient,,,2338.16,1767.15,United Health ,United Health Medicare Advantage,222.29,,,,,,,Fee Schedule,220.99,729.93,
MRA Pelvis w/o Contrast,1168691,LOCAL,C8919,CPT,,,,,,Outpatient,,,2338.16,,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,729.93,
XR Myelogram Cervical Spine,1170319,LOCAL,62302,CPT,,,,,,Outpatient,,,2349.36,1527,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,722.32,1291,
XR Myelogram Thoracic Spine,1170327,LOCAL,62303,CPT,,,,,,Outpatient,,,2349.36,1527,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,722.32,1291,
MRI Spine Thoracic w/o Contrast,1169066,LOCAL,72146,CPT,,,,,,Outpatient,,,2365.31,1268.03,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
ILR REMOVAL,8267777,LOCAL,33286,CPT,,,,,,Outpatient,,,2381.18,1548,United Health ,United Health Medicare Advantage,643.26,,,,,,,Fee Schedule,643.26,2484.2,
CT Spine Lumbar w/o Contrast,1168246,LOCAL,72131,CPT,,,,,,Outpatient,,,2398.23,1286.18,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
NM Bone Three Phase Study Injection/Scan,1169190,LOCAL,78315,CPT,,,,,,Outpatient,,,2428.11,1301.85,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,560.96,
36002 Pseudoanrsm Repair W Thrombin Us Gud,8212049,LOCAL,36002,CPT,,,,,,Outpatient,,,2429.28,1579,United Health ,United Health Medicare Advantage,565.25,,,,,,,Fee Schedule,565.25,1291,
AV FISTULAGRAM S&I,8210332,LOCAL,36901,CPT,,,,,,Outpatient,,,2442.76,1588,United Health ,United Health Medicare Advantage,1420.25,,,,,,,Fee Schedule,1420.25,2669.67,
"CRMP5/CV2 Ab, LB, CSF QSTC",13873605,LOCAL,84182,CPT,,,,,,Outpatient,,,2443.5,35.05,United Health ,United Health Medicare Advantage,29.21,,,,,,,Fee Schedule,15.29,29.21,
"GAD65 Ab, LB, CSF QSTC",13873611,LOCAL,86341,CPT,,,,,,Outpatient,,,2443.5,28.28,United Health ,United Health Medicare Advantage,23.57,,,,,,,Fee Schedule,15.29,23.57,
INTERNAL MAMMARY S&I,8210631,LOCAL,75756,CPT,,,,,,Outpatient,,,2455.14,1316.7,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
PULMONARY NONSELECTIVE S&I,8210620,LOCAL,75746,CPT,,,,,,Outpatient,,,2455.14,1316.7,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
CT Angio Pelvis,1167881,LOCAL,72191,CPT,,,,,,Outpatient,,,2457.05,1317.53,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Thoracentesis w/ CT Guidance,2424869,LOCAL,77012,CPT,,,,,,Outpatient,,,2458.4,1318.35,United Health ,United Health Medicare Advantage,48.7,,,,,,,Fee Schedule,48.7,136.03,
KERECIS OMEGA 3 - 1.75 X 1.75 CM,13962574,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,2475,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
CT Neck Soft Tissue w/o Contrast,1168234,LOCAL,70490,CPT,,,,,,Outpatient,,,2479.06,1329.08,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
64450 INJECTION ANESTHETIC AGENT PERIPHERAL NE,13437921,LOCAL,64450,CPT,,,,,,Outpatient,,,2482.29,1613,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
tetanus immune globulin 250 units/mL intramuscular solution 1 mL [CULL],11212346,LOCAL,J1670,CPT,,,,,,Outpatient,1,ML,2492.8,,United Health ,United Health Medicare Advantage,593,,,,,,,Fee Schedule,525.49,593,
CT Ankle w/ Contrast Left,1167897,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Ankle w/ Contrast Right,1167899,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Clavicle w/ Contrast Left,12885304,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Clavicle w/ Contrast Right,12885307,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Elbow w/ Contrast Left,1167996,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Elbow w/ Contrast Right,1167998,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Femur w/ Contrast Left,8202918,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Femur w/ Contrast Right,8202920,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Foot w/ Contrast Left,1168034,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Foot w/ Contrast Right,1168036,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Forearm w/ Contrast Left,8202943,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Forearm w/ Contrast Right,8202945,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Hand w/ Contrast Left,1168080,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Hand w/ Contrast Right,1168082,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Hip w/ Contrast Left,1168110,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hip w/ Contrast Right,1168112,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Humerus w/ Contrast Left,8202990,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Humerus w/ Contrast Right,8202992,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Knee w/ Contrast Left,1168152,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Knee w/ Contrast Right,1168154,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Shoulder w/ Contrast Left,1168214,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Shoulder w/ Contrast Right,1168216,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Tibia/Fibula w/ Contrast Left,8203041,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Tibia/Fibula w/ Contrast Right,8203043,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Wrist w/ Contrast Left,1168335,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Wrist w/ Contrast Right,1168337,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
64454 - Injection of anesthetic agent into genicular nerve branches including imaging guidance.,14144343,LOCAL,64454,CPT,,,,,,Outpatient,,,2500,244,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
"64624 Destruction by neurolytic agent, genicular nerve branches",9487180,LOCAL,64624,CPT,,,,,,Outpatient,,,2500,926,United Health ,United Health Medicare Advantage,1785.34,,,,,,,Fee Schedule,1695.82,2315,
64421 NERVE BLOCK INTERCOSTAL MULTIPLE NERVES,5661026,LOCAL,64421,CPT,,,,,,Outpatient,,,2501.54,890,United Health ,United Health Medicare Advantage,813.96,,,,,,,Fee Schedule,813.96,1695.82,
15273 ACELLULAR DERM REPL LTH 100 SQ CM,8716218,LOCAL,15273,CPT,,,,,,Outpatient,,,2508.54,1631,United Health ,United Health Medicare Advantage,3347.08,,,,,,,Fee Schedule,2599,3347.08,
PRIMATRIX 3X3,13962595,LOCAL,,,Q4110,HCPCS,,,,Outpatient,,,2528.69,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
dimethyl sulfoxide 50% irrigation solution 50 mL [CULL],11205390,LOCAL,J1212,CPT,,,,,,Outpatient,50,ML,2541.664,,United Health ,United Health Medicare Advantage,748.85,,,,,,,Fee Schedule,525.49,748.85,
INJ PERC CHOL W EXIS CATH,8210336,LOCAL,47531,CPT,,,,,,Outpatient,,,2566.23,298,United Health ,United Health Medicare Advantage,3226.48,,,,,,,Fee Schedule,2599,3226.48,
MRI Elbow w/o Contrast Left,1168848,LOCAL,73221,CPT,,,,,LT,Outpatient,,,2584.17,1242.45,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Elbow w/o Contrast Right,1168850,LOCAL,73221,CPT,,,,,RT,Outpatient,,,2584.17,1242.45,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Shoulder w/o Contrast Left,1169044,LOCAL,73221,CPT,,,,,LT,Outpatient,,,2584.17,1242.45,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Shoulder w/o Contrast Right,1169046,LOCAL,73221,CPT,,,,,RT,Outpatient,,,2584.17,1242.45,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Wrist w/o Contrast Left,1169140,LOCAL,73221,CPT,,,,,LT,Outpatient,,,2584.17,1242.45,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Wrist w/o Contrast Right,1169142,LOCAL,73221,CPT,,,,,RT,Outpatient,,,2584.17,1242.45,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
ASPIRATION / INJECTION OF RENAL PELVIS,8210655,LOCAL,50390,CPT,,,,,,Outpatient,,,2587.86,1682,United Health ,United Health Medicare Advantage,643.26,,,,,,,Fee Schedule,555.55,1291,
MRI Femur w/o Contrast Lt,8058707,LOCAL,73718,CPT,,,,,LT,Outpatient,,,2591.03,1389.3,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Femur w/o Contrast Rt,8058710,LOCAL,73718,CPT,,,,,RT,Outpatient,,,2591.03,1389.3,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Foot w/o Contrast Left,1168890,LOCAL,73718,CPT,,,,,LT,Outpatient,,,2591.03,1389.3,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Foot w/o Contrast Right,1168892,LOCAL,73718,CPT,,,,,RT,Outpatient,,,2591.03,1389.3,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Tibia/Fibula w/o Contrast Left,8206789,LOCAL,73718,CPT,,,,,LT,Outpatient,,,2591.03,1389.3,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Tibia/Fibula w/o Contrast Right,8206791,LOCAL,73718,CPT,,,,,RT,Outpatient,,,2591.03,1389.3,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRA Neck w/ Contrast,1168681,LOCAL,70548,CPT,,,,,,Outpatient,,,2591.04,1389.3,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,729.93,
AMNIOEXCEL SKIN SUBSTITUTE 18MM,13962552,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,2593.13,3028,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
LENS TORIC #SA6AT4,4853560,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,2596,410,United Health ,United Health Medicare Advantage,145.73,,,,,,,Fee Schedule,145.73,145.73,
LENS TORIC ABSORBING SA6AT5,4853594,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,2596,410,United Health ,United Health Medicare Advantage,145.73,,,,,,,Fee Schedule,145.73,145.73,
IR Venogram Cava Superior1,8071895,LOCAL,75827,CPT,,,,,,Outpatient,,,2596.75,1392.6,United Health ,United Health Medicare Advantage,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
SUPERIOR VENA CAVA S&I,8210670,LOCAL,75827,CPT,,,,,,Outpatient,,,2596.75,1392.6,United Health ,United Health Medicare Advantage,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
VENOGRAM UNILATERAL EXT S&I,8211100,LOCAL,75820,CPT,,,,,,Outpatient,,,2596.75,1392.6,United Health ,United Health Medicare Advantage,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
XR Venogram Extremity Left,8115647,LOCAL,75820,CPT,,,,,LT,Outpatient,,,2596.75,1392.6,United Health ,United Health Medicare Advantage,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
XR Venogram Extremity Right,8115650,LOCAL,75820,CPT,,,,,RT,Outpatient,,,2596.75,1392.6,United Health ,United Health Medicare Advantage,1420.25,,,,,,,Fee Schedule,1231.66,1420.25,
Procedure Performed. -> Paracentesis,9739222,LOCAL,49082,CPT,,,,,,Outpatient,,,2601.5,1691,United Health ,United Health Medicare Advantage,857.17,,,,,,,Fee Schedule,857.17,1496,
MRA Pelvis w/ Contrast,1168689,LOCAL,72198,CPT,,,,,,Outpatient,,,2611.62,1767.15,United Health ,United Health Medicare Advantage,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Pelvis w/ Contrast,1168689,LOCAL,C8918,CPT,,,,,,Outpatient,,,2611.62,,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,222.29,729.93,
NM Bone Imaging Whole Body Injection,1169180,LOCAL,78306,CPT,,,,,,Outpatient,,,2623.86,1407.45,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,560.96,
CT Angio Lower Extremity Bilateral,8058637,LOCAL,73706,CPT,,,,,,Outpatient,,,2637.85,1414.88,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Lower Extremity Left,1167875,LOCAL,73706,CPT,,,,,LT,Outpatient,,,2637.85,1414.88,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Lower Extremity Right,1167877,LOCAL,73706,CPT,,,,,RT,Outpatient,,,2637.85,1414.88,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,565.59,
MRI Spine Thoracic w/ Contrast,1169064,LOCAL,72147,CPT,,,,,,Outpatient,,,2638.77,1414.88,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
AMNIOEXCEL PLUS 17MM,13962547,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,2639.25,3028,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
C8925 TEE COMPLETE 2D WWO CHARGE,8200184,LOCAL,,,C8925,HCPCS,,,,Outpatient,,,2643.51,1718,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,678.38,722.32,
ECHO COMPLETE WITH DOP/CONTRAST,8200176,LOCAL,,,C8929,HCPCS,,,,Outpatient,,,2643.51,1718,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,678.38,722.32,
US Echo Doppler Complete w/ Contrast,13780988,LOCAL,93306,CPT,C8929,HCPCS,,,,Outpatient,,,2643.51,1036,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,678.38,722.32,
95805 MAINTENANCE OF WAKEFULNESS CHARGE,9569825,LOCAL,95805,CPT,,,,,,Outpatient,,,2652.34,1724,United Health ,United Health Medicare Advantage,485.11,,,,,,,Fee Schedule,485.11,1113.98,
95805 MSLT CHARGES,8795717,LOCAL,95805,CPT,,,,,,Outpatient,,,2652.34,1724,United Health ,United Health Medicare Advantage,485.11,,,,,,,Fee Schedule,485.11,1113.98,
95805 MSLT/MWT CHARGES,9442365,LOCAL,95805,CPT,,,,,,Outpatient,,,2652.34,1724,United Health ,United Health Medicare Advantage,485.11,,,,,,,Fee Schedule,485.11,1113.98,
".MOG Ab, Titer QSTC",13864468,LOCAL,86362,CPT,,,,,,Outpatient,,,2653.38,14.46,United Health ,United Health Medicare Advantage,12.05,,,,,,,Fee Schedule,12.05,15.29,
PURAPLY AM 2X2 COMMERCIAL 4SQ CM,13962597,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,2664,3861,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
CT Spine Lumbar w/ Contrast,1168244,LOCAL,72132,CPT,,,,,,Outpatient,,,2671.69,1433.03,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
MRA Brain/Head w/o Contrast,1168653,LOCAL,70544,CPT,,,,,,Outpatient,,,2690.84,1442.93,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,729.93,
MRA Lower Extremity w/ + w/o Cnt Left,1168663,LOCAL,73725,CPT,,,,,LT,Outpatient,,,2690.84,1442.93,United Health ,United Health Medicare Advantage,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Lower Extremity w/ + w/o Cnt Right,1168665,LOCAL,73725,CPT,,,,,RT,Outpatient,,,2690.84,1442.93,United Health ,United Health Medicare Advantage,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRV Head w/o Contrast,8450965,LOCAL,70544,CPT,,,,,,Outpatient,,,2690.84,1442.93,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,729.93,
CT Clavicle w/ + w/o Contrast Left,12885298,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Clavicle w/ + w/o Contrast Right,12885301,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Elbow w/ + w/o Contrast Left,8202901,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Elbow w/ + w/o Contrast Right,8202903,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Forearm w/ + w/o Contrast Left,8202936,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Forearm w/ + w/o Contrast Right,8202938,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hand w/ + w/o Contrast Left,8202957,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hand w/ + w/o Contrast Right,8202959,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Humerus w/ + w/o Contrast Left,8202983,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Humerus w/ + w/o Contrast Right,8202985,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Shoulder w/ + w/o Contrast Left,8203023,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Shoulder w/ + w/o Contrast Right,8203025,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Wrist w/ + w/o Contrast Left,8203057,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Wrist w/ + w/o Contrast Right,8203059,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Spine Thoracic w/o Contrast,1168252,LOCAL,72128,CPT,,,,,,Outpatient,,,2704.58,1450.35,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Spine Cervical w/o Contrast,1168240,LOCAL,72125,CPT,,,,,,Outpatient,,,2712.02,1454.48,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Abdomen w/ Oral Contrast Only,8206354,LOCAL,74150,CPT,,,,,,Outpatient,,,2720.92,1459.43,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Abdomen w/o Contrast,1167849,LOCAL,74150,CPT,,,,,,Outpatient,,,2720.92,1459.43,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Pelvis w/ Oral Contrast Only,8206452,LOCAL,72192,CPT,,,,,,Outpatient,,,2720.92,1459.43,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Pelvis w/o Contrast,1168198,LOCAL,72192,CPT,,,,,,Outpatient,,,2720.92,1459.43,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
MRI Ankle w/o Contrast Left,1168750,LOCAL,73721,CPT,,,,,LT,Outpatient,,,2733.23,1466.03,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Ankle w/o Contrast Right,1168752,LOCAL,73721,CPT,,,,,RT,Outpatient,,,2733.23,1466.03,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Hip w/o Contrast Left,1168948,LOCAL,73721,CPT,,,,,LT,Outpatient,,,2733.23,1466.03,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Hip w/o Contrast Right,1168950,LOCAL,73721,CPT,,,,,RT,Outpatient,,,2733.23,1466.03,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Knee w/o Contrast Left,1168984,LOCAL,73721,CPT,,,,,LT,Outpatient,,,2733.23,1466.03,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Knee w/o Contrast Right,1168986,LOCAL,73721,CPT,,,,,RT,Outpatient,,,2733.23,1466.03,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Neck Soft Tissue w/ Contrast,1168232,LOCAL,70491,CPT,,,,,,Outpatient,,,2752.53,1475.93,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRA Abdomen w/o Contrast,1168639,LOCAL,74185,CPT,,,,,,Outpatient,,,2786.55,2017.13,United Health ,United Health Medicare Advantage,221.41,,,,,,,Fee Schedule,221.41,729.93,
64483 TRANS INJ LUMB/SACR-BILATERAL CHARGE,5661040,LOCAL,64483,CPT,,,,,,Outpatient,,,2788.44,1812,United Health ,United Health Medicare Advantage,813.96,,,,,,,Fee Schedule,813.96,1291,
64484 TRANS INJ LUMB/SACR EA ADD BIL CHARGE,5661049,LOCAL,64484,CPT,,,,,,Outpatient,,,2788.44,1812,United Health ,United Health Medicare Advantage,41.55,,,,,,,Fee Schedule,41.55,1250.53,
MRA Chest w/o Contrast,1168647,LOCAL,71555,CPT,,,,,,Outpatient,,,2794.75,1645.05,United Health ,United Health Medicare Advantage,220.24,,,,,,,Fee Schedule,220.24,729.93,
MRA Chest w/o Contrast,1168647,LOCAL,C8910,CPT,,,,,,Outpatient,,,2794.75,,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.24,729.93,
MRI Abdomen w/o Contrast,1168734,LOCAL,74181,CPT,,,,,,Outpatient,,,2804.32,1503.98,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI MRCP w/o Contrast,8203102,LOCAL,74181,CPT,,,,,,Outpatient,,,2804.32,1503.98,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Spine Cervical w/o Contrast,1169054,LOCAL,72141,CPT,,,,,,Outpatient,,,2804.32,1503.98,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Spine Lumbar w/o Contrast,1169060,LOCAL,72148,CPT,,,,,,Outpatient,,,2804.32,1503.98,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Brain/Head Stroke Alert,8202967,LOCAL,70450,CPT,,,,,,Outpatient,,,2816.63,1510.58,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,461.98,
CT Brain/Head w/o Contrast,1168094,LOCAL,70450,CPT,,,,,,Outpatient,,,2816.63,1510.58,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,461.98,
PLACE CENTRAL VENOUS LINE,8210290,LOCAL,36556,CPT,,,,,,Outpatient,,,2850.87,1853,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,1291,2877.63,
MRI Brachial Plexus w/ Contrast Lt,10558521,LOCAL,73222,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Brachial Plexus w/ Contrast Rt,10558524,LOCAL,73222,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Clavicle w/ Contrast Left,12912772,LOCAL,71551,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Clavicle w/ Contrast Right,12912775,LOCAL,71551,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Elbow w/ Contrast Left,1168842,LOCAL,73222,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Elbow w/ Contrast Right,1168844,LOCAL,73222,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Shoulder w/ Contrast Left,1169038,LOCAL,73222,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Shoulder w/ Contrast Right,1169040,LOCAL,73222,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Wrist w/ Contrast Left,1169134,LOCAL,73222,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Wrist w/ Contrast Right,1169136,LOCAL,73222,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,652.35,722.32,
AMNIOEXCEL SKIN SUBSTITUTE 1.5CM X 1.5CM,13962551,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,2862.09,3028,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRI Femur w/ Contrast Left,8206704,LOCAL,73719,CPT,,,,,LT,Outpatient,,,2864.49,1536.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Femur w/ Contrast Right,8206706,LOCAL,73719,CPT,,,,,RT,Outpatient,,,2864.49,1536.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Foot w/ Contrast Left,1168884,LOCAL,73719,CPT,,,,,LT,Outpatient,,,2864.49,1536.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Foot w/ Contrast Right,1168886,LOCAL,73719,CPT,,,,,RT,Outpatient,,,2864.49,1536.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Tibia/Fibula w/ Contrast Left,8206783,LOCAL,73719,CPT,,,,,LT,Outpatient,,,2864.49,1536.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Tibia/Fibula w/ Contrast Right,8206785,LOCAL,73719,CPT,,,,,RT,Outpatient,,,2864.49,1536.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Angio Chest,1167863,LOCAL,71275,CPT,,,,,,Outpatient,,,2871.32,1539.45,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,565.59,
20220 BIOPSY BONE TROC/NDL SUPERFICL CHARGE,9709066,LOCAL,20220,CPT,,,,,,Outpatient,,,2874.06,1868,United Health ,United Health Medicare Advantage,1481.32,,,,,,,Fee Schedule,923.18,1481.32,
CT Orbit Sella etc. or IAC w/o Cont,8362458,LOCAL,70480,CPT,,,,,,Outpatient,,,2874.06,1541.1,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
Antenatal Testing Type -> Non-Stress test,9848446,LOCAL,59025,CPT,,,,,,Outpatient,,,2886.2,1876,United Health ,United Health Medicare Advantage,183.92,,,,,,,Fee Schedule,183.92,863,
Non Stress Test Charge,9919812,LOCAL,59025,CPT,,,,,,Outpatient,,,2886.2,1876,United Health ,United Health Medicare Advantage,183.92,,,,,,,Fee Schedule,183.92,863,
Abeta 40 QST,13873829,LOCAL,82542,CPT,,,,,,Outpatient,,,2925,28.91,United Health ,United Health Medicare Advantage,24.09,,,,,,,Fee Schedule,17.73,24.09,
Abeta 42/40 Ratio QST,13873830,LOCAL,82172,CPT,,,,,,Outpatient,,,2925,25.31,United Health ,United Health Medicare Advantage,37.52,,,,,,,Fee Schedule,17.73,37.515,
MRI Pelvis w/o Contrast,1169028,LOCAL,72195,CPT,,,,,,Outpatient,,,2958.83,1586.48,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRA Lower Extremity w/o Contrast Left,1168675,LOCAL,73725,CPT,,,,,LT,Outpatient,,,2964.3,1442.93,United Health ,United Health Medicare Advantage,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Lower Extremity w/o Contrast Right,1168677,LOCAL,73725,CPT,,,,,RT,Outpatient,,,2964.3,1442.93,United Health ,United Health Medicare Advantage,222.29,,,,,,,Fee Schedule,222.29,729.93,
CT Angio Abdomen,1167853,LOCAL,74175,CPT,,,,,,Outpatient,,,2965.92,1590.6,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,565.59,
MRI TMJ,1169068,LOCAL,70336,CPT,,,,,,Outpatient,,,2973.87,1594.73,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Spine Thoracic w/ Contrast,1168250,LOCAL,72129,CPT,,,,,,Outpatient,,,2978.05,1597.2,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Spine Cervical w/ Contrast,1168238,LOCAL,72126,CPT,,,,,,Outpatient,,,2985.5,1601.33,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
NM Cisternography Injection,1169226,LOCAL,78630,CPT,A9548,HCPCS,,,,Outpatient,,,2985.52,1601.33,United Health ,United Health Medicare Advantage,715.29,,,,,,,Fee Schedule,715.29,1409.71,
CT Angio Brain/Head,1167871,LOCAL,70496,CPT,,,,,,Outpatient,,,2990.01,1603.8,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Upper Extremity Bilateral,8058640,LOCAL,73206,CPT,,,,,,Outpatient,,,2990.01,1603.8,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Upper Extremity Left,1167885,LOCAL,73206,CPT,,,,,LT,Outpatient,,,2990.01,1603.8,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Angio Upper Extremity Right,1167887,LOCAL,73206,CPT,,,,,RT,Outpatient,,,2990.01,1603.8,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Abdomen w/ Contrast,1167847,LOCAL,74160,CPT,,,,,,Outpatient,,,2994.38,1605.45,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Abdomen w/ Contrast + Oral,13452972,LOCAL,74160,CPT,,,,,,Outpatient,,,2994.38,1605.45,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Pelvis w/ Contrast,1168196,LOCAL,72193,CPT,,,,,,Outpatient,,,2994.38,1605.45,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Pelvis w/ Contrast + Oral,13554960,LOCAL,72193,CPT,,,,,,Outpatient,,,2994.38,1605.45,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRI Ankle w/ Contrast Left,1168744,LOCAL,73722,CPT,,,,,LT,Outpatient,,,3006.69,1612.05,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Ankle w/ Contrast Right,1168746,LOCAL,73722,CPT,,,,,RT,Outpatient,,,3006.69,1612.05,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Hip w/ Contrast Left,1168942,LOCAL,73722,CPT,,,,,LT,Outpatient,,,3006.69,1612.05,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Hip w/ Contrast Right,1168944,LOCAL,73722,CPT,,,,,RT,Outpatient,,,3006.69,1612.05,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Knee w/ Contrast Left,1168978,LOCAL,73722,CPT,,,,,LT,Outpatient,,,3006.69,1612.05,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,652.35,722.32,
MRI Knee w/ Contrast Right,1168980,LOCAL,73722,CPT,,,,,RT,Outpatient,,,3006.69,1612.05,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,652.35,722.32,
IMPLANT BREAST 360CC,4850676,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3025,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
CT Angio Neck,1167879,LOCAL,70498,CPT,,,,,,Outpatient,,,3039.77,1630.2,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,565.59,
CT Chest High Resolution,8658939,LOCAL,71250,CPT,,,,,,Outpatient,,,3049.07,1635.15,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,461.98,
CT Chest High Resolution w/o Contrast,8658939,LOCAL,71250,CPT,,,,,,Outpatient,,,3049.07,1635.15,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,461.98,
CT Chest w/o Contrast,8071395,LOCAL,71250,CPT,,,,,,Outpatient,,,3049.07,1635.15,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
CT Low Dose Lung Screening,8090304,LOCAL,71271,CPT,,,,,,Outpatient,,,3049.07,1635.15,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
MRA Abdomen w/ Contrast,1168637,LOCAL,74185,CPT,,,,,,Outpatient,,,3060.01,2017.13,United Health ,United Health Medicare Advantage,221.41,,,,,,,Fee Schedule,221.41,729.93,
MRA Chest w/ Contrast,1168645,LOCAL,71555,CPT,,,,,,Outpatient,,,3068.21,1645.05,United Health ,United Health Medicare Advantage,220.24,,,,,,,Fee Schedule,220.24,729.93,
MRA Chest w/ Contrast,1168645,LOCAL,C8909,CPT,,,,,,Outpatient,,,3068.21,,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,220.24,729.93,
MRI Abdomen w/ Contrast,1168732,LOCAL,74182,CPT,,,,,,Outpatient,,,3077.78,1650.83,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Spine Cervical w/ Contrast,1169052,LOCAL,72142,CPT,,,,,,Outpatient,,,3077.78,1650.83,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Spine Lumbar w/ Contrast,1169058,LOCAL,72149,CPT,,,,,,Outpatient,,,3077.78,1650.83,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Brain/Head w/ Contrast,1168092,LOCAL,70460,CPT,,,,,,Outpatient,,,3090.07,1657.43,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
immune globulin intravenous and subcutaneous 10% injectable solution 50 mL [CULL],11205108,LOCAL,J1561,CPT,,,,,,Outpatient,50,ML,3099.84,,United Health ,United Health Medicare Advantage,48.96,,,,,,,Fee Schedule,48.96,2110.36,
CT Maxillofacial w/o Contrast,1168186,LOCAL,70486,CPT,,,,,,Outpatient,,,3131.11,1678.88,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,170.53,
Central Line Access Type. -> Peripherally inserted central catheter (PICC),9344166,LOCAL,36569,CPT,,,,,,Outpatient,,,3141.6,2042,United Health ,United Health Medicare Advantage,1420.25,,,,,,,Fee Schedule,1291,1644.1,
CT Orbit Sella etc. or IAC w/ Cont,8362455,LOCAL,70481,CPT,,,,,,Outpatient,,,3147.52,1687.95,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
NM Tumor Loc Whole Body 2+ Days,1169416,LOCAL,78804,CPT,,,,,,Outpatient,,,3150.27,1689.6,United Health ,United Health Medicare Advantage,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
NM Tumor Loc Whole Body 2+ Days Gallium,1169418,LOCAL,78804,CPT,A9556,HCPCS,,,,Outpatient,,,3150.27,1689.6,United Health ,United Health Medicare Advantage,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
CT Ankle w/ + w/o Contrast Left,8202894,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Ankle w/ + w/o Contrast Right,8202896,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Femur w/ + w/o Contrast Left,8202914,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Femur w/ + w/o Contrast Right,8202916,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Foot w/ + w/o Contrast Left,8202926,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Foot w/ + w/o Contrast Right,8202928,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hip w/ + w/o Contrast Left,8202973,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Hip w/ + w/o Contrast Right,8202975,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Knee w/ + w/o Contrast Left,8203007,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Knee w/ + w/o Contrast Right,8203009,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Tibia/Fibula w/ + w/o Contrast Left,8203037,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Tibia/Fibula w/ + w/o Contrast Right,8203039,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CHOLECYSTOSTOMY DRAIN PLACEMENT,8267773,LOCAL,47490,CPT,,,,,,Outpatient,,,3200,2080,United Health ,United Health Medicare Advantage,3226.48,,,,,,,Fee Schedule,2599,3682.65,
"11047  Debridement Sub-Q, bone each add l 20sq cm",10013082,LOCAL,11047,CPT,,,,,,Outpatient,,,3218.96,2092,United Health ,United Health Medicare Advantage,78.26,,,,,,,Fee Schedule,78.26,1466.58,
11047 Debrid bone > 20 sq cm charge,12508109,LOCAL,11047,CPT,,,,,,Outpatient,,,3218.96,2092,United Health ,United Health Medicare Advantage,78.26,,,,,,,Fee Schedule,78.26,1466.58,
CT Guided Perc Drain/Placement,7936217,LOCAL,75989,CPT,,,,,,Outpatient,,,3232.87,618.75,United Health ,United Health Medicare Advantage,50.75,,,,,,,Fee Schedule,50.75,262.79,
XR Drainage Perc Cath Placement,8058781,LOCAL,75989,CPT,,,,,,Outpatient,,,3232.87,618.75,United Health ,United Health Medicare Advantage,50.75,,,,,,,Fee Schedule,50.75,262.79,
LENS DIU450,4852298,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,3272.5,410,United Health ,United Health Medicare Advantage,145.73,,,,,,,Fee Schedule,145.73,145.73,
MRA Neck w/ + w/o Contrast,1168679,LOCAL,70549,CPT,,,,,,Outpatient,,,3274.68,1756.43,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,729.93,
MRI Brachial Plexus w/ + w/o Contrast Lt,8784905,LOCAL,73223,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Brachial Plexus w/ + w/o Contrast Rt,8784908,LOCAL,73223,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Clavicle w/ + w/o Contrast Left,9647306,LOCAL,71552,CPT,,,,,LT,Outpatient,,,3274.68,2131.8,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Clavicle w/ + w/o Contrast Right,9647309,LOCAL,71552,CPT,,,,,RT,Outpatient,,,3274.68,2131.8,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Fingers w/ + w/o Contrast Left,8513072,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Fingers w/ + w/o Contrast Right,8513075,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Forearm w/ + w/o Contrast Lt,8058713,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Forearm w/ + w/o Contrast Rt,8058716,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hand w/ + w/o Contrast Left,1168918,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hand w/ + w/o Contrast Right,1168920,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Humerus w/ + w/o Contrast Left,8203076,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Humerus w/ + w/o Contrast Right,8203078,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Scapula w/ + w/o Contrast Left,9647333,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Scapula w/ + w/o Contrast Right,9647336,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
XR Myelogram 2 or More Regions,10386814,LOCAL,62305,CPT,,,,,,Outpatient,,,3282.36,2134,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,722.32,1291,
MRI Chest w/o Contrast,1168824,LOCAL,71550,CPT,,,,,,Outpatient,,,3292.3,1765.5,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRA Pelvis w/ + w/o Contrast,1168687,LOCAL,72198,CPT,,,,,,Outpatient,,,3295.27,1767.15,United Health ,United Health Medicare Advantage,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Pelvis w/ + w/o Contrast,1168687,LOCAL,C8920,CPT,,,,,,Outpatient,,,3295.27,,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,222.29,729.93,
CT Chest w/ Contrast,8071392,LOCAL,71260,CPT,,,,,,Outpatient,,,3322.53,1782,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,162.76,
US Echo Transesophag w/ Cont,13770878,LOCAL,93312,CPT,C8925,HCPCS,,,,Outpatient,,,3329.37,1482,United Health ,United Health Medicare Advantage,722.32,,,,,,,Fee Schedule,678.38,722.32,
PERC PLEURAL INSERTION/DRAINAGE AND S&I,8230068,LOCAL,32557,CPT,,,,,,Outpatient,,,3332.77,2166,United Health ,United Health Medicare Advantage,1420.25,,,,,,,Fee Schedule,1291,1420.25,
GRAFIX PRIME 1.5 X 2CM,13962569,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,3348,3671,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 18MM,13962561,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,3350.25,1755,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
CT Spine Lumbar w/ + w/o Contrast,1168242,LOCAL,72133,CPT,,,,,,Outpatient,,,3355.34,1799.33,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
EPIFIX SKIN SUBSTITUTE 18MM,10510009,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,3359.95,1755,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
"Poliovirus 1, 3 Ab, Neutralization QSTC",13864497,LOCAL,86382,CPT,,,,,,Outpatient,,,3375,20.29,United Health ,United Health Medicare Advantage,16.91,,,,,,,Fee Schedule,15.29,16.91,
MRA Lower Extremity w/ Contrast Left,90720012,LOCAL,73725,CPT,,,,,LT,Outpatient,,,3383,1442.93,United Health ,United Health Medicare Advantage,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Lower Extremity w/ Contrast Right,90720013,LOCAL,73725,CPT,,,,,RT,Outpatient,,,3383,1442.93,United Health ,United Health Medicare Advantage,222.29,,,,,,,Fee Schedule,222.29,729.93,
MRA Upper Extremity w/ Contrast Left,90720010,LOCAL,73225,CPT,,,,,LT,Outpatient,,,3383,2038.58,United Health ,United Health Medicare Advantage,214.69,,,,,,,Fee Schedule,214.69,729.93,
MRA Upper Extremity w/ Contrast Right,90720011,LOCAL,73225,CPT,,,,,RT,Outpatient,,,3383,2038.58,United Health ,United Health Medicare Advantage,214.69,,,,,,,Fee Schedule,214.69,729.93,
MRI Face Neck Orbit w/o Contrast,1168856,LOCAL,70540,CPT,,,,,,Outpatient,,,3383.36,1814.18,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Maxillofacial w/ Contrast,1168184,LOCAL,70487,CPT,,,,,,Outpatient,,,3404.57,1825.73,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
KERECIS OMEGA 3 - 3 X 3.5 CM,13962576,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,3406.5,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
TRANSCATH EMBOLIZATION S&I,8267120,LOCAL,75894,CPT,,,,,,Outpatient,,,3428.95,1838.93,United Health ,United Health Medicare Advantage,165.4,,,,,,,Fee Schedule,165.4,262.79,
CT Neck Soft Tissue w/ + w/o Contrast,1168230,LOCAL,70492,CPT,,,,,,Outpatient,,,3436.18,1843.05,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Parathyroid 4-Phase Study,13554957,LOCAL,70492,CPT,,,,,,Outpatient,,,3436.18,1843.05,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRI Brain + IAC w/o Contrast,9427804,LOCAL,70551,CPT,,,,,,Outpatient,,,3446.61,1848,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Brain w/o Contrast,1168800,LOCAL,70551,CPT,,,,,,Outpatient,,,3446.61,1848,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
MRI Pituitary w/o Contrast,8203111,LOCAL,70551,CPT,,,,,,Outpatient,,,3446.61,1848,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
DISKOGRAM LUMBAR S & I,8299004,LOCAL,72295,CPT,,,,,,Outpatient,,,3452,1851.3,United Health ,United Health Medicare Advantage,1785.34,,,,,,,Fee Schedule,857.13,1785.34,
NM Tumor Loc Spect,1169408,LOCAL,78803,CPT,,,,,,Outpatient,,,3466,1181.4,United Health ,United Health Medicare Advantage,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
NM Tumor Loc Whole Body 1 Day,1169414,LOCAL,78802,CPT,,,,,,Outpatient,,,3466,2870.18,United Health ,United Health Medicare Advantage,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
NUSHIELD 2X3CM,13962587,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,3487.5,1155,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
28090 EXCISION GANGLION CYST FOOT,13436341,LOCAL,28090,CPT,,,,,,Outpatient,,,3532.98,2296,United Health ,United Health Medicare Advantage,1463.19,,,,,,,Fee Schedule,1463.19,3153.58,
ICD REMOVAL SC/DC LEAD TV EXTRACT,8231010,LOCAL,33244,CPT,,,,,,Outpatient,,,3541,2302,United Health ,United Health Medicare Advantage,3327.27,,,,,,,Fee Schedule,2484.2,3327.27,
MRI Elbow w/ + w/o Contrast Left,1168836,LOCAL,73223,CPT,,,,,LT,Outpatient,,,3541.3,1756.43,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Elbow w/ + w/o Contrast Right,1168838,LOCAL,73223,CPT,,,,,RT,Outpatient,,,3541.3,1756.43,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Shoulder w/ + w/o Contrast Left,1169032,LOCAL,73223,CPT,,,,,LT,Outpatient,,,3541.3,1756.43,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Shoulder w/ + w/o Contrast Right,1169034,LOCAL,73223,CPT,,,,,RT,Outpatient,,,3541.3,1756.43,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Wrist w/ + w/o Contrast Left,1169128,LOCAL,73223,CPT,,,,,LT,Outpatient,,,3541.3,1756.43,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Wrist w/ + w/o Contrast Right,1169130,LOCAL,73223,CPT,,,,,RT,Outpatient,,,3541.3,1756.43,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Femur w/ + w/o Contrast Lt,8058701,LOCAL,73720,CPT,,,,,LT,Outpatient,,,3548.14,1902.45,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Femur w/ + w/o Contrast Rt,8058704,LOCAL,73720,CPT,,,,,RT,Outpatient,,,3548.14,1902.45,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Foot w/ + w/o Contrast Left,1168878,LOCAL,73720,CPT,,,,,LT,Outpatient,,,3548.14,1902.45,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Foot w/ + w/o Contrast Right,1168880,LOCAL,73720,CPT,,,,,RT,Outpatient,,,3548.14,1902.45,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Tibia/Fibula w/ + w/o Contrast Left,8206777,LOCAL,73720,CPT,,,,,LT,Outpatient,,,3548.14,1902.45,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Tibia/Fibula w/ + w/o Contrast Right,8206779,LOCAL,73720,CPT,,,,,RT,Outpatient,,,3548.14,1902.45,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
THERASKIN 1.75 X 1.75,13962605,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,3577.5,2431,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
L3900 WHFO DYNAMIC,9856098,LOCAL,,,L3900,HCPCS,,,,Outpatient,,,3580.05,2327,United Health ,United Health Medicare Advantage,1756.7,,,,,,,Fee Schedule,1756.7,1756.7,
"L3900 Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger",9856099,LOCAL,,,L3900,HCPCS,,,,Outpatient,,,3580.05,2327,United Health ,United Health Medicare Advantage,1756.7,,,,,,,Fee Schedule,1756.7,1756.7,
11044 DEBRID BONE FIRST 20SQ CM OR < CHARGE,8019965,LOCAL,11044,CPT,,,,,,Outpatient,,,3581.67,2328,United Health ,United Health Medicare Advantage,1481.32,,,,,,,Fee Schedule,1291,1481.32,
MRI Face Neck Orbit w/ Contrast,1168854,LOCAL,70542,CPT,,,,,,Outpatient,,,3633.36,1948.65,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
bivalirudin 250 mg intravenous injection [CULL],11220339,LOCAL,J0583,CPT,,,,,,Outpatient,1,EA,3639.2608,,United Health ,United Health Medicare Advantage,0.16,,,,,,,Fee Schedule,0.157,233.26,
MRI Pelvis w/ + w/o Contrast,1169024,LOCAL,72197,CPT,,,,,,Outpatient,,,3642.47,1953.6,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Prostate w/ + w/o Contrast,4126347,LOCAL,72197,CPT,,,,,,Outpatient,,,3642.47,1953.6,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Spine Thoracic w/ + w/o Contrast,1168248,LOCAL,72130,CPT,,,,,,Outpatient,,,3661.7,1963.5,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRI Breast w/o Contrast Bilateral.,8784923,LOCAL,77047,CPT,,,,,,Outpatient,,,3667.77,1966.8,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,372.26,
CT Spine Cervical w/ + w/o Contrast,1168236,LOCAL,72127,CPT,,,,,,Outpatient,,,3669.14,1967.63,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Abdomen w/ + w/o Contrast,1167845,LOCAL,74170,CPT,,,,,,Outpatient,,,3678.03,1972.58,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
CT Pelvis w/ + w/o Contrast,1168194,LOCAL,72194,CPT,,,,,,Outpatient,,,3678.03,1972.58,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
28190 Appy Rigid Leg Cast (Professional Charge only if Provider Applies),12642333,LOCAL,28190,CPT,,,,,,Outpatient,,,3680.71,2392,United Health ,United Health Medicare Advantage,643.26,,,,,,,Fee Schedule,643.26,1291,
MRI Ankle w/ + w/o Contrast Left,1168738,LOCAL,73723,CPT,,,,,LT,Outpatient,,,3690.34,1979.18,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Ankle w/ + w/o Contrast Right,1168740,LOCAL,73723,CPT,,,,,RT,Outpatient,,,3690.34,1979.18,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hip w/ + w/o Contrast Left,1168936,LOCAL,73723,CPT,,,,,LT,Outpatient,,,3690.34,1979.18,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Hip w/ + w/o Contrast Right,1168938,LOCAL,73723,CPT,,,,,RT,Outpatient,,,3690.34,1979.18,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Knee w/ + w/o Contrast Left,1168972,LOCAL,73723,CPT,,,,,LT,Outpatient,,,3690.34,1979.18,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Knee w/ + w/o Contrast Right,1168974,LOCAL,73723,CPT,,,,,RT,Outpatient,,,3690.34,1979.18,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
IMPLANT BREAST #350-2004BC,4802098,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-3004 300cc,4801298,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-3504bc,4801299,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-4754BC,4852770,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-5504BC,4803723,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-6501BC,4805039,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST 445ML,4855517,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST GEL 700CC,4850683,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST MEMORY GEL 510CC,4853454,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT MEMORY GEL 225CC,4830332,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3690.5,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
MRA Brain/Head w/ + w/o Contrast,1168649,LOCAL,70546,CPT,,,,,,Outpatient,,,3690.84,1979.18,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,729.93,
MRI Brain + IAC w/ Contrast,9427801,LOCAL,70552,CPT,,,,,,Outpatient,,,3720.07,1994.85,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Brain w/ Contrast,1168798,LOCAL,70552,CPT,,,,,,Outpatient,,,3720.07,1994.85,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
THERASKIN 2.5 X 2.5 CM,13962606,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,3739.5,2431,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRA Abdomen w/ + w/o Contrast,1168635,LOCAL,74185,CPT,,,,,,Outpatient,,,3761.43,2017.13,United Health ,United Health Medicare Advantage,221.41,,,,,,,Fee Schedule,221.41,729.93,
MRI Abdomen w/ + w/o Contrast,1168730,LOCAL,74183,CPT,,,,,,Outpatient,,,3761.43,2017.13,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Brain/Head w/ + w/o Contrast,1168090,LOCAL,70470,CPT,,,,,,Outpatient,,,3773.72,2023.73,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
10140 DRAINAGE OF HEMATOMA,8715913,LOCAL,10140,CPT,,,,,,Outpatient,,,3775.02,2454,United Health ,United Health Medicare Advantage,1481.32,,,,,,,Fee Schedule,1481.32,1605.05,
MRA Upper Extremity w/ + w/o Cnt Left,1168704,LOCAL,73225,CPT,,,,,LT,Outpatient,,,3801.65,2038.58,United Health ,United Health Medicare Advantage,214.69,,,,,,,Fee Schedule,214.69,729.93,
MRA Upper Extremity w/ + w/o Cnt Left,1168704,LOCAL,C8936,CPT,,,,,LT,Outpatient,,,3801.65,,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,214.69,729.93,
MRA Upper Extremity w/ + w/o Cnt Right,1168707,LOCAL,73225,CPT,,,,,RT,Outpatient,,,3801.65,2038.58,United Health ,United Health Medicare Advantage,214.69,,,,,,,Fee Schedule,214.69,729.93,
MRA Upper Extremity w/ + w/o Cnt Right,1168707,LOCAL,C8936,CPT,,,,,RT,Outpatient,,,3801.65,,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,214.69,729.93,
CT Orbit Sella etc. or IAC w/ + w/o Cont,8362452,LOCAL,70482,CPT,,,,,,Outpatient,,,3831.16,2054.25,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
IMPLANT BREAST #350-2504 250CC,4801300,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3844.5,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-3501BC,4803006,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3844.5,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST 565CC,4851020,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3850,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
CT Abdomen and Pelvis w/ Oral Contrast,8206351,LOCAL,74176,CPT,,,,,,Outpatient,,,3869.45,2074.88,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,461.98,
CT Abdomen and Pelvis w/o Contrast,2424650,LOCAL,74176,CPT,,,,,,Outpatient,,,3869.45,2074.88,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,461.98,
AMNIOEXCEL SKIN SUBSTITUTE 2CM X 3CM,13962553,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,3902.85,3028,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
11404 EXCISION BENIGN LESION 3.1 CM TO 4.0 CM CHARGE,8726719,LOCAL,11404,CPT,,,,,,Outpatient,,,3913.86,2544,United Health ,United Health Medicare Advantage,1481.32,,,,,,,Fee Schedule,1481.32,1679.75,
OASIS ULTRA THIN DRESSING 7 X 10 CM,13962594,LOCAL,,,Q4124,HCPCS,,,,Outpatient,,,3937.5,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
KERECIS OMEGA 3 - 3 X 7CM,13962579,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,3960,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRI Chest w/ + w/o Contrast,1168820,LOCAL,71552,CPT,,,,,,Outpatient,,,3975.96,2131.8,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
IMPLANT BREAST #350-3754BC,4804163,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,3982,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
CT Chest High Resolution w/ + w/o Contrast,8658939,LOCAL,71270,CPT,,,,,,Outpatient,,,4006.18,2148.3,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,97.22,461.98,
CT Chest w/ + w/o Contrast,8071389,LOCAL,71270,CPT,,,,,,Outpatient,,,4006.18,2148.3,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
MRI Breast w/ + w/o Contrast Left.,8784917,LOCAL,77048,CPT,,,,,LT,Outpatient,,,4030.86,2161.5,United Health ,United Health Medicare Advantage,207.49,,,,,,,Fee Schedule,207.49,652.35,
MRI Breast w/ + w/o Contrast Left.,8784917,LOCAL,C8905,CPT,,,,,LT,Outpatient,,,4030.86,,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,207.49,652.35,
MRI Breast w/ + w/o Contrast Right.,8784920,LOCAL,77048,CPT,,,,,RT,Outpatient,,,4030.86,2161.5,United Health ,United Health Medicare Advantage,207.49,,,,,,,Fee Schedule,207.49,652.35,
MRI Breast w/ + w/o Contrast Right.,8784920,LOCAL,C8905,CPT,,,,,RT,Outpatient,,,4030.86,,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,207.49,652.35,
PACEMAKER POCKET,8210140,LOCAL,33222,CPT,,,,,,Outpatient,,,4031.48,2620,United Health ,United Health Medicare Advantage,1672.39,,,,,,,Fee Schedule,1496,2484.2,
PURAPLY AM 2X4 COMMERCIAL 8SQ CM,13962598,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,4032,3861,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
AMNIOEXCEL PLUS 2CMX2CM,13962548,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,4050,3028,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRI Face Neck Orbit w/ + w/o Contrast,1168852,LOCAL,70543,CPT,,,,,,Outpatient,,,4067.02,2181.3,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
CT Maxillofacial w/ + w/o Contrast,1168182,LOCAL,70488,CPT,,,,,,Outpatient,,,4088.22,2192.03,United Health ,United Health Medicare Advantage,162.76,,,,,,,Fee Schedule,162.76,461.98,
"64625 Radiofrequency ablation, nerves innervating the SI joint",5661090,LOCAL,64625,CPT,,,,,,Outpatient,,,4100,2665,United Health ,United Health Medicare Advantage,1785.34,,,,,,,Fee Schedule,1785.34,2315,
CT Abdomen and Pelvis w/ Contrast,2424647,LOCAL,74177,CPT,,,,,,Outpatient,,,4142.9,2221.73,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Abdomen and Pelvis w/ Contrast + Oral,13452969,LOCAL,74177,CPT,,,,,,Outpatient,,,4142.9,2221.73,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
95808 SLEEP STAGING CHARGE,13485403,LOCAL,95808,CPT,,,,,,Outpatient,,,4155.71,2701,United Health ,United Health Medicare Advantage,930.16,,,,,,,Fee Schedule,930.16,1113.98,
PRIMATRIX 4X4 MESH,13962596,LOCAL,,,Q4110,HCPCS,,,,Outpatient,,,4162.5,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
THERASKIN 2.5 X 5.1 CM,13962607,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,4167,2431,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
"Beta Amyloid 42/40 Ratio, CSF QST",13873765,LOCAL,82542,CPT,,,,,,Outpatient,,,4168.13,28.91,United Health ,United Health Medicare Advantage,24.09,,,,,,,Fee Schedule,17.73,24.09,
INSERTION OF INTRAPERITONEAL CATHETER,8267131,LOCAL,49418,CPT,,,,,,Outpatient,,,4189,2723,United Health ,United Health Medicare Advantage,3226.48,,,,,,,Fee Schedule,2599,5444.44,
US Insert Tun IP Cath Perc,10460131,LOCAL,49418,CPT,,,,,,Outpatient,,,4189,2723,United Health ,United Health Medicare Advantage,3226.48,,,,,,,Fee Schedule,2599,5444.44,
AMNIOEXCEL SKIN SUBSTITUTE 3.5CM X 3.5CM,13962554,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,4213.58,3028,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
NUSHIELD 2X3CM,10510072,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,4262.5,1155,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
NUSHIELD 2X4CM,13962588,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,4275,1155,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
MRI Breast w/ + w/o Contrast Bilateral.,8145272,LOCAL,77049,CPT,,,,,,Outpatient,,,4351.43,2333.1,United Health ,United Health Medicare Advantage,204.56,,,,,,,Fee Schedule,204.56,652.35,
IR Nephro Plcmt New Access W Cath,8267190,LOCAL,50432,CPT,,,,,,Outpatient,,,4351.75,2829,United Health ,United Health Medicare Advantage,1872.87,,,,,,,Fee Schedule,1872.87,2315,
NEPHROSTOGRAM CATHETER PLACEMENT S&I,8267190,LOCAL,50432,CPT,,,,,,Outpatient,,,4351.75,2829,United Health ,United Health Medicare Advantage,1872.87,,,,,,,Fee Schedule,1872.87,2315,
EXCHANGE NEPHROSTOMY TUBE,8212021,LOCAL,50435,CPT,,,,,,Outpatient,,,4357.87,2833,United Health ,United Health Medicare Advantage,1872.87,,,,,,,Fee Schedule,1291,2206.55,
ACTIGRAFT PRO-RD2301,10510000,LOCAL,,,G0460,HCPCS,,,,Outpatient,,,4400,,United Health ,United Health Medicare Advantage,1672.39,,,,,,,Fee Schedule,1466.58,1672.39,
MRI Brain + IAC w/ + w/o Contrast,9427798,LOCAL,70553,CPT,,,,,,Outpatient,,,4403.72,2361.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Brain w/ + w/o Contrast,1168796,LOCAL,70553,CPT,,,,,,Outpatient,,,4403.72,2361.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
MRI Pituitary w/ + w/o Contrast,8058740,LOCAL,70553,CPT,,,,,,Outpatient,,,4403.72,2361.15,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
AMNIOEXCEL SKIN SUBSTITUTE 4CM X 4CM,13962555,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,4423.23,3028,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
PULMONARY UNILATERAL S&I,8210600,LOCAL,75741,CPT,,,,,,Outpatient,,,4485,2404.88,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
VENOUS SAMPLING WO/W ANGIO,8210720,LOCAL,75893,CPT,,,,,,Outpatient,,,4485,2404.88,United Health ,United Health Medicare Advantage,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
VISCERAL S&I,8210570,LOCAL,75726,CPT,,,,,,Outpatient,,,4485,2404.88,United Health ,United Health Medicare Advantage,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
CT Angio Abdomen and Pelvis,2424686,LOCAL,74174,CPT,,,,,,Outpatient,,,4538.98,2433.75,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,565.59,
THERASKIN 2.5 X 2.5 CM,10510018,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,4570.5,2431,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
IMPLANT BREAST #350-4004BC,4803833,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,4598,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-4504BC,4841089,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,4598,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT MEMORY GEL 300CC,4852825,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,4598,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
GRAFIX PRIME 2 X 3CM,13962571,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,4612.5,3671,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
PTA URETERAL STRICTURE WITH IMAGING,8267792,LOCAL,50706,CPT,,,,,,Outpatient,,,4747.36,3086,United Health ,United Health Medicare Advantage,147.16,,,,,,,Fee Schedule,147.16,10138.5,
MRI Spine Cervical w/ + w/o Contrast,1169050,LOCAL,72156,CPT,,,,,,Outpatient,,,4747.92,2545.95,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
EPIFIX SKIN SUBSTITUTE 2 X 2 CM,13962562,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,4790.25,1755,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
CT Abdomen and Pelvis w/ + w/o Contrast,2424644,LOCAL,74178,CPT,,,,,,Outpatient,,,4826.55,2588.03,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
CT Urogram,8203051,LOCAL,74178,CPT,,,,,,Outpatient,,,4826.55,2588.03,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,461.98,
EPIFIX SKIN SUBSTITUTE 2 X 2 CM,10510011,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,4950,1755,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
NM Inflammation Loc Spect,1169158,LOCAL,78803,CPT,,,,,,Outpatient,,,5051.75,1181.4,United Health ,United Health Medicare Advantage,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
antivenin (Crotalidae equine) polyvalent intravenous injection [CULL],11250856,LOCAL,J0841,CPT,,,,,,Outpatient,1,EA,5068.8,,United Health ,United Health Medicare Advantage,1045.15,,,,,,,Fee Schedule,1045.15,11608.84,
THERASKIN 2.5 X 5.1 CM,10510019,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,5093,2431,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
tocilizumab 20 mg/mL Sol 10 mL [CULL],11260565,LOCAL,J3262,CPT,,,,,,Outpatient,10,ML,5099.1744,,United Health ,United Health Medicare Advantage,5.71,,,,,,,Fee Schedule,5.71,1641.22,
MRI Spine Thoracic w/ + w/o Contrast,1169062,LOCAL,72157,CPT,,,,,,Outpatient,,,5102.75,2736.53,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
CATH LAB INSERTION OF PLEURAL CATHETER,8230067,LOCAL,32550,CPT,,,,,,Outpatient,,,5132.46,3336,United Health ,United Health Medicare Advantage,3226.48,,,,,,,Fee Schedule,1392.67,3226.48,
95782 PEDI POLYSOMNOGRAPHY (<6YO) CHARGE,9303178,LOCAL,95782,CPT,,,,,,Outpatient,,,5141.48,3342,United Health ,United Health Medicare Advantage,930.16,,,,,,,Fee Schedule,930.16,1113.98,
95810 POLYSOMNOGRAPHY CHARGE.,8303749,LOCAL,95810,CPT,,,,,,Outpatient,,,5141.48,3342,United Health ,United Health Medicare Advantage,930.16,,,,,,,Fee Schedule,930.16,1113.98,
NUSHIELD 2X4CM,10510073,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,5225,1155,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
NM Cardiac Amyloid PYP Spect,9955566,LOCAL,78803,CPT,A9538,HCPCS,,,,Outpatient,,,5230.76,1181.4,United Health ,United Health Medicare Advantage,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
MRI Spine Lumbar w/ + w/o Contrast,1169056,LOCAL,72158,CPT,,,,,,Outpatient,,,5301.01,2842.95,United Health ,United Health Medicare Advantage,326.51,,,,,,,Fee Schedule,326.51,652.35,
95783 POLYSOM <6 YRS SLP W/CPAP CHARGE,10732463,LOCAL,95783,CPT,,,,,,Outpatient,,,5349.1,3477,United Health ,United Health Medicare Advantage,930.16,,,,,,,Fee Schedule,930.16,1113.98,
95811 POLYSOMMOGRAPHY w/ CPAP CHARGE,8303770,LOCAL,95811,CPT,,,,,,Outpatient,,,5349.1,3477,United Health ,United Health Medicare Advantage,930.16,,,,,,,Fee Schedule,930.16,930.16,
NM Inflammation Loc Whole Body - Ceretec,1169152,LOCAL,78802,CPT,A9521,HCPCS,,,,Outpatient,,,5351.75,2870.18,United Health ,United Health Medicare Advantage,802.34,,,,,,,Fee Schedule,802.34,1409.71,
EPIFIX SKIN SUBSTITUTE 2 X 3 CM,13962563,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,5377.5,1755,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
NM Inflammation Loc Limited - Indium,1169148,LOCAL,78801,CPT,,,,,,Outpatient,,,5399.5,2895.75,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,1409.71,
NM Inflammation Loc Multi,12113627,LOCAL,78801,CPT,,,,,,Outpatient,,,5399.5,2895.75,United Health ,United Health Medicare Advantage,367.38,,,,,,,Fee Schedule,367.38,1409.71,
AMNIOEXCEL PLUS 3X3,13962549,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,5400,3028,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY VENOUS ADDL,8210394,LOCAL,37188,CPT,,,,,,Outpatient,,,5419.5,3523,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2599,5228.12,
KERECIS OMEGA 3 - 3 X 7,13962578,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,5436,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
THERASKIN 5.1 X 7.6 CM,13962608,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,5449.5,2431,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
NEW ACCESS NEPHROSTOMY TUBE,8200537,LOCAL,50433,CPT,,,,,,Outpatient,,,5454.2,3545,United Health ,United Health Medicare Advantage,3153.26,,,,,,,Fee Schedule,2315,4301.28,
PTA RENAL ARTERY (ADD'L),8210240,LOCAL,37247,CPT,,,,,,Outpatient,,,5488.12,3567,United Health ,United Health Medicare Advantage,140.82,,,,,,,Fee Schedule,140.82,8616.54,
IMPLANT BREAST #350-6504BC 650CC,4801608,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,5500,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST #350-8004BC,4803074,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,5500,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST 700CC #350-7004BC MENTOR,4803075,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,5500,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST SILICONE 500CC,4805180,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,5500,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT SILICONE 750CC,4851569,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,5500,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
PURAPLY AM 3.76 CM X 4.76 CM,13962601,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,5512.5,3861,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
27603 DRAIN LOWER LEG LESION,13043453,LOCAL,27603,CPT,,,,,LT,Outpatient,,,5526.21,3592,United Health ,United Health Medicare Advantage,2616.66,,,,,,,Fee Schedule,2315,2616.66,
NM Myocardial Planar Rest and Stress,2425972,LOCAL,78454,CPT,A9500,HCPCS,,,,Outpatient,,,5593.52,2999.7,United Health ,United Health Medicare Advantage,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
EPIFIX SKIN SUBSTITUTE 3.5 X 3.5 CM,13962565,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,5602.5,1755,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
GRAFIX PRIME 2 X 3CM,10510014,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,5637.5,3671,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
GRAFIX PL 3.0 X 4.0CM,13962568,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,5647.5,3671,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
REVISION REPLACE GENERATOR  BLADDER,8268108,LOCAL,64595,CPT,,,,,,Outpatient,,,5690.13,3699,United Health ,United Health Medicare Advantage,3144.15,,,,,,,Fee Schedule,2599,5487.33,
REVISION REPLACE LEAD BLADDER STIMULATOR,8268107,LOCAL,64585,CPT,,,,,,Outpatient,,,5690.13,3699,United Health ,United Health Medicare Advantage,3144.15,,,,,,,Fee Schedule,2599,5487.33,
AMNIOEXCEL PLUS 2CMX2CM,10510060,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,5693.33,3028,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
INTRO AV SHUNT W S&I,8267106,LOCAL,36902,CPT,,,,,,Outpatient,,,5734.69,11107,United Health ,United Health Medicare Advantage,5212.67,,,,,,,Fee Schedule,5212.67,5787,
APLIGRAF-COM,13962557,LOCAL,,,Q4101,HCPCS,,,,Outpatient,,,5737.5,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 4 X 4.5 CM,13962566,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,5737.5,1755,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 4 X 4.5CM,13962567,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,5737.5,1755,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
15120 SKN SPLT A-GRFT FAC/NCK/HF/G 100 SQ CM/1% BA,10006441,LOCAL,15120,CPT,,,,,,Outpatient,,,5746.86,3735,United Health ,United Health Medicare Advantage,3347.08,,,,,,,Fee Schedule,2599,3347.08,
REPOSITION IVC FILTER,8267129,LOCAL,37192,CPT,,,,,,Outpatient,,,5771.49,3751,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2599,5228.12,
EPICORD 2CM X 3CM,13962558,LOCAL,,,Q4187,HCPCS,,,,Outpatient,,,5827.5,3788,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
VENOUS PTA EACH ADD'L,8267100,LOCAL,37249,CPT,,,,,,Outpatient,,,5876.95,3820,United Health ,United Health Medicare Advantage,118.76,,,,,,,Fee Schedule,118.76,8616.54,
PURAPLY AM 3 CM X 4 CM,13962599,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,5940,3861,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
PURAPLY AM 3 X 4CM FEN FINISHED PROD,13962600,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,5940,3861,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
Central Line Access Type. -> Tunneled,13449753,LOCAL,36810,CPT,,,,,,Outpatient,,,5960.36,3874,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2599,3211.33,
NUSHIELD 3X4CM,13962589,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,5962.5,1155,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
NUSHIELD 4X4CM,13962590,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,5962.5,1155,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
prothrombin complex - Pow [CULL],11220535,LOCAL,J7168,CPT,,,,,,Outpatient,1,EA,6048,,United Health ,United Health Medicare Advantage,2.14,,,,,,,Fee Schedule,2.14,3347.61,
AFFINITY 1.5 CM X 1.5 CM,10500119,LOCAL,,,Q4159,HCPCS,,,,Outpatient,,,6075,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 2 X 4 CM,13962564,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,6075,1755,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
33215 Reposition Pacing Defibrillator Lead,8212027,LOCAL,33215,CPT,,,,,,Outpatient,,,6104.24,3968,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2484.2,2877.63,
ICD REMOVAL ONLY,8231005,LOCAL,33241,CPT,,,,,,Outpatient,,,6104.24,3968,United Health ,United Health Medicare Advantage,3327.27,,,,,,,Fee Schedule,2599,10220.8,
EXTREMITY UNILATERAL S&I,8210530,LOCAL,75710,CPT,,,,,,Outpatient,,,6132.32,3288.45,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
XR Angio Extremity in OR SI Left,2425383,LOCAL,75710,CPT,,,,,LT,Outpatient,,,6132.32,3288.45,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
XR Angio Extremity in OR SI Right,2425386,LOCAL,75710,CPT,,,,,RT,Outpatient,,,6132.32,3288.45,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
immune globulin intravenous and subcutaneous 10% injectable solution 100 mL [CULL],11205089,LOCAL,J1561,CPT,,,,,,Outpatient,100,ML,6199.68,,United Health ,United Health Medicare Advantage,48.96,,,,,,,Fee Schedule,48.96,2110.36,
TRANSCATH THER.ART.INF.(FINAL DAY),8210027,LOCAL,37214,CPT,,,,,,Outpatient,,,6313.68,4104,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,1291,5228.12,
BULKAMID URETHRAL BULKING SYSTEM,4830058,LOCAL,,,L8603,HCPCS,,,,Outpatient,,,6325,3364,United Health ,United Health Medicare Advantage,536.91,,,,,,,Fee Schedule,536.91,536.91,
EXPANDER TISSUE 750-900ML,4854109,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6325,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE DERMASPAN 600-720CC,4805041,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6325,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE LPP-FH13S,4832956,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6325,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE LPP-FH14S,4803623,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6325,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
93503 INSERTION OF SWAN GANZ CHARGE,8210870,LOCAL,93503,CPT,,,,,,Outpatient,,,6394.68,4157,United Health ,United Health Medicare Advantage,1420.25,,,,,,,Fee Schedule,1291,1644.1,
PA CATHETER SV02,4221129,LOCAL,93503,CPT,,,,,,Outpatient,,,6394.68,4157,United Health ,United Health Medicare Advantage,1420.25,,,,,,,Fee Schedule,1291,1644.1,
GENERATOR REMOVAL ONLY,8210160,LOCAL,33233,CPT,,,,,,Outpatient,,,6446.76,4190,United Health ,United Health Medicare Advantage,7566.4,,,,,,,Fee Schedule,2599,10220.8,
fomepizole 1 g/mL intravenous solution 1.5 mL [CULL],11290124,LOCAL,J1451,CPT,,,,,,Outpatient,1.5,ML,6649.376,,United Health ,United Health Medicare Advantage,6.28,,,,,,,Fee Schedule,6.28,525.49,
NM Myocardial SPECT Drug Stress Multi,8567792,LOCAL,78452,CPT,,,,,,Outpatient,,,6759.97,3625.05,United Health ,United Health Medicare Advantage,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
NM Myocardial SPECT Rest and Stress,2425975,LOCAL,78452,CPT,,,,,,Outpatient,,,6759.97,3625.05,United Health ,United Health Medicare Advantage,1193.55,,,,,,,Fee Schedule,1193.55,1409.71,
dalbavancin 500 mg Pow [CULL],11287452,LOCAL,J0875,CPT,,,,,,Outpatient,1,UN,6831.8592,4440,United Health ,United Health Medicare Advantage,15.61,,,,,,,Fee Schedule,0.21,5685.74,
IMPLANT BREAST SHPB-235,4852442,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6875,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST SHPB-585,4851979,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6875,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
IMPLANT BREAST SHPB-635,4805161,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,6875,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
GRAFIX PL 3.0 X 4.0CM,10510066,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,6902.5,3671,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
PERC URETERAL STENT REMOVAL & REPLACE,8210741,LOCAL,50382,CPT,,,,,,Outpatient,,,6922.86,4500,United Health ,United Health Medicare Advantage,1872.87,,,,,,,Fee Schedule,1872.87,2315,
CULL NM TC99M Ceretec Per Dose,13644947,LOCAL,,,A9521,HCPCS,,,,Outpatient,,,6990.26,4544,United Health ,United Health Medicare Advantage,802.34,,,,,,,Fee Schedule,802.34,802.34,
EPICORD 2CM X 3CM,10510051,LOCAL,,,Q4187,HCPCS,,,,Outpatient,,,7122.5,3788,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
IMPLANT BREAST 775,4850675,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,7150,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
"BRCAvantage(R), Comprehensive QSTC",9039435,LOCAL,81162,CPT,,,,,,Outpatient,,,7200,2189.86,United Health ,United Health Medicare Advantage,1824.88,,,,,,,Fee Schedule,590.67,1824.88,
PURAPLY AM 3 X 4CM FEN FINISHED PROD,10510076,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,7260,3861,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
NUSHIELD 4X4CM,10510075,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,7287.5,1155,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY ARTERIAL SECONDARY PERC,8210390,LOCAL,37186,CPT,,,,,,Outpatient,,,7383.75,4799,United Health ,United Health Medicare Advantage,199.65,,,,,,,Fee Schedule,199.65,16037.41,
"15100 AUTO-SPLIT THICK T/A/L, 1ST 100 SQCM CHARGE",12816476,LOCAL,15100,CPT,,,,,,Outpatient,,,7387.97,4802,United Health ,United Health Medicare Advantage,1672.39,,,,,,,Fee Schedule,1496,2862.92,
AFFINITY 1.5CM X 1.5CM,10500119,LOCAL,,,Q4159,HCPCS,,,,Outpatient,,,7425,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY VENOUS PRIMARY,8210393,LOCAL,37187,CPT,,,,,,Outpatient,,,7579,4926,United Health ,United Health Medicare Advantage,10368.23,,,,,,,Fee Schedule,5228.12,10368.23,
GRAFT STRAVIX 2 X 4,13962572,LOCAL,,,Q4132,HCPCS,,,,Outpatient,,,7650,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
EPIFIX SKIN SUBSTITUTE 4 X 4.5 CM,10510064,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,7672.5,1755,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
EXCHANGE OF BILIARY DRAIN CATH,8267769,LOCAL,47536,CPT,,,,,,Outpatient,,,7882.57,5124,United Health ,United Health Medicare Advantage,3226.48,,,,,,,Fee Schedule,2599,3682.65,
PLACEMENT BILIARY DRAIN CATH INT/EXT,8201219,LOCAL,47534,CPT,,,,,,Outpatient,,,7882.57,5124,United Health ,United Health Medicare Advantage,3226.48,,,,,,,Fee Schedule,2599,3682.65,
36253 Insertion Of Cath Renal Arterial 2Nd Unilateral,8212045,LOCAL,36253,CPT,,,,,,Outpatient,,,8050.63,5233,United Health ,United Health Medicare Advantage,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
CERVICOCEREBRAL S&I,8201615,LOCAL,36221,CPT,,,,,,Outpatient,,,8050.63,5233,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2599,6018.68,
COMMON CAROTID UNI S&I,8201600,LOCAL,36223,CPT,,,,,,Outpatient,,,8050.63,5233,United Health ,United Health Medicare Advantage,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
EXTERNAL CAROTID UNI S&I,8201610,LOCAL,36222,CPT,,,,,,Outpatient,,,8050.63,5233,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2599,6018.68,
INFERIOR VENA CAVA S&I,8210660,LOCAL,75825,CPT,,,,,,Outpatient,,,8050.63,4317.23,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
IR Angio Pulmonary Bilateral,7949335,LOCAL,75743,CPT,,,,,,Outpatient,,,8050.63,4317.23,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
PULMONARY BILATERAL S&I,8210610,LOCAL,75743,CPT,,,,,,Outpatient,,,8050.63,4317.23,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
RENAL UNILATERAL PLACEMENT & SI,8210550,LOCAL,36251,CPT,,,,,,Outpatient,,,8050.63,5233,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2599,6018.68,
VERTEBRAL SUBCLAVIAN OR INNOMINATE,8201625,LOCAL,36225,CPT,,,,,,Outpatient,,,8050.63,5233,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2599,6018.68,
XR Venogram Cava Inferior,10386826,LOCAL,75825,CPT,,,,,,Outpatient,,,8050.63,4317.23,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
25040 FOREIGN BODY REMOVAL FOREARM LEFT,13416875,LOCAL,25040,CPT,,,,,LT,Outpatient,,,8076.78,5250,United Health ,United Health Medicare Advantage,2966.42,,,,,,,Fee Schedule,2528.75,2966.42,
FOREIGN BODY RETRIEVAL,8201630,LOCAL,37197,CPT,,,,,,Outpatient,,,8080.32,5252,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2599,5228.12,
FOREIGN BODY RETRIEVAL S&I,8201635,LOCAL,37197,CPT,,,,,,Outpatient,,,8080.32,5252,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2599,5228.12,
REMOVAL IVC FILTER,8267130,LOCAL,37193,CPT,,,,,,Outpatient,,,8080.32,5252,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2599,5228.12,
CULL NM Indium WBC Per 0.5 MCI,13644939,LOCAL,,,A9547,HCPCS,,,,Outpatient,,,8102.03,5266,United Health ,United Health Medicare Advantage,772.64,,,,,,,Fee Schedule,772.64,772.64,
CULL NM Kinevac Per 5 MCG Vial,13644941,LOCAL,,,A9547,HCPCS,,,,Outpatient,,,8102.03,5266,United Health ,United Health Medicare Advantage,772.64,,,,,,,Fee Schedule,772.64,772.64,
PERC INTRO CATH/STENT URETERAL PREEXIST,8200532,LOCAL,50693,CPT,,,,,,Outpatient,,,8122.9,5280,United Health ,United Health Medicare Advantage,3153.26,,,,,,,Fee Schedule,2599,4301.28,
PERC INTRO URETERAL NEW ACCESS W CATH,8200534,LOCAL,50695,CPT,,,,,,Outpatient,,,8122.9,5280,United Health ,United Health Medicare Advantage,3153.26,,,,,,,Fee Schedule,2599,4301.28,
PERC INTRO URETERAL NEW ACCESS WO CATH,8200533,LOCAL,50694,CPT,,,,,,Outpatient,,,8122.9,5280,United Health ,United Health Medicare Advantage,3153.26,,,,,,,Fee Schedule,2599,4301.28,
VERTEBROPLASTY ADDL THOR/LUMB,8267765,LOCAL,22512,CPT,,,,,,Outpatient,,,8365.99,5438,United Health ,United Health Medicare Advantage,167.55,,,,,,,Fee Schedule,167.55,6803.47,
VERTEBROPLASTY LUMBAR,8211170,LOCAL,22511,CPT,,,,,,Outpatient,,,8365.99,5438,United Health ,United Health Medicare Advantage,2966.42,,,,,,,Fee Schedule,2599,6803.47,
VERTEBROPLASTY THORACIC,8211160,LOCAL,22510,CPT,,,,,,Outpatient,,,8365.99,5438,United Health ,United Health Medicare Advantage,2966.42,,,,,,,Fee Schedule,2599,6803.47,
RENAL BILATERAL PLACEMENT & SI,8210560,LOCAL,36252,CPT,,,,,,Outpatient,,,8539.16,5550,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2599,6018.68,
93452 Left Heart Cath,8230003,LOCAL,93452,CPT,,,,,,Outpatient,,,8778,5706,United Health ,United Health Medicare Advantage,2940.64,,,,,,,Fee Schedule,2940.64,4325,
TEMP SACRAL ELECTRODE WITH IMAGING,8268102,LOCAL,64561,CPT,,,,,,Outpatient,,,8900,5785,United Health ,United Health Medicare Advantage,6000.2,,,,,,,Fee Schedule,5787,8672.71,
27372 FOREIGN BODY REMOVAL KNEE,13435628,LOCAL,27372,CPT,,,,,,Outpatient,,,8946.89,5815,United Health ,United Health Medicare Advantage,2616.66,,,,,,,Fee Schedule,2315,2616.66,
IMPLANT BREAST ARTOURA 455CC SMOOTH,4853890,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,8976,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
75630-IR Aortogram Abdominal + Iliofemoral1,8071871,LOCAL,75630,CPT,,,,,,Outpatient,,,9016.7,4835.33,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
AORTO ABD+ILIOFEMORAL SERIAL,8210430,LOCAL,75630,CPT,,,,,,Outpatient,,,9016.7,4835.33,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
AORTOGRAM THORACIC S&I,8210410,LOCAL,75605,CPT,,,,,,Outpatient,,,9016.7,4835.33,United Health ,United Health Medicare Advantage,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
EXTREMITY BILATERAL S&I,8210540,LOCAL,75716,CPT,,,,,,Outpatient,,,9016.7,4835.33,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
IR Aortogram Thoracic w/ Serialography,7949377,LOCAL,75605,CPT,,,,,,Outpatient,,,9016.7,4835.33,United Health ,United Health Medicare Advantage,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
XR Angio Extremity in OR SI Bilat,9343676,LOCAL,75716,CPT,,,,,,Outpatient,,,9016.7,4835.33,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
20240 BIOPSY BONE EXCISIONAL SUPERFI CHARGE,8020082,LOCAL,20240,CPT,,,,,,Outpatient,,,9171.4,5961,United Health ,United Health Medicare Advantage,2616.66,,,,,,,Fee Schedule,2315,2616.66,
20240-BIOPSY BONE EXCISIONAL SUPERFI CHARGE,8020082,LOCAL,20240,CPT,,,,,,Outpatient,,,9171.4,5961,United Health ,United Health Medicare Advantage,2616.66,,,,,,,Fee Schedule,2315,2616.66,
EXPANDER TISSUE ALLOX2,4850383,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,9350,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE ALLOX2-15SE,4800802,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,9350,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE ALLOX2-FH13E,4800497,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,9350,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE ALLOX2-FH14E,4840653,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,9350,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
TISSUE EXPANDER ALLOX2-FH15E,4810961,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,9350,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
AMINOFIX 7CM X 6CM,13962545,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,9515.25,3028,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
AMNIOEXCEL PLUS  3 X 4CM,13962546,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,9548.1,3028,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
"93451 Catheterization, Right Heart",8230000,LOCAL,93451,CPT,,,,,,Outpatient,,,9609.02,6246,United Health ,United Health Medicare Advantage,2940.64,,,,,,,Fee Schedule,2940.64,4325,
93453 Combined Left and Right Heart Cath,8230006,LOCAL,93453,CPT,,,,,,Outpatient,,,9609.02,6246,United Health ,United Health Medicare Advantage,2940.64,,,,,,,Fee Schedule,2940.64,4325,
AMNIOFIX 4X6CM,13962556,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,9654.75,3028,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY ARTERIAL ADDL,8210392,LOCAL,37185,CPT,,,,,,Outpatient,,,9751.88,6339,United Health ,United Health Medicare Advantage,130.9,,,,,,,Fee Schedule,130.9,8616.54,
93454 HT Left Heart Cath WO LV,8210890,LOCAL,93454,CPT,,,,,,Outpatient,,,9833.36,6392,United Health ,United Health Medicare Advantage,2940.64,,,,,,,Fee Schedule,2940.64,4325,
92973 PTC Thromebectomy Add On,8200030,LOCAL,92973,CPT,,,,,,Outpatient,,,9838.19,6395,United Health ,United Health Medicare Advantage,74.32,,,,,,,Fee Schedule,74.32,12572.64,
NUSHIELD 6CM X 6CM,13962591,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,10012.5,1155,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
TRANSCATH THER ART INFUSION FOR THROM,8210026,LOCAL,37211,CPT,,,,,,Outpatient,,,10140.58,6591,United Health ,United Health Medicare Advantage,4942.22,,,,,,,Fee Schedule,4942.22,5787,
CATH LAB IVC FILTER PLACEMENT,8210330,LOCAL,37191,CPT,,,,,,Outpatient,,,10180.79,6618,United Health ,United Health Medicare Advantage,4942.22,,,,,,,Fee Schedule,4942.22,5787,
INSERTION IVC FILTER,8267128,LOCAL,37191,CPT,,,,,,Outpatient,,,10180.79,6618,United Health ,United Health Medicare Advantage,4942.22,,,,,,,Fee Schedule,4942.22,5787,
PERC PLACE IVC FILTER S&I,8210740,LOCAL,37191,CPT,,,,,,Outpatient,,,10180.79,6618,United Health ,United Health Medicare Advantage,4942.22,,,,,,,Fee Schedule,4942.22,5787,
leuprolide 45 mg/6 months Pow [CULL],11299002,LOCAL,J9217,CPT,,,,,,Outpatient,1,ML,10406.8992,,United Health ,United Health Medicare Advantage,176.45,,,,,,,Fee Schedule,176.45,733.68,
CULL NM Indium DTPA Per 0.5 MCI,13644937,LOCAL,,,A9548,HCPCS,,,,Outpatient,,,10432.89,6781,United Health ,United Health Medicare Advantage,715.29,,,,,,,Fee Schedule,715.29,715.29,
KERECIS OMEGA 3 - 7 X 10CM,13962581,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,10552.5,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
THROMBECTOMY ARTERIAL PRIMARY,8210391,LOCAL,37184,CPT,,,,,,Outpatient,,,10806,7024,United Health ,United Health Medicare Advantage,16417.11,,,,,,,Fee Schedule,5787,16417.11,
AORTOGRAM ABDOMEN S&I,8210420,LOCAL,75625,CPT,,,,,,Outpatient,,,10898.6,5844.3,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
IR Aortogram Abdominal w/ Serialography1,8071874,LOCAL,75625,CPT,,,,,,Outpatient,,,10898.6,5844.3,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
XR Aorta Abdomen Catheter in OR SI,2425389,LOCAL,75625,CPT,,,,,,Outpatient,,,10898.6,5844.3,United Health ,United Health Medicare Advantage,2877.63,,,,,,,Fee Schedule,2669.67,2877.63,
PURAPLY AM 5 CM X 5 CM,13962602,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,11025,3861,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
EXPANDER BREAST TISSUE ARTOURA 375CC,4853226,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,11385,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDER TISSUE ARTOURA SDC100UH,4803722,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,11385,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
EXPANDERS TISSUE 475CC SDC-130H,4852707,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,11385,644,United Health ,United Health Medicare Advantage,764.47,,,,,,,Fee Schedule,764.47,764.47,
TRANSCATH STENT CERV CAROTID WITH DEVICE,8210025,LOCAL,37215,CPT,,,,,,Outpatient,,,11474.94,7459,United Health ,United Health Medicare Advantage,802.87,,,,,,,Fee Schedule,802.87,16429.41,
VERTEBRAL CERVICAL/CRANIAL S&I,8201620,LOCAL,36226,CPT,,,,,,Outpatient,,,11520.61,7488,United Health ,United Health Medicare Advantage,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
LEAD REPLACEMENT DUAL,8210110,LOCAL,33217,CPT,,,,,,Outpatient,,,11951.06,7768,United Health ,United Health Medicare Advantage,7566.4,,,,,,,Fee Schedule,2484.2,7566.4,
LEAD REPLACEMENT SGL,8210100,LOCAL,33216,CPT,,,,,,Outpatient,,,11951.06,7768,United Health ,United Health Medicare Advantage,7566.4,,,,,,,Fee Schedule,2484.2,7566.4,
calcitonin 200 intl units/mL Sol [CULL],J0630,CPT,,,,,,,,Outpatient,200,ML,12023.04,,United Health ,United Health Medicare Advantage,484.97,,,,,,,Fee Schedule,484.97,2110.36,
93455 HT Left Cath W Cor Inj WO LV,8230002,LOCAL,93455,CPT,,,,,,Outpatient,,,12026.07,7817,United Health ,United Health Medicare Advantage,2940.64,,,,,,,Fee Schedule,2940.64,4325,
immune globulin intravenous and subcutaneous 10% injectable solution 200 mL [CULL],11205107,LOCAL,J1561,CPT,,,,,,Outpatient,200,ML,12399.36,,United Health ,United Health Medicare Advantage,48.96,,,,,,,Fee Schedule,48.96,2110.36,
ALLOGRAFT DERMAPURE 7X10CM,4810278,LOCAL,Q4152,CPT,Q4152,HCPCS,,,,Outpatient,,,12446.5,,United Health ,United Health Medicare Advantage,111.35,,,,,,,Fee Schedule,111.35,111.35,
93458 HT Cath Left W LV and Cor Angio,8230004,LOCAL,93458,CPT,,,,,,Outpatient,,,12512.89,8133,United Health ,United Health Medicare Advantage,2940.64,,,,,,,Fee Schedule,2940.64,4325,
93460 HT Cath L or R W LV and Cor Angio,8230007,LOCAL,93460,CPT,,,,,,Outpatient,,,12512.89,8133,United Health ,United Health Medicare Advantage,2940.64,,,,,,,Fee Schedule,2940.64,4325,
33210 INSERTION TEMP PACEMAKER SINGLE CHAMBER CHARGE,13707085,LOCAL,33210,CPT,,,,,,Outpatient,,,12542.69,8153,United Health ,United Health Medicare Advantage,7566.4,,,,,,,Fee Schedule,2484.2,7566.4,
TEMP PACEMAKER SGL CHAMBER,8210050,LOCAL,33210,CPT,,,,,,Outpatient,,,12542.69,8153,United Health ,United Health Medicare Advantage,7566.4,,,,,,,Fee Schedule,2484.2,7566.4,
92920 PTCA 1st Vessel,8201256,LOCAL,92920,CPT,,,,,,Outpatient,,,12766.62,8298,United Health ,United Health Medicare Advantage,5212.67,,,,,,,Fee Schedule,5212.67,12572.64,
PTA RENAL ARTERY (INITIAL),8267124,LOCAL,37246,CPT,,,,,,Outpatient,,,12766.62,17592,United Health ,United Health Medicare Advantage,5212.67,,,,,,,Fee Schedule,5212.67,5787,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ANGIO CPLX 1,8230034,LOCAL,37224,CPT,,,,,,Outpatient,,,12766.62,8298,United Health ,United Health Medicare Advantage,5212.67,,,,,,,Fee Schedule,5212.67,5787,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS IVT ANGIO CPLX1,8230030,LOCAL,37220,CPT,,,,,,Outpatient,,,12766.62,8298,United Health ,United Health Medicare Advantage,5212.67,,,,,,,Fee Schedule,5212.67,5787,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS TPVT ANGIO SF 1ST,8230022,LOCAL,37228,CPT,,,,,,Outpatient,,,12766.62,8298,United Health ,United Health Medicare Advantage,10368.23,,,,,,,Fee Schedule,5787,10368.23,
THERASKIN 7.6 X 15.2 CM,13962609,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,12802.5,2431,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
93459 HT Cath Left W LV and Cor Grf Angio,8230005,LOCAL,93459,CPT,,,,,,Outpatient,,,13484.51,8765,United Health ,United Health Medicare Advantage,2940.64,,,,,,,Fee Schedule,2940.64,4325,
93461 HT Cath L or R W LV Cor Grf Angio,8230008,LOCAL,93461,CPT,,,,,,Outpatient,,,13484.51,8765,United Health ,United Health Medicare Advantage,2940.64,,,,,,,Fee Schedule,2940.64,4325,
riTUXimab pvvr 10 mg/mL Sol 50 mL [CULL],11211085,LOCAL,Q5119,CPT,,,,,,Outpatient,50,ML,13762.56,,United Health ,United Health Medicare Advantage,27.85,,,,,,,Fee Schedule,27.85,7537.07,
"C1 esterase inhibitor, human 500 intl units intravenous kit [CULL]",11201256,LOCAL,J0597,CPT,,,,,,Outpatient,1,EA,13903.4496,,United Health ,United Health Medicare Advantage,75.86,,,,,,,Fee Schedule,75.86,5685.74,
AMNIOEXCEL PLUS 4X5CM,13962550,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,13974.52,3028,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
ATHERECTOMY ABD AORTA,8230043,LOCAL,0236T,CPT,,,,,,Outpatient,,,14443,9388,United Health ,United Health Medicare Advantage,10368.23,,,,,,,Fee Schedule,6417,16037.41,
ATHERECTOMY BRACHIOCEPHALIC & BRANCHES,8230044,LOCAL,0237T,CPT,,,,,,Outpatient,,,14443,9388,United Health ,United Health Medicare Advantage,10368.23,,,,,,,Fee Schedule,6417,16037.41,
ATHERECTOMY ILIAC EACH,8230045,LOCAL,0238T,CPT,,,,,,Outpatient,,,14443,12175,United Health ,United Health Medicare Advantage,16417.11,,,,,,,Fee Schedule,6417,16417.11,
ATHERECTOMY RENAL,8230041,LOCAL,0234T,CPT,,,,,,Outpatient,,,14443,9388,United Health ,United Health Medicare Advantage,10368.23,,,,,,,Fee Schedule,6417,26140.53,
ATHERECTOMY VISCERAL,8230042,LOCAL,0235T,CPT,,,,,,Outpatient,,,14443,9388,United Health ,United Health Medicare Advantage,515.34,,,,,,,Fee Schedule,515.34,8616.54,
EPICORD 3 X 5,13962559,LOCAL,,,Q4187,HCPCS,,,,Outpatient,,,14445,3788,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
INTERNAL CAROTID UNI S&I,8201636,LOCAL,36224,CPT,,,,,,Outpatient,,,14812.21,9628,United Health ,United Health Medicare Advantage,4942.22,,,,,,,Fee Schedule,4942.22,6018.68,
37239 STENT ANGIO VEIN EA ADDL CHARGE,8230063,LOCAL,37239,CPT,,,,,,Outpatient,,,15683.4,10194,United Health ,United Health Medicare Advantage,121.17,,,,,,,Fee Schedule,121.17,16037.41,
ARTERY STENT ADD'L (NONCORONARY),8230061,LOCAL,37237,CPT,,,,,,Outpatient,,,15683.4,10194,United Health ,United Health Medicare Advantage,171.21,,,,,,,Fee Schedule,171.21,16037.41,
93456 Right Heart Catheterization With Angiography,8230009,LOCAL,93456,CPT,,,,,,Outpatient,,,16019.61,10413,United Health ,United Health Medicare Advantage,2940.64,,,,,,,Fee Schedule,2940.64,4325,
33285 Implant Pt Activated Cardiac Event Recorder,8267776,LOCAL,33285,CPT,,,,,,Outpatient,,,16029.82,10419,United Health ,United Health Medicare Advantage,7566.4,,,,,,,Fee Schedule,6417,12132.94,
92928 Trnscath Plcmnt Metal Single,8201254,LOCAL,92928,CPT,,,,,,Outpatient,,,16620.58,10803,United Health ,United Health Medicare Advantage,10368.23,,,,,,,Fee Schedule,5787,12572.64,
CULL Octreotide,14874647,LOCAL,,,A9572,HCPCS,,,,Outpatient,,,16720.11,,United Health ,United Health Medicare Advantage,1914.61,,,,,,,Fee Schedule,1914.61,1914.61,
alteplase 50 mg intravenous injection [CULL],11201048,LOCAL,J2997,CPT,,,,,,Outpatient,1,ML,16896.704,,United Health ,United Health Medicare Advantage,94.45,,,,,,,Fee Schedule,94.45,122.4,
93457 Right or Left Heart Cath with No LV Gram Charge,8230010,LOCAL,93457,CPT,,,,,,Outpatient,,,16991.23,11044,United Health ,United Health Medicare Advantage,2940.64,,,,,,,Fee Schedule,2940.64,4325,
AV FISTULAGRAM WITH ANGIOPLASTY,8210331,LOCAL,36902,CPT,,,,,,Outpatient,,,17087.76,11107,United Health ,United Health Medicare Advantage,5212.67,,,,,,,Fee Schedule,5212.67,5787,
"C9764 Revasculation, Endovascular, With Intravascular Lithotripsy, Includes Angioplasty",8230070,LOCAL,,,C9764,HCPCS,,,,Outpatient,,,17339,11270,United Health ,United Health Medicare Advantage,10368.23,,,,,,,Fee Schedule,5228.12,10368.23,
digoxin immune FAB 40 mg intravenous injection [CULL],11201675,LOCAL,J1162,CPT,,,,,,Outpatient,1,EA,17660.16,,United Health ,United Health Medicare Advantage,5168.23,,,,,,,Fee Schedule,5168.23,7537.07,
KERECIS OMEGA 3 - 7 X 10,13962580,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,17959.5,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
GENERATOR ONLY SGL CHAMBER INSERTION,8210070,LOCAL,33212,CPT,,,,,,Outpatient,,,17985.84,11691,United Health ,United Health Medicare Advantage,7566.4,,,,,,,Fee Schedule,6417,12132.94,
PACEMAKER REMOVAL SINGLE,8210171,LOCAL,33227,CPT,,,,,,Outpatient,,,17985.84,11691,United Health ,United Health Medicare Advantage,7566.4,,,,,,,Fee Schedule,6417,12132.94,
immune globulin intravenous and subcutaneous 10% injectable solution 300 mL [CULL],11205109,LOCAL,J1561,CPT,,,,,,Outpatient,300,ML,18599.04,,United Health ,United Health Medicare Advantage,48.96,,,,,,,Fee Schedule,48.96,2110.36,
0238T Iliac Athrectomy with or without PTA,8230069,LOCAL,0238T,CPT,,,,,,Outpatient,,,18730.19,12175,United Health ,United Health Medicare Advantage,16417.11,,,,,,,Fee Schedule,6417,16417.11,
INSERTION NEUROSTIMULATOR GENERATOR,8268101,LOCAL,64590,CPT,,,,,,Outpatient,,,19804,519,United Health ,United Health Medicare Advantage,19605.75,,,,,,,Fee Schedule,9233,30196.67,
GENERATOR REMOVAL AND REPLACEMENT DUAL,8210172,LOCAL,33228,CPT,,,,,,Outpatient,,,20984.23,13640,United Health ,United Health Medicare Advantage,9568.03,,,,,,,Fee Schedule,6417,12132.94,
C9604 Revasc thru Bypass Single Vessel w DES (M'care),8201640,LOCAL,,,C9604,HCPCS,,,,Outpatient,,,21116.1,13725,United Health ,United Health Medicare Advantage,10368.23,,,,,,,Fee Schedule,6417,12572.64,
C9607 Revasc CTO Single Vessel w DES (M'care),8201642,LOCAL,,,C9607,HCPCS,,,,Outpatient,,,21116.1,13725,United Health ,United Health Medicare Advantage,16417.11,,,,,,,Fee Schedule,6417,16417.11,
PERQ BM STENT ADD ON  RAMUS,8201252,LOCAL,,,C9600,HCPCS,,,,Outpatient,,,21116.1,13725,United Health ,United Health Medicare Advantage,10368.23,,,,,,,Fee Schedule,6417,12572.64,
TIB/PER REVASC W/ATHER ADD ON  LT,8210020,LOCAL,33206,CPT,,,,,,Outpatient,,,21534.36,13997,United Health ,United Health Medicare Advantage,9568.03,,,,,,,Fee Schedule,6417,12132.94,
C9772 Revasc Lithotrip Tibi/Peroneal Artery (Shockwave IVL),8230074,LOCAL,,,C9772,HCPCS,,,,Outpatient,,,22157.75,14403,United Health ,United Health Medicare Advantage,10368.23,,,,,,,Fee Schedule,6417,10368.23,
PTA VENOUS PERC W S&I,8267099,LOCAL,37248,CPT,,,,,,Outpatient,,,22271.43,14476,United Health ,United Health Medicare Advantage,5212.67,,,,,,,Fee Schedule,5212.67,5787,
VENTRICULAR PACEMAKER IMPLANT INS OR REP,8210030,LOCAL,33207,CPT,,,,,,Outpatient,,,22386.25,14551,United Health ,United Health Medicare Advantage,9568.03,,,,,,,Fee Schedule,6417,12132.94,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ATHRC CPLX 1,8230035,LOCAL,37225,CPT,,,,,,Outpatient,,,23546.83,15305,United Health ,United Health Medicare Advantage,16417.11,,,,,,,Fee Schedule,6417,16417.11,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ST CPLX 1ST,8230036,LOCAL,37226,CPT,,,,,,Outpatient,,,23546.83,15305,United Health ,United Health Medicare Advantage,10368.23,,,,,,,Fee Schedule,6417,10368.23,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS IVT ST CPLX 1ST,8230031,LOCAL,37221,CPT,,,,,,Outpatient,,,23546.83,15305,United Health ,United Health Medicare Advantage,10368.23,,,,,,,Fee Schedule,6417,10368.23,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS TPVT ATHRC CPLX 1,8230023,LOCAL,37229,CPT,,,,,,Outpatient,,,23546.83,15305,United Health ,United Health Medicare Advantage,16417.11,,,,,,,Fee Schedule,6417,16417.11,
VASC EMBOLIZE OCCLUDE ARTERY,8210362,LOCAL,37242,CPT,,,,,,Outpatient,,,23819.19,15482,United Health ,United Health Medicare Advantage,16417.11,,,,,,,Fee Schedule,6417,16417.11,
VASC EMBOLIZE OCCLUDE BLEED,8210364,LOCAL,37244,CPT,,,,,,Outpatient,,,23819.19,15482,United Health ,United Health Medicare Advantage,10368.23,,,,,,,Fee Schedule,6417,16037.41,
VASC EMBOLIZE OCCLUDE ORGAN,8210363,LOCAL,37243,CPT,,,,,,Outpatient,,,23819.19,15482,United Health ,United Health Medicare Advantage,10368.23,,,,,,,Fee Schedule,6417,16037.41,
VASC EMBOLIZE OCCLUDE VENOUS,8210361,LOCAL,37241,CPT,,,,,,Outpatient,,,23819.19,15482,United Health ,United Health Medicare Advantage,10368.23,,,,,,,Fee Schedule,6417,16037.41,
37238 STENT ANGIO VEIN INITIAL CHARGE,8230062,LOCAL,37238,CPT,,,,,,Outpatient,,,24322.23,15809,United Health ,United Health Medicare Advantage,10368.23,,,,,,,Fee Schedule,6417,16037.41,
37236 Stent Angioplasty Artery Int,8230060,LOCAL,37236,CPT,,,,,,Outpatient,,,24565.45,15968,United Health ,United Health Medicare Advantage,10368.23,,,,,,,Fee Schedule,6417,16037.41,
SACRAL NERVE (TRANSFORAMINAL PLACEMENT),8268100,LOCAL,64581,CPT,,,,,,Outpatient,,,25121.42,1108,United Health ,United Health Medicare Advantage,6000.2,,,,,,,Fee Schedule,6000.2,8672.71,
SHOULDER SYSTEMHEAD DWF041,4811086,LOCAL,,,L3975,HCPCS,,,,Outpatient,,,25817,,United Health ,United Health Medicare Advantage,1889.33,,,,,,,Fee Schedule,1889.33,1889.33,
PTA BRACHIOCEPHALIC TRUNK W S&I,8210280,LOCAL,37246,CPT,,,,,,Outpatient,,,27065.23,17592,United Health ,United Health Medicare Advantage,5212.67,,,,,,,Fee Schedule,5212.67,5787,
A V PACEMAKER IMPLANT INS OR REPLACE,8210040,LOCAL,33208,CPT,,,,,,Outpatient,,,27707.8,18010,United Health ,United Health Medicare Advantage,9568.03,,,,,,,Fee Schedule,8379,12132.94,
UPGRADE SGL DUAL LEAD/CHAMBER,8210090,LOCAL,33214,CPT,,,,,,Outpatient,,,27707.8,18010,United Health ,United Health Medicare Advantage,9568.03,,,,,,,Fee Schedule,8379,12132.94,
C9773 Revasc Lithotrip-Stent Tib/Peroneal Atr (Shockwave IVL),8230075,LOCAL,,,C9773,HCPCS,,,,Outpatient,,,28353.6,18430,United Health ,United Health Medicare Advantage,16417.11,,,,,,,Fee Schedule,6417,16417.11,
C9774 Revasc Lithotr-Ather Tib/Peroneal Atr (Shockwave IVL),8230076,LOCAL,,,C9774,HCPCS,,,,Outpatient,,,28353.6,18430,United Health ,United Health Medicare Advantage,16417.11,,,,,,,Fee Schedule,6417,16417.11,
C9775 Revasc Lithotr-Stent-Ather-Peroneal Atr (Shockwave IVL),8230077,LOCAL,,,C9775,HCPCS,,,,Outpatient,,,28353.6,18430,United Health ,United Health Medicare Advantage,16417.11,,,,,,,Fee Schedule,6417,16417.11,
"C9765 Revasculation, Endovascular, With Intravascular Lithotripsy, With Stent Placement Includes Ang",8230071,LOCAL,,,C9765,HCPCS,,,,Outpatient,,,29724,19321,United Health ,United Health Medicare Advantage,16417.11,,,,,,,Fee Schedule,6417,16417.11,
"C9766 Revasculation, Endovascular, With Intravascular Lithotripsy, Includes Atherectomy",8230072,LOCAL,,,C9766,HCPCS,,,,Outpatient,,,29724,19321,United Health ,United Health Medicare Advantage,16417.11,,,,,,,Fee Schedule,6417,16417.11,
tenecteplase 50 mg intravenous injection [CULL],11211269,LOCAL,J3101,CPT,,,,,,Outpatient,1,EA,31861.472,,United Health ,United Health Medicare Advantage,172.22,,,,,,,Fee Schedule,172.22,7537.07,
PTA STENT TIBPERONEAL INITIAL,8230024,LOCAL,37230,CPT,,,,,,Outpatient,,,32737,21279,United Health ,United Health Medicare Advantage,16417.11,,,,,,,Fee Schedule,6417,16417.11,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ST ATHRC CPX 1,8230037,LOCAL,37227,CPT,,,,,,Outpatient,,,33085.18,21505,United Health ,United Health Medicare Advantage,16417.11,,,,,,,Fee Schedule,9233,16417.11,
alteplase 100 mg intravenous injection [CULL],11201042,LOCAL,J2997,CPT,,,,,,Outpatient,1,ML,33793.376,,United Health ,United Health Medicare Advantage,94.45,,,,,,,Fee Schedule,94.45,122.4,
SIMPLIDERM ACELLULAR DERMAL,13962604,LOCAL,,,Q4116,HCPCS,,,,Outpatient,,,38160,,United Health ,United Health Medicare Advantage,111.91,,,,,,,Fee Schedule,111.91,111.91,
"C9767 Revasculation, Endovascular, With Intravascular Lithotripsy, With Stent Placement And Atherect",8230073,LOCAL,,,C9767,HCPCS,,,,Outpatient,,,39850,25903,United Health ,United Health Medicare Advantage,16417.11,,,,,,,Fee Schedule,6417,16417.11,
IMPLANTABLE STIM 2-LEAD EBI 10-1335M,4802519,LOCAL,,,E0749,HCPCS,,,,Outpatient,,,43032,22885,United Health ,United Health Medicare Advantage,347.98,,,,,,,Fee Schedule,347.98,347.98,
PTA ARTHRECTOMY STENT TIBPERONEAL INITIA,8230025,LOCAL,37231,CPT,,,,,,Outpatient,,,50564,32867,United Health ,United Health Medicare Advantage,16417.11,,,,,,,Fee Schedule,9233,16417.11,
ICD INSERTION WITH EXISTING SINGLE LEAD,8231000,LOCAL,33240,CPT,,,,,,Outpatient,,,51027.88,33168,United Health ,United Health Medicare Advantage,20521.65,,,,,,,Fee Schedule,12499,36378.11,
ICD REMOVAL&REPLACE SINGLE,8267790,LOCAL,33262,CPT,,,,,,Outpatient,,,65510.7,42582,United Health ,United Health Medicare Advantage,20521.65,,,,,,,Fee Schedule,12499,36378.11,
ICD REMOVAL&REPLACE DUAL LEAD,8267778,LOCAL,33263,CPT,,,,,,Outpatient,,,67510.7,43882,United Health ,United Health Medicare Advantage,20521.65,,,,,,,Fee Schedule,12499,36378.11,
ICD REMOVAL&REPLACE MULTIPLE,8267791,LOCAL,33264,CPT,,,,,,Outpatient,,,70510.7,45832,United Health ,United Health Medicare Advantage,29312.62,,,,,,,Fee Schedule,12499,36378.11,
"45300 Proctosigmoidoscopy, rigid; diagnostic, w/ or w/o collection by brushing or washing",7962380,LOCAL,45300,CPT,,,,,,Outpatient,,,198,129,United Health ,United Health Medicare Advantage,833.54,,,,,,,Fee Schedule,833.54,1419.32,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,90471,CPT,,,,,,Outpatient,,,216.15,140,United Health ,United Health Medicare Advantage,65.07,,,,,,,Fee Schedule,42.18,65.07,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,G0010,CPT,,,,,,Outpatient,,,216.15,,United Health ,United Health Medicare Advantage,42.18,,,,,,,Fee Schedule,42.18,65.07,
"25105 ARTHROTOMY, WRIST JOINT WITH SYNOVECTOMY",14130163,LOCAL,25105,CPT,,,,,,Outpatient,,,895,3245,United Health ,United Health Medicare Advantage,2966.42,,,,,,,Fee Schedule,2528.75,2966.42,
PC DOPP ART BIL REST MULTIPLE/SINGLE,8230015,LOCAL,93923,CPT,,,,,26,Outpatient,,,57.19,401,United Health ,United Health Medicare Advantage,143.05,,,,,,,Fee Schedule,143.05,244.97,
PC DOPP ART W/TREADMILL,8230020,LOCAL,93924,CPT,,,,,26,Outpatient,,,241,302,United Health ,United Health Medicare Advantage,143.05,,,,,,,Fee Schedule,143.05,161.71,
PC DOPP LEA LIMITED,8230019,LOCAL,93922,CPT,,,,,26,Outpatient,,,150,265,United Health ,United Health Medicare Advantage,117.85,,,,,,,Fee Schedule,117.85,161.71,
PC DUP ABD RENAL COMPLETE,8200571,LOCAL,93975,CPT,,,,,26,Outpatient,,,229.11,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP ABD RENAL LIMITED,8200581,LOCAL,93976,CPT,,,,,26,Outpatient,,,134.88,482,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,245.49,
PC DUP AO IVC COMPLETE,8200570,LOCAL,93978,CPT,,,,,26,Outpatient,,,74.95,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP AO IVC LIMITED,8200580,LOCAL,93979,CPT,,,,,26,Outpatient,,,50.12,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP CAROTID BILATERAL,8200229,LOCAL,93880,CPT,,,,,26,Outpatient,,,76.13,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP CAROTID UNILATERAL,8200228,LOCAL,93882,CPT,,,,,26,Outpatient,,,46.65,482,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP HEMODIALYSIS ACCESS,8200582,LOCAL,93990,CPT,,,,,26,Outpatient,,,29.64,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP LEA BIL,8200577,LOCAL,93925,CPT,,,,,26,Outpatient,,,66.27,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP LEA UNI,8200576,LOCAL,93926,CPT,,,,,26,Outpatient,,,45.08,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP UPPER ART BIL,8200575,LOCAL,93930,CPT,,,,,26,Outpatient,,,53.18,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,161.71,220.99,
PC DUP UPPER ART UNI,8200574,LOCAL,93931,CPT,,,,,26,Outpatient,,,35.48,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC DUP VENOUS BIL,8200573,LOCAL,93970,CPT,,,,,26,Outpatient,,,87.58,482,United Health ,United Health Medicare Advantage,220.99,,,,,,,Fee Schedule,220.99,245.49,
PC DUP VENOUS UNI,8200572,LOCAL,93971,CPT,,,,,26,Outpatient,,,57.12,310,United Health ,United Health Medicare Advantage,97.22,,,,,,,Fee Schedule,97.22,161.71,
PC US PSEUDOANEURYSM COMPRESSION REPAIR,8200583,LOCAL,76936,CPT,,,,,26,Outpatient,,,285.6,237.6,United Health ,United Health Medicare Advantage,284.7,,,,,,,Fee Schedule,262.79,284.7,
97802 MEDICAL NUTRITIONAL THERAPY PROF CHARGE,13475611,LOCAL,97802,CPT,,,,,,Outpatient,,,70,55,United Health ,United Health Medicare Advantage,25.2,,,,,,,Fee Schedule,25.2,287.34,
97803 MEDICAL NUTRITIONAL RE-ASSESSMENT PROF CHARG,13481228,LOCAL,97803,CPT,,,,,,Outpatient,,,60,48,United Health ,United Health Medicare Advantage,21.06,,,,,,,Fee Schedule,21.06,287.34,
"64640 Destruction by neurolytic agent, other perip",13959658,LOCAL,64640,CPT,,,,,,Outpatient,,,500,927,United Health ,United Health Medicare Advantage,813.96,,,,,,,Fee Schedule,813.96,1695.82,
10060 PROFEE Drainage of skin abscess,13954453,LOCAL,10060,CPT,,,,,,Outpatient,,,220,420,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
10061  I&D abscess complicated/multiple Profee,13769279,LOCAL,10061,CPT,,,,,,Outpatient,,,385,420,United Health ,United Health Medicare Advantage,365.27,,,,,,,Fee Schedule,239.03,863,
10120 Incision & Removal Foreign Body Simp PROFEE,14006132,LOCAL,10120,CPT,,,,,,Outpatient,,,285,893,United Health ,United Health Medicare Advantage,365.27,,,,,,,Fee Schedule,239.03,863,
"11042 PROFEE Debride subcutaneous tissue, 1st 20 s",13962336,LOCAL,11042,CPT,,,,,,Outpatient,,,145,836,United Health ,United Health Medicare Advantage,365.27,,,,,,,Fee Schedule,365.27,863,
11043 PROFEE DEB MUSC/FASCIA 20 SQ CM/<,13967660,LOCAL,11043,CPT,,,,,,Outpatient,,,340,836,United Health ,United Health Medicare Advantage,559.65,,,,,,,Fee Schedule,549.61,863,
"11044 Debride bone, 1st 20 sq cm or less Pro Fee",11221020,LOCAL,11044,CPT,,,,,,Outpatient,,,465,2328,United Health ,United Health Medicare Advantage,1481.32,,,,,,,Fee Schedule,1291,1481.32,
"11045 Debride subq tissue, ea addl 20 sq cm Pro Fe",11221021,LOCAL,11045,CPT,,,,,,Outpatient,,,50,836,United Health ,United Health Medicare Advantage,20.61,,,,,,,Fee Schedule,20.61,1466.58,
11046 PROFEE Debride muscle and/or fascia; ea addl,13954830,LOCAL,11046,CPT,,,,,,Outpatient,,,128,836,United Health ,United Health Medicare Advantage,44.01,,,,,,,Fee Schedule,44.01,1466.58,
"11047 PROFEE Debridement, sus tissue each add 20 s",13967661,LOCAL,11047,CPT,,,,,,Outpatient,,,195,2092,United Health ,United Health Medicare Advantage,78.26,,,,,,,Fee Schedule,78.26,1466.58,
11104 Punch Biopsy of Skin; Single Lesion ProFee,8768419,LOCAL,11104,CPT,,,,,,Outpatient,,,243.42,449,United Health ,United Health Medicare Advantage,365.27,,,,,,,Fee Schedule,365.27,863,
11106  Incisional biopsy of skin single lesion Pro,13759967,LOCAL,11106,CPT,,,,,,Outpatient,,,296,800,United Health ,United Health Medicare Advantage,559.65,,,,,,,Fee Schedule,559.65,1291,
"11400 EXCISION, BENIGN LESION INCLUDING MARGINS, E",7929974,LOCAL,11400,CPT,,,,,,Outpatient,,,160,935,United Health ,United Health Medicare Advantage,643.26,,,,,,,Fee Schedule,643.26,1291,
"11406 EXCISION, BENIGN LESION INCLUDING MARGINS, E",7929979,LOCAL,11406,CPT,,,,,,Outpatient,,,470,1620,United Health ,United Health Medicare Advantage,1481.32,,,,,,,Fee Schedule,1481.32,2584.84,
"11604 EXCISION, MALIGNANT LESION INCLUDING MARGINS",7930002,LOCAL,11604,CPT,,,,,,Outpatient,,,410,704,United Health ,United Health Medicare Advantage,643.26,,,,,,,Fee Schedule,643.26,1679.75,
"11730 PROFEE Avulsion nail plate simple, single",13967650,LOCAL,11730,CPT,,,,,,Outpatient,,,195,228,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,95.93,863,
"11750 PROFEE Excision of nail and nail matrix, par",13954836,LOCAL,11750,CPT,,,,,,Outpatient,,,305,1342,United Health ,United Health Medicare Advantage,365.27,,,,,,,Fee Schedule,365.27,863,
15271 PROFEE Application of skin substitute graft,13967652,LOCAL,15271,CPT,,,,,,Outpatient,,,296,1092,United Health ,United Health Medicare Advantage,1672.39,,,,,,,Fee Schedule,1496,2862.92,
15275 PROFEE APPLICATION OF SKIN SUBSTITUTE GRAFT,13954832,LOCAL,15275,CPT,,,,,,Outpatient,,,306,1092,United Health ,United Health Medicare Advantage,1672.39,,,,,,,Fee Schedule,1496,2862.92,
"28810 AMPUTATION, METATARSAL, WITH TOE, SINGLE Pro",7931853,LOCAL,28810,CPT,,,,,,Outpatient,,,820,3245,United Health ,United Health Medicare Advantage,2966.42,,,,,,,Fee Schedule,2315,7645.84,
29445 PROFEE APPLICATION OF RIGID TOTAL CONTACT LE,13962328,LOCAL,29445,CPT,,,,,,Outpatient,,,200,266,United Health ,United Health Medicare Advantage,242.81,,,,,,,Fee Schedule,242.81,863,
31502 Tracheotomy tube change prior to establishme,14397259,LOCAL,31502,CPT,,,,,,Outpatient,,,80,232,United Health ,United Health Medicare Advantage,212.31,,,,,,,Fee Schedule,162.41,863,
"31899 UNLISTED PROCEDURE, TRACHEA, BRONCHI ProFee",7932202,LOCAL,31899,CPT,,,,,,Outpatient,,,91,194,United Health ,United Health Medicare Advantage,177.49,,,,,,,Fee Schedule,177.49,2400.33,
"58573 LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTO",14831670,LOCAL,58573,CPT,,,,,,Outpatient,,,2172,10411,United Health ,United Health Medicare Advantage,9518.56,,,,,,,Fee Schedule,5787,9518.56,
64454 Genicular Nerve Block Profee,13911832,LOCAL,64454,CPT,,,,,,Outpatient,,,227,244,United Health ,United Health Medicare Advantage,633.14,,,,,,,Fee Schedule,633.14,1291,
64999 XX UNLISTED NERVOUS SYSTEM INJECTION,7939552,LOCAL,64999,CPT,,,,,,Outpatient,,,250,620,United Health ,United Health Medicare Advantage,269.88,,,,,,,Fee Schedule,269.88,863,
93010 EKG INTERPRETATION,7939709,LOCAL,93010,CPT,,,,,,Outpatient,,,65,,United Health ,United Health Medicare Advantage,10.44,,,,,,,Fee Schedule,10.44333333,38.53,
93451 RIGHT HEART CATHERIZATION (OR),8192212,LOCAL,93451,CPT,,,,,26,Outpatient,,,1008,6246,United Health ,United Health Medicare Advantage,2940.64,,,,,,,Fee Schedule,2940.64,4325,
97597 WOUND DEBRIDEMENT ProFee,7935939,LOCAL,97597,CPT,,,,,,Outpatient,,,188.32,395,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,863,
97598 DEBRID SELCT EA ADD20SQCM ProFee,7935940,LOCAL,97598,CPT,,,,,,Outpatient,,,83,395,United Health ,United Health Medicare Advantage,20.42,,,,,,,Fee Schedule,20.42,1466.58,
97605 Negative pressure wound therapy less than 50,14327888,LOCAL,97605,CPT,,,,,,Outpatient,,,80,285,United Health ,United Health Medicare Advantage,181.66,,,,,,,Fee Schedule,181.66,273.27,
99183 HBO PER SESSION ProFee,7935966,LOCAL,99183,CPT,,,,,,Outpatient,,,210,,United Health ,United Health Medicare Advantage,145.15,,,,,,,Fee Schedule,145.1479032,145.1479032,
99202 LEVEL 2 VISIT NEW PT ProFee,7935970,LOCAL,99202,CPT,,,,,,Outpatient,,,140,294,United Health ,United Health Medicare Advantage,39.11,,,,,,,Fee Schedule,39.11,39.11,
99203 LEVEL 3 VISIT NEW PT ProFee,7935971,LOCAL,99203,CPT,,,,,,Outpatient,,,200,387,United Health ,United Health Medicare Advantage,67.57,,,,,,,Fee Schedule,67.57,67.57,
99204 LEVEL 4 NEW PT PROF CHARGE,8700762,LOCAL,99204,CPT,,,,,,Outpatient,,,305,513,United Health ,United Health Medicare Advantage,110.67,,,,,,,Fee Schedule,110.67,110.67,
99205 PROFEE OFFICE VISIT LEV 5 NEW PT,13962366,LOCAL,99205,CPT,,,,,,Outpatient,,,385,701,United Health ,United Health Medicare Advantage,151.18,,,,,,,Fee Schedule,151.18,151.18,
99211 LEVEL 1 EST PT PROF CHARGE,8700763,LOCAL,99211,CPT,,,,,,Outpatient,,,40,226,United Health ,United Health Medicare Advantage,7.37,,,,,,,Fee Schedule,7.37,7.37,
99212 LEVEL 2 EST PT PROF CHARGE,8700764,LOCAL,99212,CPT,,,,,,Outpatient,,,100,294,United Health ,United Health Medicare Advantage,29.48,,,,,,,Fee Schedule,29.48,29.48,
99213 LEVEL 3 EST PT PROF CHARGE,8700765,LOCAL,99213,CPT,,,,,,Outpatient,,,135,387,United Health ,United Health Medicare Advantage,54.77,,,,,,,Fee Schedule,54.77,54.77,
99214 LEVEL 4 EST PT PROF CHARGE,8700766,LOCAL,99214,CPT,,,,,,Outpatient,,,200,513,United Health ,United Health Medicare Advantage,80.51,,,,,,,Fee Schedule,80.51,80.51,
99215 LEVEL 5 EST PT PROF CHARGE,8700767,LOCAL,99215,CPT,,,,,,Outpatient,,,270,701,United Health ,United Health Medicare Advantage,119.41,,,,,,,Fee Schedule,119.41,119.41,
G0108 DIABETES SERVICE 30 MIN PROF CHARGE,13484119,LOCAL,G0108,CPT,,,,,,Outpatient,,,105,128,United Health ,United Health Medicare Advantage,52.15,,,,,,,Fee Schedule,52.15,95.93,
G0109 DSMT DIABETES GROUP 30 MIN ProFee,7936084,LOCAL,G0109,CPT,,,,,,Outpatient,,,40,18,United Health ,United Health Medicare Advantage,14.97,,,,,,,Fee Schedule,14.97,67.18,
20560 DRY NEEDLING 1 OR 2 MUSCLES WO INJECTION,9650048,LOCAL,20560,CPT,,,,,,Outpatient,,,77.31,26,UHC Comm,UHC Comm,863,,,,,,,Case Rate,22.39,863,
64461 THORACIC PARAVERTEBRAL BLOCK,5661020,LOCAL,64461,CPT,,,,,,Outpatient,,,80,50,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
20561 DRY NEEDLING 3+ MUSCLES WO INJECTION,9650049,LOCAL,20561,CPT,,,,,,Outpatient,,,100,52,UHC Comm,UHC Comm,863,,,,,,,Case Rate,22.39,863,
"64420 INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVE, SINGLE ProFee",13959631,LOCAL,64420,CPT,,,,,,Outpatient,,,103,693,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
CYSTOGRAM INJ,8210035,LOCAL,51600,CPT,,,,,,Outpatient,,,120,246,UHC Comm,UHC Comm,863,,,,,,,Case Rate,35.39,863,
"29125 Application of short arm splint (forearm to hand); static, right",8584933,LOCAL,29125,CPT,,,,,,Outpatient,,,125,129,UHC Comm,UHC Comm,863,,,,,,,Case Rate,63.51,863,
29584 PT APPLICATION OF MULTI-LAYER COMPRESSION SYSTEM,9109668,LOCAL,29584,CPT,,,,,GP,Outpatient,,,125,81,UHC Comm,UHC Comm,863,,,,,,,Case Rate,63.51,863,
PT MultiLayer Compress Below Knee Charge,7896004,LOCAL,29584,CPT,,,,,GP,Outpatient,,,144.74,81,UHC Comm,UHC Comm,863,,,,,,,Case Rate,63.51,863,
Urinary Catheter Type:; -> Straight/Intermittent,4610954,LOCAL,51701,CPT,,,,,,Outpatient,,,148.2,94,UHC Comm,UHC Comm,863,,,,,,,Case Rate,105.27,863,
Blood Gas Arterial RT,8172944,LOCAL,36600,CPT,,,,,,Outpatient,,,148.2,96,UHC Comm,UHC Comm,863,,,,,,,Case Rate,85.79,863,
Blood Gas Draw Type -> Arterial (Puncture),5230102,LOCAL,36600,CPT,,,,,,Outpatient,,,148.2,96,UHC Comm,UHC Comm,863,,,,,,,Case Rate,85.79,863,
RT Arterial Puncture CHARGE,8143881,LOCAL,36600,CPT,,,,,,Outpatient,,,151.98,96,UHC Comm,UHC Comm,863,,,,,,,Case Rate,85.79,863,
36430 BLOOD TRANSFUSION CHARGE,9284603,LOCAL,36430,CPT,,,,,,Outpatient,,,151.98,99,UHC Comm,UHC Comm,863,,,,,,,Case Rate,399.7,863,
BLOOD ADMINISTRATION Charge,5240125,LOCAL,36430,CPT,,,,,,Outpatient,,,155.91,99,UHC Comm,UHC Comm,863,,,,,,,Case Rate,399.7,863,
"16000 Initial treatment, first degree burn, when no more than local treatment required",9400038,LOCAL,16000,CPT,,,,,,Outpatient,,,163.39,101,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
11719 TRIM NAIL(S) ANY NUMBER WC CHARGE,8726774,LOCAL,11719,CPT,,,,,,Outpatient,,,165,106,UHC Comm,UHC Comm,863,,,,,,,Case Rate,54.31,863,
29105 - Long Arm Splint,9322359,LOCAL,29105,CPT,,,,,,Outpatient,,,174.99,158,UHC Comm,UHC Comm,863,,,,,,,Case Rate,63.51,863,
CULL MG Wire Loc Needle,13721990,LOCAL,10035,CPT,A4648,HCPCS,,,,Outpatient,,,208.54,114,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,643.26,1291,
RT CHARGE Suction -> BBG/Nasopharyngeal,6690655,LOCAL,31720,CPT,,,,,,Outpatient,,,216.87,136,UHC Comm,UHC Comm,863,,,,,,,Case Rate,76.09,863,
Bladder Scan,649589,LOCAL,51798,CPT,,,,,,Outpatient,,,219.69,59,UHC Comm,UHC Comm,863,,,,,,,Case Rate,54.31,863,
69209 REM IMPACT CERUMEN REQ IRRIGAT CHARGE,8020086,LOCAL,69209,CPT,,,,,,Outpatient,,,225,143,UHC Comm,UHC Comm,863,,,,,,,Case Rate,54.31,863,
64418- Suprascapular nerve block,10452404,LOCAL,64418,CPT,,,,,,Outpatient,,,239.9,693,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
11732 AVULSION OF EACH ADDITIONAL NAIL PLATE,13029593,LOCAL,11732,CPT,,,,,,Outpatient,,,240,156,UHC Comm,UHC Comm,863,,,,,,,Case Rate,14.39,863,
93463 Pharmacologic Agent Administration,8230065,LOCAL,93463,CPT,,,,,,Outpatient,,,241.46,156,UHC Comm,UHC Comm,863,,,,,,,Case Rate,64.56,863,
36591 COLLECT BLOOD FROM IMPL VEN DEVICE CHARGE,10451346,LOCAL,36591,CPT,,,,,,Outpatient,,,241.46,157,UHC Comm,UHC Comm,863,,,,,,,Case Rate,85.79,863,
Central Line Activity. -> Blood drawn,12856467,LOCAL,36592,CPT,,,,,,Outpatient,,,255.9,157,UHC Comm,UHC Comm,863,,,,,,,Case Rate,85.79,863,
69210 REM IMPACT CERUMEN REQ INSTRU CHARGE,8020194,LOCAL,69210,CPT,,,,,,Outpatient,,,300,166,UHC Comm,UHC Comm,863,,,,,,,Case Rate,54.31,863,
29581 PT Lower Extremity Application of Strapping,9640079,LOCAL,29581,CPT,,,,,GP,Outpatient,,,300,195,UHC Comm,UHC Comm,863,,,,,,,Case Rate,144.26,863,
PT Lymphedema Wrap below Knee Charge,7895901,LOCAL,29581,CPT,,,,,GP,Outpatient,,,330.88,195,UHC Comm,UHC Comm,863,,,,,,,Case Rate,144.26,863,
XR Portogram,8602535,LOCAL,36598,CPT,,,,,,Outpatient,,,350,587,UHC Comm,UHC Comm,863,,,,,,,Case Rate,192.63,863,
17110 CRYOSURGERY REMOVAL OF LESIONS CHARGE,9038957,LOCAL,17110,CPT,,,,,,Outpatient,,,350.01,228,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
11730 AVULSION OF NAIL PLATE SINGLE,8715870,LOCAL,11730,CPT,,,,,,Outpatient,,,373.99,228,UHC Comm,UHC Comm,863,,,,,,,Case Rate,95.93,863,
27095 INJ PROC FOR HIP ARTHROGRAPHY W/ ANESTH,5661071,LOCAL,27095,CPT,,,,,,Outpatient,,,375,,UHC Comm,UHC Comm,863,,,,,,,Case Rate,64.91,863,
"64454 - Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imagin",12897048,LOCAL,64454,CPT,,,,,,Outpatient,,,375,244,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
"64454 Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging",9520502,LOCAL,64454,CPT,,,,,,Outpatient,,,419.53,244,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
15272 APP SKN SUB GRFT TAL 100 SQ CM ADDT FAC CHARGE,12831013,LOCAL,15272,CPT,,,,,,Outpatient,,,426.97,273,UHC Comm,UHC Comm,863,,,,,,,Case Rate,13.68,2862.92,
"11055 BENIGN LESION PARING/CUTTING, SINGLE",13043366,LOCAL,11055,CPT,,,,,,Outpatient,,,439.05,278,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
11056 BENIGN LESION PARING(2-4),13029575,LOCAL,11056,CPT,,,,,,Outpatient,,,439.05,285,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
11103 TANGENTIAL BIOP EA ADDT CHARGE,9322081,LOCAL,11103,CPT,,,,,,Outpatient,,,439.05,285,UHC Comm,UHC Comm,863,,,,,,,Case Rate,16.62,863,
11721 DEBRIDE NAIL 6 OR MORE WC CHARGE,8726776,LOCAL,11721,CPT,,,,,,Outpatient,,,454.38,285,UHC Comm,UHC Comm,863,,,,,,,Case Rate,54.31,863,
12001 SIMPLE REPAIR OF WOUND TRUNK,13029607,LOCAL,12001,CPT,,,,,,Outpatient,,,458,295,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
CHOLANGIO W EXIST CATH S&I,8210339,LOCAL,47531,CPT,,,,,,Outpatient,,,462.53,298,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,3226.48,
29580 Application of a Paste Boot (Bilateral),12642335,LOCAL,29580,CPT,,,,,,Outpatient,,,462.53,301,UHC Comm,UHC Comm,863,,,,,,,Case Rate,144.26,863,
29580 PT UNNA BOOT APPL,9410275,LOCAL,29580,CPT,,,,,GP,Outpatient,,,481.51,301,UHC Comm,UHC Comm,863,,,,,,,Case Rate,144.26,863,
CULL MG Needle/Wire Loc Breast,13720943,LOCAL,19281,CPT,,,,,,Outpatient,,,481.51,313,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,1200.99,1496,
MG Mammo Guided Needle Loc Left,8206592,LOCAL,19281,CPT,,,,,LT,Outpatient,,,481.51,313,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,1200.99,1496,
MG Mammo Guided Needle Loc Right,8206595,LOCAL,19281,CPT,,,,,RT,Outpatient,,,491.38,313,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,1200.99,1496,
"11105 Punch Biopsy of Skin, Ea Separate/Additional CRRH_GA",13243078,LOCAL,11105,CPT,,,,,,Outpatient,,,498,319,UHC Comm,UHC Comm,863,,,,,,,Case Rate,19.82,863,
"45300 PROCTOSIGMOIDOSCOPY, RIGID, DIAGNOSTIC, W OR W/O COLLECTION BY BRUSHING OR WASHING",8934255,LOCAL,45300,CPT,,,,,,Outpatient,,,506,129,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,833.54,1419.32,
IVUS ADDL VESSEL,8230049,LOCAL,92979,CPT,,,,,,Outpatient,,,509,329,UHC Comm,UHC Comm,863,,,,,,,Case Rate,130.59,863,
Administration of Blood (Bridge),8019084,LOCAL,36430,CPT,,,,,,Outpatient,,,509,99,UHC Comm,UHC Comm,863,,,,,,,Case Rate,399.7,863,
TRANSFUSE Fresh Frozen Plasma (Bridge),8482691,LOCAL,36430,CPT,,,,,,Outpatient,,,509,99,UHC Comm,UHC Comm,863,,,,,,,Case Rate,399.7,863,
TRANSFUSE Platelet Product (Bridge),8482692,LOCAL,36430,CPT,,,,,,Outpatient,,,509,99,UHC Comm,UHC Comm,863,,,,,,,Case Rate,399.7,863,
TRANSFUSE Red Blood Cells Leukoreduced (Bridge),8482690,LOCAL,36430,CPT,,,,,,Outpatient,,,517.48,99,UHC Comm,UHC Comm,863,,,,,,,Case Rate,399.7,863,
XR Arthrogram Injection Ankle Left,1169950,LOCAL,20605,CPT,,,,,LT,Outpatient,,,517.48,336,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
XR Arthrogram Injection Ankle Right,1169952,LOCAL,20605,CPT,,,,,RT,Outpatient,,,517.48,336,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
XR Arthrogram Injection Elbow Right,1169958,LOCAL,20605,CPT,,,,,RT,Outpatient,,,517.48,336,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
XR Arthrogram Injection Wrist Left,1169996,LOCAL,20605,CPT,,,,,LT,Outpatient,,,517.48,336,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
XR Arthrogram Injection Wrist Right,1169998,LOCAL,20605,CPT,,,,,RT,Outpatient,,,523.3,336,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
11057 BENIGN LESION PARING(4+),13029576,LOCAL,11057,CPT,,,,,,Outpatient,,,523.3,340,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
16030 Dressing/Debridement Large More than one ext or >10% total body,9400041,LOCAL,16030,CPT,,,,,,Outpatient,,,526.26,863,UHC Comm,UHC Comm,863,,,,,,,Case Rate,365.27,863,
15276 APPL-HC SKSB GRT F/N/H/G-AD 25CM CHARGE,9709030,LOCAL,15276,CPT,,,,,,Outpatient,,,535.14,342,UHC Comm,UHC Comm,863,,,,,,,Case Rate,20.61,2862.92,
93799 INPATIENT TEACH CARDIAC REHAB CHARGE,8230066,LOCAL,93799,CPT,,,,,,Outpatient,,,580.2,348,UHC Comm,UHC Comm,863,,,,,,,Case Rate,38.53,863,
29581 APPL MULTLAY COMPRS LWR LEG,9739188,LOCAL,29581,CPT,,,,,,Outpatient,,,585,195,UHC Comm,UHC Comm,863,,,,,,,Case Rate,144.26,863,
Oviduct chromotubation 58350,9093091,LOCAL,58350,CPT,,,,,,Outpatient,,,587.24,4936,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,4513.2,
64445 NERV BLOCK SCIATIC,5661029,LOCAL,64445,CPT,,,,,,Outpatient,,,604.59,382,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
36010 INTRO CATH SUP/INF VENA CAVA,8266890,LOCAL,36010,CPT,,,,,,Outpatient,,,604.59,393,UHC Comm,UHC Comm,863,,,,,,,Case Rate,87.95,929.12,
INTRO CATH VENA CAVA,8267101,LOCAL,36010,CPT,,,,,,Outpatient,,,607.55,393,UHC Comm,UHC Comm,863,,,,,,,Case Rate,87.95,929.12,
Antenatal Testing Type -> Contraction stress test,10446024,LOCAL,59020,CPT,,,,,,Outpatient,,,608.25,94,UHC Comm,UHC Comm,863,,,,,,,Case Rate,183.92,863,
97597 ACTIVE WOUND CARE MANAGEMENT FIRST 20 CM,13048047,LOCAL,97597,CPT,,,,,59,Outpatient,,,608.25,395,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
97597 DEBRIDE SCISSOR/SCAPEL 20SQ CM,9410251,LOCAL,97597,CPT,,,,,GP,Outpatient,,,608.25,395,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
97597 DEBRIDEMENT,9866113,LOCAL,97597,CPT,,,,,GO|CO,Outpatient,,,608.25,395,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
97597 OT SELECT DEBRIDE ME CHARGE,9856113,LOCAL,97597,CPT,,,,,GO,Outpatient,,,608.25,395,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
97598 Debrid Open wound > 20 sq cm charge,12511973,LOCAL,97598,CPT,,,,,,Outpatient,,,608.25,395,UHC Comm,UHC Comm,863,,,,,,,Case Rate,20.42,1466.58,
OT Removal Devitalized Tissue < 20 cm Units,7897756,LOCAL,97597,CPT,,,,,GO,Outpatient,,,608.25,395,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
OT Removal Tissue <20 Assist Units,7897756,LOCAL,97597,CPT,,,,,CQ,Outpatient,,,608.25,395,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
OT Selective Debridement Charge,7895252,LOCAL,97597,CPT,,,,,GO,Outpatient,,,608.25,395,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
Selective Debridement Charge,7895942,LOCAL,97597,CPT,,,,,GP,Outpatient,,,608.25,395,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
"Selective Debridement Charge -> Yes, total wound surface area, first 20 sq cm or less",8968080,LOCAL,97597,CPT,,,,,GP,Outpatient,,,637.75,395,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
64486 TAP BLOCK UNILATERAL BY INJECTION(S),5661023,LOCAL,64486,CPT,,,,,,Outpatient,,,638.52,415,UHC Comm,UHC Comm,863,,,,,,,Case Rate,46.33,863,
INTRO CATH RT HEART PA,8267102,LOCAL,36013,CPT,,,,,,Outpatient,,,646.72,415,UHC Comm,UHC Comm,863,,,,,,,Case Rate,104.34,929.12,
10060 DRAINAGE OF SKIN ABSCESS CHARGE,9704026,LOCAL,10060,CPT,,,,,,Outpatient,,,646.72,420,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
10061 I & D COMPLEX,13048116,LOCAL,10061,CPT,,,,,,Outpatient,,,656.43,420,UHC Comm,UHC Comm,863,,,,,,,Case Rate,239.03,863,
"11102 Tangential Biopsy of Skin, 1 lesion",9620037,LOCAL,11102,CPT,,,,,,Outpatient,,,656.43,427,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
16020 BURN DEBRIDEMENT/DRESSING INITIAL OR SUB,13043448,LOCAL,16020,CPT,,,,,,Outpatient,,,656.43,427,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
16020 Chemical Canterizaiton,9400039,LOCAL,16020,CPT,,,,,,Outpatient,,,656.43,427,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
17250 CAUTERY OF WOUND (ELECTRICAL),13033473,LOCAL,17250,CPT,,,,,,Outpatient,,,660,427,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
13133 >  Each additional 5 cm or less (List separately in addition to primary procedure),12788295,LOCAL,13133,CPT,,,,,,Outpatient,,,660,,UHC Comm,UHC Comm,863,,,,,,,Case Rate,95.58,863,
"13133-Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; e",14746903,LOCAL,13133,CPT,,,,,,Outpatient,,,680,,UHC Comm,UHC Comm,863,,,,,,,Case Rate,95.58,863,
64450 INJECTION PERIPHERAL NERVE OR BRANCH,5661030,LOCAL,64450,CPT,,,,,,Outpatient,,,685,1613,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
57105 - BIOPSY VAGINAL MUCOSA EXTENSIVE,14749499,LOCAL,57105,CPT,,,,,,Outpatient,,,691.38,3180,UHC Comm,UHC Comm,2315,,,,,,,Case Rate,2315,3558.77,
11104 Punch Biopsy,10017193,LOCAL,11104,CPT,,,,,,Outpatient,,,710.23,449,UHC Comm,UHC Comm,863,,,,,,,Case Rate,365.27,863,
64495 - INJ PARAVERT F JNT L/S 3 LEV,5661079,LOCAL,64495,CPT,,,,,,Outpatient,,,710.94,462,UHC Comm,UHC Comm,863,,,,,,,Case Rate,42.72,1250.53,
INTRO CAROTID VERTEBRAL ARTERY,8267188,LOCAL,36100,CPT,,,,,,Outpatient,,,724.33,462,UHC Comm,UHC Comm,863,,,,,,,Case Rate,122.25,929.12,
64405 Occipital Nerve Block Unilateral,5661077,LOCAL,64405,CPT,,,,,,Outpatient,,,734.27,879,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
93571 Cor Flow Wire 1st Measure,8230055,LOCAL,93571,CPT,,,,,,Outpatient,,,740,477,UHC Comm,UHC Comm,863,,,,,,,Case Rate,143.66,2669.67,
XR Arthrocentesis Asp/Inj Intmed Jt Lt,14807134,LOCAL,20605,CPT,,,,,LT,Outpatient,,,740,336,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
XR Arthrocentesis Asp/Inj Intmed Jt Rt,14807137,LOCAL,20605,CPT,,,,,RT,Outpatient,,,740,336,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
XR Arthrocentesis Asp/Inj Major Jt Bilat,14807140,LOCAL,20610,CPT,,,,,50,Outpatient,,,740,650,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
XR Arthrocentesis Asp/Inj Major Jt Lt,14807143,LOCAL,20610,CPT,,,,,LT,Outpatient,,,740,650,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
XR Arthrocentesis Asp/Inj Major Jt Rt,14807146,LOCAL,20610,CPT,,,,,RT,Outpatient,,,740,650,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
XR Arthrocentesis Asp/Inj Small Jt Lt,14807149,LOCAL,20600,CPT,,,,,LT,Outpatient,,,740,295,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
XR Arthrocentesis Asp/Inj Small Jt Rt,14807152,LOCAL,20600,CPT,,,,,RT,Outpatient,,,761,295,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
64494 - INJ PARAVERT F JNT L/S 2 LEV,5661036,LOCAL,64494,CPT,,,,,,Outpatient,,,782.44,495,UHC Comm,UHC Comm,863,,,,,,,Case Rate,41.55,1250.53,
64491 INJ PARAVER CERV/THOR 2ND LEVEL,5661064,LOCAL,64491,CPT,,,,,,Outpatient,,,782.44,509,UHC Comm,UHC Comm,863,,,,,,,Case Rate,48.01,1250.53,
64492 FACET CERV/THOR 3RD ADDTL LEVEL CHARGE,5661080,LOCAL,64492,CPT,,,,,,Outpatient,,,788,509,UHC Comm,UHC Comm,863,,,,,,,Case Rate,48.5,1250.53,
ICD DFT TESTING,8231015,LOCAL,93641,CPT,,,,,,Outpatient,,,794.92,512,UHC Comm,UHC Comm,863,,,,,,,Case Rate,205.74,9059.73,
36593 DECLOT IMPLANT DEVICE/CATHETER CHARGE,8700839,LOCAL,36593,CPT,,,,,,Outpatient,,,798,517,UHC Comm,UHC Comm,863,,,,,,,Case Rate,303.25,863,
64590  Insertion or replacement of peripheral or gastric neurostimulator pulse generator,8529396,LOCAL,64590,CPT,,,,,,Outpatient,,,820.1,519,UHC Comm,UHC Comm,9233,,,,,,,Case Rate,9233,30196.67,
ADD'L ART 2ND/3RD ABD,8267115,LOCAL,36248,CPT,,,,,,Outpatient,,,828.2,533,UHC Comm,UHC Comm,863,,,,,,,Case Rate,39.09,929.12,
92978 Cath IVUS First Vessel,8230048,LOCAL,92978,CPT,,,,,,Outpatient,,,847.39,538,UHC Comm,UHC Comm,863,,,,,,,Case Rate,164.22,863,
36005 Venogram Injection,8212037,LOCAL,36005,CPT,,,,,,Outpatient,,,874.14,551,UHC Comm,UHC Comm,863,,,,,,,Case Rate,38.76,929.12,
CARDIAC THROMBOLYTICS IV,8267127,LOCAL,92977,CPT,,,,,,Outpatient,,,908.34,568,UHC Comm,UHC Comm,863,,,,,,,Case Rate,303.25,863,
CATH PL 1ST ORDER VENOUS,8267186,LOCAL,36011,CPT,,,,,,Outpatient,,,914.51,590,UHC Comm,UHC Comm,863,,,,,,,Case Rate,126.74,929.12,
VENOGRAM INJ BILATERAL,8267755,LOCAL,36005,CPT,,,,,,Outpatient,,,927.16,551,UHC Comm,UHC Comm,863,,,,,,,Case Rate,38.76,929.12,
US Breast Needle Loc Left,7936259,LOCAL,19285,CPT,,,,,LT,Outpatient,,,927.16,603,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,643.26,1291,
US Breast Needle Loc Right,7936262,LOCAL,19285,CPT,,,,,RT,Outpatient,,,927.38,603,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,643.26,1291,
XR Cholangiogram T-Tube Check,8207012,LOCAL,47531,CPT,,,,,,Outpatient,,,953.35,298,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,3226.48,
64999 PERI-INFILTRATION HARDWARE,5661083,LOCAL,64999,CPT,,,,,,Outpatient,,,970.36,620,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
ADD'L ART 2ND/3RD THORAC,8267111,LOCAL,36218,CPT,,,,,,Outpatient,,,980.22,631,UHC Comm,UHC Comm,863,,,,,,,Case Rate,42.55,929.12,
CATH PLACE SEG SUBSEG PA,8267104,LOCAL,36015,CPT,,,,,,Outpatient,,,991.5,637,UHC Comm,UHC Comm,863,,,,,,,Case Rate,139.57,929.12,
16025 DRESS AN/OR DEBMT BURN INI MED CHARGE,8020080,LOCAL,16025,CPT,,,,,,Outpatient,,,1000,644,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
20610 INJECT MAJOR JOINT,5661087,LOCAL,20610,CPT,,,,,,Outpatient,,,1022.12,650,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
INTRO EXTREMITY ARTERY,8267105,LOCAL,36140,CPT,,,,,,Outpatient,,,1030.62,664,UHC Comm,UHC Comm,863,,,,,,,Case Rate,72.34,929.12,
11107 INCAL BX SKN EA SEP/ADDL CHARGE,9704096,LOCAL,11107,CPT,,,,,,Outpatient,,,1035.43,670,UHC Comm,UHC Comm,863,,,,,,,Case Rate,23.51,863,
US Joint/Bursa Lw Int Arth/Asp/Inj Left,3148332,LOCAL,20606,CPT,,,,,LT,Outpatient,,,1035.43,673,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
US Joint/Bursa Lw Int Arth/Asp/Inj Right,3148335,LOCAL,20606,CPT,,,,,RT,Outpatient,,,1035.43,673,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
US Joint/Bursa Lw Maj Arth/Asp/Inj Left,3148338,LOCAL,20611,CPT,,,,,LT,Outpatient,,,1035.43,673,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
US Joint/Bursa Lw Maj Arth/Asp/Inj Right,3148341,LOCAL,20611,CPT,,,,,RT,Outpatient,,,1035.43,673,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
US Joint/Bursa Lw Sm Arth/Asp/Inj Left,6130396,LOCAL,20604,CPT,,,,,LT,Outpatient,,,1035.43,673,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
US Joint/Bursa Lw Sm Arth/Asp/Inj Right,6130399,LOCAL,20604,CPT,,,,,RT,Outpatient,,,1035.43,673,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
US Joint/Bursa Up Int Arth/Asp/Inj Left,2425353,LOCAL,20606,CPT,,,,,LT,Outpatient,,,1035.43,673,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
US Joint/Bursa Up Int Arth/Asp/Inj Right,2425356,LOCAL,20606,CPT,,,,,RT,Outpatient,,,1035.43,673,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
US Joint/Bursa Up Maj Arth/Asp/Inj Left,2425359,LOCAL,20611,CPT,,,,,LT,Outpatient,,,1035.43,673,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
US Joint/Bursa Up Maj Arth/Asp/Inj Right,2425362,LOCAL,20611,CPT,,,,,RT,Outpatient,,,1035.43,673,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
US Joint/Bursa Up Sm Arth/Asp/Inj Left,6130402,LOCAL,20604,CPT,,,,,LT,Outpatient,,,1035.43,673,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
US Joint/Bursa Up Sm Arth/Asp/Inj Right,6130405,LOCAL,20604,CPT,,,,,RT,Outpatient,,,1040.53,673,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
GASTRO-JEJUNOSTOMY TUBE REPLACEMENT,8200254,LOCAL,49452,CPT,,,,,,Outpatient,,,1052.64,676,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,857.17,1496,
ARTERIAL LINE PLACEMENT,8210320,LOCAL,36620,CPT,,,,,,Outpatient,,,1122.44,684,UHC Comm,UHC Comm,863,,,,,,,Case Rate,38.92,929.12,
CATH PL 2ND ORDER VENOUS,8267187,LOCAL,36012,CPT,,,,,,Outpatient,,,1160.76,730,UHC Comm,UHC Comm,863,,,,,,,Case Rate,142.32,929.12,
29445 APPL RIGID LEG CAST,9739196,LOCAL,29445,CPT,,,,,,Outpatient,,,1193.14,266,UHC Comm,UHC Comm,863,,,,,,,Case Rate,242.81,863,
64480 CERVICAL THORACIC TRANSFORAMINAL EACH AD,5661052,LOCAL,64480,CPT,,,,,,Outpatient,,,1230.36,776,UHC Comm,UHC Comm,863,,,,,,,Case Rate,50.22,1250.53,
15274 App Skin Sub Graft (TWSA>100cm2) t/s/l ; add 100 cm 2,12642329,LOCAL,15274,CPT,,,,,,Outpatient,,,1230.36,800,UHC Comm,UHC Comm,863,,,,,,,Case Rate,35.4,2862.92,
15278 APPL-HC SKSB GRT F/N/H/G-KD A100 CHARGE,9709036,LOCAL,15278,CPT,,,,,,Outpatient,,,1230.62,800,UHC Comm,UHC Comm,863,,,,,,,Case Rate,44.7,2862.92,
11106 INCAL BX SKN SINGLE LES CHARGE,9704095,LOCAL,11106,CPT,,,,,,Outpatient,,,1239.7,800,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,559.65,1291,
"64520 Injection Lumbar or Thoracic, Paravertebral Sympathetic",5661043,LOCAL,64520,CPT,,,,,,Outpatient,,,1284.42,806,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,813.96,1291,
62320 Cervical/Thoracic Epidural without Fluor,5661014,LOCAL,62320,CPT,,,,,,Outpatient,,,1286.64,835,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
11042 DEB SQ TISSUE-1ST 20SQCM/< CHARGE,9704056,LOCAL,11042,CPT,,,,,,Outpatient,,,1286.64,836,UHC Comm,UHC Comm,863,,,,,,,Case Rate,365.27,863,
11043 DEB MUS/FASCIA-1ST 20SQCM/< CHARGE,9704059,LOCAL,11043,CPT,,,,,,Outpatient,,,1286.64,836,UHC Comm,UHC Comm,863,,,,,,,Case Rate,549.61,863,
11045 Debrid bone 1st 20 sq cm charge,12510099,LOCAL,11045,CPT,,,,,,Outpatient,,,1286.64,836,UHC Comm,UHC Comm,863,,,,,,,Case Rate,20.61,1466.58,
11045 Debrid Sub Tissue > 20 sq cm charge,12511974,LOCAL,11045,CPT,,,,,,Outpatient,,,1286.64,836,UHC Comm,UHC Comm,863,,,,,,,Case Rate,20.61,1466.58,
11046 DEB MUS/FASCIA-EA ADDL 20SQCM CHARGE,9704068,LOCAL,11046,CPT,,,,,,Outpatient,,,1328,836,UHC Comm,UHC Comm,863,,,,,,,Case Rate,44.01,1466.58,
16030 DRESS AN/OR DEBMT BURN INI LG CHARGE,8020081,LOCAL,16030,CPT,,,,,,Outpatient,,,1338.01,863,UHC Comm,UHC Comm,863,,,,,,,Case Rate,365.27,863,
93660 STRESS TILT TABLE CHARGE,8200435,LOCAL,93660,CPT,,,,,,Outpatient,,,1339,870,UHC Comm,UHC Comm,863,,,,,,,Case Rate,244.97,863,
JEJUNOSTOMY PERC,8200251,LOCAL,49441,CPT,,,,,,Outpatient,,,1345.12,870,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,983.02,1734.34,
64620 DESTR INTERCOSTAL NERVE,5661066,LOCAL,64620,CPT,,,,,,Outpatient,,,1345.12,874,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,813.96,1695.82,
64634 DESTR FACET CRV/THR EA ADL LVL,5661058,LOCAL,64634,CPT,,,,,,Outpatient,,,1348.68,874,UHC Comm,UHC Comm,863,,,,,,,Case Rate,54.71,1250.53,
15002 SITE PREP -100 SQCM(TAL),12625535,LOCAL,15002,CPT,,,,,,Outpatient,,,1352.9,877,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,1466.58,1672.39,
64405 OCCIPITAL - BILATERAL CHARGE,5661078,LOCAL,64405,CPT,,,,,,Outpatient,,,1373.45,879,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
10120 Incision & removal of Foreign Body Simple,9620024,LOCAL,10120,CPT,,,,,,Outpatient,,,1375.34,893,UHC Comm,UHC Comm,863,,,,,,,Case Rate,239.03,863,
62321 CERVICAL THORACIC EPIDURAL,5661016,LOCAL,62321,CPT,,,,,,Outpatient,,,1375.34,894,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
64520 LUMBAR OR THORACIC Sympathetic Charge,5661033,LOCAL,64520,CPT,,,,,,Outpatient,,,1376.78,806,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,813.96,1291,
64490 INJ PARAVER CERV/THOR 1ST LEVEL,5661063,LOCAL,64490,CPT,,,,,,Outpatient,,,1379.82,895,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,813.96,1291,
INTRO CATH AORTA,8267107,LOCAL,36200,CPT,,,,,,Outpatient,,,1397.93,897,UHC Comm,UHC Comm,863,,,,,,,Case Rate,112.42,929.12,
64479 CERVICAL THORACIC TRANSFORAMINAL EPIDRL,5661051,LOCAL,64479,CPT,,,,,,Outpatient,,,1408.03,909,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,813.96,1291,
62323 LUMBAR OR CAUDAL EPIDURAL,5661015,LOCAL,62323,CPT,,,,,,Outpatient,,,1409.73,915,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
PERC ASPIRATION DISC,8230054,LOCAL,62267,CPT,,,,,,Outpatient,,,1418.86,916,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,643.26,1291,
64510 NERV BLK STELLATE GANGLION,5661032,LOCAL,64510,CPT,,,,,,Outpatient,,,1425,922,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,813.96,1695.82,
"64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when per",9520503,LOCAL,64624,CPT,,,,,,Outpatient,,,1425.83,926,UHC Comm,UHC Comm,2315,,,,,,,Case Rate,1695.82,2315,
64640 DESTR OTH PERIPHERAL NERVE/BRCH,5661065,LOCAL,64640,CPT,,,,,,Outpatient,,,1432.9,927,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,813.96,1695.82,
62290 INJ DISKOGRAPH LUMBAR EA LVL,5661062,LOCAL,62290,CPT,,,,,,Outpatient,,,1438,931,UHC Comm,UHC Comm,863,,,,,,,Case Rate,134.34,863,
11400 EXC BENIGN LES-T/A/L 0.5CM OR < CHARGE FACILITY,9704107,LOCAL,11400,CPT,,,,,,Outpatient,,,1441.95,935,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,643.26,1291,
PLACE ART 2ND ABD & BELOW,8267113,LOCAL,36246,CPT,,,,,,Outpatient,,,1448.28,937,UHC Comm,UHC Comm,863,,,,,,,Case Rate,203.35,929.12,
"92950 Cardiopulmonary resuscitation (eg, in cardiac arrest)",7968980,LOCAL,92950,CPT,,,,,,Outpatient,,,1448.28,941,UHC Comm,UHC Comm,863,,,,,,,Case Rate,284.7,1328.28,
92950 Cardiopulmonary Resuscitation Cath Lab,8212013,LOCAL,92950,CPT,,,,,,Outpatient,,,1448.28,941,UHC Comm,UHC Comm,863,,,,,,,Case Rate,284.7,1328.28,
92950 CARDIOPULMONARY RESUSCITATION CHARGE,8207219,LOCAL,92950,CPT,,,,,,Outpatient,,,1481.17,941,UHC Comm,UHC Comm,863,,,,,,,Case Rate,284.7,1328.28,
11402 EXC BENIGN LES-T/A/L 1.1-2.0 CM CHARGE,9704151,LOCAL,11402,CPT,,,,,,Outpatient,,,1494.18,963,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,643.26,1291,
62273 BLOOD PATCH,5661017,LOCAL,62273,CPT,,,,,,Outpatient,,,1505,971,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
"13131-Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1",14749500,LOCAL,13131,CPT,,,,,,Outpatient,,,1563.68,400,UHC Comm,UHC Comm,863,,,,,,,Case Rate,365.27,863,
64493 - INJ PARAVERT F JNT L/S 1 LEV,5661035,LOCAL,64493,CPT,,,,,,Outpatient,,,1564.95,1016,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,813.96,1291,
G0260 INJ SACRO JNT ARTHR ANEST/STER,8132863,LOCAL,G0260,CPT,,,,,,Outpatient,,,1587.32,1017,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
"62272 SPINAL PUNC, THERAP",5661019,LOCAL,62272,CPT,,,,,,Outpatient,,,1587.32,693,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
64425 NERV BLK ILIOINGUINAL,5661024,LOCAL,64425,CPT,,,,,,Outpatient,,,1587.72,1032,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
64483 TRANS INJ LUMB/SACR-UNILATERAL CHARGE,5661053,LOCAL,64483,CPT,,,,,,Outpatient,,,1587.72,1812,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,813.96,1291,
64484 TRANS INJ LUMB/SACR EA ADD UIL CHARGE,5661054,LOCAL,64484,CPT,,,,,,Outpatient,,,1614.14,1812,UHC Comm,UHC Comm,863,,,,,,,Case Rate,41.55,1250.53,
64636 DESTR FACET LUM/SAC EA ADL LVL,5661056,LOCAL,64636,CPT,,,,,,Outpatient,,,1615.12,1049,UHC Comm,UHC Comm,863,,,,,,,Case Rate,48.01,1250.53,
"12020 SIMP CLOSURE, SUPERF WOUND CHARGE",9303466,LOCAL,12020,CPT,,,,,,Outpatient,,,1660,1050,UHC Comm,UHC Comm,863,,,,,,,Case Rate,549.61,863,
63650 IMPLANT NEURSTIM ELEC EPIDURAL,10283945,LOCAL,63650,CPT,,,,,,Outpatient,,,1660,6563,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5787,8672.71,
63650 IMPLANT NEURSTIM ELEC EPIDURAL,8132877,LOCAL,63650,CPT,,,,,,Outpatient,,,1660,6563,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5787,8672.71,
63650-IMPLANT NEURSTIM ELEC EPIDURAL,8132877,LOCAL,63650,CPT,,,,,,Outpatient,,,1670,6563,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5787,8672.71,
XR Nephrostogram,8115644,LOCAL,50430,CPT,,,,,,Outpatient,,,1670,1389,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,555.55,1291,
XR Nephrostogram Existing Access,10454588,LOCAL,50431,CPT,,,,,,Outpatient,,,1678,1389,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,555.55,1291,
36568 INTRO CATH VENA CAVA PICC CHARGE,13709100,LOCAL,36568,CPT,,,,,,Outpatient,,,1678,1091,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,1291,1644.1,
REPOSITION CVL UNDER FLUORO,8210300,LOCAL,36597,CPT,,,,,,Outpatient,,,1680.09,1091,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,1068.64,1420.25,
15271 APP SKN SUB GRFT T/A/L 100 SQ CM FAC CHARGE,12831012,LOCAL,15271,CPT,,,,,,Outpatient,,,1680.09,1092,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,1496,2862.92,
"15275 App Skin Sub Graft (TWSA<100cm2) f/a/h-ft/aig; 1""25 sp cm",12641291,LOCAL,15275,CPT,,,,,,Outpatient,,,1704,1092,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,1496,2862.92,
64581 Incision for implantation of neurostimulator electrode array; sacral nerve,8603595,LOCAL,64581,CPT,,,,,,Outpatient,,,1735,1108,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6000.2,8672.71,
64418 - suprascapular nerve block,10452404,LOCAL,64418,CPT,,,,,,Outpatient,,,1735,693,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
64420 NERV BLK INTERCSTL NERV SNGL,5661025,LOCAL,64420,CPT,,,,,,Outpatient,,,1735,693,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
64454 Genicular block,13776911,LOCAL,64454,CPT,,,,,,Outpatient,,,1735,244,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
64461 THORACIC PARAVERTEBRAL BLOCK,13786726,LOCAL,64461,CPT,,,,,,Outpatient,,,1735,50,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
Injection Blood Patch Epidural,7633812,LOCAL,62273,CPT,,,,,,Outpatient,,,1744,971,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
PULM ANGIO DURING CORONARIES,8230012,LOCAL,93568,CPT,,,,,,Outpatient,,,1759.91,1134,UHC Comm,UHC Comm,863,,,,,,,Case Rate,37.1,863,
92960 ELEC CARDIOVERSION/DEFIBRILATION OP Tech Fee,7969852,LOCAL,92960,CPT,,,,,,Outpatient,,,1759.91,1144,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,598.27,1291,
Perc Cor Stent-Drug Eluding LD,4221012,LOCAL,92960,CPT,,,,,,Outpatient,,,1760,1144,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,598.27,1291,
10030 FLUID DRAIN SOFT TIS PERC GUID,8266849,LOCAL,10030,CPT,,,,,,Outpatient,,,1793.73,704,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,643.26,1605.05,
GASTROSTOMY TUBE REPLACEMENT,8200253,LOCAL,49450,CPT,,,,,,Outpatient,,,1793.73,1166,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,857.17,1496,
JEJUNOSTOMY REPLACEMENT PERC,8200252,LOCAL,49451,CPT,,,,,,Outpatient,,,1830,1166,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,857.17,1496,
"13132 -Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet;",14751269,LOCAL,13132,CPT,,,,,,Outpatient,,,1857.81,612,UHC Comm,UHC Comm,863,,,,,,,Case Rate,559.65,863,
PARACENTESIS ABDOMINAL WITH IMAGING,8267134,LOCAL,49083,CPT,,,,,,Outpatient,,,1882.73,1208,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,857.17,1496,
PLACE ART 1ST ABD & BELOW,8267112,LOCAL,36245,CPT,,,,,,Outpatient,,,1917.07,1224,UHC Comm,UHC Comm,863,,,,,,,Case Rate,191.24,929.12,
PLACE ART 1ST THORAC/BRAC,8267108,LOCAL,36215,CPT,,,,,,Outpatient,,,1917.07,1246,UHC Comm,UHC Comm,863,,,,,,,Case Rate,175.13,929.12,
PLACE ART 2ND THORAC/BRAC,8267109,LOCAL,36216,CPT,,,,,,Outpatient,,,1917.07,1246,UHC Comm,UHC Comm,863,,,,,,,Case Rate,222.85,929.12,
PLACE ART 3RD THORAC/BRAC,8267110,LOCAL,36217,CPT,,,,,,Outpatient,,,1927.08,1246,UHC Comm,UHC Comm,863,,,,,,,Case Rate,273.71,929.12,
PLACE ART 3RD ABD & BELOW,8267114,LOCAL,36247,CPT,,,,,,Outpatient,,,1966.67,1253,UHC Comm,UHC Comm,863,,,,,,,Case Rate,240.87,929.12,
PERICARDIOCENTESIS INITIAL,8230050,LOCAL,33016,CPT,,,,,,Outpatient,,,1966.67,1278,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,1291,1420.25,
REMOVAL BILIARY DRAIN CATH,8200538,LOCAL,47537,CPT,,,,,,Outpatient,,,1986.67,1278,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,291.97,1496,
CATH PLACE LT RT PA,8267103,LOCAL,36014,CPT,,,,,,Outpatient,,,2025.12,1291,UHC Comm,UHC Comm,863,,,,,,,Case Rate,121.59,929.12,
36589 - Removal of tunneled central venous catheter,12431092,LOCAL,36589,CPT,,,,,,Outpatient,,,2035,1316,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,565.25,1291,
37253 Invasc US Each Addl Vessel,8230057,LOCAL,37253,CPT,,,,,,Outpatient,,,2035,1323,UHC Comm,UHC Comm,863,,,,,,,Case Rate,57.61,2669.67,
"64449 N BLOCK INJ, LUMBAR PLEXUS",8882246,LOCAL,64449,CPT,,,,,,Outpatient,,,2060.2,890,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,813.96,1695.82,
92953 TRANSCUTANEOUS PACING TechFee,8057710,LOCAL,92953,CPT,,,,,,Outpatient,,,2060.2,1339,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,598.27,1291,
92953-Temp transcutaneous pacing Charge,8212036,LOCAL,92953,CPT,,,,,,Outpatient,,,2060.2,1339,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,598.27,1291,
EXTERNAL PACER,4221033,LOCAL,92953,CPT,,,,,,Outpatient,,,2064.41,1339,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,598.27,1291,
11750 EXCISION NAIL MATRIX PERMANENT CHARGE,9303447,LOCAL,11750,CPT,,,,,,Outpatient,,,2102.51,1342,UHC Comm,UHC Comm,863,,,,,,,Case Rate,365.27,863,
33967 Insertion Intra-aortic Percutaneous Device Charge,8211150,LOCAL,33967,CPT,,,,,,Outpatient,,,2179,1367,UHC Comm,UHC Comm,9233,,,,,,,Case Rate,205.15,12132.94,
64633 DESTR FACET CERV/THOR SNG LVL,5661057,LOCAL,64633,CPT,,,,,,Outpatient,,,2179,1416,UHC Comm,UHC Comm,2315,,,,,,,Case Rate,1250.53,2315,
64635 DESTR FACET LUM/SAC SINGLE LVL,5661055,LOCAL,64635,CPT,,,,,,Outpatient,,,2187.66,1416,UHC Comm,UHC Comm,2315,,,,,,,Case Rate,1250.53,2315,
93567 Inj Supra Aortography,8230011,LOCAL,93567,CPT,,,,,,Outpatient,,,2221.65,1422,UHC Comm,UHC Comm,863,,,,,,,Case Rate,29.54,863,
APPLY SKIN SUB 1ST 255Q CM LEG UP TO 100,13531303,LOCAL,15271,CPT,,,,,25,Outpatient,,,2252.25,1092,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,1496,2862.92,
37252 Invasc US Initial Vessel,8230056,LOCAL,37252,CPT,,,,,,Outpatient,,,2263.33,1464,UHC Comm,UHC Comm,863,,,,,,,Case Rate,72.79,2669.67,
15277 App Skin Sub Graft(TWSA>100cm2 f/a/h-ft diag add 100 cm2,12635466,LOCAL,15277,CPT,,,,,,Outpatient,,,2349.36,1471,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,1496,2862.92,
XR Myelogram Cervical Spine,1170319,LOCAL,62302,CPT,,,,,,Outpatient,,,2349.36,1527,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,722.32,1291,
XR Myelogram Thoracic Spine,1170327,LOCAL,62303,CPT,,,,,,Outpatient,,,2381.18,1527,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,722.32,1291,
ILR REMOVAL,8267777,LOCAL,33286,CPT,,,,,,Outpatient,,,2429.28,1548,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,643.26,2484.2,
36002 Pseudoanrsm Repair W Thrombin Us Gud,8212049,LOCAL,36002,CPT,,,,,,Outpatient,,,2442.76,1579,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,565.25,1291,
AV FISTULAGRAM S&I,8210332,LOCAL,36901,CPT,,,,,,Outpatient,,,2482.29,1588,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,1420.25,2669.67,
64450 INJECTION ANESTHETIC AGENT PERIPHERAL NE,13437921,LOCAL,64450,CPT,,,,,,Outpatient,,,2500,1613,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
64454 - Injection of anesthetic agent into genicular nerve branches including imaging guidance.,14144343,LOCAL,64454,CPT,,,,,,Outpatient,,,2500,244,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
"64624 Destruction by neurolytic agent, genicular nerve branches",9487180,LOCAL,64624,CPT,,,,,,Outpatient,,,2501.54,926,UHC Comm,UHC Comm,2315,,,,,,,Case Rate,1695.82,2315,
64421 NERVE BLOCK INTERCOSTAL MULTIPLE NERVES,5661026,LOCAL,64421,CPT,,,,,,Outpatient,,,2508.54,890,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,813.96,1695.82,
15273 ACELLULAR DERM REPL LTH 100 SQ CM,8716218,LOCAL,15273,CPT,,,,,,Outpatient,,,2566.23,1631,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,3347.08,
INJ PERC CHOL W EXIS CATH,8210336,LOCAL,47531,CPT,,,,,,Outpatient,,,2587.86,298,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,3226.48,
ASPIRATION / INJECTION OF RENAL PELVIS,8210655,LOCAL,50390,CPT,,,,,,Outpatient,,,2601.5,1682,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,555.55,1291,
Procedure Performed. -> Paracentesis,9739222,LOCAL,49082,CPT,,,,,,Outpatient,,,2788.44,1691,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,857.17,1496,
64483 TRANS INJ LUMB/SACR-BILATERAL CHARGE,5661040,LOCAL,64483,CPT,,,,,,Outpatient,,,2788.44,1812,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,813.96,1291,
64484 TRANS INJ LUMB/SACR EA ADD BIL CHARGE,5661049,LOCAL,64484,CPT,,,,,,Outpatient,,,2850.87,1812,UHC Comm,UHC Comm,863,,,,,,,Case Rate,41.55,1250.53,
PLACE CENTRAL VENOUS LINE,8210290,LOCAL,36556,CPT,,,,,,Outpatient,,,2874.06,1853,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,1291,2877.63,
20220 BIOPSY BONE TROC/NDL SUPERFICL CHARGE,9709066,LOCAL,20220,CPT,,,,,,Outpatient,,,2886.2,1868,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,923.18,1481.32,
Antenatal Testing Type -> Non-Stress test,9848446,LOCAL,59025,CPT,,,,,,Outpatient,,,2886.2,1876,UHC Comm,UHC Comm,863,,,,,,,Case Rate,183.92,863,
Non Stress Test Charge,9919812,LOCAL,59025,CPT,,,,,,Outpatient,,,3042.12,1876,UHC Comm,UHC Comm,863,,,,,,,Case Rate,183.92,863,
CLOSURE DEVICE PLACEMENT,8212014,LOCAL,,,G0269,HCPCS,481,RC,,Outpatient,,,3141.6,1977,UHC Comm,UHC Comm,863,,,,,,,Case Rate,863,863,
Central Line Access Type. -> Peripherally inserted central catheter (PICC),9344166,LOCAL,36569,CPT,,,,,,Outpatient,,,3200,2042,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,1291,1644.1,
CHOLECYSTOSTOMY DRAIN PLACEMENT,8267773,LOCAL,47490,CPT,,,,,,Outpatient,,,3218.96,2080,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,3682.65,
"11047  Debridement Sub-Q, bone each add l 20sq cm",10013082,LOCAL,11047,CPT,,,,,,Outpatient,,,3218.96,2092,UHC Comm,UHC Comm,863,,,,,,,Case Rate,78.26,1466.58,
11047 Debrid bone > 20 sq cm charge,12508109,LOCAL,11047,CPT,,,,,,Outpatient,,,3282.36,2092,UHC Comm,UHC Comm,863,,,,,,,Case Rate,78.26,1466.58,
XR Myelogram 2 or More Regions,10386814,LOCAL,62305,CPT,,,,,,Outpatient,,,3332.77,2134,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,722.32,1291,
PERC PLEURAL INSERTION/DRAINAGE AND S&I,8230068,LOCAL,32557,CPT,,,,,,Outpatient,,,3532.98,2166,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,1291,1420.25,
28090 EXCISION GANGLION CYST FOOT,13436341,LOCAL,28090,CPT,,,,,,Outpatient,,,3541,2296,UHC Comm,UHC Comm,2315,,,,,,,Case Rate,1463.19,3153.58,
ICD REMOVAL SC/DC LEAD TV EXTRACT,8231010,LOCAL,33244,CPT,,,,,,Outpatient,,,3581.67,2302,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2484.2,3327.27,
11044 DEBRID BONE FIRST 20SQ CM OR < CHARGE,8019965,LOCAL,11044,CPT,,,,,,Outpatient,,,3680.71,2328,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,1291,1481.32,
28190 Appy Rigid Leg Cast (Professional Charge only if Provider Applies),12642333,LOCAL,28190,CPT,,,,,,Outpatient,,,3775.02,2392,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,643.26,1291,
10140 DRAINAGE OF HEMATOMA,8715913,LOCAL,10140,CPT,,,,,,Outpatient,,,3913.86,2454,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,1481.32,1605.05,
11404 EXCISION BENIGN LESION 3.1 CM TO 4.0 CM CHARGE,8726719,LOCAL,11404,CPT,,,,,,Outpatient,,,4031.48,2544,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,1481.32,1679.75,
PACEMAKER POCKET,8210140,LOCAL,33222,CPT,,,,,,Outpatient,,,4100,2620,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,1496,2484.2,
"64625 Radiofrequency ablation, nerves innervating the SI joint",5661090,LOCAL,64625,CPT,,,,,,Outpatient,,,4189,2665,UHC Comm,UHC Comm,2315,,,,,,,Case Rate,1785.34,2315,
INSERTION OF INTRAPERITONEAL CATHETER,8267131,LOCAL,49418,CPT,,,,,,Outpatient,,,4189,2723,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,5444.44,
US Insert Tun IP Cath Perc,10460131,LOCAL,49418,CPT,,,,,,Outpatient,,,4351.75,2723,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,5444.44,
IR Nephro Plcmt New Access W Cath,8267190,LOCAL,50432,CPT,,,,,,Outpatient,,,4351.75,2829,UHC Comm,UHC Comm,2315,,,,,,,Case Rate,1872.87,2315,
NEPHROSTOGRAM CATHETER PLACEMENT S&I,8267190,LOCAL,50432,CPT,,,,,,Outpatient,,,4357.87,2829,UHC Comm,UHC Comm,2315,,,,,,,Case Rate,1872.87,2315,
EXCHANGE NEPHROSTOMY TUBE,8212021,LOCAL,50435,CPT,,,,,,Outpatient,,,4747.36,2833,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,1291,2206.55,
PTA URETERAL STRICTURE WITH IMAGING,8267792,LOCAL,50706,CPT,,,,,,Outpatient,,,5132.46,3086,UHC Comm,UHC Comm,863,,,,,,,Case Rate,147.16,10138.5,
CATH LAB INSERTION OF PLEURAL CATHETER,8230067,LOCAL,32550,CPT,,,,,,Outpatient,,,5419.5,3336,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,1392.67,3226.48,
THROMBECTOMY VENOUS ADDL,8210394,LOCAL,37188,CPT,,,,,,Outpatient,,,5454.2,3523,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,5228.12,
NEW ACCESS NEPHROSTOMY TUBE,8200537,LOCAL,50433,CPT,,,,,,Outpatient,,,5488.12,3545,UHC Comm,UHC Comm,2315,,,,,,,Case Rate,2315,4301.28,
PTA RENAL ARTERY (ADD'L),8210240,LOCAL,37247,CPT,,,,,,Outpatient,,,5526.21,3567,UHC Comm,UHC Comm,863,,,,,,,Case Rate,140.82,8616.54,
27603 DRAIN LOWER LEG LESION,13043453,LOCAL,27603,CPT,,,,,LT,Outpatient,,,5690.13,3592,UHC Comm,UHC Comm,2315,,,,,,,Case Rate,2315,2616.66,
REVISION REPLACE GENERATOR  BLADDER,8268108,LOCAL,64595,CPT,,,,,,Outpatient,,,5690.13,3699,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,5487.33,
REVISION REPLACE LEAD BLADDER STIMULATOR,8268107,LOCAL,64585,CPT,,,,,,Outpatient,,,5734.69,3699,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,5487.33,
INTRO AV SHUNT W S&I,8267106,LOCAL,36902,CPT,,,,,,Outpatient,,,5746.86,11107,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5212.67,5787,
15120 SKN SPLT A-GRFT FAC/NCK/HF/G 100 SQ CM/1% BA,10006441,LOCAL,15120,CPT,,,,,,Outpatient,,,5771.49,3735,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,3347.08,
REPOSITION IVC FILTER,8267129,LOCAL,37192,CPT,,,,,,Outpatient,,,5876.95,3751,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,5228.12,
VENOUS PTA EACH ADD'L,8267100,LOCAL,37249,CPT,,,,,,Outpatient,,,5960.36,3820,UHC Comm,UHC Comm,863,,,,,,,Case Rate,118.76,8616.54,
Central Line Access Type. -> Tunneled,13449753,LOCAL,36810,CPT,,,,,,Outpatient,,,6104.24,3874,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,3211.33,
33215 Reposition Pacing Defibrillator Lead,8212027,LOCAL,33215,CPT,,,,,,Outpatient,,,6104.24,3968,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2484.2,2877.63,
ICD REMOVAL ONLY,8231005,LOCAL,33241,CPT,,,,,,Outpatient,,,6313.68,3968,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,10220.8,
TRANSCATH THER.ART.INF.(FINAL DAY),8210027,LOCAL,37214,CPT,,,,,,Outpatient,,,6394.68,4104,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,1291,5228.12,
93503 INSERTION OF SWAN GANZ CHARGE,8210870,LOCAL,93503,CPT,,,,,,Outpatient,,,6394.68,4157,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,1291,1644.1,
PA CATHETER SV02,4221129,LOCAL,93503,CPT,,,,,,Outpatient,,,6446.76,4157,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,1291,1644.1,
GENERATOR REMOVAL ONLY,8210160,LOCAL,33233,CPT,,,,,,Outpatient,,,6922.86,4190,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,10220.8,
PERC URETERAL STENT REMOVAL & REPLACE,8210741,LOCAL,50382,CPT,,,,,,Outpatient,,,7383.75,4500,UHC Comm,UHC Comm,2315,,,,,,,Case Rate,1872.87,2315,
THROMBECTOMY ARTERIAL SECONDARY PERC,8210390,LOCAL,37186,CPT,,,,,,Outpatient,,,7387.97,4799,UHC Comm,UHC Comm,863,,,,,,,Case Rate,199.65,16037.41,
"15100 AUTO-SPLIT THICK T/A/L, 1ST 100 SQCM CHARGE",12816476,LOCAL,15100,CPT,,,,,,Outpatient,,,7579,4802,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,1496,2862.92,
THROMBECTOMY VENOUS PRIMARY,8210393,LOCAL,37187,CPT,,,,,,Outpatient,,,7882.57,4926,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5228.12,10368.23,
EXCHANGE OF BILIARY DRAIN CATH,8267769,LOCAL,47536,CPT,,,,,,Outpatient,,,7882.57,5124,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,3682.65,
PLACEMENT BILIARY DRAIN CATH INT/EXT,8201219,LOCAL,47534,CPT,,,,,,Outpatient,,,8050.63,5124,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,3682.65,
36253 Insertion Of Cath Renal Arterial 2Nd Unilateral,8212045,LOCAL,36253,CPT,,,,,,Outpatient,,,8050.63,5233,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,4942.22,6018.68,
CERVICOCEREBRAL S&I,8201615,LOCAL,36221,CPT,,,,,,Outpatient,,,8050.63,5233,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,6018.68,
COMMON CAROTID UNI S&I,8201600,LOCAL,36223,CPT,,,,,,Outpatient,,,8050.63,5233,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,4942.22,6018.68,
EXTERNAL CAROTID UNI S&I,8201610,LOCAL,36222,CPT,,,,,,Outpatient,,,8050.63,5233,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,6018.68,
RENAL UNILATERAL PLACEMENT & SI,8210550,LOCAL,36251,CPT,,,,,,Outpatient,,,8050.63,5233,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,6018.68,
VERTEBRAL SUBCLAVIAN OR INNOMINATE,8201625,LOCAL,36225,CPT,,,,,,Outpatient,,,8076.78,5233,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,6018.68,
25040 FOREIGN BODY REMOVAL FOREARM LEFT,13416875,LOCAL,25040,CPT,,,,,LT,Outpatient,,,8080.32,5250,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2528.75,2966.42,
FOREIGN BODY RETRIEVAL,8201630,LOCAL,37197,CPT,,,,,,Outpatient,,,8080.32,5252,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,5228.12,
FOREIGN BODY RETRIEVAL S&I,8201635,LOCAL,37197,CPT,,,,,,Outpatient,,,8080.32,5252,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,5228.12,
REMOVAL IVC FILTER,8267130,LOCAL,37193,CPT,,,,,,Outpatient,,,8122.9,5252,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,5228.12,
PERC INTRO CATH/STENT URETERAL PREEXIST,8200532,LOCAL,50693,CPT,,,,,,Outpatient,,,8122.9,5280,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,4301.28,
PERC INTRO URETERAL NEW ACCESS W CATH,8200534,LOCAL,50695,CPT,,,,,,Outpatient,,,8122.9,5280,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,4301.28,
PERC INTRO URETERAL NEW ACCESS WO CATH,8200533,LOCAL,50694,CPT,,,,,,Outpatient,,,8365.99,5280,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,4301.28,
VERTEBROPLASTY ADDL THOR/LUMB,8267765,LOCAL,22512,CPT,,,,,,Outpatient,,,8365.99,5438,UHC Comm,UHC Comm,863,,,,,,,Case Rate,167.55,6803.47,
VERTEBROPLASTY LUMBAR,8211170,LOCAL,22511,CPT,,,,,,Outpatient,,,8365.99,5438,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,6803.47,
VERTEBROPLASTY THORACIC,8211160,LOCAL,22510,CPT,,,,,,Outpatient,,,8539.16,5438,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,6803.47,
RENAL BILATERAL PLACEMENT & SI,8210560,LOCAL,36252,CPT,,,,,,Outpatient,,,8778,5550,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2599,6018.68,
93452 Left Heart Cath,8230003,LOCAL,93452,CPT,,,,,,Outpatient,,,8900,5706,UHC Comm,UHC Comm,4325,,,,,,,Case Rate,2940.64,4325,
TEMP SACRAL ELECTRODE WITH IMAGING,8268102,LOCAL,64561,CPT,,,,,,Outpatient,,,8946.89,5785,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5787,8672.71,
27372 FOREIGN BODY REMOVAL KNEE,13435628,LOCAL,27372,CPT,,,,,,Outpatient,,,9171.4,5815,UHC Comm,UHC Comm,2315,,,,,,,Case Rate,2315,2616.66,
20240 BIOPSY BONE EXCISIONAL SUPERFI CHARGE,8020082,LOCAL,20240,CPT,,,,,,Outpatient,,,9171.4,5961,UHC Comm,UHC Comm,2315,,,,,,,Case Rate,2315,2616.66,
20240-BIOPSY BONE EXCISIONAL SUPERFI CHARGE,8020082,LOCAL,20240,CPT,,,,,,Outpatient,,,9609.02,5961,UHC Comm,UHC Comm,2315,,,,,,,Case Rate,2315,2616.66,
"93451 Catheterization, Right Heart",8230000,LOCAL,93451,CPT,,,,,,Outpatient,,,9609.02,6246,UHC Comm,UHC Comm,4325,,,,,,,Case Rate,2940.64,4325,
93453 Combined Left and Right Heart Cath,8230006,LOCAL,93453,CPT,,,,,,Outpatient,,,9751.88,6246,UHC Comm,UHC Comm,4325,,,,,,,Case Rate,2940.64,4325,
THROMBECTOMY ARTERIAL ADDL,8210392,LOCAL,37185,CPT,,,,,,Outpatient,,,9833.36,6339,UHC Comm,UHC Comm,863,,,,,,,Case Rate,130.9,8616.54,
93454 HT Left Heart Cath WO LV,8210890,LOCAL,93454,CPT,,,,,,Outpatient,,,9838.19,6392,UHC Comm,UHC Comm,4325,,,,,,,Case Rate,2940.64,4325,
92973 PTC Thromebectomy Add On,8200030,LOCAL,92973,CPT,,,,,,Outpatient,,,10140.58,6395,UHC Comm,UHC Comm,863,,,,,,,Case Rate,74.32,12572.64,
TRANSCATH THER ART INFUSION FOR THROM,8210026,LOCAL,37211,CPT,,,,,,Outpatient,,,10180.79,6591,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,4942.22,5787,
CATH LAB IVC FILTER PLACEMENT,8210330,LOCAL,37191,CPT,,,,,,Outpatient,,,10180.79,6618,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,4942.22,5787,
INSERTION IVC FILTER,8267128,LOCAL,37191,CPT,,,,,,Outpatient,,,10180.79,6618,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,4942.22,5787,
PERC PLACE IVC FILTER S&I,8210740,LOCAL,37191,CPT,,,,,,Outpatient,,,10806,6618,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,4942.22,5787,
THROMBECTOMY ARTERIAL PRIMARY,8210391,LOCAL,37184,CPT,,,,,,Outpatient,,,10920,7024,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5787,16417.11,
PTA IPSI ILIAC ADDL VESSEL,8230032,LOCAL,37222,CPT,,,480,RC,,Outpatient,,,11474.94,7098,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5787,5787,
TRANSCATH STENT CERV CAROTID WITH DEVICE,8210025,LOCAL,37215,CPT,,,,,,Outpatient,,,11520.61,7459,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,802.87,16429.41,
VERTEBRAL CERVICAL/CRANIAL S&I,8201620,LOCAL,36226,CPT,,,,,,Outpatient,,,11951.06,7488,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,4942.22,6018.68,
LEAD REPLACEMENT DUAL,8210110,LOCAL,33217,CPT,,,,,,Outpatient,,,11951.06,7768,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,2484.2,7566.4,
LEAD REPLACEMENT SGL,8210100,LOCAL,33216,CPT,,,,,,Outpatient,,,12026.07,7768,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,2484.2,7566.4,
93455 HT Left Cath W Cor Inj WO LV,8230002,LOCAL,93455,CPT,,,,,,Outpatient,,,12512.89,7817,UHC Comm,UHC Comm,4325,,,,,,,Case Rate,2940.64,4325,
93458 HT Cath Left W LV and Cor Angio,8230004,LOCAL,93458,CPT,,,,,,Outpatient,,,12512.89,8133,UHC Comm,UHC Comm,4325,,,,,,,Case Rate,2940.64,4325,
93460 HT Cath L or R W LV and Cor Angio,8230007,LOCAL,93460,CPT,,,,,,Outpatient,,,12542.69,8133,UHC Comm,UHC Comm,4325,,,,,,,Case Rate,2940.64,4325,
33210 INSERTION TEMP PACEMAKER SINGLE CHAMBER CHARGE,13707085,LOCAL,33210,CPT,,,,,,Outpatient,,,12542.69,8153,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,2484.2,7566.4,
TEMP PACEMAKER SGL CHAMBER,8210050,LOCAL,33210,CPT,,,,,,Outpatient,,,12766.62,8153,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,2484.2,7566.4,
92920 PTCA 1st Vessel,8201256,LOCAL,92920,CPT,,,,,,Outpatient,,,12766.62,8298,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5212.67,12572.64,
PTA RENAL ARTERY (INITIAL),8267124,LOCAL,37246,CPT,,,,,,Outpatient,,,12766.62,17592,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5212.67,5787,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ANGIO CPLX 1,8230034,LOCAL,37224,CPT,,,,,,Outpatient,,,12766.62,8298,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5212.67,5787,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS IVT ANGIO CPLX1,8230030,LOCAL,37220,CPT,,,,,,Outpatient,,,12766.62,8298,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5212.67,5787,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS IVT ST CPLX EA,8230033,LOCAL,37223,CPT,,,481,RC,,Outpatient,,,12766.62,8298,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5787,5787,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS TPVT ANGIO CPLX EA,8230026,LOCAL,37232,CPT,,,481,RC,,Outpatient,,,12766.62,8298,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5787,5787,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS TPVT ANGIO SF 1ST,8230022,LOCAL,37228,CPT,,,,,,Outpatient,,,13484.51,8298,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5787,10368.23,
93459 HT Cath Left W LV and Cor Grf Angio,8230005,LOCAL,93459,CPT,,,,,,Outpatient,,,13484.51,8765,UHC Comm,UHC Comm,4325,,,,,,,Case Rate,2940.64,4325,
93461 HT Cath L or R W LV Cor Grf Angio,8230008,LOCAL,93461,CPT,,,,,,Outpatient,,,14443,8765,UHC Comm,UHC Comm,4325,,,,,,,Case Rate,2940.64,4325,
ATHERECTOMY ABD AORTA,8230043,LOCAL,0236T,CPT,,,,,,Outpatient,,,14443,9388,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16037.41,
ATHERECTOMY BRACHIOCEPHALIC & BRANCHES,8230044,LOCAL,0237T,CPT,,,,,,Outpatient,,,14443,9388,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16037.41,
ATHERECTOMY ILIAC EACH,8230045,LOCAL,0238T,CPT,,,,,,Outpatient,,,14443,12175,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16417.11,
ATHERECTOMY RENAL,8230041,LOCAL,0234T,CPT,,,,,,Outpatient,,,14443,9388,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,26140.53,
ATHERECTOMY VISCERAL,8230042,LOCAL,0235T,CPT,,,,,,Outpatient,,,14812.21,9388,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,515.34,8616.54,
INTERNAL CAROTID UNI S&I,8201636,LOCAL,36224,CPT,,,,,,Outpatient,,,15168.26,9628,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,4942.22,6018.68,
PTCA ADD VESSEL,8201257,LOCAL,92921,CPT,,,480,RC,,Outpatient,,,15683.4,9859,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5787,5787,
37239 STENT ANGIO VEIN EA ADDL CHARGE,8230063,LOCAL,37239,CPT,,,,,,Outpatient,,,15683.4,10194,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,121.17,16037.41,
ARTERY STENT ADD'L (NONCORONARY),8230061,LOCAL,37237,CPT,,,,,,Outpatient,,,16019.61,10194,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,171.21,16037.41,
93456 Right Heart Catheterization With Angiography,8230009,LOCAL,93456,CPT,,,,,,Outpatient,,,16029.82,10413,UHC Comm,UHC Comm,4325,,,,,,,Case Rate,2940.64,4325,
33285 Implant Pt Activated Cardiac Event Recorder,8267776,LOCAL,33285,CPT,,,,,,Outpatient,,,16620.58,10419,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,12132.94,
92928 Trnscath Plcmnt Metal Single,8201254,LOCAL,92928,CPT,,,,,,Outpatient,,,16620.58,10803,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5787,12572.64,
92929 Trnscath Plcmnt Metal Addl,8201255,LOCAL,92929,CPT,,,481,RC,,Outpatient,,,16991.23,10803,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5787,5787,
93457 Right or Left Heart Cath with No LV Gram Charge,8230010,LOCAL,93457,CPT,,,,,,Outpatient,,,17087.76,11044,UHC Comm,UHC Comm,4325,,,,,,,Case Rate,2940.64,4325,
AV FISTULAGRAM WITH ANGIOPLASTY,8210331,LOCAL,36902,CPT,,,,,,Outpatient,,,17339,11107,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5212.67,5787,
"C9764 Revasculation, Endovascular, With Intravascular Lithotripsy, Includes Angioplasty",8230070,LOCAL,,,C9764,HCPCS,,,,Outpatient,,,17985.84,11270,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5228.12,10368.23,
GENERATOR ONLY SGL CHAMBER INSERTION,8210070,LOCAL,33212,CPT,,,,,,Outpatient,,,17985.84,11691,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,12132.94,
PACEMAKER REMOVAL SINGLE,8210171,LOCAL,33227,CPT,,,,,,Outpatient,,,18730.19,11691,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,12132.94,
0238T Iliac Athrectomy with or without PTA,8230069,LOCAL,0238T,CPT,,,,,,Outpatient,,,19804,12175,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16417.11,
INSERTION NEUROSTIMULATOR GENERATOR,8268101,LOCAL,64590,CPT,,,,,,Outpatient,,,20984.23,519,UHC Comm,UHC Comm,9233,,,,,,,Case Rate,9233,30196.67,
GENERATOR REMOVAL AND REPLACEMENT DUAL,8210172,LOCAL,33228,CPT,,,,,,Outpatient,,,21116.1,13640,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,12132.94,
C9604 Revasc thru Bypass Single Vessel w DES (M'care),8201640,LOCAL,,,C9604,HCPCS,,,,Outpatient,,,21116.1,13725,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,12572.64,
C9605 DES Coronary Revasc CABG Each Addl,8201643,LOCAL,,,C9605,HCPCS,481,RC,,Outpatient,,,21116.1,13725,UHC Comm,UHC Comm,863,,,,,,,Case Rate,863,12572.64,
C9606 Revasc During MI w DES (M'care),8201641,LOCAL,,,C9606,HCPCS,481,RC,,Outpatient,,,21116.1,13725,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,1496,12572.64,
C9607 Revasc CTO Single Vessel w DES (M'care),8201642,LOCAL,,,C9607,HCPCS,,,,Outpatient,,,21116.1,13725,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16417.11,
PERQ BM STENT ADD ON  RAMUS,8201252,LOCAL,,,C9600,HCPCS,,,,Outpatient,,,21116.1,13725,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,12572.64,
PERQ BM STENT INITIAL  LM,8201253,LOCAL,,,C9601,HCPCS,481,RC,,Outpatient,,,21534.36,13725,UHC Comm,UHC Comm,863,,,,,,,Case Rate,863,12572.64,
TIB/PER REVASC W/ATHER ADD ON  LT,8210020,LOCAL,33206,CPT,,,,,,Outpatient,,,22157.75,13997,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,12132.94,
C9772 Revasc Lithotrip Tibi/Peroneal Artery (Shockwave IVL),8230074,LOCAL,,,C9772,HCPCS,,,,Outpatient,,,22271.43,14403,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,10368.23,
PTA VENOUS PERC W S&I,8267099,LOCAL,37248,CPT,,,,,,Outpatient,,,22386.25,14476,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5212.67,5787,
VENTRICULAR PACEMAKER IMPLANT INS OR REP,8210030,LOCAL,33207,CPT,,,,,,Outpatient,,,23546.83,14551,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,12132.94,
37233 Revas Tp Art Uni Ea Addl Vsl W Ath Sm,8230027,LOCAL,37233,CPT,,,481,RC,,Outpatient,,,23546.83,15305,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,6417,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ATHRC CPLX 1,8230035,LOCAL,37225,CPT,,,,,,Outpatient,,,23546.83,15305,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16417.11,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ST CPLX 1ST,8230036,LOCAL,37226,CPT,,,,,,Outpatient,,,23546.83,15305,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,10368.23,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS IVT ST CPLX 1ST,8230031,LOCAL,37221,CPT,,,,,,Outpatient,,,23546.83,15305,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,10368.23,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS TPVT ATHRC CPLX 1,8230023,LOCAL,37229,CPT,,,,,,Outpatient,,,23819.19,15305,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16417.11,
VASC EMBOLIZE OCCLUDE ARTERY,8210362,LOCAL,37242,CPT,,,,,,Outpatient,,,23819.19,15482,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16417.11,
VASC EMBOLIZE OCCLUDE BLEED,8210364,LOCAL,37244,CPT,,,,,,Outpatient,,,23819.19,15482,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16037.41,
VASC EMBOLIZE OCCLUDE ORGAN,8210363,LOCAL,37243,CPT,,,,,,Outpatient,,,23819.19,15482,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16037.41,
VASC EMBOLIZE OCCLUDE VENOUS,8210361,LOCAL,37241,CPT,,,,,,Outpatient,,,24322.23,15482,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16037.41,
37238 STENT ANGIO VEIN INITIAL CHARGE,8230062,LOCAL,37238,CPT,,,,,,Outpatient,,,24565.45,15809,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16037.41,
37236 Stent Angioplasty Artery Int,8230060,LOCAL,37236,CPT,,,,,,Outpatient,,,25121.42,15968,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16037.41,
SACRAL NERVE (TRANSFORAMINAL PLACEMENT),8268100,LOCAL,64581,CPT,,,,,,Outpatient,,,27065.23,1108,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6000.2,8672.71,
PTA BRACHIOCEPHALIC TRUNK W S&I,8210280,LOCAL,37246,CPT,,,,,,Outpatient,,,27707.8,17592,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5212.67,5787,
A V PACEMAKER IMPLANT INS OR REPLACE,8210040,LOCAL,33208,CPT,,,,,,Outpatient,,,27707.8,18010,UHC Comm,UHC Comm,8379,,,,,,,Case Rate,8379,12132.94,
UPGRADE SGL DUAL LEAD/CHAMBER,8210090,LOCAL,33214,CPT,,,,,,Outpatient,,,28060,18010,UHC Comm,UHC Comm,8379,,,,,,,Case Rate,8379,12132.94,
PTA STENT TIBPERONEAL ADDL VESSEL,8230028,LOCAL,37234,CPT,,,480,RC,,Outpatient,,,28353.6,18239,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5787,5787,
C9773 Revasc Lithotrip-Stent Tib/Peroneal Atr (Shockwave IVL),8230075,LOCAL,,,C9773,HCPCS,,,,Outpatient,,,28353.6,18430,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16417.11,
C9774 Revasc Lithotr-Ather Tib/Peroneal Atr (Shockwave IVL),8230076,LOCAL,,,C9774,HCPCS,,,,Outpatient,,,28353.6,18430,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16417.11,
C9775 Revasc Lithotr-Stent-Ather-Peroneal Atr (Shockwave IVL),8230077,LOCAL,,,C9775,HCPCS,,,,Outpatient,,,29724,18430,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16417.11,
"C9765 Revasculation, Endovascular, With Intravascular Lithotripsy, With Stent Placement Includes Ang",8230071,LOCAL,,,C9765,HCPCS,,,,Outpatient,,,29724,19321,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16417.11,
"C9766 Revasculation, Endovascular, With Intravascular Lithotripsy, Includes Atherectomy",8230072,LOCAL,,,C9766,HCPCS,,,,Outpatient,,,32737,19321,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16417.11,
PTA STENT TIBPERONEAL INITIAL,8230024,LOCAL,37230,CPT,,,,,,Outpatient,,,33085.18,21279,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16417.11,
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ST ATHRC CPX 1,8230037,LOCAL,37227,CPT,,,,,,Outpatient,,,39850,21505,UHC Comm,UHC Comm,9233,,,,,,,Case Rate,9233,16417.11,
"C9767 Revasculation, Endovascular, With Intravascular Lithotripsy, With Stent Placement And Atherect",8230073,LOCAL,,,C9767,HCPCS,,,,Outpatient,,,45887,25903,UHC Comm,UHC Comm,6417,,,,,,,Case Rate,6417,16417.11,
PTA ATHRECTOMY STENT TIBPERONEAL ADDL VE,8230029,LOCAL,37235,CPT,,,480,RC,,Outpatient,,,50564,29827,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5787,5787,
PTA ARTHRECTOMY STENT TIBPERONEAL INITIA,8230025,LOCAL,37231,CPT,,,,,,Outpatient,,,51027.88,32867,UHC Comm,UHC Comm,9233,,,,,,,Case Rate,9233,16417.11,
ICD INSERTION WITH EXISTING SINGLE LEAD,8231000,LOCAL,33240,CPT,,,,,,Outpatient,,,65510.7,33168,UHC Comm,UHC Comm,12499,,,,,,,Case Rate,12499,36378.11,
ICD REMOVAL&REPLACE SINGLE,8267790,LOCAL,33262,CPT,,,,,,Outpatient,,,67510.7,42582,UHC Comm,UHC Comm,12499,,,,,,,Case Rate,12499,36378.11,
ICD REMOVAL&REPLACE DUAL LEAD,8267778,LOCAL,33263,CPT,,,,,,Outpatient,,,70510.7,43882,UHC Comm,UHC Comm,12499,,,,,,,Case Rate,12499,36378.11,
ICD REMOVAL&REPLACE MULTIPLE,8267791,LOCAL,33264,CPT,,,,,,Outpatient,,,198,45832,UHC Comm,UHC Comm,12499,,,,,,,Case Rate,12499,36378.11,
"45300 Proctosigmoidoscopy, rigid; diagnostic, w/ or w/o collection by brushing or washing",7962380,LOCAL,45300,CPT,,,,,,Outpatient,,,895,129,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,833.54,1419.32,
"25105 ARTHROTOMY, WRIST JOINT WITH SYNOVECTOMY",14130163,LOCAL,25105,CPT,,,,,,Outpatient,,,500,3245,UHC Comm,UHC Comm,2599,,,,,,,Case Rate,2528.75,2966.42,
"64640 Destruction by neurolytic agent, other perip",13959658,LOCAL,64640,CPT,,,,,,Outpatient,,,220,927,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,813.96,1695.82,
10060 PROFEE Drainage of skin abscess,13954453,LOCAL,10060,CPT,,,,,,Outpatient,,,385,420,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
10061  I&D abscess complicated/multiple Profee,13769279,LOCAL,10061,CPT,,,,,,Outpatient,,,285,420,UHC Comm,UHC Comm,863,,,,,,,Case Rate,239.03,863,
10120 Incision & Removal Foreign Body Simp PROFEE,14006132,LOCAL,10120,CPT,,,,,,Outpatient,,,145,893,UHC Comm,UHC Comm,863,,,,,,,Case Rate,239.03,863,
"11042 PROFEE Debride subcutaneous tissue, 1st 20 s",13962336,LOCAL,11042,CPT,,,,,,Outpatient,,,340,836,UHC Comm,UHC Comm,863,,,,,,,Case Rate,365.27,863,
11043 PROFEE DEB MUSC/FASCIA 20 SQ CM/<,13967660,LOCAL,11043,CPT,,,,,,Outpatient,,,465,836,UHC Comm,UHC Comm,863,,,,,,,Case Rate,549.61,863,
"11044 Debride bone, 1st 20 sq cm or less Pro Fee",11221020,LOCAL,11044,CPT,,,,,,Outpatient,,,50,2328,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,1291,1481.32,
"11045 Debride subq tissue, ea addl 20 sq cm Pro Fe",11221021,LOCAL,11045,CPT,,,,,,Outpatient,,,128,836,UHC Comm,UHC Comm,863,,,,,,,Case Rate,20.61,1466.58,
11046 PROFEE Debride muscle and/or fascia; ea addl,13954830,LOCAL,11046,CPT,,,,,,Outpatient,,,195,836,UHC Comm,UHC Comm,863,,,,,,,Case Rate,44.01,1466.58,
"11047 PROFEE Debridement, sus tissue each add 20 s",13967661,LOCAL,11047,CPT,,,,,,Outpatient,,,243.42,2092,UHC Comm,UHC Comm,863,,,,,,,Case Rate,78.26,1466.58,
11104 Punch Biopsy of Skin; Single Lesion ProFee,8768419,LOCAL,11104,CPT,,,,,,Outpatient,,,296,449,UHC Comm,UHC Comm,863,,,,,,,Case Rate,365.27,863,
11106  Incisional biopsy of skin single lesion Pro,13759967,LOCAL,11106,CPT,,,,,,Outpatient,,,160,800,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,559.65,1291,
"11400 EXCISION, BENIGN LESION INCLUDING MARGINS, E",7929974,LOCAL,11400,CPT,,,,,,Outpatient,,,470,935,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,643.26,1291,
"11406 EXCISION, BENIGN LESION INCLUDING MARGINS, E",7929979,LOCAL,11406,CPT,,,,,,Outpatient,,,410,1620,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,1481.32,2584.84,
"11604 EXCISION, MALIGNANT LESION INCLUDING MARGINS",7930002,LOCAL,11604,CPT,,,,,,Outpatient,,,195,704,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,643.26,1679.75,
"11730 PROFEE Avulsion nail plate simple, single",13967650,LOCAL,11730,CPT,,,,,,Outpatient,,,305,228,UHC Comm,UHC Comm,863,,,,,,,Case Rate,95.93,863,
"11750 PROFEE Excision of nail and nail matrix, par",13954836,LOCAL,11750,CPT,,,,,,Outpatient,,,296,1342,UHC Comm,UHC Comm,863,,,,,,,Case Rate,365.27,863,
15271 PROFEE Application of skin substitute graft,13967652,LOCAL,15271,CPT,,,,,,Outpatient,,,306,1092,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,1496,2862.92,
15275 PROFEE APPLICATION OF SKIN SUBSTITUTE GRAFT,13954832,LOCAL,15275,CPT,,,,,,Outpatient,,,820,1092,UHC Comm,UHC Comm,1496,,,,,,,Case Rate,1496,2862.92,
"28810 AMPUTATION, METATARSAL, WITH TOE, SINGLE Pro",7931853,LOCAL,28810,CPT,,,,,,Outpatient,,,200,3245,UHC Comm,UHC Comm,2315,,,,,,,Case Rate,2315,7645.84,
29445 PROFEE APPLICATION OF RIGID TOTAL CONTACT LE,13962328,LOCAL,29445,CPT,,,,,,Outpatient,,,80,266,UHC Comm,UHC Comm,863,,,,,,,Case Rate,242.81,863,
31502 Tracheotomy tube change prior to establishme,14397259,LOCAL,31502,CPT,,,,,,Outpatient,,,91,232,UHC Comm,UHC Comm,863,,,,,,,Case Rate,162.41,863,
"31899 UNLISTED PROCEDURE, TRACHEA, BRONCHI ProFee",7932202,LOCAL,31899,CPT,,,,,,Outpatient,,,2172,194,UHC Comm,UHC Comm,863,,,,,,,Case Rate,177.49,2400.33,
"58573 LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTO",14831670,LOCAL,58573,CPT,,,,,,Outpatient,,,227,10411,UHC Comm,UHC Comm,5787,,,,,,,Case Rate,5787,9518.56,
64454 Genicular Nerve Block Profee,13911832,LOCAL,64454,CPT,,,,,,Outpatient,,,250,244,UHC Comm,UHC Comm,1291,,,,,,,Case Rate,633.14,1291,
64999 XX UNLISTED NERVOUS SYSTEM INJECTION,7939552,LOCAL,64999,CPT,,,,,,Outpatient,,,1008,620,UHC Comm,UHC Comm,863,,,,,,,Case Rate,269.88,863,
93451 RIGHT HEART CATHERIZATION (OR),8192212,LOCAL,93451,CPT,,,,,26,Outpatient,,,188.32,6246,UHC Comm,UHC Comm,4325,,,,,,,Case Rate,2940.64,4325,
97597 WOUND DEBRIDEMENT ProFee,7935939,LOCAL,97597,CPT,,,,,,Outpatient,,,83,395,UHC Comm,UHC Comm,863,,,,,,,Case Rate,181.66,863,
97598 DEBRID SELCT EA ADD20SQCM ProFee,7935940,LOCAL,97598,CPT,,,,,,Outpatient,,,863,395,UHC Comm,UHC Comm,863,,,,,,,Case Rate,20.42,1466.58,
"Protein, Tot & Prot Electrop Interp QSTC",8852423,LOCAL,84165,CPT,,,,,,Outpatient,,,3.92,12.89,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,2.796363636,17.73,Based on EAPG RVU's
"Protein, Total QSTC",8852413,LOCAL,84165,CPT,,,,,,Outpatient,,,3.92,12.89,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,2.796363636,17.73,Based on EAPG RVU's
.RPR Titer QSTC,6231113,LOCAL,86593,CPT,,,,,,Outpatient,,,5.9,5.28,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,4.4,15.29,Based on EAPG RVU's
UA Microscopic,633864,LOCAL,81015,CPT,,,,,,Outpatient,,,6,3.66,Blue Cross of AL,Blue Cross,4.02,,,,,,,Other,1.68192607,4.02,Based on EAPG RVU's
Urinalysis Review Manual,8502419,LOCAL,81015,CPT,,,,,,Outpatient,,,6,3.66,Blue Cross of AL,Blue Cross,4.02,,,,,,,Other,1.68192607,4.02,Based on EAPG RVU's
Hematocrit QSTC,8852782,LOCAL,85014,CPT,,,,,,Outpatient,,,7.21,2.84,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,8.21,12.62068493,Based on EAPG RVU's
Hemoglobin A2 (Quant) QSTC,8852791,LOCAL,83020,CPT,,,,,,Outpatient,,,7.21,15.44,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,12.87,17.73,Based on EAPG RVU's
Hemoglobin QSTC,8852780,LOCAL,85018,CPT,,,,,,Outpatient,,,7.21,2.84,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,8.21,10.94316176,Based on EAPG RVU's
Red Blood Cell Count QSTC,8852779,LOCAL,85041,CPT,,,,,,Outpatient,,,7.21,3.62,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,3.02,8.21,Based on EAPG RVU's
87107 Fungal Isolate Identification QST,14813753,LOCAL,87107,CPT,,,,,,Outpatient,,,7.5,12.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.32,20.05,Based on EAPG RVU's
87143 Fungal Isolate Identification QST,14815667,LOCAL,87143,CPT,,,,,,Outpatient,,,7.5,15.02,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,12.52,Based on EAPG RVU's
87149 Fungal Isolate Identification QST,14813753,LOCAL,87149,CPT,,,,,,Outpatient,,,7.5,24.06,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.32,20.05,Based on EAPG RVU's
87999 Fungal Isolate Identification QST,14811558,LOCAL,87999,CPT,,,300,RC,,Outpatient,,,7.5,,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,10.57,Based on EAPG RVU's
Fungal Isolate ID QST,12862037,LOCAL,87106,CPT,,,311,RC,,Outpatient,,,7.5,12.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,10.57,Based on EAPG RVU's
Glucose Fasting Urine,7974487,LOCAL,81003,CPT,,,,,,Outpatient,,,7.88,2.7,Blue Cross of AL,Blue Cross,4.02,,,,,,,Other,3.795286195,4.02,Based on EAPG RVU's
"Uric Acid, Synovial Fluid QSTC",9607980,LOCAL,84560,CPT,,,,,,Outpatient,,,8.37,6.1,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,19.49,Based on EAPG RVU's
Alkaline Phosphatase QSTC,8848272,LOCAL,84075,CPT,,,,,,Outpatient,,,9.11,6.22,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,5.18,7.16,Based on EAPG RVU's
Bone Isoenzymes QSTC,8848275,LOCAL,84080,CPT,,,,,,Outpatient,,,9.11,17.74,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,14.78,17.73,Based on EAPG RVU's
mitoMYcin 20 mg/40 mL Sol [CULL],11205507,LOCAL,J9280,CPT,,,,,,Outpatient,0.5,ML,10,,Blue Cross of AL,Blue Cross,525.49,,,,,,,Other,20.35,525.49,Based on EAPG RVU's
"rabies immune globulin, human 150 intl units/mL intramuscular solution 2 mL [CULL]",11212251,LOCAL,90376,CPT,,,,,,Outpatient,0.007,ML,10,347,Blue Cross of AL,Blue Cross,2110.36,,,,,,,Other,347.32,2110.36,Based on EAPG RVU's
"Protein, Total, Peritoneal Fluid QSTC",9039313,LOCAL,84157,CPT,,,,,,Outpatient,,,10.44,4.8,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,4,7.16,Based on EAPG RVU's
Rheumatoid Factor QSTC,9039252,LOCAL,86431,CPT,,,,,,Outpatient,,,10.8,6.8,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,6.29875,15.29,Based on EAPG RVU's
RPR (Dx) w/Refl Titer/Confrm Testing QST,8972905,LOCAL,86592,CPT,,,,,,Outpatient,,,11.16,5.12,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,19.99375,Based on EAPG RVU's
RPR (Monitor) w/Refl Titer QSTC,8972905,LOCAL,86592,CPT,,,,,,Outpatient,,,11.16,5.12,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,19.99375,Based on EAPG RVU's
"Creatinine, Random Ur QSTC",9320766,LOCAL,82570,CPT,,,,,,Outpatient,,,11.25,6.22,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,40.97514925,Based on EAPG RVU's
Source QSTC,8983584,LOCAL,87209,CPT,,,,,,Outpatient,,,13.19,21.58,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,17.98,Based on EAPG RVU's
"ANA IFA Scrn w/Rfx Titr & Patt, IFA QSTC",8764654,LOCAL,86038,CPT,,,,,,Outpatient,,,13.5,14.51,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,10.70333333,15.29,Based on EAPG RVU's
"ANA Scr,IFA w/R Tit/Ptn/MPX Ab Casc QSTC",8764642,LOCAL,86038,CPT,,,,,,Outpatient,,,13.5,14.51,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,10.70333333,15.29,Based on EAPG RVU's
"Bacterial Identification, Aerobic QST",13344175,LOCAL,87077,CPT,,,,,,Outpatient,,,13.5,9.7,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,16.47987421,Based on EAPG RVU's
T3 Uptake QSTC,9039244,LOCAL,84479,CPT,,,,,,Outpatient,,,13.5,7.76,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,6.47,18.43,Based on EAPG RVU's
Measles Antibody (IgG) QSTC,8764682,LOCAL,86765,CPT,,,,,,Outpatient,,,14.63,15.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.88,15.29,Based on EAPG RVU's
"hCG, Total, QN Male Only QSTC",8853229,LOCAL,84702,CPT,,,,,,Outpatient,,,15,18.06,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,15.05,18.43,Based on EAPG RVU's
"Herpes Simplex Virus 2 (IgG), with Reflex to HSV-2 Inhibition QST",14811888,LOCAL,86696,CPT,,,,,,Outpatient,,,15,23.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,19.35,Based on EAPG RVU's
alpha 1-proteinase inhibitor human Sol 10 mg [CULL],11211124,LOCAL,J0256,CPT,,,,,,Outpatient,1,EA,16,,Blue Cross of AL,Blue Cross,2110.36,,,,,,,Other,5.46,2110.36,Based on EAPG RVU's
"Chloride, Random Urine without Creatinine QSTC",10011691,LOCAL,82436,CPT,,,,,,Outpatient,,,16.25,6.9,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,5.75,7.16,Based on EAPG RVU's
"Potassium, U24 w/o Creatinine QSTC",13864422,LOCAL,84133,CPT,,,,,,Outpatient,,,16.25,5.68,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,19.32,Based on EAPG RVU's
Sickle Cell Screen QSTC,10073685,LOCAL,85660,CPT,,,,,,Outpatient,,,16.25,6.61,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,5.51,8.21,Based on EAPG RVU's
"Creatinine, Random Ur, Microalbumin QSTC",9041589,LOCAL,82570,CPT,,,,,,Outpatient,,,16.88,6.22,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,40.97514925,Based on EAPG RVU's
"Ratio, Microalbumin Random Ur QSTC",9041592,LOCAL,82043,CPT,,,,,,Outpatient,,,16.88,6.94,Blue Cross of AL,Blue Cross,4.02,,,,,,,Other,4.02,20.15557971,Based on EAPG RVU's
Protein Level 24 Hour Urine,633811,LOCAL,84156,CPT,,,,,,Outpatient,,,17,4.4,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,11.68,Based on EAPG RVU's
Thrombin Clotting Time QSTC,8764547,LOCAL,85670,CPT,,,,,,Outpatient,,,17.1,6.92,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,5.77,Based on EAPG RVU's
"Urea Nitrogen Ur, Rand QSTC",13864416,LOCAL,84540,CPT,,,,,,Outpatient,,,17.1,6.67,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,5.56,7.16,Based on EAPG RVU's
Creatine Kinase Isoenzyme Interp. QSTC,8852390,LOCAL,82550,CPT,,,,,,Outpatient,,,18,7.81,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,23.7373913,Based on EAPG RVU's
Creatine Kinase Isoenzyme w/ Tot CK QSTC,8764767,LOCAL,82552,CPT,,,,,,Outpatient,,,18,16.07,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,13.39,17.73,Based on EAPG RVU's
Creatine Kinase Isoenzymes w/o Ttl QSTC,13864524,LOCAL,82552,CPT,,,,,,Outpatient,,,18,16.07,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,13.39,17.73,Based on EAPG RVU's
"Creatine Kinase, Total QSTC",8852386,LOCAL,82552,CPT,,,,,,Outpatient,,,18,16.07,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,13.39,17.73,Based on EAPG RVU's
Rubella Antibody (IgG) QSTC,8853250,LOCAL,86762,CPT,,,,,,Outpatient,,,18,17.27,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.39,15.29,Based on EAPG RVU's
Urine Creatinine,7050475,LOCAL,82570,CPT,,,,,,Outpatient,,,18,6.22,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,40.97514925,Based on EAPG RVU's
Urine Protein Level,7412757,LOCAL,84156,CPT,,,,,,Outpatient,,,18,4.4,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,11.68,Based on EAPG RVU's
Almond (F20) IgE QST,14586519,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Alternaria Alternata (M6) IgE QST,14586545,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Brazil Nut (F18) IgE QST,14586553,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Cashew Nut (F202) IgE QST,14586555,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Cat Dander (E1) IgE QST,14586539,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Cladosporium Herbarum (M2) IgE QST,14586543,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Cockroach (I6) IgE QST,14586549,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Codfish (F3) IgE QST,14586521,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Cow's Milk (F2) IgE QST,14586529,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Dermatophagoides Farinae (D2) IgE QST,14586537,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Dermatophagoides Pteronyssinu D1 IgE QST,14586535,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Dog Dander (E5) IgE QST,14586541,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Egg White (F1) IgE QST,14586527,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Hazelnut (F17) IgE QST,14586551,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Immunoglobulin E QST,14586516,LOCAL,82785,CPT,,,,,,Outpatient,,,18.5,19.75,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,203.9616667,Based on EAPG RVU's
Macadamia Nut (RF345) IgE QST,14586525,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Mouse Urine Proteins (E72) IgE QST,14586547,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Peanut (F13) IgE QST,14586517,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Shrimp (F24) IgE QST,14586523,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Soybean (F14) IgE QST,14586533,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Walnut (F256) IgE QST,14586557,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Wheat (F4) IgE QST,14586531,LOCAL,86003,CPT,,,,,,Outpatient,,,18.5,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
"HPV mRNA E6/E7, POST-$HYST, VAGINAL W/REFL QST",14782711,LOCAL,87624,CPT,,,,,,Outpatient,,,18.9,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,67.195,Based on EAPG RVU's
"Osmolality, Urine QSTC",8972834,LOCAL,83935,CPT,,,301,RC,,Outpatient,,,18.99,8.18,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,7.16,Based on EAPG RVU's
Lead Capillary QSTC,14116315,LOCAL,83655,CPT,,,,,,Outpatient,,,19.12,14.53,Blue Cross of AL,Blue Cross,16.07,,,,,,,Other,13.99076923,16.07,Based on EAPG RVU's
"Lead, Blood QSTC",8764839,LOCAL,83655,CPT,,,,,,Outpatient,,,19.13,14.53,Blue Cross of AL,Blue Cross,16.07,,,,,,,Other,13.99076923,16.07,Based on EAPG RVU's
"Lead, Blood QSTC",13864923,LOCAL,83655,CPT,,,,,,Outpatient,,,19.13,14.53,Blue Cross of AL,Blue Cross,16.07,,,,,,,Other,13.99076923,16.07,Based on EAPG RVU's
"Albumin, Peritoneal Fluid QSTC",8972935,LOCAL,82042,CPT,,,,,,Outpatient,,,19.4,9.34,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,7.78,Based on EAPG RVU's
"Albumin, Pleural Fluid QST",12130816,LOCAL,82042,CPT,,,,,,Outpatient,,,19.4,9.34,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,7.78,Based on EAPG RVU's
"Albumin, Pleural Fluid QSTC",12130706,LOCAL,82042,CPT,,,,,,Outpatient,,,19.4,9.34,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,7.78,Based on EAPG RVU's
"Glucose, Peritoneal Fluid QSTC",9039310,LOCAL,82945,CPT,,,,,,Outpatient,,,19.4,4.72,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,3.93,7.16,Based on EAPG RVU's
Cardiolipin Ab (IgA)QSTC,9215429,LOCAL,86147,CPT,,,,,,Outpatient,,,19.58,30.54,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,25.45,Based on EAPG RVU's
Cardiolipin Antibody IgG QSTC,10100354,LOCAL,86147,CPT,,,,,,Outpatient,,,19.58,30.54,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,25.45,Based on EAPG RVU's
Cardiolipin Antibody IgM QSTC,10100355,LOCAL,86147,CPT,,,,,,Outpatient,,,19.58,30.54,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,25.45,Based on EAPG RVU's
24hr Urine Creatinine QSTC,10005155,LOCAL,82570,CPT,,,,,,Outpatient,,,19.76,6.22,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,40.97514925,Based on EAPG RVU's
"Creatinine, Random U QSTC",12290061,LOCAL,82570,CPT,,,,,,Outpatient,,,19.76,6.22,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,40.97514925,Based on EAPG RVU's
Interp: QSTC,8851928,LOCAL,84166,CPT,,,,,,Outpatient,,,19.76,21.4,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,18.62,Based on EAPG RVU's
Interp: QSTC,8851952,LOCAL,84166,CPT,,,,,,Outpatient,,,19.76,21.4,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,18.62,Based on EAPG RVU's
"Protein, Total, Random Urine QSTC",8851945,LOCAL,84156,CPT,,,,,,Outpatient,,,19.76,4.4,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,11.68,Based on EAPG RVU's
Carbon Dioxide Level,7903173,LOCAL,82374,CPT,,,,,,Outpatient,,,20,5.86,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,4.88,7.16,Based on EAPG RVU's
Creatinine,3454470,LOCAL,82565,CPT,,,,,,Outpatient,,,20,6.14,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,10.061625,Based on EAPG RVU's
Gastric Occult Blood,7974128,LOCAL,82271,CPT,,,,,,Outpatient,,,20.16,6.38,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,5.32,7.16,Based on EAPG RVU's
Immunoglobulin A QSTC,8764567,LOCAL,82784,CPT,,,,,,Outpatient,,,20.25,11.16,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,34.958,Based on EAPG RVU's
Immunoglobulin M QSTC,8853219,LOCAL,82784,CPT,,,,,,Outpatient,,,20.25,11.16,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,34.958,Based on EAPG RVU's
"PSA, Free QSTC",8852652,LOCAL,84154,CPT,,,,,,Outpatient,,,20.25,22.07,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,19.14,Based on EAPG RVU's
.Manual Differential (CULL),13467987,LOCAL,85007,CPT,,,,,,Outpatient,,,20.81,4.56,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,3.338698061,8.21,Based on EAPG RVU's
.Manual Differential (CULL_AL),6237143,LOCAL,85007,CPT,,,,,,Outpatient,,,20.81,4.56,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,3.338698061,8.21,Based on EAPG RVU's
"Albumin, CSF QSTC",13873322,LOCAL,82042,CPT,,,,,,Outpatient,,,20.95,9.34,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,7.78,Based on EAPG RVU's
"IgG, CSF QSTC",13873321,LOCAL,82784,CPT,,,,,,Outpatient,,,20.95,11.16,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,34.958,Based on EAPG RVU's
"Amylase, Pleural Fluid QSTC",9039309,LOCAL,82150,CPT,,,,,,Outpatient,,,20.97,7.78,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,1.237209302,7.16,Based on EAPG RVU's
"Calcium, Random Ur QSTC",13864744,LOCAL,82310,CPT,,,,,,Outpatient,,,20.99,6.19,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,5.16,7.16,Based on EAPG RVU's
"Creatinine, Random U QSTC",13864745,LOCAL,82570,CPT,,,,,,Outpatient,,,20.99,6.22,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,40.97514925,Based on EAPG RVU's
Fructosamine QSTC,8853273,LOCAL,82985,CPT,,,,,,Outpatient,,,21.02,20.11,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,16.76,17.73,Based on EAPG RVU's
Direct LDL QSTC,9039357,LOCAL,83721,CPT,,,,,,Outpatient,,,21.6,12.6,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,10.5,17.73,Based on EAPG RVU's
Hemoglobin A1c QSTC,6213055,LOCAL,83036,CPT,,,,,,Outpatient,,,21.6,11.65,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,28.59604426,Based on EAPG RVU's
Thyroglobulin Abs QSTC,8861418,LOCAL,86800,CPT,,,302,RC,,Outpatient,,,21.6,19.09,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,15.29,Based on EAPG RVU's
Thyroglobulin Antibodies QSTC,8764576,LOCAL,86800,CPT,,,301,RC,,Outpatient,,,21.6,19.09,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,15.29,Based on EAPG RVU's
Varicella-Zoster Virus Ab (IgG) QSTC,8853252,LOCAL,86787,CPT,,,,,,Outpatient,,,21.6,15.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.88,15.29,Based on EAPG RVU's
Serum Osmolality QSTC,8972765,LOCAL,83930,CPT,,,,,,Outpatient,,,21.65,7.93,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,6.61,7.16,Based on EAPG RVU's
POC Hgb,7160347,LOCAL,83036,CPT,,,,,,Outpatient,,,22,11.65,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,28.59604426,Based on EAPG RVU's
Creatinine Level 24 Hour Urine,1634894,LOCAL,82570,CPT,,,,,,Outpatient,,,22.03,6.22,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,40.97514925,Based on EAPG RVU's
"Albumin, 24 Hour Urine w/o Creat QSTC",13864523,LOCAL,82043,CPT,,,,,,Outpatient,,,22.5,6.94,Blue Cross of AL,Blue Cross,4.02,,,,,,,Other,4.02,20.15557971,Based on EAPG RVU's
"Folate, RBC QSTS",13899938,LOCAL,82747,CPT,,,,,,Outpatient,,,22.5,21.18,Blue Cross of AL,Blue Cross,46.74,,,,,,,Other,17.65,46.74,Based on EAPG RVU's
Hepatitis C Ab rfx HCV RNA Qnt PCR QSTC,8764583,LOCAL,86803,CPT,,,,,,Outpatient,,,22.5,17.12,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,32.10014925,Based on EAPG RVU's
"PSA, Total QSTC",8852651,LOCAL,84153,CPT,,,,,,Outpatient,,,22.5,22.07,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,104.8447059,Based on EAPG RVU's
"T4, Free QSTC",9291013,LOCAL,84439,CPT,,,,,,Outpatient,,,22.5,10.82,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,28.58065455,Based on EAPG RVU's
"Heterophile, Mono Screen QSTC",13864506,LOCAL,86308,CPT,,,,,,Outpatient,,,22.68,6.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.18,15.29,Based on EAPG RVU's
"T3, Free QSTC",8972902,LOCAL,84481,CPT,,,,,,Outpatient,,,22.68,20.33,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,34.46424242,Based on EAPG RVU's
COLLECTION: Venous Draw,1779389,LOCAL,36415,CPT,,,,,,Outpatient,,,22.73,10.91,Blue Cross of AL,Blue Cross,3.41,,,,,,,Other,3.41,6.740753664,Based on EAPG RVU's
Urine Eosinophil Smear,8690390,LOCAL,85008,CPT,,,,,,Outpatient,,,22.85,4.12,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,3.43,8.21,Based on EAPG RVU's
Urine Eosinophils,7974116,LOCAL,89051,CPT,,,,,,Outpatient,,,22.85,6.72,Blue Cross of AL,Blue Cross,14.07,,,,,,,Other,14.07,35.795,Based on EAPG RVU's
Sodium Level Urine,4185817,LOCAL,84300,CPT,,,,,,Outpatient,,,23,6.07,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,9.74,Based on EAPG RVU's
Almond (F20) IgE QST,13344505,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Almond (f20) IgE QSTC,8764712,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Beef (f27) IgE QSTC,8764717,LOCAL,86003,CPT,86003,HCPCS,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Brazil Nut (F18) IgE QST,13344495,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Brazil Nut (f18) IgE QSTC,8764711,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Cashew Nut (F202) IgE QST,13344499,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Cashew Nut (f202) IgE QSTC,8764689,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Cat Dander (e1) IgE QSTC,6241002,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Catfish (f369) IgE QSTC,8764761,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Chicken Meat (f83) IgE QSTC,8761426,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Clam (f207) IgE QSTC,8764592,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Cocoa (f93) IgE QSTC,8764728,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Coconut (f36) IgE QSTC,8764719,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Cow'S Milk (F2) IgE w/Rflx to Panel QST,12886535,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Cow'S Milk(F2) IgE W/Rfx Panel QSTC,14129187,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Crab (f23) IgE QSTC,6210507,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Crayfish (Rf320) IgE** QSTC,9039458,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
D. Pteronyssinus (d1) IgE QST,6241001,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Dermatophagoides Farinae (d2) IgE QST,10217085,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Dog Dander (e5) IgE QSTC,6241003,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Egg White (f1) IgE QSTC,8764699,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Egg White (F2) IgE w/Rflx to Panel QST,12886536,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Egg Yolk (f75) IgE QSTC,8764725,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Fire Ant (i70) IgE QSTC,8764698,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Gluten (f79) IgE QSTC,9039341,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Hazelnut (F17) IgE QST,13344503,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Hazelnut (f17) IgE QSTC,8764710,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Lobster (f80) IgE QSTC,6210505,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Macadamia Nut (RF345) IgE QST,13344491,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Milk Component Panel QST,10217179,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Oyster (f290) IgE QSTC,6210503,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Peanut (F13) IgE QST,13344507,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Peanut (f13) IgE QSTC,8764708,LOCAL,86003,CPT,86003,HCPCS,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
"Peanut,Tot w/rfx to Peanut Comp Pnl QSTC",8764811,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Pecan Nut (F201) IgE QST,13344493,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Pecan Nut (f201) IgE QSTC,8764727,LOCAL,86003,CPT,86003,HCPCS,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Perch Ocean IgE QSTC,8764760,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Pistachio (F203) IgE QST,13344501,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Pork (f26) IgE QSTC,8764716,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Scallop (f338) IgE QSTC,6210506,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Shrimp (f24) IgE QSTC,6241010,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Soybean (f14) IgE QSTC,8764709,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Strawberry (f44) IgE QSTC,8764722,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Tilapia IgE* QSTC,8972793,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Tomato (f25) IgE QSTC,8764715,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Walnut (F256) IgE QST,13344497,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Walnut (f256) IgE QSTC,8764747,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Wheat (f4) IgE QSTC,6241013,LOCAL,86003,CPT,,,,,,Outpatient,,,23.13,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Immunoglobulin G QSTC,8764569,LOCAL,82784,CPT,,,,,,Outpatient,,,24.75,11.16,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,34.958,Based on EAPG RVU's
Sjogren's Antibody (SS-A) QSTC,8860711,LOCAL,86235,CPT,,,,,,Outpatient,,,24.75,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
Sjogren's Antibody (SS-A) QSTC,9039451,LOCAL,86235,CPT,,,,,,Outpatient,,,24.75,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
Sjogren's Antibody (SS-B) QSTC,8860712,LOCAL,86235,CPT,,,,,,Outpatient,,,24.75,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
Sjogren's Antibody (SS-B) QSTC,9039452,LOCAL,86235,CPT,,,,,,Outpatient,,,24.75,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
Aerobic Bacterium ID/ Susceptibility QST,13344167,LOCAL,87077,CPT,,,,,,Outpatient,,,25,9.7,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,16.47987421,Based on EAPG RVU's
"Catecholamines, Fractionated, Plasma QSTC",11335672,LOCAL,82384,CPT,,,,,,Outpatient,,,25,30.3,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,25.25,Based on EAPG RVU's
Tissue A Clinical Impression QST,10148697,LOCAL,88300,CPT,,,,,,Outpatient,,,25,,Blue Cross of AL,Blue Cross,32.32,,,,,,,Other,22.39,32.32,Based on EAPG RVU's
Tissue A Comment QST,10148702,LOCAL,88302,CPT,,,,,,Outpatient,,,25,,Blue Cross of AL,Blue Cross,32.32,,,,,,,Other,32.32,35.88,Based on EAPG RVU's
Tissue A Diagnosis QST,10148701,LOCAL,88304,CPT,,,,,,Outpatient,,,25,,Blue Cross of AL,Blue Cross,32.32,,,,,,,Other,32.32,48.85,Based on EAPG RVU's
Tissue A Gross Description QST,10148699,LOCAL,88305,CPT,,,,,,Outpatient,,,25,,Blue Cross of AL,Blue Cross,59.06,,,,,,,Other,48.85,59.06,Based on EAPG RVU's
Tissue A Micro Description QST,10148700,LOCAL,88307,CPT,,,,,,Outpatient,,,25,,Blue Cross of AL,Blue Cross,59.06,,,,,,,Other,59.06,328.88,Based on EAPG RVU's
Tissue A Procedure QST,10148698,LOCAL,88309,CPT,,,,,,Outpatient,,,25,,Blue Cross of AL,Blue Cross,59.06,,,,,,,Other,59.06,746.86,Based on EAPG RVU's
Childhood Allergy Profile QSTC,8972792,LOCAL,86003,CPT,,,,,,Outpatient,,,25.16,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Expanded Childhood Allergy Profile ADD ON,14019143,LOCAL,86003,CPT,,,,,,Outpatient,,,25.16,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
"Albumin, CSF QSTC",8861454,LOCAL,82042,CPT,,,,,,Outpatient,,,25.28,9.34,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,7.78,Based on EAPG RVU's
"Albumin, Serum QSTC",8861457,LOCAL,82040,CPT,,,,,,Outpatient,,,25.28,5.94,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,127.89,Based on EAPG RVU's
Immunoglobulin G QSTC,8861456,LOCAL,82784,CPT,,,,,,Outpatient,,,25.28,11.16,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,34.958,Based on EAPG RVU's
Maternal Serum AFP QST,8972825,LOCAL,82105,CPT,,,,,,Outpatient,,,25.88,20.12,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,26.22,Based on EAPG RVU's
Maternal Serum AFP QSTC,8972825,LOCAL,82105,CPT,,,,,,Outpatient,,,25.88,20.12,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,26.22,Based on EAPG RVU's
"G-6-PD, RBC QSTC",8764537,LOCAL,82955,CPT,,,,,,Outpatient,,,26.15,11.64,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,9.7,Based on EAPG RVU's
Serotype 1 (1) QST,10243602,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 12 (12F) QST,10243608,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 14 (14) QST,10243609,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 17 (17F) QST,10242538,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 19 (19F) QST,10243610,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 2 (2) QST,10242514,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 20 (20) QST,10242544,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 22 (22F) QST,10242547,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 23 (23F) QST,10243611,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 26 (6B) QST,10243612,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 3 (3) QST,10243603,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 34 (10A) QST,10242556,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 4 (4) QST,10243604,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 43 (11A) QST,10242559,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 5 (5) QST,10243605,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 51 (7F) QST,10243613,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 54 (15B) QST,10242565,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 56 (18C) QST,10243614,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 57 (19A) QST,10242571,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 68 (9V) QST,10243615,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 70 (33F) QST,10242577,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 8 (8) QST,10243606,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Serotype 9 (9N) QST,10243607,LOCAL,86317,CPT,,,,,,Outpatient,,,26.78,17.99,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.99,15.29,Based on EAPG RVU's
Aldolase QSTC,8764531,LOCAL,82085,CPT,,,,,,Outpatient,,,26.87,11.65,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,18.195,Based on EAPG RVU's
Glucose Fingerstick Clinic POC (RE),4192199,LOCAL,82962,CPT,,,,,,Outpatient,,,26.93,3.94,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,9.084767596,Based on EAPG RVU's
".Smooth Muscle Ab, Titer QSTC",13864540,LOCAL,86256,CPT,,,,,,Outpatient,,,27,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.05,15.29,Based on EAPG RVU's
DNA (ds) Antibody QSTC,8764566,LOCAL,86225,CPT,,,,,,Outpatient,,,27,16.49,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.71636364,15.29,Based on EAPG RVU's
Hepatitis B Core Ab (IgM) QSTC,8764681,LOCAL,86705,CPT,,,,,,Outpatient,,,27,14.12,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,32.80285714,Based on EAPG RVU's
Mumps Virus Antibody (IgG) QSTC,8764679,LOCAL,86735,CPT,,,,,,Outpatient,,,27,15.66,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,13.05,15.29,Based on EAPG RVU's
Prolactin QSTC,8972761,LOCAL,84146,CPT,,,,,,Outpatient,,,27,23.26,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,19.38,Based on EAPG RVU's
Smooth Muscle Ab w/refl Titer QSTC,13864539,LOCAL,83497,CPT,,,,,,Outpatient,,,27,15.48,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,12.9,19.405,Based on EAPG RVU's
Smooth Muscle Ab w/rfx Titer QSTC,13864539,LOCAL,86015,CPT,,,,,,Outpatient,,,27,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.9,19.405,Based on EAPG RVU's
"Treponema pall Ab, Particle Agg QSTC",8972906,LOCAL,86780,CPT,,,,,,Outpatient,,,27,15.89,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,13.24,15.29,Based on EAPG RVU's
Protein Level Urine,4186691,LOCAL,84156,CPT,,,,,,Outpatient,,,27.74,4.4,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,11.68,Based on EAPG RVU's
Lipid Panel w/ Rfx to Direct LDL QSTC,13864433,LOCAL,80061,CPT,,,,,,Outpatient,,,27.9,16.07,Blue Cross of AL,Blue Cross,12.14,,,,,,,Other,12.14,16.59934459,Based on EAPG RVU's
G0109 DM OP SMT GRP PER 30 MIN CHARGE,8709096,LOCAL,,,G0109,HCPCS,,,,Outpatient,,,27.99,18,Blue Cross of AL,Blue Cross,67.18,,,,,,,Other,15.04,67.18,Based on EAPG RVU's
ID,8131550,LOCAL,87077,CPT,,,,,,Outpatient,,,28.15,9.7,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,16.47987421,Based on EAPG RVU's
ID Add On,13661571,LOCAL,87077,CPT,,,,,,Outpatient,,,28.15,9.7,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,16.47987421,Based on EAPG RVU's
Mitochondria M2 Ab (IgG) QSTC,8764575,LOCAL,86381,CPT,,,,,,Outpatient,,,28.26,30.54,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,26.605,Based on EAPG RVU's
PC DOPP LOWER EXT ART/ABI,8200227,LOCAL,93922,CPT,,,,,,Outpatient,,,28.29,265,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,117.85,161.71,Based on EAPG RVU's
"Gastrin, Serum QSTC",8764526,LOCAL,82941,CPT,,,,,,Outpatient,,,28.8,21.16,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,17.63,18.43,Based on EAPG RVU's
Hep B Core Ab (Total)w/Rfx to IgM QSTC,9039408,LOCAL,86704,CPT,,,,,,Outpatient,,,28.8,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,17.40428571,Based on EAPG RVU's
Hepatitis A IgM QSTC,8764600,LOCAL,86709,CPT,,,,,,Outpatient,,,28.8,13.51,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,11.26,15.29,Based on EAPG RVU's
"Hepatitis B Core Ab, Total QSTC",8764579,LOCAL,86704,CPT,,,,,,Outpatient,,,28.8,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,17.40428571,Based on EAPG RVU's
Complement Component C3c QSTC,8972768,LOCAL,86160,CPT,,,,,,Outpatient,,,29.25,14.4,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,36.909,Based on EAPG RVU's
Complement Component C4c QSTC,8972769,LOCAL,86160,CPT,,,,,,Outpatient,,,29.25,14.4,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,36.909,Based on EAPG RVU's
Insulin QSTC,9039285,LOCAL,83525,CPT,,,,,,Outpatient,,,29.25,13.72,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,11.43,18.43,Based on EAPG RVU's
Clozapine QSTC,8764629,LOCAL,80159,CPT,,,,,,Outpatient,,,29.7,24.18,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,20.15,Based on EAPG RVU's
HSV 1 and 2 IgG Antibodies QSTC,8853241,LOCAL,86695,CPT,,,,,,Outpatient,,,29.97,15.83,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,13.19,15.29,Based on EAPG RVU's
"HSV 1/2 IgG,Type Specific Ab QST",8389465,LOCAL,86695,CPT,,,,,,Outpatient,,,29.97,15.83,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,13.19,15.29,Based on EAPG RVU's
97804 Medical Nutrit Group 30Min CHARGE,9323172,LOCAL,97804,CPT,,,,,,Outpatient,,,30,20,Blue Cross of AL,Blue Cross,287.34,,,,,,,Other,11.75,287.34,Based on EAPG RVU's
Insulin Level Total,3454335,LOCAL,83525,CPT,,,,,,Outpatient,,,30,13.72,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,11.43,18.43,Based on EAPG RVU's
".ANA, Titer and Pattern QSTC",8764643,LOCAL,86039,CPT,,,,,,Outpatient,,,31.5,13.39,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,21.22,Based on EAPG RVU's
Cytomegalovirus Antibody (IgG) QSTC,13972135,LOCAL,86644,CPT,,,,,,Outpatient,,,31.5,17.27,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.39,15.29,Based on EAPG RVU's
Cytomegalovirus Antibody (IgG) QSTC,8853227,LOCAL,86644,CPT,,,,,,Outpatient,,,31.5,17.27,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.39,15.29,Based on EAPG RVU's
Osmolality Urine,4186098,LOCAL,83935,CPT,,,301,RC,,Outpatient,,,31.5,8.18,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,7.16,Based on EAPG RVU's
C-Reactive Protein,1628890,LOCAL,86140,CPT,,,,,,Outpatient,,,32,6.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,13.29690962,15.29,Based on EAPG RVU's
Fecal WBC,4123047,LOCAL,87205,CPT,,,,,,Outpatient,,,32,5.12,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,12.26595628,Based on EAPG RVU's
Stool WBC,10294481,LOCAL,87205,CPT,,,,,,Outpatient,,,32,5.12,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,12.26595628,Based on EAPG RVU's
"Complement, Total (CH50) QSTC",8764582,LOCAL,86162,CPT,,,,,,Outpatient,,,32.4,24.38,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,20.32,Based on EAPG RVU's
DHEA Sulfate QSTC,9696140,LOCAL,82627,CPT,,,,,,Outpatient,,,32.4,26.68,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,27.095,Based on EAPG RVU's
Haptoglobin QSTC,8764542,LOCAL,83010,CPT,,,,,,Outpatient,,,32.4,15.1,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,12.58,17.73,Based on EAPG RVU's
"Hepatitis A Ab, Total QSTC",8764599,LOCAL,86708,CPT,,,,,,Outpatient,,,32.4,14.87,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.39,15.29,Based on EAPG RVU's
Jo-1 Antibody QSTC,8764688,LOCAL,86235,CPT,,,,,,Outpatient,,,32.4,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
"RNP Antibody, QSTC",10100359,LOCAL,86235,CPT,,,,,,Outpatient,,,32.4,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
"Sm Antibody, QSTC",10100362,LOCAL,86235,CPT,,,,,,Outpatient,,,32.4,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
"Albumin, CSF QSTC",13873031,LOCAL,82042,CPT,,,,,,Outpatient,,,32.46,9.34,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,7.78,Based on EAPG RVU's
"Albumin, Serum QSTC",13873034,LOCAL,82040,CPT,,,,,,Outpatient,,,32.46,5.94,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,127.89,Based on EAPG RVU's
Immunoglobulin G QSTC,13873033,LOCAL,82784,CPT,,,,,,Outpatient,,,32.46,11.16,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,34.958,Based on EAPG RVU's
"Oligoclonal Bands (IgG),CSF QSTC",13873028,LOCAL,83916,CPT,,,,,,Outpatient,,,32.46,32.87,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,27.39,Based on EAPG RVU's
Immunoglobulin A QSTC,13904383,LOCAL,82784,CPT,,,,,,Outpatient,,,32.62,11.16,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,34.958,Based on EAPG RVU's
tTG IgA Ab QSTC,13904382,LOCAL,86364,CPT,,,,,,Outpatient,,,32.63,13.84,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,61.9,Based on EAPG RVU's
"Delta-Aminolevulinic Acid, Random Urine QSTC",12329984,LOCAL,82135,CPT,,,,,,Outpatient,,,32.81,19.74,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,16.45,17.73,Based on EAPG RVU's
Bilirubin Cord Blood,10237211,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,5.02,7.16,Based on EAPG RVU's
Bilirubin Neonatal (Bu/Bc),14541767,LOCAL,82248,CPT,,,,,,Outpatient,,,33.46,6.02,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,26.6275,Based on EAPG RVU's
Bilirubin Neonatal 2,8883195,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,5.02,7.16,Based on EAPG RVU's
Bilirubin Total,633672,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,5.02,7.16,Based on EAPG RVU's
Bilirubin Total,7939102,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,5.02,7.16,Based on EAPG RVU's
Bilirubin Total,8443661,LOCAL,82247,CPT,,,,,,Outpatient,,,33.46,6.02,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,5.02,7.16,Based on EAPG RVU's
Cyclic Citrull Peptide (CCP) Ab IgG QSTC,8764613,LOCAL,86200,CPT,,,,,,Outpatient,,,33.75,15.54,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,7.491935484,15.29,Based on EAPG RVU's
"Cholinesterase, Plasma QSTC",13873320,LOCAL,82482,CPT,,,,,,Outpatient,,,33.8,11.77,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,9.81,Based on EAPG RVU's
"Cholinesterase, RBC QSTC",13873317,LOCAL,82480,CPT,,,,,,Outpatient,,,33.8,9.44,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,7.87,Based on EAPG RVU's
"Calcium, 24 hour Urine QSTC",13864700,LOCAL,82340,CPT,,,,,,Outpatient,,,33.95,7.24,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,22.61833333,Based on EAPG RVU's
"Citric Acid, 24 Hour Urine QSTC",13864703,LOCAL,82507,CPT,,,,,,Outpatient,,,33.95,33.36,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,30.625,Based on EAPG RVU's
"Creatinine, 24 Hour Urine QSTC",13864712,LOCAL,82570,CPT,,,,,,Outpatient,,,33.95,6.22,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,40.97514925,Based on EAPG RVU's
"Magnesium, 24 Hour Urine QSTC",13864709,LOCAL,83735,CPT,,,,,,Outpatient,,,33.95,8.04,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,3.657824427,7.16,Based on EAPG RVU's
"Oxalate, 24 Hour Urine QSTC",13864701,LOCAL,83945,CPT,,,,,,Outpatient,,,33.95,17.34,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,24.085,Based on EAPG RVU's
pH Urine QSTC,13864699,LOCAL,83986,CPT,,,,,,Outpatient,,,33.95,4.3,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,18.755,Based on EAPG RVU's
"Phosphorus, 24 Hour Urine QSTC",13864707,LOCAL,84105,CPT,,,,,,Outpatient,,,33.95,6.94,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,19.835,Based on EAPG RVU's
"Potassium, 24 Hour Urine QSTC",13864711,LOCAL,84133,CPT,,,,,,Outpatient,,,33.95,5.68,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,19.32,Based on EAPG RVU's
"Sodium, 24 Hour Urine QSTC",13864704,LOCAL,84300,CPT,,,,,,Outpatient,,,33.95,6.07,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,9.74,Based on EAPG RVU's
"Sulfate, 24 Hour Urine QSTC",13864705,LOCAL,84392,CPT,,,,,,Outpatient,,,33.95,6.59,Blue Cross of AL,Blue Cross,4.02,,,,,,,Other,4.02,19.695,Based on EAPG RVU's
Uric Acid QSTC,13864716,LOCAL,84560,CPT,,,,,,Outpatient,,,33.95,6.1,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,19.49,Based on EAPG RVU's
Ammonium Urine QSTC,8997190,LOCAL,82140,CPT,,,,,,Outpatient,,,34,17.48,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,22.62909091,Based on EAPG RVU's
"Calcium, 24 hour Urine QSTC",8997182,LOCAL,82340,CPT,,,,,,Outpatient,,,34,7.24,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,22.61833333,Based on EAPG RVU's
"Citric Acid, 24 Hour Urine QSTC",8997185,LOCAL,82507,CPT,,,,,,Outpatient,,,34,33.36,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,30.625,Based on EAPG RVU's
"Creatinine, 24 Hour Urine QSTC",8997192,LOCAL,82570,CPT,,,,,,Outpatient,,,34,6.22,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,40.97514925,Based on EAPG RVU's
"Magnesium, 24 Hour Urine QSTC",8997189,LOCAL,83735,CPT,,,,,,Outpatient,,,34,8.04,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,3.657824427,7.16,Based on EAPG RVU's
"Oxalate, 24 Hour Urine QSTC",8997183,LOCAL,83945,CPT,,,,,,Outpatient,,,34,17.34,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,24.085,Based on EAPG RVU's
pH Urine QSTC,8997180,LOCAL,83986,CPT,,,,,,Outpatient,,,34,4.3,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,18.755,Based on EAPG RVU's
"Phosphorus, 24 Hour Urine QSTC",8997188,LOCAL,84105,CPT,,,,,,Outpatient,,,34,6.94,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,19.835,Based on EAPG RVU's
"Potassium, 24 Hour Urine QSTC",8997191,LOCAL,84133,CPT,,,,,,Outpatient,,,34,5.68,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,19.32,Based on EAPG RVU's
"Sodium, 24 Hour Urine QSTC",8997186,LOCAL,84300,CPT,,,,,,Outpatient,,,34,6.07,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,9.74,Based on EAPG RVU's
"Sulfate, 24 Hour Urine QSTC",8997187,LOCAL,84392,CPT,,,,,,Outpatient,,,34,6.59,Blue Cross of AL,Blue Cross,4.02,,,,,,,Other,4.02,19.695,Based on EAPG RVU's
"Uric Acid, 24 Hour Urine QSTC",8997184,LOCAL,84560,CPT,,,,,,Outpatient,,,34,6.1,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,19.49,Based on EAPG RVU's
Lipase Level,633776,LOCAL,83690,CPT,,,,,,Outpatient,,,34.27,8.27,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,1.304132029,7.16,Based on EAPG RVU's
"Alcohol, Ethyl QSTC",13864525,LOCAL,80320,CPT,,,301,RC,,Outpatient,,,34.88,,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,17.73,Based on EAPG RVU's
Ceruloplasmin QSTC,8764535,LOCAL,82390,CPT,,,,,,Outpatient,,,34.88,12.89,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,10.74,17.73,Based on EAPG RVU's
Amikacin Level,9034955,LOCAL,80150,CPT,,,,,,Outpatient,,,35,18.1,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.08,15.38,Based on EAPG RVU's
"ANA Screen, IFA QSTC",14116751,LOCAL,86038,CPT,,,,,,Outpatient,,,35,14.51,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,10.70333333,15.29,Based on EAPG RVU's
Breath Alcohol,9687753,LOCAL,82075,CPT,,,,,,Outpatient,,,35,36,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,30,Based on EAPG RVU's
"CCP, Antibody (IgG) QSTC",14116753,LOCAL,86200,CPT,,,,,,Outpatient,,,35,15.54,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,7.491935484,15.29,Based on EAPG RVU's
"MCV, Antibody QSTC",14116754,LOCAL,83520,CPT,,,,,,Outpatient,,,35,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,117.3767568,Based on EAPG RVU's
Rheumatoid Factor QSTC,14116752,LOCAL,86431,CPT,,,,,,Outpatient,,,35,6.8,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,6.29875,15.29,Based on EAPG RVU's
T4 Total,633845,LOCAL,84436,CPT,,,,,,Outpatient,,,35.09,8.24,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,17.54230769,18.43,Based on EAPG RVU's
Rheumatoid Factor Qualitative,7906954,LOCAL,86430,CPT,,,,,,Outpatient,,,35.1,7.37,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,20.56,Based on EAPG RVU's
Carboxyhemoglobin (B) QSTC,9039255,LOCAL,82375,CPT,,,301,RC,,Outpatient,,,35.19,14.78,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,17.73,Based on EAPG RVU's
Protein Tot & Protein Electrophore QSTC,8764768,LOCAL,84155,CPT,,,,,,Outpatient,,,35.23,4.4,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,3.67,7.16,Based on EAPG RVU's
Glucose 2 Hour Post Prandial,7973897,LOCAL,82947,CPT,,,,,,Outpatient,,,35.5,4.72,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,10.29541667,Based on EAPG RVU's
Lithium Level,2046348,LOCAL,80178,CPT,,,,,,Outpatient,,,35.5,7.93,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,20.99,Based on EAPG RVU's
Magnesium Level,633781,LOCAL,83735,CPT,,,,,,Outpatient,,,35.5,8.04,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,3.657824427,7.16,Based on EAPG RVU's
Thyroglobulin Monitoring QSTC,13864484,LOCAL,86800,CPT,,,301,RC,,Outpatient,,,35.55,19.09,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,15.29,Based on EAPG RVU's
Crystal Analysis QSTC,9658951,LOCAL,89060,CPT,,,,,,Outpatient,,,35.87,8.8,Blue Cross of AL,Blue Cross,14.07,,,,,,,Other,14.07,21.53,Based on EAPG RVU's
Glucose 1 Hour,7973889,LOCAL,82951,CPT,,,,,,Outpatient,,,35.9,15.44,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,12.87,17.73,Based on EAPG RVU's
Glucose 2 Hour,7973890,LOCAL,82952,CPT,,,,,,Outpatient,,,35.9,4.7,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,3.92,7.16,Based on EAPG RVU's
Glucose Level,633594,LOCAL,82947,CPT,,,,,,Outpatient,,,35.9,4.72,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,10.29541667,Based on EAPG RVU's
Thyroid Peroxidase Abs QSTC,8861417,LOCAL,86376,CPT,,,,,,Outpatient,,,35.91,17.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,25.085,Based on EAPG RVU's
Thyroid Peroxidase Antibodies QSTC,8764563,LOCAL,86376,CPT,,,,,,Outpatient,,,35.91,17.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,25.085,Based on EAPG RVU's
"Alpha-1-Antitrypsin, Qn QSTC",9039253,LOCAL,82103,CPT,,,,,,Outpatient,,,36,16.13,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,60.59,Based on EAPG RVU's
"Alpha-Fetoprotein, Tumor Marker QSTC",8764596,LOCAL,82105,CPT,,,,,,Outpatient,,,36,20.12,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,26.22,Based on EAPG RVU's
"B2 Microglobulin, Serum QSTC",8764794,LOCAL,82232,CPT,,,,,,Outpatient,,,36,19.42,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,16.18,18.43,Based on EAPG RVU's
Bill Decalcification Procedure,8489589,LOCAL,88311,CPT,,,,,,Outpatient,,,36,,Blue Cross of AL,Blue Cross,59.06,,,,,,,Other,7.2,59.06,Based on EAPG RVU's
CA 125 QSTC,8764680,LOCAL,86304,CPT,,,,,,Outpatient,,,36,24.97,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,20.81,Based on EAPG RVU's
CA 19-9 QSTC,8764669,LOCAL,86301,CPT,,,,,,Outpatient,,,36,24.97,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,20.81,Based on EAPG RVU's
CA 27.29 QSTC,8764762,LOCAL,86300,CPT,,,,,,Outpatient,,,36,24.97,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,43.34448276,Based on EAPG RVU's
Copper QSTC,8764536,LOCAL,82525,CPT,,,,,,Outpatient,,,36,14.89,Blue Cross of AL,Blue Cross,16.07,,,,,,,Other,16.07,24.085,Based on EAPG RVU's
"Fungal Identification, Molds QSTC",8873558,LOCAL,87107,CPT,,,,,,Outpatient,,,36,12.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.32,10.57,Based on EAPG RVU's
"Gliadin(Deamidated) Ab,IgA QSTC",9039363,LOCAL,86258,CPT,,,,,,Outpatient,,,36,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.05,15.29,Based on EAPG RVU's
"Gliadin(Deamidated) Ab,IgG QSTC",9039362,LOCAL,86258,CPT,,,,,,Outpatient,,,36,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.05,15.29,Based on EAPG RVU's
Lamotrigine QSTC,8853218,LOCAL,80175,CPT,,,,,,Outpatient,,,36,15.9,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,13.25,15.38,Based on EAPG RVU's
"Protein, Total, w/Creat, Random Ur QSTC",9291011,LOCAL,84156,CPT,,,,,,Outpatient,,,36,4.4,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,11.68,Based on EAPG RVU's
"Testosterone, Total, MS QSTC",8848606,LOCAL,84402,CPT,,,,,,Outpatient,,,36,30.56,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,30.485,Based on EAPG RVU's
"Copper, 24-Hour Urine QSTC",9390117,LOCAL,82525,CPT,,,,,,Outpatient,,,36.27,14.89,Blue Cross of AL,Blue Cross,16.07,,,,,,,Other,16.07,24.085,Based on EAPG RVU's
MALDI ID,X87077,LOCAL,87077,CPT,,,,,,Outpatient,,,36.36,9.7,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,16.47987421,Based on EAPG RVU's
Pathology Smear Review,633774,LOCAL,85060,CPT,,,301,RC,,Outpatient,,,36.72,,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,17.73,Based on EAPG RVU's
"ANA Screen, IFA QST",9110748,LOCAL,86038,CPT,,,,,,Outpatient,,,37,14.51,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,10.70333333,15.29,Based on EAPG RVU's
Complement Component C3C QST,12876950,LOCAL,86160,CPT,,,,,,Outpatient,,,37,14.4,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,36.909,Based on EAPG RVU's
Complement Component C4C QST,12876951,LOCAL,86160,CPT,,,,,,Outpatient,,,37,14.4,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,36.909,Based on EAPG RVU's
DNA (DS) Antibody QST,9110747,LOCAL,86225,CPT,,,,,,Outpatient,,,37,16.49,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.71636364,15.29,Based on EAPG RVU's
Microalbumin Level Urine,7974117,LOCAL,82043,CPT,,,,,,Outpatient,,,37,6.94,Blue Cross of AL,Blue Cross,4.02,,,,,,,Other,4.02,20.15557971,Based on EAPG RVU's
Rheumatoid Factor QST,9110751,LOCAL,86431,CPT,,,,,,Outpatient,,,37,6.8,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,6.29875,15.29,Based on EAPG RVU's
Ribosomal P Antibody QST,9110754,LOCAL,83516,CPT,,,,,,Outpatient,,,37,13.84,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,11.53,17.73,Based on EAPG RVU's
SCL-70 Antibody QST,9110757,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
Sjogren's Antibody (SS-A) QST,9110760,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
Sjogren's Antibody (SS-B) QST,9110763,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
Sm Antibody QST,9110766,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
SM/RNP Antibody QST,9110769,LOCAL,86235,CPT,,,,,,Outpatient,,,37,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
Thyroid Peroxidase Antibodies QST,9110772,LOCAL,86376,CPT,,,,,,Outpatient,,,37,17.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,25.085,Based on EAPG RVU's
EBV EBNA Ab (IgG) Interp QSTC,8849012,LOCAL,86664,CPT,,,,,,Outpatient,,,37.13,18.35,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,15.29,Based on EAPG RVU's
EBV VCA Ab (IgM) QSTC,8849009,LOCAL,86665,CPT,,,,,,Outpatient,,,37.13,21.77,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,18.14,Based on EAPG RVU's
".B. henselae Ab(IgG),Titer QSTC",8764830,LOCAL,86611,CPT,,,,,,Outpatient,,,37.35,12.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,10.18,15.29,Based on EAPG RVU's
".B. henselae Ab(IgM),Titer QSTC",8764831,LOCAL,86611,CPT,,,,,,Outpatient,,,37.35,12.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,10.18,15.29,Based on EAPG RVU's
".B. quintana Ab(IgG),Titer QSTC",10128892,LOCAL,86611,CPT,,,,,,Outpatient,,,37.35,12.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,10.18,15.29,Based on EAPG RVU's
TBG QSTC,8853216,LOCAL,84442,CPT,,,,,,Outpatient,,,39.06,17.74,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,14.78,18.43,Based on EAPG RVU's
"Culture, Fungus, Skin, Hair, Nails QSTC",8972785,LOCAL,87101,CPT,,,,,,Outpatient,,,39.11,9.25,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,7.71,10.57,Based on EAPG RVU's
Prostate Specific Antigen Total,7939094,LOCAL,84153,CPT,,,,,,Outpatient,,,39.17,22.07,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,104.8447059,Based on EAPG RVU's
Prealbumin,3454341,LOCAL,84134,CPT,,,,,,Outpatient,,,39.98,17.51,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,4.934545455,17.73,Based on EAPG RVU's
20560 DRY NEEDLING 1 OR 2 MUSCLES WO INJECTION,9650048,LOCAL,20560,CPT,,,,,,Outpatient,,,40,26,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,22.39,863,Based on EAPG RVU's
92551 EMH HEARING TEST CHARGE,13441384,LOCAL,92551,CPT,,,471,RC,,Outpatient,,,40,26,Blue Cross of AL,Blue Cross,50.58,,,,,,,Other,50.58,50.58,Based on EAPG RVU's
Beef (F27) IgE Class QSTC,14129407,LOCAL,86003,CPT,,,,,,Outpatient,,,40,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Glucose Body Fluid,1628896,LOCAL,82945,CPT,,,,,,Outpatient,,,40,4.72,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,3.93,7.16,Based on EAPG RVU's
Lamb (F88) IgE Class QSTC,14129413,LOCAL,86003,CPT,,,,,,Outpatient,,,40,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Pork (F26) IgE Class QSTC,14129419,LOCAL,86003,CPT,,,,,,Outpatient,,,40,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
RESULTS_QSTC,14755730,LOCAL,86008,CPT,,,,,,Outpatient,,,40,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,17.93,Based on EAPG RVU's
"Pyruvic Acid (Pyruvate),B QSTC",13864526,LOCAL,84210,CPT,,,,,,Outpatient,,,40.1,17.38,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,14.48,17.73,Based on EAPG RVU's
"VDRL, CSF QSTC",8764738,LOCAL,86592,CPT,,,,,,Outpatient,,,40.41,5.12,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,19.99375,Based on EAPG RVU's
Angiotensin Converting Enzyme QSTC,8764564,LOCAL,82164,CPT,,,,,,Outpatient,,,40.5,17.52,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,27.405,Based on EAPG RVU's
Intrinsic Factor Blocking Antibody QSTC,8764611,LOCAL,86340,CPT,,,,,,Outpatient,,,40.5,18.1,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.08,15.29,Based on EAPG RVU's
Osmolality Serum,9414322,LOCAL,83930,CPT,,,,,,Outpatient,,,40.5,7.93,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,6.61,7.16,Based on EAPG RVU's
97018 OT PARAFFIN BATH 1+ AREAS APPLIC CHARGE,9850020,LOCAL,97018,CPT,,,,,GO,Outpatient,,,40.9,27,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,5.41,47.26,Based on EAPG RVU's
97018 OT PARAFFIN BATH CHARGE,9860020,LOCAL,97018,CPT,,,,,GO|CO,Outpatient,,,40.9,27,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,5.41,47.26,Based on EAPG RVU's
OT Paraffin Bath Assistant Units,7895270,LOCAL,97018,CPT,,,,,CQ,Outpatient,,,40.9,27,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,5.41,47.26,Based on EAPG RVU's
OT Paraffin Bath Units,1373447,LOCAL,97018,CPT,,,,,GO,Outpatient,,,40.9,27,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,5.41,47.26,Based on EAPG RVU's
Paraffin Bath Charge,7895270,LOCAL,97018,CPT,,,,,GO,Outpatient,,,40.9,27,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,5.41,47.26,Based on EAPG RVU's
Centromere B Antibody QSTC,8764633,LOCAL,86235,CPT,,,,,,Outpatient,,,40.91,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
Beta Hydroxybutyrate,3454370,LOCAL,82010,CPT,,,301,RC,,Outpatient,,,41,9.8,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,7.16,Based on EAPG RVU's
M. pneumoniae Ab (IgM) QSTC,8764773,LOCAL,86738,CPT,,,,,,Outpatient,,,41.49,15.89,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,13.24,15.29,Based on EAPG RVU's
Zinc QSTC,8764557,LOCAL,84630,CPT,,,,,,Outpatient,,,41.58,13.67,Blue Cross of AL,Blue Cross,16.07,,,,,,,Other,16.07,26.375,Based on EAPG RVU's
Gram Stain (General Lab),8726050,LOCAL,87205,CPT,,,,,,Outpatient,,,41.62,5.12,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,12.26595628,Based on EAPG RVU's
Gram Stain Intraoperative,13436049,LOCAL,87205,CPT,,,,,,Outpatient,,,41.62,5.12,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,12.26595628,Based on EAPG RVU's
Gram Stain Report,634217,LOCAL,87205,CPT,,,,,,Outpatient,,,41.62,5.12,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,12.26595628,Based on EAPG RVU's
"Bile Acids, Fractionated and Total QSTC",13864500,LOCAL,82542,CPT,,,,,,Outpatient,,,41.85,28.91,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,24.09,Based on EAPG RVU's
"Calcium, 24 hr Ur (w/o Creatinine) QSTC",9039238,LOCAL,82340,CPT,,,,,,Outpatient,,,41.99,7.24,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,22.61833333,Based on EAPG RVU's
Drug Panel (10),13954356,LOCAL,80306,CPT,,,,,,Outpatient,,,42.45,20.57,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,0.2416,17.73,Based on EAPG RVU's
Bill Intraoperative Additonal,14048005,LOCAL,88332,CPT,,,,,,Outpatient,,,42.46,,Blue Cross of AL,Blue Cross,53.82,,,,,,,Other,21.23,53.82,Based on EAPG RVU's
Toxoplasma Antibody (IgG) QSTC,8861628,LOCAL,86777,CPT,,,,,,Outpatient,,,42.48,17.27,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.39,15.29,Based on EAPG RVU's
Toxoplasma Antibody (IgM) QSTC,8861629,LOCAL,86778,CPT,,,,,,Outpatient,,,42.48,17.29,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.41,15.29,Based on EAPG RVU's
"Cadmium, Blood, QSTC",13864925,LOCAL,82300,CPT,,,,,,Outpatient,,,42.75,28.37,Blue Cross of AL,Blue Cross,16.07,,,,,,,Other,16.07,29.91,Based on EAPG RVU's
"Vitamin B1 (Thiamine), B QSTC",8972833,LOCAL,84425,CPT,,,,,,Outpatient,,,42.75,25.48,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,30.04654545,Based on EAPG RVU's
"Calcium, Ionized QSTC",9039239,LOCAL,82330,CPT,,,,,,Outpatient,,,43.2,16.42,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,28.305,Based on EAPG RVU's
"Cortisol, Free, U24 QSTC",8764823,LOCAL,82530,CPT,,,,,,Outpatient,,,43.2,20.05,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,29.79,Based on EAPG RVU's
"Vanillylmandelic Acid, U24 QSTC",8764683,LOCAL,84585,CPT,,,,,,Outpatient,,,43.2,18.6,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,15.5,18.43,Based on EAPG RVU's
"Aspergillus fumigatus, IgG Ab QSTC",13864492,LOCAL,86606,CPT,,,,,,Outpatient,,,43.25,18.06,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.05,15.29,Based on EAPG RVU's
"Blastomyces Ab,Immunodiff QSTC",10100364,LOCAL,86612,CPT,,,,,,Outpatient,,,43.25,15.48,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.9,15.29,Based on EAPG RVU's
Cryptococcal Antigen Latex QSTC,8972754,LOCAL,86403,CPT,,,,,,Outpatient,,,43.25,13.85,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,11.54,15.29,Based on EAPG RVU's
"5HIAA, 24-Hour Urine QSTC",8764545,LOCAL,83497,CPT,,,,,,Outpatient,,,43.34,15.48,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,12.9,18.43,Based on EAPG RVU's
COHb Arterial,10217315,LOCAL,82375,CPT,,,301,RC,,Outpatient,,,43.6,14.78,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,17.73,Based on EAPG RVU's
O2 Saturation Arterial,12487723,LOCAL,82810,CPT,,,,,,Outpatient,,,43.6,11.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,9.77,17.73,Based on EAPG RVU's
O2 Saturation Venous,12487723,LOCAL,82810,CPT,,,,,,Outpatient,,,43.6,11.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,9.77,17.73,Based on EAPG RVU's
"Creatinine Random Ur, QSTC",10127838,LOCAL,82570,CPT,,,,,,Outpatient,,,43.61,6.22,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,40.97514925,Based on EAPG RVU's
"Metanephrine Ur, Total QSTC",10127837,LOCAL,83835,CPT,,,,,,Outpatient,,,43.61,20.33,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,98.305,Based on EAPG RVU's
"Myoglobin, Urine QSTC",8853210,LOCAL,83874,CPT,,,301,RC,,Outpatient,,,43.74,15.5,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,17.73,Based on EAPG RVU's
CA 15-3 QSTC,8764684,LOCAL,86300,CPT,,,,,,Outpatient,,,44.55,24.97,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,43.34448276,Based on EAPG RVU's
"Electrolytes, Urine",12312936,LOCAL,84166,CPT,,,,,,Outpatient,,,44.88,21.4,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,18.62,Based on EAPG RVU's
Occult Blood Stool Screen,7909957,LOCAL,82272,CPT,,,,,,Outpatient,,,44.88,5.08,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,4.457272727,7.16,Based on EAPG RVU's
"Carbamazepine, Total QSTC",9039320,LOCAL,80156,CPT,,,,,,Outpatient,,,44.95,17.48,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,16.45277778,Based on EAPG RVU's
Gastric Parietal Cell AB QSTC,8764524,LOCAL,83516,CPT,,,,,,Outpatient,,,44.96,13.84,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,11.53,17.73,Based on EAPG RVU's
"ACTH, Plasma QSTC",8764544,LOCAL,82024,CPT,,,,,,Outpatient,,,45,46.34,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,38.62,Based on EAPG RVU's
Amphetamine - QSTC,13873198,LOCAL,80325,CPT,,,,,,Outpatient,,,45,,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,7.16,Based on EAPG RVU's
Beta2-Glycoprotein IgA QSTC,10100357,LOCAL,86146,CPT,,,,,,Outpatient,,,45,30.54,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,25.45,Based on EAPG RVU's
Immunoglobulin G Subclass 4 QSTC,10100372,LOCAL,82787,CPT,,,,,,Outpatient,,,45,9.62,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,8.02,Based on EAPG RVU's
Methamphetamine - QSTC,13873201,LOCAL,80359,CPT,,,,,,Outpatient,,,45,,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,7.16,Based on EAPG RVU's
Myeloperoxidase Antibody QSTC,9039345,LOCAL,86021,CPT,,,301,RC,,Outpatient,,,45,18.06,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,15.29,Based on EAPG RVU's
Proteinase-3 Antibody QSTC,9039336,LOCAL,86021,CPT,,,301,RC,,Outpatient,,,45,18.06,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,15.29,Based on EAPG RVU's
Testosterone Free & Total MS QSTC,8764632,LOCAL,84403,CPT,,,,,,Outpatient,,,45,30.97,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,52.3775,Based on EAPG RVU's
Tissue Transglutaminase IgA Ab QSTC,8764753,LOCAL,86364,CPT,,,,,,Outpatient,,,45,13.84,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,61.9,Based on EAPG RVU's
Scl-70 Antibody QSTC,8853206,LOCAL,86235,CPT,,,,,,Outpatient,,,46.17,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
Egg Component Panel QSTC,9039428,LOCAL,86008,CPT,,,,,,Outpatient,,,46.26,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,17.93,Based on EAPG RVU's
Total Iron Binding Capacity,7909796,LOCAL,83550,CPT,,,,,,Outpatient,,,47,10.49,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,8.74,17.73,Based on EAPG RVU's
Yeast Culture,7909554,LOCAL,87101,CPT,,,,,,Outpatient,,,47.7,9.25,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,7.71,10.57,Based on EAPG RVU's
T3 Total,633833,LOCAL,84480,CPT,,,,,,Outpatient,,,48,17.02,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,33.01411765,Based on EAPG RVU's
97035 OT ULTRASOUND,9850026,LOCAL,97035,CPT,,,,,GO,Outpatient,,,48.35,31,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.34,47.26,Based on EAPG RVU's
97035 OT Ultrasound Assistant Units,9860026,LOCAL,97035,CPT,,,,,GO|CO,Outpatient,,,48.35,31,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.34,47.26,Based on EAPG RVU's
97035 PT ULTRASOUND,9640026,LOCAL,97035,CPT,,,,,GP,Outpatient,,,48.35,31,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.34,47.26,Based on EAPG RVU's
97035 PT Ultrasound Assistant Units,9650026,LOCAL,97035,CPT,,,,,GP|CQ,Outpatient,,,48.35,31,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.34,47.26,Based on EAPG RVU's
97035 ULTRASOUND EA 15 MIN CHARGE,9410126,LOCAL,97035,CPT,,,,,GP,Outpatient,,,48.35,31,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.34,47.26,Based on EAPG RVU's
OT Ultrasound Assistant Units,1366376,LOCAL,97035,CPT,,,,,CQ,Outpatient,,,48.35,31,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.34,47.26,Based on EAPG RVU's
OT Ultrasound Charges,1366376,LOCAL,97035,CPT,,,,,GO,Outpatient,,,48.35,31,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.34,47.26,Based on EAPG RVU's
OT Ultrasound Units,1373448,LOCAL,97035,CPT,,,,,GO,Outpatient,,,48.35,31,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.34,47.26,Based on EAPG RVU's
PT Ultrasound Assistant Units,9390428,LOCAL,97035,CPT,,,,,CQ,Outpatient,,,48.35,31,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.34,47.26,Based on EAPG RVU's
Ultrasound Charges,1366376,LOCAL,97035,CPT,,,,,GO,Outpatient,,,48.35,31,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.34,47.26,Based on EAPG RVU's
Ultrasound Charges,7895933,LOCAL,97035,CPT,,,,,GP,Outpatient,,,48.35,31,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.34,47.26,Based on EAPG RVU's
Phenobarbital QSTC,8972760,LOCAL,80184,CPT,,,,,,Outpatient,,,48.65,18.36,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.3,15.38,Based on EAPG RVU's
Semen Analysis Post Vasectomy,3454457,LOCAL,89320,CPT,,,,,,Outpatient,,,48.96,14.77,Blue Cross of AL,Blue Cross,14.07,,,,,,,Other,12.31,14.07,Based on EAPG RVU's
"HIV Ag/Ab, 4th Gen w reflexes QSTC",8764806,LOCAL,87389,CPT,,,,,,Outpatient,,,49.5,28.9,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,36.55,Based on EAPG RVU's
"Phenytoin, Free QSTC",8764686,LOCAL,80186,CPT,,,,,,Outpatient,,,49.5,16.51,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,31.495,Based on EAPG RVU's
"T3, Reverse, LCMSMS QSTC",8764804,LOCAL,84482,CPT,,,,,,Outpatient,,,49.5,18.91,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,32.475,Based on EAPG RVU's
"82140 Ammonium, 24 HR, U",14789403,LOCAL,82140,CPT,,,,,,Outpatient,,,49.65,17.48,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,22.62909091,Based on EAPG RVU's
"82340 Calcium, 24 HR, U",14797185,LOCAL,82340,CPT,,,,,,Outpatient,,,49.65,7.24,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,22.61833333,Based on EAPG RVU's
"82436 Chloride, 24 HR, U",14797182,LOCAL,82436,CPT,,,,,,Outpatient,,,49.65,6.9,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,5.75,7.16,Based on EAPG RVU's
"82507 Citrate Excretion, 24 HR, U",14787436,LOCAL,82507,CPT,,,,,,Outpatient,,,49.65,33.36,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,30.625,Based on EAPG RVU's
"82570 Creatinine, 24 HR, U",14798767,LOCAL,82570,CPT,,,,,,Outpatient,,,49.65,6.22,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,40.97514925,Based on EAPG RVU's
"83735 Magnesium, 24 HR, U",14789401,LOCAL,83735,CPT,,,,,,Outpatient,,,49.65,8.04,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,3.657824427,7.16,Based on EAPG RVU's
"83935 Osmolality, 24 HR, U",14789402,LOCAL,83935,CPT,,,301,RC,,Outpatient,,,49.65,8.18,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,7.16,Based on EAPG RVU's
"83945 Oxalate, 24 HR, U",14797186,LOCAL,83945,CPT,,,,,,Outpatient,,,49.65,17.34,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,24.085,Based on EAPG RVU's
"84105 Phosphorus, 24 HR, U",14787442,LOCAL,84105,CPT,,,,,,Outpatient,,,49.65,6.94,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,19.835,Based on EAPG RVU's
"84133 Potassium, 24 HR, U",14797183,LOCAL,84133,CPT,,,,,,Outpatient,,,49.65,5.68,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,19.32,Based on EAPG RVU's
"84300 Sodium, 24 HR, U",14797184,LOCAL,84300,CPT,,,,,,Outpatient,,,49.65,6.07,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,9.74,Based on EAPG RVU's
"84540 Urea Nitrogen, 24 HR, U",14789404,LOCAL,84540,CPT,,,,,,Outpatient,,,49.65,6.67,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,5.56,7.16,Based on EAPG RVU's
"84560 Uric Acid, 24 HR, U",14787441,LOCAL,84560,CPT,,,,,,Outpatient,,,49.65,6.1,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,19.49,Based on EAPG RVU's
C-Peptide,12252873,LOCAL,84681,CPT,,,,,,Outpatient,,,50,24.97,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,33.24444444,Based on EAPG RVU's
D-Dimer,3454398,LOCAL,85380,CPT,,,,,,Outpatient,,,50,12.22,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,5.76079096,8.21,Based on EAPG RVU's
G0447 BEHAVIORAL COUNSIL OBESITY 15 MIN CHARGE,8635988,LOCAL,,,G0447,HCPCS,,,,Outpatient,,,50,33,Blue Cross of AL,Blue Cross,177.17,,,,,,,Other,84.57,177.17,Based on EAPG RVU's
Hepatitis B S Ab,1628908,LOCAL,86706,CPT,,,,,,Outpatient,,,50,12.89,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,17.794,Based on EAPG RVU's
Hepatitis B Surface Antibody w/ Interp,9299896,LOCAL,86706,CPT,,,,,,Outpatient,,,50,12.89,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,17.794,Based on EAPG RVU's
Lactate Dehydrogenase Body Fluid,3454444,LOCAL,83615,CPT,,,,,,Outpatient,,,50,7.25,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,21.675,Based on EAPG RVU's
Strep A (Sofia),8267162,LOCAL,87430,CPT,,,306,RC,,Outpatient,,,50,20.17,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,10.57,Based on EAPG RVU's
"Strep A, Rapid",7909915,LOCAL,87430,CPT,,,306,RC,,Outpatient,,,50,20.17,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,10.57,Based on EAPG RVU's
"Cytomegalovirus Antibodies (IgG,IgM) QSTC",8972893,LOCAL,86645,CPT,,,,,,Outpatient,,,50.4,20.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,16.85,Based on EAPG RVU's
Cytomegalovirus Antibody (IgM) QSTC,8764581,LOCAL,86645,CPT,,,,,,Outpatient,,,50.4,20.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,16.85,Based on EAPG RVU's
Micronutrient Vitamin E QSTC,14116320,LOCAL,84446,CPT,,,,,,Outpatient,,,50.4,17.02,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,14.18,17.73,Based on EAPG RVU's
Vitamin A (Retinol) QSTC,8764529,LOCAL,84590,CPT,,,,,,Outpatient,,,50.4,13.93,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,30.89,Based on EAPG RVU's
Ethosuximide QSTC,8764552,LOCAL,80168,CPT,,,,,,Outpatient,,,50.54,19.61,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,16.34,Based on EAPG RVU's
Hot/Cold Pack Application Charge,7895287,LOCAL,97010,CPT,430,RC,,,GO,Outpatient,,,50.54,33,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,47.26,47.26,Based on EAPG RVU's
77061 MG Diagnostic Tomo Charge: AddOn Left,13960722,LOCAL,77061,CPT,401,RC,,,LT,Outpatient,,,50.92,41.25,Blue Cross of AL,Blue Cross,74,,,,,,,Other,11.11,74,Based on EAPG RVU's
77061 MG Diagnostic Tomo Charge: AddOn Left,13960722,LOCAL,G0279,CPT,,,,,LT,Outpatient,,,50.92,,Blue Cross of AL,Blue Cross,74,,,,,,,Other,11.11,74,Based on EAPG RVU's
77061 MG Diagnostic Tomo Charge: AddOn Right,13960723,LOCAL,77061,CPT,401,RC,,,RT,Outpatient,,,50.92,41.25,Blue Cross of AL,Blue Cross,74,,,,,,,Other,11.11,74,Based on EAPG RVU's
77061 MG Diagnostic Tomo Charge: AddOn Right,13969683,LOCAL,77061,CPT,401,RC,,,RT,Outpatient,,,50.92,41.25,Blue Cross of AL,Blue Cross,74,,,,,,,Other,11.11,74,Based on EAPG RVU's
77061 MG Diagnostic Tomo Charge: AddOn Right,13960723,LOCAL,G0279,CPT,,,,,RT,Outpatient,,,50.92,,Blue Cross of AL,Blue Cross,74,,,,,,,Other,11.11,74,Based on EAPG RVU's
77061 MG Diagnostic Tomo Charge: AddOn Right,13969683,LOCAL,G0279,CPT,,,,,RT,Outpatient,,,50.92,,Blue Cross of AL,Blue Cross,74,,,,,,,Other,11.11,74,Based on EAPG RVU's
77063 MG Tomo Charge: AddOn Left,13621442,LOCAL,77063,CPT,,,,,LT,Outpatient,,,50.92,54.45,Blue Cross of AL,Blue Cross,74,,,,,,,Other,20.75,74,Based on EAPG RVU's
77063 MG Tomo Charge: AddOn Right,13621441,LOCAL,77063,CPT,,,,,RT,Outpatient,,,50.92,54.45,Blue Cross of AL,Blue Cross,74,,,,,,,Other,20.75,74,Based on EAPG RVU's
PC DOPP ART BIL REST,8200579,LOCAL,93923,CPT,,,,,,Outpatient,,,51.06,401,Blue Cross of AL,Blue Cross,244.97,,,,,,,Other,143.05,244.97,Based on EAPG RVU's
Chloride Level,633621,LOCAL,82435,CPT,,,,,,Outpatient,,,51.41,5.52,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,4.6,7.16,Based on EAPG RVU's
KOH POCT,10913182,LOCAL,87220,CPT,,,,,,Outpatient,,,51.41,5.12,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,4.27,10.57,Based on EAPG RVU's
E-Stim for Wound Other Charge,7895924,LOCAL,G0283,CPT,G0283,HCPCS,,,GP,Outpatient,,,51.51,33,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,11.75,47.26,Based on EAPG RVU's
G0283 INTERFERENCE CHARGES,9640019,LOCAL,,,G0283,HCPCS,,,GP,Outpatient,,,51.51,33,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,11.81,47.26,Based on EAPG RVU's
G0283 PT Elect Stim Unattended Assistant Units Charge,9650019,LOCAL,,,G0283,HCPCS,,,GP,Outpatient,,,51.51,33,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,11.81,47.26,Based on EAPG RVU's
G0283 OT ELEC STIM MEDICARE CHARGE,9860018,LOCAL,,,G0283,HCPCS,,,GO|CO,Outpatient,,,51.52,33,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,11.81,47.26,Based on EAPG RVU's
G0283 OT ESTIM UNATTENDED CHARGE,9850018,LOCAL,,,G0283,HCPCS,,,GO,Outpatient,,,51.52,33,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,11.81,47.26,Based on EAPG RVU's
OT Unattended E-Stim Assistant Units,7895266,LOCAL,,,G0283,HCPCS,,,CQ,Outpatient,,,51.52,33,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,11.81,47.26,Based on EAPG RVU's
OTElectrical Stim (Unattended) - Non-Wound,1373552,LOCAL,,,G0283,HCPCS,,,GO,Outpatient,,,51.52,33,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,11.81,47.26,Based on EAPG RVU's
Unattended Electrical Therapy Charge,7895266,LOCAL,97014,CPT,430,RC,,,GO,Outpatient,,,51.52,33,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,11.81,47.26,Based on EAPG RVU's
UA w Micro if Ind,1148022,LOCAL,81003,CPT,,,,,,Outpatient,,,51.6,2.7,Blue Cross of AL,Blue Cross,4.02,,,,,,,Other,3.795286195,4.02,Based on EAPG RVU's
UA w Micro if Ind & Cult if Ind,8088555,LOCAL,81003,CPT,,,,,,Outpatient,,,51.6,2.7,Blue Cross of AL,Blue Cross,4.02,,,,,,,Other,3.795286195,4.02,Based on EAPG RVU's
Urinalysis Macroscopic,633863,LOCAL,81003,CPT,,,,,,Outpatient,,,51.6,2.7,Blue Cross of AL,Blue Cross,4.02,,,,,,,Other,3.795286195,4.02,Based on EAPG RVU's
"T4, Free, Direct Dialysis QSTC",13864535,LOCAL,84439,CPT,,,,,,Outpatient,,,51.98,10.82,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,28.58065455,Based on EAPG RVU's
"Immunofixation, Serum QSTC",8764779,LOCAL,86334,CPT,,,,,,Outpatient,,,52.7,26.81,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.3,Based on EAPG RVU's
Methemoglobin Arterial,10217316,LOCAL,88741,CPT,,,301,RC,,Outpatient,,,52.71,11.24,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,8.21,8.21,Based on EAPG RVU's
77061 MG Diagnostic Tomo Charge: AddOn Left,13960724,LOCAL,77061,CPT,401,RC,,,LT,Outpatient,,,52.92,41.25,Blue Cross of AL,Blue Cross,74,,,,,,,Other,11.11,74,Based on EAPG RVU's
77061 MG Diagnostic Tomo Charge: AddOn Left,13960724,LOCAL,G0279,CPT,,,,,LT,Outpatient,,,52.92,,Blue Cross of AL,Blue Cross,74,,,,,,,Other,11.11,74,Based on EAPG RVU's
"CtrachomatisRNA, TMA, Urog QSTC",8996973,LOCAL,87491,CPT,,,,,QW,Outpatient,,,53.48,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
"NgonorrhoeaeRNA, TMA, Urog QSTC",8996974,LOCAL,87591,CPT,,,,,QW,Outpatient,,,53.48,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
"Chlamydia Trachomatis RNA, TMA QST",8395007,LOCAL,87491,CPT,,,,,,Outpatient,,,53.5,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
"Neisseria Gonorrhoeae RNA, TMA QST",8395010,LOCAL,87591,CPT,,,,,,Outpatient,,,53.5,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
"N. Gonorrhoeae RNA, TMA, Urogenital QSTC",13864518,LOCAL,87591,CPT,,,,,QW,Outpatient,,,53.51,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
Homocysteine QSTC,8764574,LOCAL,83090,CPT,,,,,,Outpatient,,,53.55,21.5,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,17.92,18.43,Based on EAPG RVU's
"Mycobact Culture, w Fluorochrome Sm QSTC",9039257,LOCAL,87116,CPT,,,,,,Outpatient,,,53.55,12.96,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,25.656,Based on EAPG RVU's
"Mycobacteria, Cult, w Fluoro Smear QST",9039257,LOCAL,87116,CPT,,,,,,Outpatient,,,53.55,12.96,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,25.656,Based on EAPG RVU's
"Angiotensin Converting Enzyme (ACE), CSF QSTC",10170069,LOCAL,82164,CPT,,,,,,Outpatient,,,54,17.52,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,27.405,Based on EAPG RVU's
"Endomysial Ab Screen IgA, Rfx Titer QSTC",8764677,LOCAL,86231,CPT,,,,,,Outpatient,,,54,14.51,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,106.935,Based on EAPG RVU's
Hexagonal Phase Confirm. QSTC,9039456,LOCAL,85598,CPT,,,,,,Outpatient,,,54,21.58,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,17.98,Based on EAPG RVU's
hs-CRP QSTC,8853237,LOCAL,86141,CPT,,,,,,Outpatient,,,54,15.54,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.95,15.29,Based on EAPG RVU's
Lipoprotein (a) QSTC,8853258,LOCAL,83695,CPT,,,,,,Outpatient,,,54,17.18,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,14.32,17.73,Based on EAPG RVU's
"Oligoclonal Bands (IgG), CSF QSTC",8764540,LOCAL,83916,CPT,,,,,,Outpatient,,,54,32.87,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,27.39,Based on EAPG RVU's
"Plasma Renin Activity, LC/MS/MS QSTC",8764647,LOCAL,84244,CPT,,,,,,Outpatient,,,54,26.39,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,37.78,Based on EAPG RVU's
"Vitamin D, 1,25-Dihydroxy QSTC",8764639,LOCAL,82652,CPT,,,,,,Outpatient,,,54,46.2,Blue Cross of AL,Blue Cross,46.74,,,,,,,Other,38.5,46.74,Based on EAPG RVU's
Apolipoprotein Evaluation QSTC,13864521,LOCAL,82172,CPT,,,,,,Outpatient,,,54.36,25.31,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,37.515,Based on EAPG RVU's
"C1 Esterase Inhibitor, Protein QSTC",8764554,LOCAL,86160,CPT,,,,,,Outpatient,,,54.9,14.4,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,36.909,Based on EAPG RVU's
Hepatitis B Surface Antigen,633752,LOCAL,87340,CPT,,,,,,Outpatient,,,55,12.4,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,22.20058824,Based on EAPG RVU's
Hepatitis B Surface Antigen w/ Interp,9517997,LOCAL,87340,CPT,,,,,,Outpatient,,,55,12.4,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,22.20058824,Based on EAPG RVU's
HIV 1/2 Antibody Screen (exposure only),9609059,LOCAL,86701,CPT,,,,,,Outpatient,,,55,10.67,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,8.89,15.29,Based on EAPG RVU's
Potassium POCT,9616981,LOCAL,84132,CPT,,,,,,Outpatient,,,55,5.71,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,8.697880184,Based on EAPG RVU's
Additional Testing PTT-LA QSTC,9004754,LOCAL,85730,CPT,,,,,,Outpatient,,,55.1,7.21,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,1.648553055,5.42,Based on EAPG RVU's
dRVVT Mix Interpretation: QSTC,9004757,LOCAL,85613,CPT,,,,,,Outpatient,,,55.1,11.5,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,9.58,Based on EAPG RVU's
Valproic Acid Level,3170351,LOCAL,80164,CPT,,,,,,Outpatient,,,55.49,16.25,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,34.38,Based on EAPG RVU's
.RMSF IgG Titer QSTC,8764766,LOCAL,86757,CPT,,,,,,Outpatient,,,56.25,23.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,19.35,Based on EAPG RVU's
.RMSF IgM Titer QSTC,8764765,LOCAL,86757,CPT,,,,,,Outpatient,,,56.25,23.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,19.35,Based on EAPG RVU's
HIV 1 Antibody QSTC,8852095,LOCAL,86701,CPT,,,,,,Outpatient,,,56.25,10.67,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,8.89,15.29,Based on EAPG RVU's
HIV 2 Antibody QSTC,8852096,LOCAL,86702,CPT,,,,,,Outpatient,,,56.25,16.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,13.52,15.29,Based on EAPG RVU's
"Aldosterone, LC/MS QSTC",8853271,LOCAL,82088,CPT,,,,,,Outpatient,,,56.93,48.9,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,48.435,Based on EAPG RVU's
Calcium Level Total,1628887,LOCAL,82310,CPT,,,,,,Outpatient,,,57.12,6.19,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,5.16,7.16,Based on EAPG RVU's
Bill UA With Microscopic,14634624,LOCAL,81001,CPT,,,,,,Outpatient,,,57.6,3.8,Blue Cross of AL,Blue Cross,4.02,,,,,,,Other,4.02,6.910081301,Based on EAPG RVU's
PC DOPP ART BIL EXERCISE,8200578,LOCAL,93924,CPT,,,,,,Outpatient,,,57.94,302,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,143.05,161.71,Based on EAPG RVU's
Reticulocyte Count,7909814,LOCAL,85044,CPT,,,,,,Outpatient,,,57.94,5.17,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,8.21,16.95545455,Based on EAPG RVU's
Reticulocyte Count with Immature Reticulocyte Fraction,3454466,LOCAL,85044,CPT,,,,,,Outpatient,,,57.94,5.17,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,8.21,16.95545455,Based on EAPG RVU's
CLO Test,8127247,LOCAL,87046,CPT,,,306,RC,,Outpatient,,,58.37,11.33,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,10.57,Based on EAPG RVU's
"Vitamin B6, Plasma QSTC",8853234,LOCAL,84207,CPT,,,,,,Outpatient,,,58.5,33.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,40.33125,Based on EAPG RVU's
AMB haemophils b (PRP-T) vaccine,63690648,LOCAL,90648,CPT,,,250,RC,,Outpatient,,,58.65,38,Blue Cross of AL,Blue Cross,39.58,,,,,,,Other,39.58,39.58,Based on EAPG RVU's
AMB haemophils b (PRP-T) vaccine,63690648,LOCAL,90648,CPT,90648,HCPCS,250,RC,,Outpatient,,,58.65,38,Blue Cross of AL,Blue Cross,39.58,,,,,,,Other,39.58,39.58,Based on EAPG RVU's
Total Iron Binding Capacity,7050172,LOCAL,84466,CPT,,,,,,Outpatient,,,58.75,15.31,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,29.64248366,Based on EAPG RVU's
Total Iron Binding Capacity,10543521,LOCAL,84466,CPT,,,,,,Outpatient,,,58.75,15.31,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,29.64248366,Based on EAPG RVU's
"Varicella-Zoster Virus Abs(IgG,IgM) QSTC",8853253,LOCAL,86787,CPT,,,,,,Outpatient,,,59.4,15.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.88,15.29,Based on EAPG RVU's
Immunoglobulin E QSTC,8764571,LOCAL,82785,CPT,,,,,,Outpatient,,,59.49,19.75,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,203.9616667,Based on EAPG RVU's
Cortisol,3352314,LOCAL,82533,CPT,,,,,,Outpatient,,,60,19.56,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,15.196,18.43,Based on EAPG RVU's
Cortisol 60 Min,8373789,LOCAL,82533,CPT,,,,,,Outpatient,,,60,19.56,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,15.196,18.43,Based on EAPG RVU's
Free T4 Level,3170324,LOCAL,84439,CPT,,,,,,Outpatient,,,60,10.82,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,28.58065455,Based on EAPG RVU's
Hepatitis A Antibody IgM,1628904,LOCAL,86709,CPT,,,,,,Outpatient,,,60,13.51,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,11.26,15.29,Based on EAPG RVU's
HIV 1/2 Antibody and P24 Screen,633757,LOCAL,87389,CPT,,,,,,Outpatient,,,60,28.9,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,36.55,Based on EAPG RVU's
HIV 1/2 Antibody and P24 Screen,633757,LOCAL,G0475,CPT,,,,,,Outpatient,,,60,28.9,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,10.57,36.55,Based on EAPG RVU's
Protein Body Fluid,1634879,LOCAL,84157,CPT,,,,,,Outpatient,,,60.38,4.8,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,4,7.16,Based on EAPG RVU's
HLA-B27 Antigen QSTC,8764565,LOCAL,86812,CPT,,,301,RC,,Outpatient,,,60.75,30.97,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,6.29,Based on EAPG RVU's
Aspergillus fumigatus QSTC,9966204,LOCAL,86331,CPT,,,,,,Outpatient,,,60.8,14.38,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,11.98,15.29,Based on EAPG RVU's
S. viridis QSTC,9966214,LOCAL,86609,CPT,,,,,,Outpatient,,,60.8,15.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.88,15.29,Based on EAPG RVU's
T. candidus QSTC,9966205,LOCAL,86606,CPT,,,,,,Outpatient,,,60.8,18.06,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.05,15.29,Based on EAPG RVU's
"Mercury, Blood QSTC",13864924,LOCAL,83825,CPT,,,,,,Outpatient,,,61.2,19.51,Blue Cross of AL,Blue Cross,16.07,,,,,,,Other,16.07,35.86038462,Based on EAPG RVU's
Sex Hormone Binding Glob QSTC,8764670,LOCAL,84270,CPT,,,,,,Outpatient,,,61.2,26.08,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,21.73,Based on EAPG RVU's
Stone Analysis w/ Image QSTC,9777240,LOCAL,82365,CPT,,,,,,Outpatient,,,61.2,15.48,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,24.61666667,Based on EAPG RVU's
Wet Prep General,8933821,LOCAL,87210,CPT,,,306,RC,,Outpatient,,,61.2,6.98,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,10.57,Based on EAPG RVU's
Wet Prep Oral,8022016,LOCAL,87210,CPT,,,306,RC,,Outpatient,,,61.2,6.98,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,10.57,Based on EAPG RVU's
Wet Prep Penile,8933820,LOCAL,87210,CPT,,,306,RC,,Outpatient,,,61.2,6.98,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,10.57,Based on EAPG RVU's
Wet Prep Vaginal,7939361,LOCAL,87210,CPT,,,306,RC,,Outpatient,,,61.2,6.98,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,10.57,Based on EAPG RVU's
97012 APPLICATION OF TRACTION/MECH CHARGE,8133034,LOCAL,97012,CPT,,,,,GP,Outpatient,,,61.28,40,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.47,47.26,Based on EAPG RVU's
97012 MECH TRACTION THERAPY Assistant Charge,9860050,LOCAL,97012,CPT,,,,,GO|CO,Outpatient,,,61.28,40,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.47,47.26,Based on EAPG RVU's
97012 Mechanical Traction PT,9850050,LOCAL,97012,CPT,,,,,GO,Outpatient,,,61.28,40,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.47,47.26,Based on EAPG RVU's
97012 TRACTION - MECHANICAL,9640018,LOCAL,97012,CPT,,,,,GP,Outpatient,,,61.28,40,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.47,47.26,Based on EAPG RVU's
Mechanical Traction Charge -> Yes,13786833,LOCAL,97012,CPT,,,,,GP,Outpatient,,,61.28,40,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.47,47.26,Based on EAPG RVU's
Mechanical Traction Provided,8510678,LOCAL,97012,CPT,,,,,GP,Outpatient,,,61.28,40,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.47,47.26,Based on EAPG RVU's
OT Mechanical Trac Therapy Asist Units,7897758,LOCAL,97012,CPT,,,,,CQ,Outpatient,,,61.28,40,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.47,47.26,Based on EAPG RVU's
OT Mechanical Traction Therapy Units,7897758,LOCAL,97012,CPT,,,,,GO,Outpatient,,,61.28,40,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.47,47.26,Based on EAPG RVU's
PT Mechanical Traction Assistant Units,9390392,LOCAL,97012,CPT,,,,,CQ,Outpatient,,,61.28,40,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.47,47.26,Based on EAPG RVU's
PT TRACTION MECHANICAL,9650018,LOCAL,97012,CPT,,,,,GP|CQ,Outpatient,,,61.28,40,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.47,47.26,Based on EAPG RVU's
"Ethylene Glycol, Blood QSTC",8764539,LOCAL,82693,CPT,,,,,,Outpatient,,,61.34,17.88,Blue Cross of AL,Blue Cross,16.07,,,,,,,Other,14.9,16.07,Based on EAPG RVU's
HIV 1/2 Antibody Screen,7939338,LOCAL,86703,CPT,,,,,,Outpatient,,,61.7,16.45,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.57,Based on EAPG RVU's
"Alprazolam (Xanax), Serum QSTC",8972830,LOCAL,80299,CPT,,,,,,Outpatient,,,62.06,22.37,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,18.64,Based on EAPG RVU's
Glucose 3 Hour,7973891,LOCAL,82952,CPT,,,,,,Outpatient,,,62.17,4.7,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,3.92,7.16,Based on EAPG RVU's
Glucose 4 Hour,7973892,LOCAL,82952,CPT,,,,,,Outpatient,,,62.17,4.7,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,3.92,7.16,Based on EAPG RVU's
Glucose 5 Hour,7973894,LOCAL,82952,CPT,,,,,,Outpatient,,,62.17,4.7,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,3.92,7.16,Based on EAPG RVU's
"Cyclosporine Trough,LCMSMS QSTC",8764656,LOCAL,80158,CPT,,,,,,Outpatient,,,62.37,21.66,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,18.05,Based on EAPG RVU's
"Ova&Parasite,Conc&Perm Smear Result QSTC",8873966,LOCAL,87177,CPT,,,,,,Outpatient,,,62.37,10.68,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,8.9,10.57,Based on EAPG RVU's
97150  Group Therapeutic Procedure,9640074,LOCAL,97150,CPT,,,,,GP,Outpatient,,,62.69,41,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,16.89,56.44,Based on EAPG RVU's
97150 OT Group Therapy Charge,9850058,LOCAL,97150,CPT,,,,,GO,Outpatient,,,62.69,41,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,16.89,56.44,Based on EAPG RVU's
97150 OT Group Therapy Modifier Charge,9860058,LOCAL,97150,CPT,,,,,GO|CO,Outpatient,,,62.69,41,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,16.89,56.44,Based on EAPG RVU's
97150 PT Group Therapy Assistant Units,9650074,LOCAL,97150,CPT,,,,,GP|CQ,Outpatient,,,62.69,41,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,16.89,56.44,Based on EAPG RVU's
Group Therapy Charge,7895938,LOCAL,97150,CPT,,,,,GP,Outpatient,,,62.69,41,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,16.89,56.44,Based on EAPG RVU's
Group Therapy Provided,7895280,LOCAL,97150,CPT,,,,,GO,Outpatient,,,62.69,41,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,16.89,56.44,Based on EAPG RVU's
OT Group Therapy Assistant Units,7895280,LOCAL,97150,CPT,,,,,CQ,Outpatient,,,62.69,41,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,16.89,56.44,Based on EAPG RVU's
OT Group Therapy Assistant Units,7897695,LOCAL,97150,CPT,,,,,CQ,Outpatient,,,62.69,41,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,16.89,56.44,Based on EAPG RVU's
OT Group Therapy Rehab Units,7897695,LOCAL,97150,CPT,,,,,GO,Outpatient,,,62.69,41,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,16.89,56.44,Based on EAPG RVU's
PT Group Therapy Assistant Units,9390418,LOCAL,97150,CPT,,,,,CQ,Outpatient,,,62.69,41,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,16.89,56.44,Based on EAPG RVU's
"Giardia Antigen, EIA, Stool QSTC",8972764,LOCAL,87329,CPT,,,,,,Outpatient,,,63,14.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,11.98,Based on EAPG RVU's
Methylmalonic Acid QSTC,8853212,LOCAL,83921,CPT,,,,,,Outpatient,,,63,25.45,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,21.21,Based on EAPG RVU's
Nortriptyline QSTC,8853203,LOCAL,80299,CPT,,,,,,Outpatient,,,63.45,22.37,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,18.64,Based on EAPG RVU's
97034 CONTRAST BATH THERAPY,9860025,LOCAL,97034,CPT,,,,,GO|CO,Outpatient,,,63.72,41,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.05,47.26,Based on EAPG RVU's
97034 CONTRAST BATHS EACH 15 MIN CHARGE,9640025,LOCAL,97034,CPT,,,,,GP,Outpatient,,,63.72,41,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.05,47.26,Based on EAPG RVU's
97034 OT CONTRAST BATH 15 MIN APPL CHARGE,9850025,LOCAL,97034,CPT,,,,,GO,Outpatient,,,63.72,41,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.05,47.26,Based on EAPG RVU's
97034 PT CONTRAST BATH 15 MIN ASST,9650025,LOCAL,97034,CPT,,,,,GP|CQ,Outpatient,,,63.72,41,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.05,47.26,Based on EAPG RVU's
OT Contrast Bath Assistant Units,7895283,LOCAL,97034,CPT,,,,,CQ,Outpatient,,,63.72,41,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.05,47.26,Based on EAPG RVU's
OT Contrast Bath Assistant Units,1373567,LOCAL,97034,CPT,,,,,CQ,Outpatient,,,63.72,41,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.05,47.26,Based on EAPG RVU's
OT Contrast Bath Charges,7895283,LOCAL,97034,CPT,,,,,GO,Outpatient,,,63.72,41,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.05,47.26,Based on EAPG RVU's
OT Contrast Bath Units,1373567,LOCAL,97034,CPT,,,,,GO,Outpatient,,,63.72,41,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.05,47.26,Based on EAPG RVU's
PT Attended E-Stim Assistant Units,9390422,LOCAL,97034,CPT,,,,,CQ,Outpatient,,,63.72,41,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.05,47.26,Based on EAPG RVU's
PT Contrast Bath Charges,7895979,LOCAL,97034,CPT,,,,,GP,Outpatient,,,63.72,41,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.05,47.26,Based on EAPG RVU's
"ANA Screen, IFA QSTC",14127792,LOCAL,86038,CPT,,,,,,Outpatient,,,64.31,14.51,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,10.70333333,15.29,Based on EAPG RVU's
Beta2-Glycoprotein I (IgA) QSTC,14127808,LOCAL,86146,CPT,,,,,,Outpatient,,,64.31,30.54,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,25.45,Based on EAPG RVU's
Beta2-Glycoprotein I (IgG) QSTC,14127809,LOCAL,86146,CPT,,,,,,Outpatient,,,64.31,30.54,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,25.45,Based on EAPG RVU's
Beta2-Glycoprotein I (IgM) QSTC,14127810,LOCAL,86146,CPT,,,,,,Outpatient,,,64.31,30.54,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,25.45,Based on EAPG RVU's
Cardiolipin Ab (IgA) QSTC,14127805,LOCAL,86147,CPT,,,,,,Outpatient,,,64.31,30.54,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,25.45,Based on EAPG RVU's
Cardiolipin Ab (IgG) QSTC,14127806,LOCAL,86147,CPT,,,,,,Outpatient,,,64.31,30.54,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,25.45,Based on EAPG RVU's
Cardiolipin Ab (IgM) QSTC,14127807,LOCAL,86147,CPT,,,,,,Outpatient,,,64.31,30.54,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,25.45,Based on EAPG RVU's
"CCP, Antibody (IgG) QSTC",14127817,LOCAL,86200,CPT,,,,,,Outpatient,,,64.31,15.54,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,7.491935484,15.29,Based on EAPG RVU's
Centromere B Antibody QSTC,14127802,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
Chromatin (Nucleosomal) Ab QSTC,14127794,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
Complement Component C3c QSTC,14127803,LOCAL,86160,CPT,,,,,,Outpatient,,,64.31,14.4,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,36.909,Based on EAPG RVU's
Complement Component C4c QSTC,14127804,LOCAL,86160,CPT,,,,,,Outpatient,,,64.31,14.4,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,36.909,Based on EAPG RVU's
"DNA Ab (DS) Crithidia, IFA QSTC",14127793,LOCAL,86255,CPT,,,,,,Outpatient,,,64.31,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.05,15.29,Based on EAPG RVU's
Jo-1 Antibody QSTC,14127801,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
"MCV, Antibody QSTC",14127818,LOCAL,83520,CPT,,,,,,Outpatient,,,64.31,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,117.3767568,Based on EAPG RVU's
Rheumatoid Factor (IgA) QSTC,14127812,LOCAL,83520,CPT,,,,,,Outpatient,,,64.31,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,117.3767568,Based on EAPG RVU's
Rheumatoid Factor (IgG) QSTC,14127814,LOCAL,83520,CPT,,,,,,Outpatient,,,64.31,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,117.3767568,Based on EAPG RVU's
Rheumatoid Factor (IgM) QSTC,14127816,LOCAL,83520,CPT,,,,,,Outpatient,,,64.31,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,117.3767568,Based on EAPG RVU's
RNP Antibody QSTC,14127797,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
Scl-70 Antibody QSTC,14127800,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
Sjogren's Antibody (SS-A) QSTC,14127798,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
Sjogren's Antibody (SS-B) QSTC,14127799,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
Sm Antibody QSTC,14127795,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
Sm/RNP Antibody QSTC,14127796,LOCAL,86235,CPT,,,,,,Outpatient,,,64.31,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
Thyroid Peroxidase Abs QSTC,14127819,LOCAL,86376,CPT,,,,,,Outpatient,,,64.31,17.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,25.085,Based on EAPG RVU's
Calcitonin QSTC,8764739,LOCAL,82308,CPT,,,,,,Outpatient,,,64.8,32.15,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,26.79,Based on EAPG RVU's
"DHEA, Unconjugated QSTC",8853248,LOCAL,82626,CPT,,,,,,Outpatient,,,64.8,30.32,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,25.27,Based on EAPG RVU's
"Sjogren's Antibodies (SS-A, SS-B) QSTC",8853207,LOCAL,86235,CPT,,,,,,Outpatient,,,64.85,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
Bill Special Stains Group II,8489591,LOCAL,88313,CPT,,,,,,Outpatient,,,64.93,,Blue Cross of AL,Blue Cross,32.32,,,,,,,Other,32.32,117.85,Based on EAPG RVU's
17-Hydroxyprogesterone QSTC,8853287,LOCAL,83498,CPT,,,,,,Outpatient,,,64.94,32.6,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,27.17,Based on EAPG RVU's
Carcinoembryonic Antigen,633697,LOCAL,82378,CPT,,,,,,Outpatient,,,65,22.75,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,36.03017241,Based on EAPG RVU's
Hepatitis B Core Antibody IgM,1628907,LOCAL,86705,CPT,,,,,,Outpatient,,,65,14.12,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,32.80285714,Based on EAPG RVU's
"Volatiles, Ur QSTC",13864417,LOCAL,80320,CPT,,,301,RC,,Outpatient,,,65.21,,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,17.73,Based on EAPG RVU's
Celiac Disease Comp w/Gliadin Ab IgG QSTC,13864455,LOCAL,82784,CPT,,,,,,Outpatient,,,65.25,11.16,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,34.958,Based on EAPG RVU's
Hep B Surface Ag w/Rflx to Confirm. QSTC,9039254,LOCAL,87340,CPT,,,,,,Outpatient,,,65.25,12.4,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,22.20058824,Based on EAPG RVU's
Immunoglobulin Panel QSTC,8764543,LOCAL,82784,CPT,,,,,,Outpatient,,,65.25,11.16,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,34.958,Based on EAPG RVU's
Body Fluid Cell Count w/ Diff,6213822,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,Blue Cross of AL,Blue Cross,14.07,,,,,,,Other,14.07,35.795,Based on EAPG RVU's
Body Fluid Cell Count with Differential If Indicated,8127214,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,Blue Cross of AL,Blue Cross,14.07,,,,,,,Other,14.07,35.795,Based on EAPG RVU's
Body Fluid Differential,4240538,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,Blue Cross of AL,Blue Cross,14.07,,,,,,,Other,14.07,35.795,Based on EAPG RVU's
CSF Cell Count with Differential If Indicated,3454318,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,Blue Cross of AL,Blue Cross,14.07,,,,,,,Other,14.07,35.795,Based on EAPG RVU's
CSF Differential,3454393,LOCAL,89051,CPT,,,,,,Outpatient,,,66.1,6.72,Blue Cross of AL,Blue Cross,14.07,,,,,,,Other,14.07,35.795,Based on EAPG RVU's
Digoxin Level,1628891,LOCAL,80162,CPT,,,,,,Outpatient,,,66.1,15.94,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,26.44,Based on EAPG RVU's
Potassium Level,633616,LOCAL,84132,CPT,,,,,,Outpatient,,,66.1,5.71,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,8.697880184,Based on EAPG RVU's
24hr Urine Creatinine QSTC,10600648,LOCAL,82570,CPT,,,,,,Outpatient,,,66.76,6.22,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,40.97514925,Based on EAPG RVU's
"Aldosterone, 24-Hour Urine QSTC",8995528,LOCAL,82088,CPT,,,,,,Outpatient,,,66.76,48.9,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,48.435,Based on EAPG RVU's
"Aspergillus Ab, Immunodiffusion QSTC",13864516,LOCAL,86606,CPT,,,,,,Outpatient,,,66.87,18.06,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.05,15.29,Based on EAPG RVU's
T3 Free,3170323,LOCAL,84481,CPT,,,,,,Outpatient,,,67,20.33,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,34.46424242,Based on EAPG RVU's
ANCA Screen w Reflex to ANCA Titer QSTC,8764789,LOCAL,86036,CPT,,,,,,Outpatient,,,67.5,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,39.655,Based on EAPG RVU's
Androstenedione QSTC,8764648,LOCAL,82157,CPT,,,,,,Outpatient,,,67.5,35.14,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,29.28,Based on EAPG RVU's
Antithrombin III Activity QSTC,8764597,LOCAL,85300,CPT,,,,,,Outpatient,,,67.5,14.22,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,11.85,Based on EAPG RVU's
Influenza A,7909953,LOCAL,87804,CPT,,,,,,Outpatient,,,67.5,19.86,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,6.419753086,10.57,Based on EAPG RVU's
Influenza B,7909954,LOCAL,87804,CPT,,,,,,Outpatient,,,67.5,19.86,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,6.419753086,10.57,Based on EAPG RVU's
"Marijuana, Conf QSTC",13864505,LOCAL,80349,CPT,,,301,RC,,Outpatient,,,67.5,,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,17.73,Based on EAPG RVU's
"Protein C, Activity QSTC",8764685,LOCAL,85303,CPT,,,,,,Outpatient,,,67.5,16.61,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,13.84,Based on EAPG RVU's
"Protein S Antigen, Free QSTC",9777259,LOCAL,85306,CPT,,,,,,Outpatient,,,67.5,18.38,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,15.32,Based on EAPG RVU's
"Protein S, Activity QSTC",8764774,LOCAL,85306,CPT,,,,,,Outpatient,,,67.5,18.38,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,15.32,Based on EAPG RVU's
Shiga Toxin 1 and 2,7939191,LOCAL,87427,CPT,,,,,,Outpatient,,,67.5,14.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,29.71875,Based on EAPG RVU's
Shiga Toxin 1 and 2,8875416,LOCAL,87427,CPT,,,,,,Outpatient,,,67.5,14.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,29.71875,Based on EAPG RVU's
Tissue Transglutaminase IgG Ab QSTC,8764825,LOCAL,86364,CPT,,,,,,Outpatient,,,67.5,13.84,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,61.9,Based on EAPG RVU's
Vitamin B12 QSTC,9291002,LOCAL,82607,CPT,,,,,,Outpatient,,,67.5,18.1,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,82.43266533,Based on EAPG RVU's
Glucose CSF,1628897,LOCAL,82945,CPT,,,,,,Outpatient,,,67.73,4.72,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,3.93,7.16,Based on EAPG RVU's
Protein CSF,1634881,LOCAL,84157,CPT,,,,,,Outpatient,,,67.73,4.8,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,4,7.16,Based on EAPG RVU's
Erythropoietin (EPO) QSTC,8764551,LOCAL,82668,CPT,,,,,,Outpatient,,,68.4,22.55,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,43.41,Based on EAPG RVU's
RT Vapotherm Subsequent CHARGE,8143879,LOCAL,94003,CPT,,,,,,Outpatient,,,68.49,613,Blue Cross of AL,Blue Cross,941,,,,,,,Other,604.42,941,Based on EAPG RVU's
Hematocrit,633742,LOCAL,85014,CPT,,,,,,Outpatient,,,68.54,2.84,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,8.21,12.62068493,Based on EAPG RVU's
Hematocrit,1635636,LOCAL,85014,CPT,,,,,,Outpatient,,,68.54,2.84,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,8.21,12.62068493,Based on EAPG RVU's
Hemoglobin,633741,LOCAL,85018,CPT,,,,,,Outpatient,,,68.54,2.84,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,8.21,10.94316176,Based on EAPG RVU's
Hemoglobin,1635635,LOCAL,85018,CPT,,,,,,Outpatient,,,68.54,2.84,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,8.21,10.94316176,Based on EAPG RVU's
C1 Esterase Inhibitor QST,13870084,LOCAL,86160,CPT,,,,,,Outpatient,,,68.85,14.4,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,36.909,Based on EAPG RVU's
"C1 Esterase Inhibitor, Functional QSTC",8853251,LOCAL,86161,CPT,,,,,,Outpatient,,,68.85,14.4,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12,15.29,Based on EAPG RVU's
Antibody Screen Gel 2,8196056,LOCAL,86850,CPT,,,,,,Outpatient,,,68.88,11.72,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,48.85,Based on EAPG RVU's
Antibody Screen Tube.,8417431,LOCAL,86850,CPT,,,,,,Outpatient,,,68.88,11.72,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,48.85,Based on EAPG RVU's
BB RH (D) TYPE XX,6432042,LOCAL,86901,CPT,,,,,,Outpatient,,,68.88,3.59,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,35.88,Based on EAPG RVU's
Acid Fast Stain Report,634214,LOCAL,87206,CPT,,,,,,Outpatient,,,69.36,6.47,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,34.45384615,Based on EAPG RVU's
Milk Component Panel QSTC,8912186,LOCAL,86008,CPT,,,,,,Outpatient,,,69.39,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,17.93,Based on EAPG RVU's
REF TRXN Pathologist Interp,13479165,LOCAL,86078,CPT,,,,,,Outpatient,,,69.8,,Blue Cross of AL,Blue Cross,38.88,,,,,,,Other,38.88,156.67,Based on EAPG RVU's
BB REF RH(D) TYPING TRANSFUSION RXN,6433001,LOCAL,86901,CPT,,,,,,Outpatient,,,69.86,3.59,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,35.88,Based on EAPG RVU's
BB REF XMATCH (IAT) TRANSFUSION RXN,6433004,LOCAL,86922,CPT,,,,,,Outpatient,,,69.86,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
REF ABO/Rh (TRXN),13479164,LOCAL,86900,CPT,,,,,,Outpatient,,,69.86,3.59,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,117.85,Based on EAPG RVU's
REF Antibody Screen (TRXN),13479162,LOCAL,86850,CPT,,,,,,Outpatient,,,69.86,11.72,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,48.85,Based on EAPG RVU's
REF Crossmatch (TRXN),13481255,LOCAL,86920,CPT,,,,,,Outpatient,,,69.86,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
REF DAT (TRXN),13479163,LOCAL,86880,CPT,,,,,,Outpatient,,,69.86,6.47,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,54.31,Based on EAPG RVU's
Clostridium difficile Quik Chek Complete,10574492,LOCAL,87324,CPT,,,,,,Outpatient,,,70,14.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,20.4375,Based on EAPG RVU's
Hemoglobin (POCT),4192190,LOCAL,85018,CPT,,,,,,Outpatient,,,70,2.84,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,8.21,10.94316176,Based on EAPG RVU's
Hepatitis C Ab,1628911,LOCAL,86803,CPT,,,,,,Outpatient,,,70,17.12,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,32.10014925,Based on EAPG RVU's
RT Education/Instruction CHARGE,90840011,LOCAL,94664,CPT,,,,,,Outpatient,,,70.15,46,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,185.95,Based on EAPG RVU's
"RT Evaluation, Respiratory CHARGE",90840013,LOCAL,94664,CPT,,,,,,Outpatient,,,70.15,46,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,185.95,Based on EAPG RVU's
CKMB,8642669,LOCAL,82553,CPT,,,301,RC,,Outpatient,,,70.18,13.86,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,17.73,Based on EAPG RVU's
"Gliadin (Deamidated) Ab (IgG, IgA) QSTC",8764748,LOCAL,86258,CPT,,,,,,Outpatient,,,72,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.05,15.29,Based on EAPG RVU's
Hemoglobin A1c,1383763,LOCAL,83036,CPT,,,,,,Outpatient,,,72.22,11.65,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,28.59604426,Based on EAPG RVU's
haemophilus b conjugate (PRP-T) vaccine intramuscular injection [CULL],11260620,LOCAL,90648,CPT,,,,,,Outpatient,1,EA,72.2432,38,Blue Cross of AL,Blue Cross,39.58,,,,,,,Other,39.58,39.58,Based on EAPG RVU's
"Arsenic, Blood QSTC",13864922,LOCAL,82175,CPT,,,,,,Outpatient,,,72.27,22.76,Blue Cross of AL,Blue Cross,16.07,,,,,,,Other,16.07,42.25673077,Based on EAPG RVU's
97032 ELECTRIC STIM,8478060,LOCAL,97032,CPT,,,,,GN,Outpatient,,,72.32,47,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.8,47.26,Based on EAPG RVU's
97032 ELECTRIC STIM OT,9630084,LOCAL,97032,CPT,,,,,GN,Outpatient,,,72.32,47,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.8,47.26,Based on EAPG RVU's
97032 OT E STIM CON - EA 15MIN CHARGE,9856105,LOCAL,97032,CPT,,,,,GO,Outpatient,,,72.32,47,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.8,47.26,Based on EAPG RVU's
97032 OT Elec Stim Attended Assistant Units,9866105,LOCAL,97032,CPT,,,,,GO|CO,Outpatient,,,72.32,47,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.8,47.26,Based on EAPG RVU's
97032 PT E STIM CON - EA 15MIN CHARGE,9640023,LOCAL,97032,CPT,,,,,GP,Outpatient,,,72.32,47,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.8,47.26,Based on EAPG RVU's
97032 PT Elect Stim Attended Assistant Units,9650023,LOCAL,97032,CPT,,,,,GP|CQ,Outpatient,,,72.32,47,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.8,47.26,Based on EAPG RVU's
Attended E-Stim Charges,1366373,LOCAL,97032,CPT,,,,,GO,Outpatient,,,72.32,47,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.8,47.26,Based on EAPG RVU's
Attended E-Stim Charges,7895926,LOCAL,97032,CPT,,,,,GP,Outpatient,,,72.32,47,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.8,47.26,Based on EAPG RVU's
OT Attended E-Stim Assistant Units,1366373,LOCAL,97032,CPT,,,,,CQ,Outpatient,,,72.32,47,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.8,47.26,Based on EAPG RVU's
OT Attended E-Stim Assistant Units,1373442,LOCAL,97032,CPT,,,,,CQ,Outpatient,,,72.32,47,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.8,47.26,Based on EAPG RVU's
OT Attended E-Stim Charges,1366373,LOCAL,97032,CPT,,,,,GO,Outpatient,,,72.32,47,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.8,47.26,Based on EAPG RVU's
OT Attended E-Stim Units,1373442,LOCAL,97032,CPT,,,,,GO,Outpatient,,,72.32,47,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.8,47.26,Based on EAPG RVU's
PT Attended E-Stim Assistant Units,9396343,LOCAL,97032,CPT,,,,,CQ,Outpatient,,,72.32,47,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,13.8,47.26,Based on EAPG RVU's
Newborn Hearing Test Type -> Auditory brainstem response,8982858,LOCAL,92700,CPT,,,,,,Outpatient,,,72.72,47,Blue Cross of AL,Blue Cross,162.41,,,,,,,Other,22.39,162.41,Based on EAPG RVU's
"IGF-1, LC/MS QSTC",8764636,LOCAL,84305,CPT,,,,,,Outpatient,,,72.9,25.51,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,46.87,Based on EAPG RVU's
"Chlamydia Trachomatis RNA, TMA QST",10578255,LOCAL,87491,CPT,,,,,,Outpatient,,,73.16,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
"Neisseria Gonorrhoeae RNA, TMA QST",10578245,LOCAL,87591,CPT,,,,,,Outpatient,,,73.16,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
Thinprep Review Cytotechnologist: QST,10590230,LOCAL,88175,CPT,,,,,,Outpatient,,,73.16,31.93,Blue Cross of AL,Blue Cross,25.25,,,,,,,Other,25.25,26.61,Based on EAPG RVU's
97803 RE-ASSESSMENT & INTERVENTION CHARGE,8821410,LOCAL,97803,CPT,,,,,,Outpatient,,,73.41,48,Blue Cross of AL,Blue Cross,287.34,,,,,,,Other,21.06,287.34,Based on EAPG RVU's
Amylase Level,631567,LOCAL,82150,CPT,,,,,,Outpatient,,,73.44,7.78,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,1.237209302,7.16,Based on EAPG RVU's
Prothrombin Time,7904947,LOCAL,85610,CPT,,,,,,Outpatient,,,73.44,5.15,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,2.355196507,5.42,Based on EAPG RVU's
Prothrombin Time and INR,633793,LOCAL,85610,CPT,,,,,,Outpatient,,,73.44,5.15,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,2.355196507,5.42,Based on EAPG RVU's
Vancomycin Level,1634895,LOCAL,80202,CPT,,,,,,Outpatient,,,73.44,16.25,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,29.0215,Based on EAPG RVU's
Vancomycin Level Peak,1634896,LOCAL,80202,CPT,,,,,,Outpatient,,,73.44,16.25,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,29.0215,Based on EAPG RVU's
Vancomycin Level Trough,1634897,LOCAL,80202,CPT,,,,,,Outpatient,,,73.44,16.25,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,29.0215,Based on EAPG RVU's
97016 OT VASOPNEUMATIC DEVICE CHARGE,9850019,LOCAL,97016,CPT,,,,,GO,Outpatient,,,73.6,48,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,11.17,47.26,Based on EAPG RVU's
97016 PT JOBST COMPRESSION CHARGE,9640020,LOCAL,97016,CPT,,,,,GP,Outpatient,,,73.6,48,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,11.17,47.26,Based on EAPG RVU's
97016 PT VASOPNEUMATIC DEVICE CHARGE,9650020,LOCAL,97016,CPT,,,,,GP|CQ,Outpatient,,,73.6,48,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,11.17,47.26,Based on EAPG RVU's
OT Vasopneumatic Device Charge,7895255,LOCAL,97016,CPT,,,,,GO,Outpatient,,,73.6,48,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,11.17,47.26,Based on EAPG RVU's
OT Vasopneumatic Devices Assistant Units,7895255,LOCAL,97016,CPT,,,,,CQ,Outpatient,,,73.6,48,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,11.17,47.26,Based on EAPG RVU's
OT Vasopneumatic Devices Units,1373553,LOCAL,97016,CPT,,,,,GO,Outpatient,,,73.6,48,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,11.17,47.26,Based on EAPG RVU's
PT Vasopneumatic Devices Assistant Units,9390396,LOCAL,97016,CPT,,,,,CQ,Outpatient,,,73.6,48,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,11.17,47.26,Based on EAPG RVU's
Vasopneumatic Device Charge,7895963,LOCAL,97016,CPT,,,,,GP,Outpatient,,,73.6,48,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,11.17,47.26,Based on EAPG RVU's
Beta hCG Quantitative,633665,LOCAL,84702,CPT,,,,,,Outpatient,,,75,18.06,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,15.05,18.43,Based on EAPG RVU's
Flu A -Sofia,8267167,LOCAL,87804,CPT,,,,,,Outpatient,,,75,19.86,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,6.419753086,10.57,Based on EAPG RVU's
Flu B -Sofia,8267168,LOCAL,87804,CPT,,,,,,Outpatient,,,75,19.86,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,6.419753086,10.57,Based on EAPG RVU's
pH Venous,3454453,LOCAL,82800,CPT,,,,,,Outpatient,,,75,13.2,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,11,17.73,Based on EAPG RVU's
"Protein, Total, 24 Hr Ur QSTC",8851917,LOCAL,84156,CPT,,,,,,Outpatient,,,75,4.4,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,11.68,Based on EAPG RVU's
SARS-CoV-2 (COVID-19) IgG Ab,9706404,LOCAL,86769,CPT,,,,,,Outpatient,,,75,50.56,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,42.13,Based on EAPG RVU's
Streptococcus Pneumoniae Antigen Urine,4126638,LOCAL,87449,CPT,,,300,RC,,Outpatient,,,75,14.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,10.57,Based on EAPG RVU's
Total hCG Quantitative,9299894,LOCAL,84702,CPT,,,,,,Outpatient,,,75,18.06,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,15.05,18.43,Based on EAPG RVU's
pH Pleural Fluid,9631697,LOCAL,83986,CPT,,,,,,Outpatient,,,75.14,4.3,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,18.755,Based on EAPG RVU's
Estradiol Lvl,3170319,LOCAL,82670,CPT,,,,,,Outpatient,,,75.89,33.53,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,51.64,Based on EAPG RVU's
"Metanephrines, Fraction, LCMSMS,U24 QSTC",8764626,LOCAL,83835,CPT,,,,,,Outpatient,,,75.96,20.33,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,98.305,Based on EAPG RVU's
"Mycobacteria Stain, Acid Fast, Fluorochrome QST",12126168,LOCAL,87206,CPT,,,,,,Outpatient,,,76,6.47,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,34.45384615,Based on EAPG RVU's
C1 Esterase Inhibitor Protein QST,13870086,LOCAL,86160,CPT,,,,,,Outpatient,,,76.5,14.4,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,36.909,Based on EAPG RVU's
Complement Component C4C QST,13870085,LOCAL,86161,CPT,,,,,,Outpatient,,,76.5,14.4,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12,15.29,Based on EAPG RVU's
"Serotonin, Serum QSTC",8853235,LOCAL,84260,CPT,,,,,,Outpatient,,,76.5,37.18,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,30.98,Based on EAPG RVU's
.Thyroglobulin QSTC,13864485,LOCAL,84432,CPT,,,,,,Outpatient,,,76.73,19.27,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,46.235,Based on EAPG RVU's
CT PCR,12526323,LOCAL,87491,CPT,,,,,,Outpatient,,,76.95,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
NG PCR,12526324,LOCAL,87591,CPT,,,,,,Outpatient,,,76.95,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
Alkaline Phosphatase,1620878,LOCAL,84075,CPT,,,,,,Outpatient,,,77.11,6.22,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,5.18,7.16,Based on EAPG RVU's
G0008 MC ADMIN INFLUENZA VIRUS VACCINE CHARGE,7923017,LOCAL,,,G0008,HCPCS,,,,Outpatient,,,77.13,50,Blue Cross of AL,Blue Cross,56.18,,,,,,,Other,42.18,56.18,Based on EAPG RVU's
G0009 VACCINE ADMINISTRATION PNEUMONIA,12214659,LOCAL,,,G0009,HCPCS,,,,Outpatient,,,77.13,50,Blue Cross of AL,Blue Cross,56.18,,,,,,,Other,42.18,56.18,Based on EAPG RVU's
64461 THORACIC PARAVERTEBRAL BLOCK,5661020,LOCAL,64461,CPT,,,,,,Outpatient,,,77.31,50,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,633.14,1291,Based on EAPG RVU's
"Cryoglobulin (% Cryocrit), Serum QSTC",8764756,LOCAL,82595,CPT,,,,,,Outpatient,,,78.75,7.76,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,6.47,7.16,Based on EAPG RVU's
Group B Strep Culture,7842541,LOCAL,87070,CPT,,,,,,Outpatient,,,79.56,10.34,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,67.60639535,Based on EAPG RVU's
Partial Thromboplastin Time,633794,LOCAL,85730,CPT,,,,,,Outpatient,,,79.56,7.21,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,1.648553055,5.42,Based on EAPG RVU's
Partial Thromboplastin Time,7904949,LOCAL,85730,CPT,,,,,,Outpatient,,,79.56,7.21,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,1.648553055,5.42,Based on EAPG RVU's
Strep Confirmation,8019111,LOCAL,87081,CPT,,,,,,Outpatient,,,79.56,7.96,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,37.17627685,Based on EAPG RVU's
99152 MOD SED SAME PHYS/QHP 5/>YRS,8653149,LOCAL,99152,CPT,,,,,,Outpatient,,,79.64,52,Blue Cross of AL,Blue Cross,34.95,,,,,,,Other,10.38,34.95,Based on EAPG RVU's
20561 DRY NEEDLING 3+ MUSCLES WO INJECTION,9650049,LOCAL,20561,CPT,,,,,,Outpatient,,,80,52,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,22.39,863,Based on EAPG RVU's
GC Culture,633895,LOCAL,87081,CPT,,,,,,Outpatient,,,80.78,7.96,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,37.17627685,Based on EAPG RVU's
Lactate Dehydrogenase,633770,LOCAL,83615,CPT,,,,,,Outpatient,,,80.78,7.25,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,21.675,Based on EAPG RVU's
MRSA Screen Culture,8244872,LOCAL,87081,CPT,,,,,,Outpatient,,,80.78,7.96,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,37.17627685,Based on EAPG RVU's
Protein Total,633818,LOCAL,84155,CPT,,,,,,Outpatient,,,80.78,4.4,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,3.67,7.16,Based on EAPG RVU's
"Bill Only ABID Panel, Selected Cell",8629507,LOCAL,86885,CPT,,,,,,Outpatient,,,81,6.86,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,156.67,Based on EAPG RVU's
"Chromium, Serum QSTC",9701437,LOCAL,82495,CPT,,,,,,Outpatient,,,81,24.34,Blue Cross of AL,Blue Cross,16.07,,,,,,,Other,16.07,20.28,Based on EAPG RVU's
Levetiracetam QSTC,8764628,LOCAL,80177,CPT,,,,,,Outpatient,,,81,15.9,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,9.399,15.38,Based on EAPG RVU's
"Chlamydia Trachomatis RNA, TMA QST",10585658,LOCAL,87491,CPT,,,,,,Outpatient,,,82,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
HPV mRNA E6/E7 QST,10585657,LOCAL,87624,CPT,,,,,,Outpatient,,,82,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,67.195,Based on EAPG RVU's
"Neisseria Gonorrhoeae RNA, TMA QST",10585659,LOCAL,87591,CPT,,,,,,Outpatient,,,82,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
Thinprep Review Cytotechnologist: QST,10585654,LOCAL,88175,CPT,,,,,,Outpatient,,,82,31.93,Blue Cross of AL,Blue Cross,25.25,,,,,,,Other,25.25,26.61,Based on EAPG RVU's
Testosterone Level Total,3170320,LOCAL,84403,CPT,,,,,,Outpatient,,,82.01,30.97,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,52.3775,Based on EAPG RVU's
Malaria/Babesia/Other Blood Parasites QSTC,10707969,LOCAL,87207,CPT,,,,,,Outpatient,,,82.35,7.19,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,5.99,10.57,Based on EAPG RVU's
H. Pylori CLO,9517164,LOCAL,86677,CPT,,,,,,Outpatient,,,83.23,20.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,16.85,Based on EAPG RVU's
Phosphorus Level,633803,LOCAL,84100,CPT,,,,,,Outpatient,,,83.23,5.69,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,26.45123596,Based on EAPG RVU's
"Estrogen, Total, Serum QSTC",8764701,LOCAL,82672,CPT,,,,,,Outpatient,,,83.25,26.04,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,21.7,Based on EAPG RVU's
97129 ST COG/ATTEN/MEM/PROD CHARGE,9600117,LOCAL,97129,CPT,,,,,GN,Outpatient,,,84.77,114,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,18.94,56.44,Based on EAPG RVU's
97130 ST Cognitive skills development each additional 15 minutes,9600118,LOCAL,97130,CPT,,,,,GN,Outpatient,,,84.77,114,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,18.08,56.44,Based on EAPG RVU's
"SLP Cog Ther Intervent, Addl 15Min Units",9399379,LOCAL,97130,CPT,,,,,GN,Outpatient,,,84.77,114,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,18.08,56.44,Based on EAPG RVU's
"SLP Cog Ther Intervent,First 15Min Units",9399375,LOCAL,97129,CPT,,,,,GN,Outpatient,,,84.77,114,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,18.94,56.44,Based on EAPG RVU's
97802 MEDICAL NUTRITIONAL THERAPY CHARGE,13475610,LOCAL,97802,CPT,,,,,,Outpatient,,,84.82,55,Blue Cross of AL,Blue Cross,287.34,,,,,,,Other,25.2,287.34,Based on EAPG RVU's
Minimum Inhibitory Concentration,294946,LOCAL,87186,CPT,,,,,,Outpatient,,,85,10.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,35.67132075,Based on EAPG RVU's
"HPV mRNA E6/E7, POST-$HYSTERECTOMY, VAGINAL QST",14782713,LOCAL,87624,CPT,,,,,,Outpatient,,,85.05,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,67.195,Based on EAPG RVU's
BB REF LAB RH (D) TYPING,6413256,LOCAL,86901,CPT,,,,,,Outpatient,,,85.5,3.59,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,35.88,Based on EAPG RVU's
"Ehrlichia chaffeensis Ab (IgG,IgM) QSTC",8853255,LOCAL,86666,CPT,,,,,,Outpatient,,,85.5,12.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,10.18,15.29,Based on EAPG RVU's
REF ABO/Rh,7939266,LOCAL,86900,CPT,,,,,,Outpatient,,,85.5,3.59,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,117.85,Based on EAPG RVU's
Uric Acid,633858,LOCAL,84550,CPT,,,,,,Outpatient,,,85.68,5.42,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,35.17852564,Based on EAPG RVU's
Chol/HDL C QSTC,14129541,LOCAL,80061,CPT,,,,,,Outpatient,,,86,16.07,Blue Cross of AL,Blue Cross,12.14,,,,,,,Other,12.14,16.59934459,Based on EAPG RVU's
HDL P QSTC,14129559,LOCAL,83704,CPT,,,,,,Outpatient,,,86,41.03,Blue Cross of AL,Blue Cross,46.74,,,,,,,Other,34.19,46.74,Based on EAPG RVU's
HPV mRNA E6/E7 QST,9773934,LOCAL,87624,CPT,,,,,,Outpatient,,,86,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,67.195,Based on EAPG RVU's
HPV mRNA E6/E7 QST,9773934,LOCAL,87624,CPT,,,,,,Outpatient,,,86,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,67.195,Based on EAPG RVU's
HPV mRNA E6/E7 QSTC,9773934,LOCAL,87624,CPT,,,,,,Outpatient,,,86,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,67.195,Based on EAPG RVU's
Estrone QSTC,8853208,LOCAL,82679,CPT,,,,,,Outpatient,,,86.4,29.94,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,24.95,Based on EAPG RVU's
Cyanide QSTC,13864508,LOCAL,82600,CPT,,,,,,Outpatient,,,86.45,23.28,Blue Cross of AL,Blue Cross,16.07,,,,,,,Other,16.07,19.4,Based on EAPG RVU's
Electrolyte Panel,633610,LOCAL,80051,CPT,,,,,,Outpatient,,,86.9,8.41,Blue Cross of AL,Blue Cross,12.14,,,,,,,Other,7.01,12.14,Based on EAPG RVU's
India Ink GL,11675075,LOCAL,87210,CPT,,,306,RC,,Outpatient,,,86.9,6.98,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,10.57,Based on EAPG RVU's
Sodium Level,633611,LOCAL,84295,CPT,,,,,,Outpatient,,,86.9,5.77,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,18.324,Based on EAPG RVU's
Measles Antibody (IgM) QSTC,8853259,LOCAL,86765,CPT,,,,,,Outpatient,,,87.8,15.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.88,15.29,Based on EAPG RVU's
Maize/Corn (F8) IgE QSTC,14116318,LOCAL,86001,CPT,,,,,,Outpatient,,,87.93,9.38,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,7.82,15.29,Based on EAPG RVU's
97022 FLUIDOTHERAPY CHARGES,9646093,LOCAL,97022,CPT,,,,,GP,Outpatient,,,88.1,57,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.34,47.26,Based on EAPG RVU's
97022 OT WHIRLPOOL - ASEPTIC,9856111,LOCAL,97022,CPT,,,,,GO,Outpatient,,,88.1,57,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.34,47.26,Based on EAPG RVU's
97022 OT WHIRLPOOL 1+ AREAS APPL CHARGE,9866111,LOCAL,97022,CPT,,,,,GO|CO,Outpatient,,,88.1,57,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.34,47.26,Based on EAPG RVU's
97022 PT SMALL WHIRLPOOL CHARGE,9656093,LOCAL,97022,CPT,,,,,GP|CQ,Outpatient,,,88.1,57,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.34,47.26,Based on EAPG RVU's
97022 WHIRLPOOL CHARGE,9410091,LOCAL,97022,CPT,,,,,GP,Outpatient,,,88.1,57,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.34,47.26,Based on EAPG RVU's
OT Whirlpool Therapy Assitant Units,9401114,LOCAL,97022,CPT,,,,,CQ,Outpatient,,,88.1,57,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.34,47.26,Based on EAPG RVU's
OT Whirlpool Units,9401114,LOCAL,97022,CPT,,,,,GO,Outpatient,,,88.1,57,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.34,47.26,Based on EAPG RVU's
"OT Whirlpool, Fluidotherapy Assistant Units",1373554,LOCAL,97022,CPT,,,,,CQ,Outpatient,,,88.1,57,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.34,47.26,Based on EAPG RVU's
"OT Whirlpool, Fluidotherapy Units",1373554,LOCAL,97022,CPT,,,,,GO,Outpatient,,,88.1,57,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.34,47.26,Based on EAPG RVU's
Whirlpool Full Body Charge,7895951,LOCAL,97022,CPT,,,,,GP,Outpatient,,,88.1,57,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.34,47.26,Based on EAPG RVU's
"Whirlpool, 1+ Areas 97022",9640021,LOCAL,97022,CPT,,,,,,Outpatient,,,88.1,57,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.34,47.26,Based on EAPG RVU's
"Factor XI Activity, Clotting QSTC",10358416,LOCAL,85270,CPT,,,,,,Outpatient,,,88.2,21.48,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,17.9,Based on EAPG RVU's
99151 MOD SED SAME PHYS/QHP <5 YRS,8653147,LOCAL,99151,CPT,,,,,,Outpatient,,,88.82,58,Blue Cross of AL,Blue Cross,34.95,,,,,,,Other,20.19,34.95,Based on EAPG RVU's
Selenium QSTC,8972757,LOCAL,84255,CPT,,,,,,Outpatient,,,89.6,30.64,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,57.31,Based on EAPG RVU's
Theophylline Level,1634886,LOCAL,80198,CPT,,,,,,Outpatient,,,89.76,16.97,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,14.14,15.38,Based on EAPG RVU's
97552 OT Caregiver Training Group,13649812,LOCAL,97552,CPT,,,,,,Outpatient,,,90,,Blue Cross of AL,Blue Cross,67.18,,,,,,,Other,9.04,67.18,Based on EAPG RVU's
97552 Speech Caregiver Training Group,13767339,LOCAL,97552,CPT,,,,,,Outpatient,,,90,,Blue Cross of AL,Blue Cross,67.18,,,,,,,Other,9.04,67.18,Based on EAPG RVU's
ANCA Vasculitides QSTC,9039411,LOCAL,86021,CPT,,,301,RC,,Outpatient,,,90,18.06,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,15.29,Based on EAPG RVU's
"Beta-2-Glycoprotein I Antibodies (IgG, IgM) QSTC",10094523,LOCAL,86146,CPT,,,,,,Outpatient,,,90,30.54,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,25.45,Based on EAPG RVU's
Bill Only ABO,7936964,LOCAL,86900,CPT,,,,,,Outpatient,,,90,3.59,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,117.85,Based on EAPG RVU's
Bill Only Rh,7936965,LOCAL,86901,CPT,,,,,,Outpatient,,,90,3.59,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,35.88,Based on EAPG RVU's
B-Type Natriuretic Peptide,1383771,LOCAL,83880,CPT,,,,,,Outpatient,,,90,47.11,Blue Cross of AL,Blue Cross,46.74,,,,,,,Other,13.36379562,46.74,Based on EAPG RVU's
"GROUP CAREGIVER TRAINING IN STRATEGIES & TECHNIQUES, FACE TO FACE, INITIAL 30 MIN 97552",13788179,LOCAL,97552,CPT,,,,,,Outpatient,,,90,,Blue Cross of AL,Blue Cross,67.18,,,,,,,Other,9.04,67.18,Based on EAPG RVU's
"Helicobacter pylori Ag, EIA, Stool QSTC",8873559,LOCAL,87338,CPT,,,,,,Outpatient,,,90,17.26,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,14.38,Based on EAPG RVU's
Heparin Induced Plt Ab QSTC,8995550,LOCAL,86022,CPT,,,,,,Outpatient,,,90,22.04,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,18.37,Based on EAPG RVU's
"HPV Genotypes 16,18/45 QST",9773953,LOCAL,87625,CPT,,,,,,Outpatient,,,90,48.66,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,64.87,Based on EAPG RVU's
"HPV GENOTYPES 16,18/45,$POST-HYST, VAGINAL QST",14782712,LOCAL,87625,CPT,,,,,,Outpatient,,,90,48.66,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,64.87,Based on EAPG RVU's
N-Terminal Pro B-Type Natriuretic Peptide,1503769,LOCAL,83880,CPT,,,,,,Outpatient,,,90,47.11,Blue Cross of AL,Blue Cross,46.74,,,,,,,Other,13.36379562,46.74,Based on EAPG RVU's
OT Group Caregiver Training Units,13624357,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,90,,Blue Cross of AL,Blue Cross,67.18,,,,,,,Other,20.25,67.18,Based on EAPG RVU's
SLP Group Caregiver Training Time,14466882,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,90,,Blue Cross of AL,Blue Cross,67.18,,,,,,,Other,20.25,67.18,Based on EAPG RVU's
"Tacrolimus, Highly Sens, LC/MS/MS QSTC",8764783,LOCAL,80197,CPT,,,,,,Outpatient,,,90,16.48,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,51.73,Based on EAPG RVU's
Topiramate QSTC,8764585,LOCAL,80201,CPT,,,,,,Outpatient,,,90,14.3,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,11.92,15.38,Based on EAPG RVU's
Vitamin D 25 Hydroxy Level,4240407,LOCAL,82306,CPT,,,,,,Outpatient,,,90,35.52,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,45.19775253,Based on EAPG RVU's
NEUROPSYCHOLOGICAL TEST ADMINISTRATION,13472049,LOCAL,96146,CPT,,,,,,Outpatient,,,91.31,59,Blue Cross of AL,Blue Cross,846.56,,,,,,,Other,22.39,846.56,Based on EAPG RVU's
Creatinine Urine,1930782,LOCAL,82570,CPT,,,,,,Outpatient,,,91.8,6.22,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,40.97514925,Based on EAPG RVU's
Fibrinogen Level,633728,LOCAL,85384,CPT,,,,,,Outpatient,,,92.21,11.66,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,9.72,Based on EAPG RVU's
Rapid Plasma Reagin,633820,LOCAL,86592,CPT,,,,,,Outpatient,,,92.21,5.12,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,19.99375,Based on EAPG RVU's
Rapid Plasma Reagin Qualitative,7948395,LOCAL,86592,CPT,,,,,,Outpatient,,,92.21,5.12,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,19.99375,Based on EAPG RVU's
Rapid Plasma Reagin Qualitative w/ Reflex,8166073,LOCAL,86592,CPT,,,,,,Outpatient,,,92.21,5.12,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,19.99375,Based on EAPG RVU's
Blood Type ABO/Rh Typing,634326,LOCAL,86900,CPT,,,,,,Outpatient,,,92.71,3.59,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,117.85,Based on EAPG RVU's
Cord ABORh,8019069,LOCAL,86900,CPT,,,,,,Outpatient,,,92.71,3.59,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,117.85,Based on EAPG RVU's
Neonatal ABORh,8070665,LOCAL,86900,CPT,,,,,,Outpatient,,,92.71,3.59,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,117.85,Based on EAPG RVU's
Fetal Screen,634335,LOCAL,85461,CPT,,,,,,Outpatient,,,93.02,11.23,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,8.21,9.36,Based on EAPG RVU's
99175 IPECAC EMESIS W/OBSERVATION TechFee,8057714,LOCAL,99175,CPT,,,,,,Outpatient,,,93.74,61,Blue Cross of AL,Blue Cross,983.02,,,,,,,Other,39.94,983.02,Based on EAPG RVU's
RT Vapotherm Initial CHARGE,8144190,LOCAL,94002,CPT,,,,,,Outpatient,,,94.68,663,Blue Cross of AL,Blue Cross,941,,,,,,,Other,604.42,941,Based on EAPG RVU's
Campylobacter Antigen,8240219,LOCAL,87449,CPT,,,300,RC,,Outpatient,,,95,14.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,10.57,Based on EAPG RVU's
"Coccidioides Antibody, CF & ID, S QSTC",8764815,LOCAL,86635,CPT,,,,,,Outpatient,,,95.18,13.76,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,11.47,15.29,Based on EAPG RVU's
Myoglobin Serum,8373798,LOCAL,83874,CPT,,,301,RC,,Outpatient,,,95.47,15.5,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,17.73,Based on EAPG RVU's
"Chlamydia Trachomatis RNA, TMA QST",9774353,LOCAL,87491,CPT,,,,,,Outpatient,,,96,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
DAPTOmycin 350 mg intravenous injection [CULL],11210540,LOCAL,J0878,CPT,,,,,,Outpatient,1,EA,96,480,Blue Cross of AL,Blue Cross,122.4,,,,,,,Other,0.01,122.4,Based on EAPG RVU's
"Neisseria Gonorrhoeae RNA, TMA QST",9774354,LOCAL,87591,CPT,,,,,,Outpatient,,,96,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
"Trichomonas Vaginalis RNA, Ql, TMA QST",9774358,LOCAL,87661,CPT,,,,,,Outpatient,,,96,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
Creat Clear,633609,LOCAL,82575,CPT,,,,,,Outpatient,,,96.29,11.35,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,52.785,Based on EAPG RVU's
Creat Clear (No U24),8477916,LOCAL,82575,CPT,,,,,,Outpatient,,,96.29,11.35,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,52.785,Based on EAPG RVU's
Aspartate aminotransferase,633633,LOCAL,84450,CPT,,,,,,Outpatient,,,96.7,6.22,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,50.89,Based on EAPG RVU's
Blood Urea Nitrogen,633605,LOCAL,84520,CPT,,,,,,Outpatient,,,96.7,4.74,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,26.82133333,Based on EAPG RVU's
Mononucleosis Screen,633785,LOCAL,86308,CPT,,,,,,Outpatient,,,96.7,6.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.18,15.29,Based on EAPG RVU's
Monospot POCT,9038464,LOCAL,86308,CPT,,,,,,Outpatient,,,96.7,6.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.18,15.29,Based on EAPG RVU's
Gentamicin Level,3454415,LOCAL,80170,CPT,,,,,,Outpatient,,,97.1,19.66,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,16.38,Based on EAPG RVU's
Gentamicin Level Peak,633736,LOCAL,80170,CPT,,,,,,Outpatient,,,97.1,19.66,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,16.38,Based on EAPG RVU's
Gentamicin Level Trough,633737,LOCAL,80170,CPT,,,,,,Outpatient,,,97.1,19.66,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,16.38,Based on EAPG RVU's
Gamma Glutamyl Transferase,1628895,LOCAL,82977,CPT,,,,,,Outpatient,,,97.92,8.64,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,52.49,Based on EAPG RVU's
Renal Function Panel,1634883,LOCAL,80069,CPT,,,,,,Outpatient,,,97.92,10.42,Blue Cross of AL,Blue Cross,12.14,,,,,,,Other,12.14,37.65984615,Based on EAPG RVU's
CULL NM Therapy I131 Cap Per MCI,13644969,LOCAL,,,A9517,HCPCS,,,,Outpatient,,,98.48,64,Blue Cross of AL,Blue Cross,662.39,,,,,,,Other,23.13,662.39,Based on EAPG RVU's
96423 CHEMO ARTRL INF EA ADDL HR CHARGE,9404493,LOCAL,96423,CPT,,,,,,Outpatient,,,98.94,64,Blue Cross of AL,Blue Cross,749.76,,,,,,,Other,42.18,749.76,Based on EAPG RVU's
cinacalcet 30 mg oral tablet [CULL],11282052,LOCAL,J0604,CPT,,,,,,Outpatient,1,EA,98.955744,,Blue Cross of AL,Blue Cross,122.4,,,,,,,Other,122.4,122.4,Based on EAPG RVU's
90913 - Bfb training ea addl 15 min.,9442436,LOCAL,90913,CPT,,,,,,Outpatient,,,99,64,Blue Cross of AL,Blue Cross,233.61,,,,,,,Other,20.19,233.61,Based on EAPG RVU's
"Amphetamine, U QSTC",8848893,LOCAL,80324,CPT,,,301,RC,,Outpatient,,,99,,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,17.73,Based on EAPG RVU's
"Benzodiazepine Conf, Ur QSTC",13864447,LOCAL,80346,CPT,,,301,RC,,Outpatient,,,99,,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,17.73,Based on EAPG RVU's
Caregiver Agreement on Discipline,7355021,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,99,,Blue Cross of AL,Blue Cross,67.18,,,,,,,Other,20.25,67.18,Based on EAPG RVU's
Caregiver Agreement on Discipline,7355021,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,99,,Blue Cross of AL,Blue Cross,67.18,,,,,,,Other,20.25,67.18,Based on EAPG RVU's
Cholesterol Total,633705,LOCAL,82465,CPT,,,,,,Outpatient,,,99.14,5.22,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,4.35,7.16,Based on EAPG RVU's
Progesterone Level,3454459,LOCAL,84144,CPT,,,,,,Outpatient,,,99.14,25.03,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,59.795,Based on EAPG RVU's
Triglyceride,633852,LOCAL,84478,CPT,,,,,,Outpatient,,,99.14,6.89,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,52.385,Based on EAPG RVU's
"Histoplasma Antibody Panel, CF and ID, Serum QSTC",10185600,LOCAL,86698,CPT,,,,,,Outpatient,,,99.5,16.55,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,13.79,15.29,Based on EAPG RVU's
"64420 INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVE, SINGLE ProFee",13959631,LOCAL,64420,CPT,,,,,,Outpatient,,,100,693,Blue Cross of AL,Blue Cross,636.45,,,,,,,Other,633.14,1291,Based on EAPG RVU's
E3581 Thawed Cryo AHF,7267123,LOCAL,,,P9012,HCPCS,,,,Outpatient,,,100,65,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,63.57,217.45,Based on EAPG RVU's
HPV mRNA E6/E7 QST,9775619,LOCAL,87624,CPT,,,,,,Outpatient,,,100,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,67.195,Based on EAPG RVU's
HPV mRNA E6/E7 QST,10585636,LOCAL,87624,CPT,,,,,,Outpatient,,,100,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,67.195,Based on EAPG RVU's
POC Chem8+ Panel,8920330,LOCAL,80048,CPT,,,,,,Outpatient,,,100,10.15,Blue Cross of AL,Blue Cross,12.14,,,,,,,Other,12.14,37.17170492,Based on EAPG RVU's
Thinprep Review Cytotechnologist: QST,9775616,LOCAL,88175,CPT,,,,,,Outpatient,,,100,31.93,Blue Cross of AL,Blue Cross,25.25,,,,,,,Other,25.25,26.61,Based on EAPG RVU's
Thinprep Review Cytotechnologist: QST,10585633,LOCAL,88175,CPT,,,,,,Outpatient,,,100,31.93,Blue Cross of AL,Blue Cross,25.25,,,,,,,Other,25.25,26.61,Based on EAPG RVU's
97116  SB Pt Gait Train 15 mn,9640030,LOCAL,97116,CPT,,,,,GP,Outpatient,,,100.04,65,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,12.1333871,47.26,Based on EAPG RVU's
97116 GAIT TRAINING CHARGE,9410151,LOCAL,97116,CPT,,,,,GP,Outpatient,,,100.04,65,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,12.1333871,47.26,Based on EAPG RVU's
97116 PT Gait Training Assistant Units,9650030,LOCAL,97116,CPT,,,,,GP|CQ,Outpatient,,,100.04,65,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,12.1333871,47.26,Based on EAPG RVU's
Gait Training Charges,7895941,LOCAL,97116,CPT,,,,,GP,Outpatient,,,100.04,65,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,12.1333871,47.26,Based on EAPG RVU's
PT Gait Training Assistant Units,9390436,LOCAL,97116,CPT,,,,,CQ,Outpatient,,,100.04,65,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,12.1333871,47.26,Based on EAPG RVU's
Activated PTT,7938959,LOCAL,85730,CPT,,,,,,Outpatient,,,101.52,7.21,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,1.648553055,5.42,Based on EAPG RVU's
Bilirubin Direct,4240528,LOCAL,82248,CPT,,,,,,Outpatient,,,101.59,6.02,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,26.6275,Based on EAPG RVU's
Bilirubin Direct,7939101,LOCAL,82248,CPT,,,,,,Outpatient,,,101.59,6.02,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,26.6275,Based on EAPG RVU's
Bilirubin Direct,8443662,LOCAL,82248,CPT,,,,,,Outpatient,,,101.59,6.02,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,26.6275,Based on EAPG RVU's
iSTAT Creatinine POCT,11673045,LOCAL,82565,CPT,,,,,,Outpatient,,,101.59,6.14,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,10.061625,Based on EAPG RVU's
Lipid Pnl,633777,LOCAL,80061,CPT,,,,,,Outpatient,,,101.59,16.07,Blue Cross of AL,Blue Cross,12.14,,,,,,,Other,12.14,16.59934459,Based on EAPG RVU's
77062 MG Diagnostic Tomo Charge: AddOn Bilateral,13969682,LOCAL,77062,CPT,,,401,RC,,Outpatient,,,101.84,41.25,Blue Cross of AL,Blue Cross,74,,,,,,,Other,11.11,74,Based on EAPG RVU's
77062 MG Diagnostic Tomo Charge: AddOn Bilateral,13969682,LOCAL,G0279,CPT,,,,,,Outpatient,,,101.84,,Blue Cross of AL,Blue Cross,74,,,,,,,Other,11.11,74,Based on EAPG RVU's
77063 MG Tomo Charge: AddOn Bilateral,13621440,LOCAL,77063,CPT,,,,,,Outpatient,,,101.84,54.45,Blue Cross of AL,Blue Cross,74,,,,,,,Other,20.75,74,Based on EAPG RVU's
CULL Mammo Tomo Add On,7867705,LOCAL,77063,CPT,,,,,,Outpatient,,,101.84,54.45,Blue Cross of AL,Blue Cross,74,,,,,,,Other,20.75,74,Based on EAPG RVU's
hepatitis B pediatric vaccine 10 mcg/0.5 mL intramuscular suspension 0.5 mL [CULL],11202559,LOCAL,90744,CPT,,,,,,Outpatient,0.5,ML,102.17472,,Blue Cross of AL,Blue Cross,39.58,,,,,,,Other,33.204,39.58,Based on EAPG RVU's
Immunoglobulin G Subclass 1 QSTC,8851875,LOCAL,82787,CPT,,,,,,Outpatient,,,102.38,9.62,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,8.02,Based on EAPG RVU's
"Immunoglobulin G, Serum QSTC",8851879,LOCAL,82784,CPT,,,,,,Outpatient,,,102.38,11.16,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,34.958,Based on EAPG RVU's
"HVA, 24h Urine w/o Creat QSTC",13864511,LOCAL,83150,CPT,,,,,,Outpatient,,,102.56,26.89,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,22.41,Based on EAPG RVU's
CYSTOGRAM INJ,8210035,LOCAL,51600,CPT,,,,,,Outpatient,,,103,246,Blue Cross of AL,Blue Cross,442.76,,,,,,,Other,35.39,863,Based on EAPG RVU's
Therapeutic Phlebotomy,8118276,LOCAL,99195,CPT,,,,,,Outpatient,,,103.04,67,Blue Cross of AL,Blue Cross,85.79,,,,,,,Other,85.79,117.85,Based on EAPG RVU's
Strep A Xpress (GeneXpert),8642789,LOCAL,87651,CPT,,,,,,Outpatient,,,103.5,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,3.7,40.19,Based on EAPG RVU's
Cerebrospinal Fluid Culture,4122737,LOCAL,87070,CPT,,,,,,Outpatient,,,103.63,10.34,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,67.60639535,Based on EAPG RVU's
Coronavirus SARS Ag (Sofia),9803641,LOCAL,87426,CPT,,,,,,Outpatient,,,104,42.4,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,56.40806897,Based on EAPG RVU's
COVID-19 Ag,11561110,LOCAL,87426,CPT,,,,,,Outpatient,,,104,42.4,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,56.40806897,Based on EAPG RVU's
Urine Drug Screen,3454403,LOCAL,80306,CPT,,,,,,Outpatient,,,104,20.57,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,0.2416,17.73,Based on EAPG RVU's
97533 PT SENSORY INTEGRATIVE TECH 15MIN,9866109,LOCAL,97533,CPT,,,,,GO|CO,Outpatient,,,104.14,68,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,55.09,56.44,Based on EAPG RVU's
97533 SENSORY INTEGATIVE TECHNIQUES EACH 15 MINS,9856109,LOCAL,97533,CPT,,,,,GO,Outpatient,,,104.14,68,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,55.09,56.44,Based on EAPG RVU's
OT Sensory Integrative Tech Assistant Units,7895276,LOCAL,97533,CPT,,,,,CQ,Outpatient,,,104.14,68,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,55.09,56.44,Based on EAPG RVU's
OT Sensory Integrative Techniques Units,1373568,LOCAL,97533,CPT,,,,,GO,Outpatient,,,104.14,68,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,55.09,56.44,Based on EAPG RVU's
Sensory Stimulation Charge,7895276,LOCAL,97533,CPT,,,,,GO,Outpatient,,,104.14,68,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,55.09,56.44,Based on EAPG RVU's
"Chlamydia Trachomatis RNA, TMA QST",14435138,LOCAL,87491,CPT,,,,,,Outpatient,,,105,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
HPV mRNA E6/E7 QST,14435137,LOCAL,87624,CPT,,,,,,Outpatient,,,105,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,67.195,Based on EAPG RVU's
"Neisseria Gonorrhoeae RNA, TMA QST",14435139,LOCAL,87591,CPT,,,,,,Outpatient,,,105,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
Thinprep Review Cytotechnologist: QST,14435134,LOCAL,88175,CPT,,,,,,Outpatient,,,105,31.93,Blue Cross of AL,Blue Cross,25.25,,,,,,,Other,25.25,26.61,Based on EAPG RVU's
Iron Level,633765,LOCAL,83540,CPT,,,,,,Outpatient,,,105.26,7.76,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,48.87820628,Based on EAPG RVU's
Iron Level,7050169,LOCAL,83540,CPT,,,,,,Outpatient,,,105.26,7.76,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,48.87820628,Based on EAPG RVU's
Iron Level,10543519,LOCAL,83540,CPT,,,,,,Outpatient,,,105.26,7.76,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,48.87820628,Based on EAPG RVU's
"Vitamin B2 (Riboflavin), P QSTC",8972877,LOCAL,84252,CPT,,,,,,Outpatient,,,106.2,24.29,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,20.24,Based on EAPG RVU's
97537 COMMUNITY/WORK REINTEGRATION,9650036,LOCAL,97537,CPT,,,,,GP|CQ,Outpatient,,,107.75,70,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.96,56.44,Based on EAPG RVU's
97537 Community/work reintegration training; each 15 minutes,9860034,LOCAL,97537,CPT,,,,,GO|CO,Outpatient,,,107.75,70,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.96,56.44,Based on EAPG RVU's
97537 OT COMM WORK INTEGRATION CHARGE,9850034,LOCAL,97537,CPT,,,,,GO,Outpatient,,,107.75,70,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.96,56.44,Based on EAPG RVU's
97537 PT ERGONOMIC TRAINING,9640036,LOCAL,97537,CPT,,,,,GP,Outpatient,,,107.75,70,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.96,56.44,Based on EAPG RVU's
Community/Work Reintegration Charges,1366455,LOCAL,97537,CPT,,,,,GO,Outpatient,,,107.75,70,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.96,56.44,Based on EAPG RVU's
"OT Community, Work Reintegration Assistant Units",1366455,LOCAL,97537,CPT,,,,,CQ,Outpatient,,,107.75,70,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.96,56.44,Based on EAPG RVU's
"OT Community, Work Reintegration Assistant Units",1373453,LOCAL,97537,CPT,,,,,CQ,Outpatient,,,107.75,70,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.96,56.44,Based on EAPG RVU's
"OT Community, Work Reintegration Units",1373453,LOCAL,97537,CPT,,,,,GO,Outpatient,,,107.75,70,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.96,56.44,Based on EAPG RVU's
OT Community/Work Reintegration Charges,1366455,LOCAL,97537,CPT,,,,,GO,Outpatient,,,107.75,70,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.96,56.44,Based on EAPG RVU's
"PT Community,Work Reintegration Assistant Units",9390450,LOCAL,97537,CPT,,,,,CQ,Outpatient,,,107.75,70,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.96,56.44,Based on EAPG RVU's
PT Community/Work Reintegration Charge,7895991,LOCAL,97537,CPT,,,,,GP,Outpatient,,,107.75,70,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.96,56.44,Based on EAPG RVU's
AChR Bind Ab w/rfx MuSK Ab QSTC,13864498,LOCAL,86041,CPT,,,,,,Outpatient,,,108,22.08,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,18.4,Based on EAPG RVU's
Alpha-1-Antitrypsin QN QSTC,13873077,LOCAL,82103,CPT,,,,,,Outpatient,,,108,16.13,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,60.59,Based on EAPG RVU's
Carnitine QSTC,8764784,LOCAL,82379,CPT,,,,,,Outpatient,,,108,20.24,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,16.87,17.73,Based on EAPG RVU's
EKG Charges - RT -> Routine ECG 12 lead/15 lead tracing only,5367589,LOCAL,93041,CPT,,,,,,Outpatient,,,108.53,71,Blue Cross of AL,Blue Cross,38.53,,,,,,,Other,38.53,54.31,Based on EAPG RVU's
97542  SB PT Wheelchair Mgt,9640037,LOCAL,97542,CPT,,,,,GP,Outpatient,,,108.91,71,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.37,56.44,Based on EAPG RVU's
97542 OT WHEELCHAIR MANAGE/TRAIN 15MIN,9820201,LOCAL,97542,CPT,,,,,GO,Outpatient,,,108.91,71,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.37,56.44,Based on EAPG RVU's
97542 PT WC SEATING EVAL CHARGE,9650037,LOCAL,97542,CPT,,,,,GP|CQ,Outpatient,,,108.91,71,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.37,56.44,Based on EAPG RVU's
"97542 Wheelchair management (eg, assessment, fitting, training), each 15 minutes",9860201,LOCAL,97542,CPT,,,,,GO|CO,Outpatient,,,108.91,71,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.37,56.44,Based on EAPG RVU's
97542 WHEELCHAIR MANAGEMENT CHARGE,9410201,LOCAL,97542,CPT,,,,,GP,Outpatient,,,108.91,71,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.37,56.44,Based on EAPG RVU's
OT Wheelchair Management Assistant Units,7895273,LOCAL,97542,CPT,,,,,CQ,Outpatient,,,108.91,71,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.37,56.44,Based on EAPG RVU's
OT Wheelchair Management Units,1373570,LOCAL,97542,CPT,,,,,GO,Outpatient,,,108.91,71,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.37,56.44,Based on EAPG RVU's
PT Wheelchair Management Assistant Units,9390452,LOCAL,97542,CPT,,,,,CQ,Outpatient,,,108.91,71,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.37,56.44,Based on EAPG RVU's
Wheelchair Charge,7895273,LOCAL,97542,CPT,,,,,GO,Outpatient,,,108.91,71,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.37,56.44,Based on EAPG RVU's
Wheelchair Management Charges,7895931,LOCAL,97542,CPT,,,,,GP,Outpatient,,,108.91,71,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,29.37,56.44,Based on EAPG RVU's
97551 OT Caregiver Training Ea Add'l 15 Mins,13647370,LOCAL,97551,CPT,,,,,,Outpatient,,,110,,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,20.67,95.93,Based on EAPG RVU's
97551 PT Caregiver Training Ea Add'l 15 Mins,13645598,LOCAL,97551,CPT,,,,,,Outpatient,,,110,,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,20.67,95.93,Based on EAPG RVU's
97551 ST Caregiver Training Ea  Addl 15 min,14017194,LOCAL,97551,CPT,,,,,,Outpatient,,,110,,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,20.67,95.93,Based on EAPG RVU's
"OT Caregiver Training, Addl 15 Min Asst",13623455,LOCAL,,,G0542,HCPCS,,,,Outpatient,,,110,,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,25.18,95.93,Based on EAPG RVU's
"OT Caregiver Training, First 30 Min Asst",13623453,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,110,,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,50.79,95.93,Based on EAPG RVU's
"SLP Caregiver Training, Addl 15 Min Time",14466886,LOCAL,,,G0542,HCPCS,,,,Outpatient,,,110,,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,25.18,95.93,Based on EAPG RVU's
% CD19 (B Cells) QSTC,9416397,LOCAL,86355,CPT,,,,,,Outpatient,,,110.25,45.28,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.73,Based on EAPG RVU's
%CD 16+CD56 (NK Cells) QSTC,9416395,LOCAL,86357,CPT,,,,,,Outpatient,,,110.25,45.28,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.73,Based on EAPG RVU's
%CD3 Mature T Cells QSTC,9416288,LOCAL,86359,CPT,,,,,,Outpatient,,,110.25,45.28,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.73,Based on EAPG RVU's
CD4/CD8 Ratio QSTC,8852258,LOCAL,86360,CPT,,,,,,Outpatient,,,110.25,56.38,Blue Cross of AL,Blue Cross,44.29,,,,,,,Other,44.29,46.98,Based on EAPG RVU's
"Parvovirus B19 Antibodies(IgG, IgM) QSTC",8764577,LOCAL,86747,CPT,,,,,,Outpatient,,,110.25,18.04,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.03,15.29,Based on EAPG RVU's
CBC w/ Manual Differential,633682,LOCAL,85027,CPT,,,,,,Outpatient,,,111.38,7.76,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,8.21,27.02937879,Based on EAPG RVU's
CBC without Differential,3798345,LOCAL,85027,CPT,,,,,,Outpatient,,,111.38,7.76,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,8.21,27.02937879,Based on EAPG RVU's
Salicylate,1503768,LOCAL,80307,CPT,,,301,RC,,Outpatient,,,111.38,74.57,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,160.4,Based on EAPG RVU's
DNase-B Antibody QSTC,8764548,LOCAL,86215,CPT,,,,,,Outpatient,,,112.5,15.9,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,13.25,15.29,Based on EAPG RVU's
"Tissue Transglutaminase Ab(IgG,IgA) QSTC",8972930,LOCAL,86364,CPT,,,,,,Outpatient,,,112.5,13.84,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,61.9,Based on EAPG RVU's
Cord DAT Gel,8416626,LOCAL,86880,CPT,,,,,,Outpatient,,,112.65,6.47,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,54.31,Based on EAPG RVU's
DAT IgG Gel,7906396,LOCAL,86880,CPT,,,,,,Outpatient,,,112.65,6.47,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,54.31,Based on EAPG RVU's
Neonatal DAT Gel,13460490,LOCAL,86880,CPT,,,,,,Outpatient,,,112.65,6.47,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,54.31,Based on EAPG RVU's
Legionella Antigen Urine,633775,LOCAL,87449,CPT,,,300,RC,,Outpatient,,,113,14.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,10.57,Based on EAPG RVU's
LA Ven - Sepsis 2Hr,8485386,LOCAL,83605,CPT,,,,,,Outpatient,,,113.42,13.88,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,0.901879518,17.73,Based on EAPG RVU's
Lactic Acid (Venous),3454442,LOCAL,83605,CPT,,,,,,Outpatient,,,113.42,13.88,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,0.901879518,17.73,Based on EAPG RVU's
Lactic Acid (Venous) - Sepsis,8058058,LOCAL,83605,CPT,,,,,,Outpatient,,,113.42,13.88,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,0.901879518,17.73,Based on EAPG RVU's
Unstable Hemoglobin QSTC,13864449,LOCAL,83068,CPT,,,,,,Outpatient,,,113.63,11.36,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,9.47,Based on EAPG RVU's
97124 MASSAGE CHARGE,9640031,LOCAL,97124,CPT,,,,,GP,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,27.37,47.26,Based on EAPG RVU's
97124 OT MASSAGE CHARGE,9850029,LOCAL,97124,CPT,,,,,GO,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,27.37,47.26,Based on EAPG RVU's
97124 OT-MASSAGE EA 15 MIN,9860029,LOCAL,97124,CPT,,,,,GO|CO,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,27.37,47.26,Based on EAPG RVU's
97124 PT Massage Assistant Units,9650031,LOCAL,97124,CPT,,,,,GP|CQ,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,27.37,47.26,Based on EAPG RVU's
97140  Manual Therapy 15 min,9850047,LOCAL,97140,CPT,,,,,GO,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,65.845,Based on EAPG RVU's
97140 MAN THER EA 15 MIN CHARGES,9640047,LOCAL,97140,CPT,,,,,GP,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,65.845,Based on EAPG RVU's
97140 OT Manual Therapy Assistant Units,9860047,LOCAL,97140,CPT,,,,,GO|CO,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,65.845,Based on EAPG RVU's
97140 PT Manual Therapy Assistant Units,9650047,LOCAL,97140,CPT,,,,,GP|CQ,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,65.845,Based on EAPG RVU's
Manual Therapy Charge Units,7895928,LOCAL,97140,CPT,,,,,GP,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,65.845,Based on EAPG RVU's
Manual Traction Charge,7895279,LOCAL,97140,CPT,,,,,GO,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,65.845,Based on EAPG RVU's
Massage Charge Units,1041799,LOCAL,97124,CPT,,,,,GO,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,27.37,47.26,Based on EAPG RVU's
Massage Charge Units,7895954,LOCAL,97124,CPT,,,,,GP,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,27.37,47.26,Based on EAPG RVU's
OT Manual Therapy Assistant Units,1373444,LOCAL,97140,CPT,,,,,CQ,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,65.845,Based on EAPG RVU's
OT Manual Therapy Units,1373444,LOCAL,97140,CPT,,,,,GO,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,65.845,Based on EAPG RVU's
OT Massage Assistant Units,1041799,LOCAL,97124,CPT,,,,,CQ,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,27.37,47.26,Based on EAPG RVU's
OT Massage Charge Units,1041799,LOCAL,97124,CPT,,,,,GO,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,27.37,47.26,Based on EAPG RVU's
OT Massage Rehab Assist Units,7897698,LOCAL,97124,CPT,,,,,CQ,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,27.37,47.26,Based on EAPG RVU's
OT Massage Rehab Units,7897698,LOCAL,97124,CPT,,,,,GO,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,27.37,47.26,Based on EAPG RVU's
PT Manual Therapy Assistant Units,9390440,LOCAL,97140,CPT,,,,,CQ,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,65.845,Based on EAPG RVU's
PT Massage Assistant Units,9390438,LOCAL,97124,CPT,,,,,CQ,Outpatient,,,114.56,74,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,27.37,47.26,Based on EAPG RVU's
Thinprep TIS Pap QST,9773891,LOCAL,88175,CPT,,,,,,Outpatient,,,115,31.93,Blue Cross of AL,Blue Cross,25.25,,,,,,,Other,25.25,26.61,Based on EAPG RVU's
Thinprep TIS Pap Rfx HPV mRNA E6/E7 QST,9773936,LOCAL,88175,CPT,,,,,,Outpatient,,,115,31.93,Blue Cross of AL,Blue Cross,25.25,,,,,,,Other,25.25,26.61,Based on EAPG RVU's
97033 IONTOPHORESIS CHARGE,9410271,LOCAL,97033,CPT,,,,,GP,Outpatient,,,115.06,75,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,17.64,47.26,Based on EAPG RVU's
97033 IONTOPHORESIS EA 15 MIN CHARGES,9640077,LOCAL,97033,CPT,,,,,GP,Outpatient,,,115.06,75,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,17.64,47.26,Based on EAPG RVU's
97033 OT IONTOPHORESIS,9850073,LOCAL,97033,CPT,,,,,GO,Outpatient,,,115.06,75,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,17.64,47.26,Based on EAPG RVU's
97033 OT IONTOPHORESIS 15 MIN APPL CHARGE,9860073,LOCAL,97033,CPT,,,,,GO|CO,Outpatient,,,115.06,75,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,17.64,47.26,Based on EAPG RVU's
97033 PT IONTOPHORESIS,9650077,LOCAL,97033,CPT,,,,,GP|CQ,Outpatient,,,115.06,75,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,17.64,47.26,Based on EAPG RVU's
Iontophoresis Charges,1366374,LOCAL,97033,CPT,,,,,GO,Outpatient,,,115.06,75,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,17.64,47.26,Based on EAPG RVU's
Iontophoresis Charges,7895927,LOCAL,97033,CPT,,,,,GP,Outpatient,,,115.06,75,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,17.64,47.26,Based on EAPG RVU's
OT Iontophoresis Assistant Units,1366374,LOCAL,97033,CPT,,,,,CQ,Outpatient,,,115.06,75,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,17.64,47.26,Based on EAPG RVU's
OT Iontophoresis Assistant Units,1373443,LOCAL,97033,CPT,,,,,CQ,Outpatient,,,115.06,75,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,17.64,47.26,Based on EAPG RVU's
OT Iontophoresis Charges,1366374,LOCAL,97033,CPT,,,,,GO,Outpatient,,,115.06,75,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,17.64,47.26,Based on EAPG RVU's
OT Iontophoresis Units,1373443,LOCAL,97033,CPT,,,,,GO,Outpatient,,,115.06,75,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,17.64,47.26,Based on EAPG RVU's
PT Iontophoresis Assistant Units,9390424,LOCAL,97033,CPT,,,,,CQ,Outpatient,,,115.06,75,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,17.64,47.26,Based on EAPG RVU's
Allergy Panel13 Stinging Insect Grp QSTC,9063178,LOCAL,86003,CPT,,,,,,Outpatient,,,115.65,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Honey Bee (I1) IgE QST,12866524,LOCAL,86003,CPT,,,,,,Outpatient,,,115.65,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Peanut Component Panel QSTC,8764809,LOCAL,86008,CPT,,,,,,Outpatient,,,115.65,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,17.93,Based on EAPG RVU's
RT CHARGE Chest Physiotherapy -> PEP Therapy Initial,8699752,LOCAL,94668,CPT,,,,,,Outpatient,,,115.89,75,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,117.85,Based on EAPG RVU's
"Chlamydia Trachomatis RNA, TMA QST",12762527,LOCAL,87491,CPT,,,,,,Outpatient,,,117,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
"Mycoplasma Genitalium, rRNA QST",12762530,LOCAL,87563,CPT,,,,,,Outpatient,,,117,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
"Neisseria Gonorrhoeae RNA, TMA QST",12762531,LOCAL,87591,CPT,,,,,,Outpatient,,,117,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
Trichomonas Vaginalis RNA QST,12762534,LOCAL,87661,CPT,,,,,,Outpatient,,,117,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
Ferritin,1628893,LOCAL,82728,CPT,,,,,,Outpatient,,,117.5,16.36,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,50.82956044,Based on EAPG RVU's
"96368 IV INFUSION, CONCURRENT, DIFFERENT MED",7904534,LOCAL,96368,CPT,,,260,RC,,Outpatient,,,117.59,76,Blue Cross of AL,Blue Cross,442.94,,,,,,,Other,442.94,442.94,Based on EAPG RVU's
"96368- IV tx, concurrent infusion",1928302,LOCAL,96368,CPT,,,450,RC,,Outpatient,,,117.59,76,Blue Cross of AL,Blue Cross,442.94,,,,,,,Other,442.94,442.94,Based on EAPG RVU's
97750 - Physical performance test or measurement,9640058,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,31.29,56.44,Based on EAPG RVU's
97750 FCE-FUNCTIONAL CAPACITY EVAL 1 CHARGE,9640050,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,31.29,56.44,Based on EAPG RVU's
97750 OT PERF TEST MEAS 15 MIN CHARGE,9850061,LOCAL,97750,CPT,,,,,GO,Outpatient,,,118.17,77,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,31.29,56.44,Based on EAPG RVU's
97750 OT Strapping Shoulder Assistant Units,9860061,LOCAL,97750,CPT,,,,,GO|CO,Outpatient,,,118.17,77,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,31.29,56.44,Based on EAPG RVU's
97750 PRE WORK SCREEN CHARGE,9650058,LOCAL,97750,CPT,,,,,GP|CQ,Outpatient,,,118.17,77,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,31.29,56.44,Based on EAPG RVU's
97750 PT ISOKINETIC TEST 15 MIN,9640053,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,31.29,56.44,Based on EAPG RVU's
97750 PT ISOKINETIC TEST 15 MIN ASST,9650053,LOCAL,97750,CPT,,,,,GP|CQ,Outpatient,,,118.17,77,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,31.29,56.44,Based on EAPG RVU's
97750 PT PHYSICAL PERFORMANCE TEST CHARGE,9650050,LOCAL,97750,CPT,,,,,GP|CQ,Outpatient,,,118.17,77,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,31.29,56.44,Based on EAPG RVU's
97761 (PROSTHETIC TRAINING CAWC),9650033,LOCAL,97761,CPT,,,,,GP|CQ,Outpatient,,,118.17,77,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,37.35,56.44,Based on EAPG RVU's
97761 PROSTHETIC TRAINING 15 MINS,9640033,LOCAL,97761,CPT,,,,,GP,Outpatient,,,118.17,77,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,37.35,56.44,Based on EAPG RVU's
97761 PT PROSTHETIC TRAINING CHARGE,9410181,LOCAL,97761,CPT,,,,,GP,Outpatient,,,118.17,77,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,37.35,56.44,Based on EAPG RVU's
Functional Capacity Eval Charge,7895967,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,31.29,56.44,Based on EAPG RVU's
OT Physical Performance Test Assistant Units,7895284,LOCAL,97750,CPT,,,,,CQ,Outpatient,,,118.17,77,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,31.29,56.44,Based on EAPG RVU's
OT Physical Performance Test Charges,7895284,LOCAL,97750,CPT,,,,,GO,Outpatient,,,118.17,77,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,31.29,56.44,Based on EAPG RVU's
OT Physical Performance Test Units,7897702,LOCAL,97750,CPT,,,,,GO,Outpatient,,,118.17,77,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,31.29,56.44,Based on EAPG RVU's
Prosthetic Training Charges,7895930,LOCAL,97761,CPT,,,,,GP,Outpatient,,,118.17,77,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,37.35,56.44,Based on EAPG RVU's
PT Physical Performance Assistant Test,9390432,LOCAL,97750,CPT,,,,,CQ,Outpatient,,,118.17,77,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,31.29,56.44,Based on EAPG RVU's
PT Physical Performance Test Charges,7895980,LOCAL,97750,CPT,,,,,GP,Outpatient,,,118.17,77,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,31.29,56.44,Based on EAPG RVU's
"PT Prosthetic Management, Train Assistant Units",9390460,LOCAL,97761,CPT,,,,,CQ,Outpatient,,,118.17,77,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,37.35,56.44,Based on EAPG RVU's
"29125 Application of short arm splint (forearm to hand); static, right",8584933,LOCAL,29125,CPT,,,,,,Outpatient,,,120,129,Blue Cross of AL,Blue Cross,63.51,,,,,,,Other,63.51,863,Based on EAPG RVU's
"Chlamydia Trachomatis RNA, TMA QST",14747186,LOCAL,87491,CPT,,,,,,Outpatient,,,120,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
Cortisol Baseline,7974014,LOCAL,80400,CPT,,,,,,Outpatient,,,120,39.14,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,75.985,Based on EAPG RVU's
Cyt Clinical Info QST,14754292,LOCAL,88104,CPT,,,,,,Outpatient,,,120,,Blue Cross of AL,Blue Cross,14.07,,,,,,,Other,14.07,35.88,Based on EAPG RVU's
Cyt Pathologist QST,14754294,LOCAL,88172,CPT,,,,,,Outpatient,,,120,,Blue Cross of AL,Blue Cross,58.01,,,,,,,Other,58.01,156.67,Based on EAPG RVU's
Cyt Report Notes QST,14754295,LOCAL,88173,CPT,,,,,,Outpatient,,,120,,Blue Cross of AL,Blue Cross,53.82,,,,,,,Other,48.85,53.82,Based on EAPG RVU's
Cyt Report Type QST,14754291,LOCAL,88121,CPT,,,,,,Outpatient,,,120,,Blue Cross of AL,Blue Cross,58.01,,,,,,,Other,58.01,156.67,Based on EAPG RVU's
Cyt Screener QST,14754293,LOCAL,87207,CPT,,,,,,Outpatient,,,120,7.19,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,5.99,10.57,Based on EAPG RVU's
"Mycoplasma Genitalium, rRNA QST",14747189,LOCAL,87563,CPT,,,,,,Outpatient,,,120,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
"Neisseria Gonorrhoeae RNA, TMA QST",14747187,LOCAL,87591,CPT,,,,,,Outpatient,,,120,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
Tissue 1A Source QST,14754297,LOCAL,88108,CPT,,,,,,Outpatient,,,120,,Blue Cross of AL,Blue Cross,14.07,,,,,,,Other,14.07,35.88,Based on EAPG RVU's
Tissue 1B Source QST,14754303,LOCAL,88108,CPT,,,,,,Outpatient,,,120,,Blue Cross of AL,Blue Cross,14.07,,,,,,,Other,14.07,35.88,Based on EAPG RVU's
Tissue 1C Source QST,14754321,LOCAL,88108,CPT,,,,,,Outpatient,,,120,,Blue Cross of AL,Blue Cross,14.07,,,,,,,Other,14.07,35.88,Based on EAPG RVU's
Tissue A Clinical Impression QST,14754296,LOCAL,88160,CPT,,,,,,Outpatient,,,120,,Blue Cross of AL,Blue Cross,14.07,,,,,,,Other,14.07,22.39,Based on EAPG RVU's
Tissue A Comment QST,14754301,LOCAL,88161,CPT,,,,,,Outpatient,,,120,,Blue Cross of AL,Blue Cross,14.07,,,,,,,Other,14.07,22.39,Based on EAPG RVU's
Tissue A Diagnosis QST,14754300,LOCAL,88162,CPT,,,,,,Outpatient,,,120,,Blue Cross of AL,Blue Cross,58.01,,,,,,,Other,48.85,58.01,Based on EAPG RVU's
Tissue A Gross Description QST,14754299,LOCAL,88305,CPT,,,,,,Outpatient,,,120,,Blue Cross of AL,Blue Cross,59.06,,,,,,,Other,48.85,59.06,Based on EAPG RVU's
Tissue B Comment QST,14754307,LOCAL,88161,CPT,,,,,,Outpatient,,,120,,Blue Cross of AL,Blue Cross,14.07,,,,,,,Other,14.07,22.39,Based on EAPG RVU's
Tissue B Diagnosis QST,14754306,LOCAL,88162,CPT,,,,,,Outpatient,,,120,,Blue Cross of AL,Blue Cross,58.01,,,,,,,Other,48.85,58.01,Based on EAPG RVU's
Tissue B Gross Description QST,14754305,LOCAL,88305,CPT,,,,,,Outpatient,,,120,,Blue Cross of AL,Blue Cross,59.06,,,,,,,Other,48.85,59.06,Based on EAPG RVU's
Tissue C Clinical Impression QST,14754320,LOCAL,88160,CPT,,,,,,Outpatient,,,120,,Blue Cross of AL,Blue Cross,14.07,,,,,,,Other,14.07,22.39,Based on EAPG RVU's
Tissue C Comment QST,14754325,LOCAL,88161,CPT,,,,,,Outpatient,,,120,,Blue Cross of AL,Blue Cross,14.07,,,,,,,Other,14.07,22.39,Based on EAPG RVU's
Tissue C Diagnosis QST,14754324,LOCAL,88162,CPT,,,,,,Outpatient,,,120,,Blue Cross of AL,Blue Cross,58.01,,,,,,,Other,48.85,58.01,Based on EAPG RVU's
Tissue C Gross Description QST,14754323,LOCAL,88305,CPT,,,,,,Outpatient,,,120,,Blue Cross of AL,Blue Cross,59.06,,,,,,,Other,48.85,59.06,Based on EAPG RVU's
Trichomonas Vaginalis RNA QST,14747188,LOCAL,87661,CPT,,,,,,Outpatient,,,120,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
T. candidus QSTC,9010450,LOCAL,86606,CPT,,,,,,Outpatient,,,120.75,18.06,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.05,15.29,Based on EAPG RVU's
T. vulgaris QSTC,9010456,LOCAL,86609,CPT,,,,,,Outpatient,,,120.75,15.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.88,15.29,Based on EAPG RVU's
Trichoderma viride IgG QSTC,9010474,LOCAL,86001,CPT,,,,,,Outpatient,,,120.75,9.38,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,7.82,15.29,Based on EAPG RVU's
"Fecal Lipids, Total QSTC",8972795,LOCAL,82710,CPT,,,,,,Outpatient,,,121.19,20.16,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,16.8,17.73,Based on EAPG RVU's
Oxcarbazepine Metabolite QSTC,8764758,LOCAL,80183,CPT,,,,,,Outpatient,,,121.5,15.9,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,13.25,15.38,Based on EAPG RVU's
97110  SB OT Thera Exer,9850027,LOCAL,97110,CPT,,,,,GO,Outpatient,,,122.28,79,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,36.59637931,56.44,Based on EAPG RVU's
97110  SB PT Thera Exer,9650027,LOCAL,97110,CPT,,,,,GP|CQ,Outpatient,,,122.28,79,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,36.59637931,56.44,Based on EAPG RVU's
97110 EXERCISE 1/MORE AREAS CHARGE,9410136,LOCAL,97110,CPT,,,,,GP,Outpatient,,,122.28,79,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,36.59637931,56.44,Based on EAPG RVU's
97110 OT Therapeutic Exercise Assistant Units,9860027,LOCAL,97110,CPT,,,,,GO|CO,Outpatient,,,122.28,79,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,36.59637931,56.44,Based on EAPG RVU's
97110 PT THERAPEUTIC EXERCISE,9640054,LOCAL,97110,CPT,,,,,GP,Outpatient,,,122.28,79,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,36.59637931,56.44,Based on EAPG RVU's
97110 PT Therapeutic Exercise Assistant Units,9650054,LOCAL,97110,CPT,,,,,GP|CQ,Outpatient,,,122.28,79,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,36.59637931,56.44,Based on EAPG RVU's
97110 THERAPEUTIC EXER 15 MIN CHARGES,9640027,LOCAL,97110,CPT,,,,,GP,Outpatient,,,122.28,79,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,36.59637931,56.44,Based on EAPG RVU's
OT Therapeutic Exercise Assistant Units,750901,LOCAL,97110,CPT,,,,,CQ,Outpatient,,,122.28,79,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,36.59637931,56.44,Based on EAPG RVU's
OT Therapeutic Exercise Charges,750901,LOCAL,97110,CPT,,,,,GO,Outpatient,,,122.28,79,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,36.59637931,56.44,Based on EAPG RVU's
OT Therapeutic Exercise Rehab Units,7897696,LOCAL,97110,CPT,,,,,GO,Outpatient,,,122.28,79,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,36.59637931,56.44,Based on EAPG RVU's
PT Therapeutic Exercise Assistant Units,9390430,LOCAL,97110,CPT,,,,,CQ,Outpatient,,,122.28,79,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,36.59637931,56.44,Based on EAPG RVU's
Therapeutic Exercise Charges,750901,LOCAL,97110,CPT,,,,,GO,Outpatient,,,122.28,79,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,36.59637931,56.44,Based on EAPG RVU's
Therapeutic Exercise Charges,7895934,LOCAL,97110,CPT,,,,,GP,Outpatient,,,122.28,79,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,36.59637931,56.44,Based on EAPG RVU's
Creatine Kinase,633712,LOCAL,82550,CPT,,,,,,Outpatient,,,122.4,7.81,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,23.7373913,Based on EAPG RVU's
Genital Culture,633894,LOCAL,87070,CPT,,,,,,Outpatient,,,122.4,10.34,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,67.60639535,Based on EAPG RVU's
Respiratory Culture,4123062,LOCAL,87070,CPT,,,,,,Outpatient,,,122.4,10.34,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,67.60639535,Based on EAPG RVU's
Sputum Culture,7909553,LOCAL,87070,CPT,,,,,,Outpatient,,,122.4,10.34,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,67.60639535,Based on EAPG RVU's
Blood Culture,4122800,LOCAL,87040,CPT,,,,,,Outpatient,,,123.22,12.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,19.45393258,Based on EAPG RVU's
Blood Unit Culture,7967813,LOCAL,87040,CPT,,,,,,Outpatient,,,123.22,12.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,19.45393258,Based on EAPG RVU's
Folate Level,1628894,LOCAL,82746,CPT,,,,,,Outpatient,,,123.62,17.64,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,48.81056075,Based on EAPG RVU's
Troponin-I,1634892,LOCAL,84484,CPT,,,,,,Outpatient,,,124.52,14.96,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,0.887987013,17.73,Based on EAPG RVU's
influenza vaccine (Flucelvax PF) vaccine 2025-2026 [CULL],11292050,LOCAL,90661,CPT,,,,,,Outpatient,0.5,ML,124.60032,,Blue Cross of AL,Blue Cross,39.58,,,,,,,Other,39.58,52.0225,Based on EAPG RVU's
29584 PT APPLICATION OF MULTI-LAYER COMPRESSION SYSTEM,9109668,LOCAL,29584,CPT,,,,,GP,Outpatient,,,125,81,Blue Cross of AL,Blue Cross,63.51,,,,,,,Other,63.51,863,Based on EAPG RVU's
Drug Screen DOT SO,13940917,LOCAL,80307,CPT,,,301,RC,,Outpatient,,,125,74.57,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,160.4,Based on EAPG RVU's
PT MultiLayer Compress Below Knee Charge,7896004,LOCAL,29584,CPT,,,,,GP,Outpatient,,,125,81,Blue Cross of AL,Blue Cross,63.51,,,,,,,Other,63.51,863,Based on EAPG RVU's
XR TMJ Open and Closed Left,9514710,LOCAL,70328,CPT,,,,,LT,Outpatient,,,125,66.83,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR TMJ Open and Closed Right,9514712,LOCAL,70328,CPT,,,,,RT,Outpatient,,,125,66.83,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
Liver Kidney Microsomal LKM1 Ab IgG QSTC,8764790,LOCAL,86376,CPT,,,,,,Outpatient,,,125.19,17.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,25.085,Based on EAPG RVU's
PTH-Related Protein (PTH-RP) QSTC,8764743,LOCAL,83519,CPT,,,,,,Outpatient,,,126,22.08,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,72.02,Based on EAPG RVU's
REF DAT IgG,7939268,LOCAL,86880,CPT,,,,,,Outpatient,,,126,6.47,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,54.31,Based on EAPG RVU's
Computer Crossmatch Interp -> Computer XM OK,8142426,LOCAL,86923,CPT,,,,,,Outpatient,,,126.02,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
Serological Immediate Spin -> Compatible,8014366,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
Serological Immediate Spin -> Corrected,10125801,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
Serological Immediate Spin -> Incompatible,9527535,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
XM AHG Gel Interp -> Compatible,8013754,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
XM AHG Gel Interp -> Incompatible,8013753,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
XM AHG Gel Interp -> Least Incompatible,8013752,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
XM AHG Tube Interp -> Compatible,8014220,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
XM AHG Tube Interp -> Incompatible,8014219,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
XM AHG Tube Interp -> Least Incompatible,8014218,LOCAL,86920,CPT,,,,,,Outpatient,,,126.02,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
Alanine aminotransferase,633632,LOCAL,84460,CPT,,,,,,Outpatient,,,126.07,6.36,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,5.3,7.16,Based on EAPG RVU's
Erythrocyte Sedimentation Rate (ESR),7909828,LOCAL,85652,CPT,,,,,,Outpatient,,,126.07,3.24,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,8.21,43.67975976,Based on EAPG RVU's
97112 BAL ACT EA 15 MIN CHARGES,9640028,LOCAL,97112,CPT,,,,,GP,Outpatient,,,127.2,83,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,30.63,56.44,Based on EAPG RVU's
97112 NEUROMUSCULAR RE-EDUCATION CHARGE,9410141,LOCAL,97112,CPT,,,,,GP,Outpatient,,,127.2,83,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,30.63,56.44,Based on EAPG RVU's
97112 OT NEURO MUSCULAR RE ED EA 15 MIN,9850028,LOCAL,97112,CPT,,,,,GO,Outpatient,,,127.2,83,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,30.63,56.44,Based on EAPG RVU's
97112 OT Neuromusc Re-education Assistant Units,9860028,LOCAL,97112,CPT,,,,,GO|CO,Outpatient,,,127.2,83,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,30.63,56.44,Based on EAPG RVU's
97112 PT Neuromuscular Re-Ed Assistant Units,9650028,LOCAL,97112,CPT,,,,,GP|CQ,Outpatient,,,127.2,83,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,30.63,56.44,Based on EAPG RVU's
Neuromuscular Reeducation Charges,750905,LOCAL,97112,CPT,,,,,GO,Outpatient,,,127.2,83,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,30.63,56.44,Based on EAPG RVU's
Neuromuscular Reeducation Charges,7895932,LOCAL,97112,CPT,,,,,GP,Outpatient,,,127.2,83,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,30.63,56.44,Based on EAPG RVU's
OT Neuromuscular Reeducation Assistant Units,750905,LOCAL,97112,CPT,,,,,CQ,Outpatient,,,127.2,83,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,30.63,56.44,Based on EAPG RVU's
OT Neuromuscular Reeducation Charges,750905,LOCAL,97112,CPT,,,,,GO,Outpatient,,,127.2,83,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,30.63,56.44,Based on EAPG RVU's
OT Neuromuscular Reeducation Rehab Units,7897697,LOCAL,97112,CPT,,,,,GO,Outpatient,,,127.2,83,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,30.63,56.44,Based on EAPG RVU's
PT Neuromuscular Reeducation Assistant Units,9390444,LOCAL,97112,CPT,,,,,CQ,Outpatient,,,127.2,83,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,30.63,56.44,Based on EAPG RVU's
Culture Fungus Smear not Hr Skn Bld QST,10217136,LOCAL,87102,CPT,,,,,,Outpatient,,,127.3,10.09,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,53.14428571,Based on EAPG RVU's
Alcohol Level,1503765,LOCAL,,,G0480,HCPCS,,,,Outpatient,,,129.74,84,Blue Cross of AL,Blue Cross,46.74,,,,,,,Other,46.74,114.43,Based on EAPG RVU's
CBC w/ Differential,633683,LOCAL,85025,CPT,,,,,,Outpatient,,,129.74,9.32,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,8.21,31.45666667,Based on EAPG RVU's
Na Citrate Platelet Count,9472554,LOCAL,85049,CPT,,,,,,Outpatient,,,129.74,5.38,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,8.21,33.535,Based on EAPG RVU's
Platelet Count,2182297,LOCAL,85049,CPT,,,,,,Outpatient,,,129.74,5.38,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,8.21,33.535,Based on EAPG RVU's
Platelet Count Manual,7974157,LOCAL,85049,CPT,,,,,,Outpatient,,,129.74,5.38,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,8.21,33.535,Based on EAPG RVU's
iron dextran 50 mg/mL injectable solution 2 mL [CULL],11205256,LOCAL,J1750,CPT,,,,,,Outpatient,2,ML,129.85728,,Blue Cross of AL,Blue Cross,122.4,,,,,,,Other,18.11,122.4,Based on EAPG RVU's
70030 X-RAY EYE FOR FOREIGN BODY,8658473,LOCAL,70030,CPT,,,,,,Outpatient,,,130,72.6,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Foreign Body Localization Eye,8658473,LOCAL,70030,CPT,,,,,,Outpatient,,,130,72.6,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
TSI(Thyroid Stimulating Immunoglob) QSTC,8764795,LOCAL,84445,CPT,,,,,,Outpatient,,,130.05,61.03,Blue Cross of AL,Blue Cross,47.35,,,,,,,Other,47.35,89.95,Based on EAPG RVU's
Glucose Fasting GTT,8238854,LOCAL,82951,CPT,,,,,,Outpatient,,,130.97,15.44,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,12.87,17.73,Based on EAPG RVU's
97535  SB PT Act of Liv 15 m,9640035,LOCAL,97535,CPT,,,,,GP,Outpatient,,,132.09,86,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.70452962,47.26,Based on EAPG RVU's
97535 OT HOME MAKING ACTIVITY CHARGE,9820191,LOCAL,97535,CPT,,,,,GO,Outpatient,,,132.09,86,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.70452962,47.26,Based on EAPG RVU's
97535 OT SELF CARE/HOME MGMT/ADL 15 MIN,9860191,LOCAL,97535,CPT,,,,,GO|CO,Outpatient,,,132.09,86,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.70452962,47.26,Based on EAPG RVU's
97535 PT ADL Training/Self Care Assistant Units,9650035,LOCAL,97535,CPT,,,,,GP|CQ,Outpatient,,,132.09,86,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.70452962,47.26,Based on EAPG RVU's
97535 SELF CARE/HOME MGMT-ADL'S CHARGE,9410191,LOCAL,97535,CPT,,,,,GP,Outpatient,,,132.09,86,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.70452962,47.26,Based on EAPG RVU's
ADL Training Charge,7895959,LOCAL,97535,CPT,,,,,GP,Outpatient,,,132.09,86,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.70452962,47.26,Based on EAPG RVU's
ADL Training Charges,1366372,LOCAL,97535,CPT,,,,,GO,Outpatient,,,132.09,86,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.70452962,47.26,Based on EAPG RVU's
OT ADL Training Charges,1366372,LOCAL,97535,CPT,,,,,GO,Outpatient,,,132.09,86,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.70452962,47.26,Based on EAPG RVU's
"OT Self Care, Home Management Units",1373569,LOCAL,97535,CPT,,,,,GO,Outpatient,,,132.09,86,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.70452962,47.26,Based on EAPG RVU's
"OT Self Care, Home Mgmt Assistant Units",1373569,LOCAL,97535,CPT,,,,,CQ,Outpatient,,,132.09,86,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,14.70452962,47.26,Based on EAPG RVU's
97530  SB OT Thera Act 15,9850032,LOCAL,97530,CPT,,,,,GO,Outpatient,,,133.15,87,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,78.32022727,Based on EAPG RVU's
97530 ACTIVITIES EACH 15 MIN CHARGE,9410270,LOCAL,97530,CPT,,,,,GP,Outpatient,,,133.15,87,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,78.32022727,Based on EAPG RVU's
97530 OT Therapeutic Activities Assistant Units,9860032,LOCAL,97530,CPT,,,,,GO|CO,Outpatient,,,133.15,87,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,78.32022727,Based on EAPG RVU's
97530 PT MAT\BED ACTIVITIES CHARGE,9640034,LOCAL,97530,CPT,,,,,GP,Outpatient,,,133.15,87,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,78.32022727,Based on EAPG RVU's
97530 PT Theraputic Activities Assistant Units,9650034,LOCAL,97530,CPT,,,,,GP|CQ,Outpatient,,,133.15,87,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,78.32022727,Based on EAPG RVU's
OT Therapeutic Activities Assistant Units,750903,LOCAL,97530,CPT,,,,,CQ,Outpatient,,,133.15,87,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,78.32022727,Based on EAPG RVU's
OT Therapeutic Activities Charges,750903,LOCAL,97530,CPT,,,,,GO,Outpatient,,,133.15,87,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,78.32022727,Based on EAPG RVU's
OT Therapeutic Activities Rehab Units,7897699,LOCAL,97530,CPT,,,,,GO,Outpatient,,,133.15,87,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,78.32022727,Based on EAPG RVU's
PT Therapeutic Activity Assistant Units,9390442,LOCAL,97530,CPT,,,,,CQ,Outpatient,,,133.15,87,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,78.32022727,Based on EAPG RVU's
Therapeutic Activities Charge,7895929,LOCAL,97530,CPT,,,,,GP,Outpatient,,,133.15,87,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,78.32022727,Based on EAPG RVU's
Therapeutic Activities Charges,750903,LOCAL,97530,CPT,,,,,GO,Outpatient,,,133.15,87,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,78.32022727,Based on EAPG RVU's
BB CROSSMATCH (AHG),6413027,LOCAL,86922,CPT,,,,,,Outpatient,,,133.82,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
BB CROSSMATCH (XMG INSTRUMENT),6413070,LOCAL,86922,CPT,,,,,,Outpatient,,,133.82,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
Urine Culture,4126493,LOCAL,87086,CPT,,,,,,Outpatient,,,134.64,9.68,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,31.43235995,Based on EAPG RVU's
.dRVVT 1:1 Mix QSTC,6230328,LOCAL,85613,CPT,,,,,,Outpatient,,,135,11.5,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,9.58,Based on EAPG RVU's
Glomerular Basement Memb. Ab (IgG) QSTC,8853257,LOCAL,83520,CPT,,,,,,Outpatient,,,135,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,117.3767568,Based on EAPG RVU's
Glutamic Acid Decarboxylase-65 Ab QSTC,8764746,LOCAL,86341,CPT,,,,,,Outpatient,,,135,28.28,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,23.57,Based on EAPG RVU's
Quad Screen QSTC,8972927,LOCAL,81511,CPT,,,,,,Outpatient,,,135,184.2,Blue Cross of AL,Blue Cross,173.68,,,,,,,Other,153.5,173.68,Based on EAPG RVU's
Ribosomal P Antibody QSTC,8853260,LOCAL,83516,CPT,,,,,,Outpatient,,,135,13.84,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,11.53,17.73,Based on EAPG RVU's
"Rickettsia RMSF IgG,IgM w rfx Titer QSTC",8764764,LOCAL,86757,CPT,,,,,,Outpatient,,,135,23.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,19.35,Based on EAPG RVU's
Tryptase QSTC,8764744,LOCAL,83520,CPT,,,,,,Outpatient,,,135,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,117.3767568,Based on EAPG RVU's
96523 Port Flush,14892040,LOCAL,96523,CPT,,,,,59,Outpatient,,,136,153,Blue Cross of AL,Blue Cross,64.56,,,,,,,Other,54.31,64.56,Based on EAPG RVU's
.Endomysial Ab Titer QSTC,8853243,LOCAL,86231,CPT,,,,,,Outpatient,,,136.17,14.51,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,106.935,Based on EAPG RVU's
Endomysial (IgG) Antibody Screen and Titer QSTC,10146198,LOCAL,86231,CPT,,,,,,Outpatient,,,136.17,14.51,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,106.935,Based on EAPG RVU's
"96361- Hydration, each additional hour",1928298,LOCAL,96361,CPT,,,,,,Outpatient,,,137.66,89,Blue Cross of AL,Blue Cross,749.76,,,,,,,Other,42.18,749.76,Based on EAPG RVU's
96361 IV INFUSION HYDRATION ADDL HR Charge,8049102,LOCAL,96361,CPT,,,,,,Outpatient,,,137.66,89,Blue Cross of AL,Blue Cross,749.76,,,,,,,Other,42.18,749.76,Based on EAPG RVU's
90472 PO IMMUNIZATION ADM EA ADDTL VAC CHARGE,9279753,LOCAL,90472,CPT,,,,,,Outpatient,,,137.77,90,Blue Cross of AL,Blue Cross,56.18,,,,,,,Other,14.55,56.18,Based on EAPG RVU's
Phenytoin Lvl Total,7973985,LOCAL,80185,CPT,,,,,,Outpatient,,,138,15.9,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,75.495,Based on EAPG RVU's
"Allergy Panel 19, Seafood QSTC",13864480,LOCAL,86003,CPT,,,,,,Outpatient,,,138.78,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Crystal Examination Body Fluid,3454316,LOCAL,89060,CPT,,,,,,Outpatient,,,139,8.8,Blue Cross of AL,Blue Cross,14.07,,,,,,,Other,14.07,21.53,Based on EAPG RVU's
Bill Cyto Path Cell Enhance Tech,8489561,LOCAL,88112,CPT,,,,,,Outpatient,,,139.94,,Blue Cross of AL,Blue Cross,42.2,,,,,,,Other,42.2,48.85,Based on EAPG RVU's
Bill FNA Eval Interp & Rpt,8489566,LOCAL,88173,CPT,,,,,,Outpatient,,,139.94,,Blue Cross of AL,Blue Cross,53.82,,,,,,,Other,48.85,53.82,Based on EAPG RVU's
Bill IHC Antibody Additional,14048006,LOCAL,88341,CPT,,,,,,Outpatient,,,139.94,,Blue Cross of AL,Blue Cross,59.06,,,,,,,Other,59.04,59.06,Based on EAPG RVU's
Bill Tissue Exam Level 3,14047998,LOCAL,88304,CPT,,,,,,Outpatient,,,139.94,,Blue Cross of AL,Blue Cross,32.32,,,,,,,Other,32.32,48.85,Based on EAPG RVU's
Bill Tissue Exam Level 4,14036169,LOCAL,88305,CPT,,,,,,Outpatient,,,139.94,,Blue Cross of AL,Blue Cross,59.06,,,,,,,Other,48.85,59.06,Based on EAPG RVU's
70250 X-RAY EXAM OF SKULL,8658523,LOCAL,70250,CPT,,,,,,Outpatient,,,140,286.28,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
hepatitis A pediatric vaccine 25 units/0.5 mL intramuscular suspension 0.5 mL [CULL],11202555,LOCAL,90632,CPT,,,,,,Outpatient,0.5,ML,140.288,,Blue Cross of AL,Blue Cross,39.58,,,,,,,Other,39.58,73.542,Based on EAPG RVU's
"West Nile Ab IgG, CSF QSTC",13872975,LOCAL,86789,CPT,,,,,,Outpatient,,,141.3,17.27,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.39,15.29,Based on EAPG RVU's
"West Nile Ab IgG, Serum QSTC",9010233,LOCAL,86789,CPT,,,,,,Outpatient,,,141.3,17.27,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.39,15.29,Based on EAPG RVU's
"West Nile Ab IgM, CSF QSTC",13872978,LOCAL,86788,CPT,,,,,,Outpatient,,,141.3,20.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,16.85,Based on EAPG RVU's
"West Nile Ab IgM, Serum QSTC",9010236,LOCAL,86788,CPT,,,,,,Outpatient,,,141.3,20.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,16.85,Based on EAPG RVU's
"Chlamydia Trachomatis RNA, TMA QST",14718353,LOCAL,87491,CPT,,,,,,Outpatient,,,142,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
HPV MRNA E6/E7 QSTA,14718356,LOCAL,87624,CPT,,,,,,Outpatient,,,142,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,67.195,Based on EAPG RVU's
Thinprep Review Cytotechnologist: QST,14718368,LOCAL,88175,CPT,,,,,,Outpatient,,,142,31.93,Blue Cross of AL,Blue Cross,25.25,,,,,,,Other,25.25,26.61,Based on EAPG RVU's
"Trichomonas vaginalis, Ql TMA, Pap QST",14718355,LOCAL,87661,CPT,,,,,,Outpatient,,,142,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
"Cardio IQ(R) Lipoprotein Fraction, Ion Mobility QSTC",9039426,LOCAL,83704,CPT,,,,,,Outpatient,,,142.38,41.03,Blue Cross of AL,Blue Cross,46.74,,,,,,,Other,34.19,46.74,Based on EAPG RVU's
Parathyroid Hormone Intact,3455483,LOCAL,83970,CPT,,,,,,Outpatient,,,143,49.54,Blue Cross of AL,Blue Cross,47.35,,,,,,,Other,47.35,92.84111111,Based on EAPG RVU's
ROOM/BED: Observation,2120846,LOCAL,,,G0378,HCPCS,762,RC,,Outpatient,,,143,,Blue Cross of AL,Blue Cross,1177.75,,,,,,,Other,1177.75,1177.75,Based on EAPG RVU's
"Factor VIII Activity, Clotting QSTC",9039263,LOCAL,85240,CPT,,,,,,Outpatient,,,144,21.48,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,17.9,Based on EAPG RVU's
"Sirolimus, LC/MS/MS QSTC",8764819,LOCAL,80195,CPT,,,,,,Outpatient,,,144,16.48,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,13.73,15.38,Based on EAPG RVU's
97760 ORTHOTICS FIT/TRAIN EA 15MN CHARGE,9410176,LOCAL,97760,CPT,,,,,GP,Outpatient,,,144.44,94,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,42.32,56.44,Based on EAPG RVU's
97760 ORTHOTICS FITTING & TRAINING CHARGE,9850030,LOCAL,97760,CPT,,,,,GO,Outpatient,,,144.44,94,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,42.32,56.44,Based on EAPG RVU's
97760 OT Orthotic Mgmt/Train Initial Charge Assistant Units,9860030,LOCAL,97760,CPT,,,,,GO|CO,Outpatient,,,144.44,94,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,42.32,56.44,Based on EAPG RVU's
97760 PO ORTHOTIC EVALUATION CHARGE,9640032,LOCAL,97760,CPT,,,,,GP,Outpatient,,,144.44,94,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,42.32,56.44,Based on EAPG RVU's
97760 PO ORTHOTIC FOLLOW UP CHARGE,9650032,LOCAL,97760,CPT,,,,,GP|CQ,Outpatient,,,144.44,94,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,42.32,56.44,Based on EAPG RVU's
Orthotic Mgmt and Training Charges,7895275,LOCAL,97760,CPT,,,,,GO,Outpatient,,,144.44,94,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,42.32,56.44,Based on EAPG RVU's
Orthotic Mgmt and Training Charges,7895953,LOCAL,97760,CPT,,,,,GP,Outpatient,,,144.44,94,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,42.32,56.44,Based on EAPG RVU's
"OT Orthotic Management, Train Assistant Units",1373573,LOCAL,97760,CPT,,,,,CQ,Outpatient,,,144.44,94,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,42.32,56.44,Based on EAPG RVU's
"OT Orthotic Management, Train Units",1373573,LOCAL,97760,CPT,,,,,GO,Outpatient,,,144.44,94,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,42.32,56.44,Based on EAPG RVU's
"PT Orthotic Management, Train Assistant Units",9390458,LOCAL,97760,CPT,,,,,CQ,Outpatient,,,144.44,94,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,42.32,56.44,Based on EAPG RVU's
Urinary Catheter Type:; -> Straight/Intermittent,4610954,LOCAL,51701,CPT,,,,,,Outpatient,,,144.74,94,Blue Cross of AL,Blue Cross,105.27,,,,,,,Other,105.27,863,Based on EAPG RVU's
EVENT MONITOR RECORDING ONLY,8200120,LOCAL,93270,CPT,,,,,,Outpatient,,,145.04,94,Blue Cross of AL,Blue Cross,99.86,,,,,,,Other,34.09,99.86,Based on EAPG RVU's
desmopressin 4 mcg/mL injectable solution 1 mL [CULL],11201582,LOCAL,J2597,CPT,,,,,,Outpatient,1,ML,145.92,,Blue Cross of AL,Blue Cross,233.26,,,,,,,Other,3.52,233.26,Based on EAPG RVU's
% CD3 (Mature T Cells) QSTC,13873423,LOCAL,86359,CPT,,,,,,Outpatient,,,146.25,45.28,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.73,Based on EAPG RVU's
CD4/CD8 Ratio QSTC,13873439,LOCAL,86360,CPT,,,,,,Outpatient,,,146.25,56.38,Blue Cross of AL,Blue Cross,44.29,,,,,,,Other,44.29,46.98,Based on EAPG RVU's
Beta hCG Qualitative,633663,LOCAL,84703,CPT,,,,,,Outpatient,,,146.88,9.02,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,7.52,Based on EAPG RVU's
Serum Pregnancy Qual POCT,10461706,LOCAL,84703,CPT,,,,,,Outpatient,,,146.88,9.02,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,7.52,Based on EAPG RVU's
Serum Pregnancy Test Qualitative,7909775,LOCAL,84703,CPT,,,,,,Outpatient,,,146.88,9.02,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,7.52,Based on EAPG RVU's
Serum Pregnancy Test Qualitative w/ Reflex,9384303,LOCAL,84703,CPT,,,,,,Outpatient,,,146.88,9.02,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,7.52,Based on EAPG RVU's
Urine Pregnancy POCT,8373784,LOCAL,81025,CPT,,,,,,Outpatient,,,146.88,10.33,Blue Cross of AL,Blue Cross,4.02,,,,,,,Other,4.02,13.375,Based on EAPG RVU's
Urine Pregnancy Test Qualitative,7909798,LOCAL,81025,CPT,,,,,,Outpatient,,,146.88,10.33,Blue Cross of AL,Blue Cross,4.02,,,,,,,Other,4.02,13.375,Based on EAPG RVU's
"IgA, Serum QSTC",13873298,LOCAL,82787,CPT,,,,,,Outpatient,,,147.38,9.62,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,8.02,Based on EAPG RVU's
IgA1 QSTC,13873292,LOCAL,82784,CPT,,,,,,Outpatient,,,147.38,11.16,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,34.958,Based on EAPG RVU's
Tobramycin Level,1634888,LOCAL,80200,CPT,,,,,,Outpatient,,,148.1,19.36,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,16.13,Based on EAPG RVU's
Blood Gas Arterial RT,8172944,LOCAL,36600,CPT,,,,,,Outpatient,,,148.2,96,Blue Cross of AL,Blue Cross,85.79,,,,,,,Other,85.79,863,Based on EAPG RVU's
Blood Gas Draw Type -> Arterial (Puncture),5230102,LOCAL,36600,CPT,,,,,,Outpatient,,,148.2,96,Blue Cross of AL,Blue Cross,85.79,,,,,,,Other,85.79,863,Based on EAPG RVU's
RT Arterial Puncture CHARGE,8143881,LOCAL,36600,CPT,,,,,,Outpatient,,,148.2,96,Blue Cross of AL,Blue Cross,85.79,,,,,,,Other,85.79,863,Based on EAPG RVU's
"RT CHARGE PFT -> Maximum breathing capacity, Maximal voluntary ventilation (M",5267133,LOCAL,94200,CPT,,,,,,Outpatient,,,148.2,96,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,54.31,76.09,Based on EAPG RVU's
XR TMJ Open and Closed Bilateral,1170502,LOCAL,70330,CPT,,,,,,Outpatient,,,150,80.85,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
Diphtheria Antitoxoid QSTC,14129477,LOCAL,86648,CPT,,,,,,Outpatient,,,151,18.25,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.21,15.29,Based on EAPG RVU's
Tetanus Antitoxoid QSTC,14129478,LOCAL,86774,CPT,,,,,,Outpatient,,,151,17.76,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.8,15.29,Based on EAPG RVU's
Hepatic Function Panel,633744,LOCAL,80076,CPT,,,,,,Outpatient,,,151.78,9.8,Blue Cross of AL,Blue Cross,12.14,,,,,,,Other,12.14,58.58814815,Based on EAPG RVU's
Hepatic Panel,633744,LOCAL,80076,CPT,,,,,,Outpatient,,,151.78,9.8,Blue Cross of AL,Blue Cross,12.14,,,,,,,Other,12.14,58.58814815,Based on EAPG RVU's
Respiratory Syncytial Virus (Sofia),82671544,LOCAL,87420,CPT,,,300,RC,,Outpatient,,,151.78,16.69,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,10.57,Based on EAPG RVU's
RSV,7909933,LOCAL,87420,CPT,,,300,RC,,Outpatient,,,151.78,16.69,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,10.57,Based on EAPG RVU's
Dihydrotestosterone QSTC,8853275,LOCAL,82642,CPT,,,,,,Outpatient,,,151.88,35.14,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,29.28,Based on EAPG RVU's
36430 BLOOD TRANSFUSION CHARGE,9284603,LOCAL,36430,CPT,,,,,,Outpatient,,,151.98,99,Blue Cross of AL,Blue Cross,672.96,,,,,,,Other,399.7,863,Based on EAPG RVU's
BLOOD ADMINISTRATION Charge,5240125,LOCAL,36430,CPT,,,,,,Outpatient,,,151.98,99,Blue Cross of AL,Blue Cross,672.96,,,,,,,Other,399.7,863,Based on EAPG RVU's
92608 ST EX FOR SPEECH DEVICE RX EACH 30 MIN ADDL TIM,9636007,LOCAL,92608,CPT,,,,,GN,Outpatient,,,152.72,99,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,44.72,337.75,Based on EAPG RVU's
SLP Speech AAC Eval Addl Half Hour Units,1373854,LOCAL,92608,CPT,,,,,GN,Outpatient,,,152.72,99,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,44.72,337.75,Based on EAPG RVU's
Speech Generating Device Eval Additional 30 Min,1373854,LOCAL,92608,CPT,,,,,GN,Outpatient,,,152.72,99,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,44.72,337.75,Based on EAPG RVU's
Bill Only REF Splitting,13514968,LOCAL,86985,CPT,,,,,,Outpatient,,,153,,Blue Cross of AL,Blue Cross,38.88,,,,,,,Other,38.88,156.67,Based on EAPG RVU's
"Quantiferon(R)-TB Gold Plus, 1 Tube QST",9384402,LOCAL,86480,CPT,,,,,,Outpatient,,,153,74.38,Blue Cross of AL,Blue Cross,44.29,,,,,,,Other,44.29,65.24390244,Based on EAPG RVU's
"Quantiferon(R)-TB Gold Plus, 1 Tube QSTC",8983765,LOCAL,86480,CPT,,,,,,Outpatient,,,153,74.38,Blue Cross of AL,Blue Cross,44.29,,,,,,,Other,44.29,65.24390244,Based on EAPG RVU's
97113 AQUATIC THERAPY 15 MINS,9650029,LOCAL,97113,CPT,,,,,GP|CQ,Outpatient,,,153.55,100,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,34.34,56.44,Based on EAPG RVU's
97113 AQUATIC THERAPY 15 MINS OT,9860051,LOCAL,97113,CPT,,,,,GO|CO,Outpatient,,,153.55,100,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,34.34,56.44,Based on EAPG RVU's
97113 Occupational Therapy Aquatic charge,9850051,LOCAL,97113,CPT,,,,,GO,Outpatient,,,153.55,100,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,34.34,56.44,Based on EAPG RVU's
97113 OT AQUATIC THERAPY CHARGE,9640029,LOCAL,97113,CPT,,,,,GP,Outpatient,,,153.55,100,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,34.34,56.44,Based on EAPG RVU's
Aquatic Charge,7895272,LOCAL,97113,CPT,,,,,GO,Outpatient,,,153.55,100,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,34.34,56.44,Based on EAPG RVU's
Aquatic Therapy Charges,7895958,LOCAL,97113,CPT,,,,,GP,Outpatient,,,153.55,100,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,34.34,56.44,Based on EAPG RVU's
OT Aquatic Exercise Assistant Units,7895272,LOCAL,97113,CPT,,,,,CQ,Outpatient,,,153.55,100,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,34.34,56.44,Based on EAPG RVU's
OT Aquatic Exercise Assistant Units,7898597,LOCAL,97113,CPT,,,,,CQ,Outpatient,,,153.55,100,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,34.34,56.44,Based on EAPG RVU's
OT Aquatic Exercise Units,7897709,LOCAL,97113,CPT,,,,,GO,Outpatient,,,153.55,100,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,34.34,56.44,Based on EAPG RVU's
OT Aquatic Exercise Units,7898597,LOCAL,97113,CPT,,,,,GO,Outpatient,,,153.55,100,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,34.34,56.44,Based on EAPG RVU's
PT Aquatic Assistant Units,9390434,LOCAL,97113,CPT,,,,,CQ,Outpatient,,,153.55,100,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,34.34,56.44,Based on EAPG RVU's
G0237 PULM REHAB EA 15 MIN,10470027,LOCAL,,,G0237,HCPCS,,,59,Outpatient,,,154.78,101,Blue Cross of AL,Blue Cross,51.98,,,,,,,Other,22.39,51.98,Based on EAPG RVU's
G0239 PULMONARY EXERCISE,10470025,LOCAL,,,G0239,HCPCS,,,,Outpatient,,,154.78,101,Blue Cross of AL,Blue Cross,51.98,,,,,,,Other,35.88,51.98,Based on EAPG RVU's
Calcium Oxalate QSTC,8997193,LOCAL,82340,CPT,,,,,,Outpatient,,,155,7.24,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,22.61833333,Based on EAPG RVU's
Sodium Urate QSTC,8997195,LOCAL,84300,CPT,,,,,,Outpatient,,,155,6.07,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,9.74,Based on EAPG RVU's
Uric Acid QSTC,8997197,LOCAL,84560,CPT,,,,,,Outpatient,,,155,6.1,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,19.49,Based on EAPG RVU's
"LD, Pericardial Fluid QSTC",13864442,LOCAL,83615,CPT,,,,,,Outpatient,,,155.39,7.25,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,21.675,Based on EAPG RVU's
"16000 Initial treatment, first degree burn, when no more than local treatment required",9400038,LOCAL,16000,CPT,,,,,,Outpatient,,,155.91,101,Blue Cross of AL,Blue Cross,273.27,,,,,,,Other,181.66,863,Based on EAPG RVU's
Diphtheria Antitoxoid QST,13824476,LOCAL,86648,CPT,,,,,,Outpatient,,,156,18.25,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.21,15.29,Based on EAPG RVU's
Tetanus Antitoxoid QST,13824477,LOCAL,86774,CPT,,,,,,Outpatient,,,156,17.76,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,14.8,15.29,Based on EAPG RVU's
Transferrin,633851,LOCAL,84466,CPT,,,,,,Outpatient,,,156.67,15.31,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,29.64248366,Based on EAPG RVU's
CANDIDA GLABRATA QST,12439000,LOCAL,87481,CPT,,,,,,Outpatient,,,157,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,478.165,Based on EAPG RVU's
CANDIDA SPECIES QST,12438999,LOCAL,87481,CPT,,,,,,Outpatient,,,157,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,478.165,Based on EAPG RVU's
"Chlamydia Trachomatis RNA, TMA QST",12439002,LOCAL,87591,CPT,,,,,,Outpatient,,,157,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
"Neisseria Gonorrhoeae RNA, TMA QST",12439003,LOCAL,87491,CPT,,,,,,Outpatient,,,157,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
SURESWAB(R) ADV BV QST,12438998,LOCAL,81513,CPT,,,,,,Outpatient,,,157,171.16,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,63.34,142.63,Based on EAPG RVU's
"TRICHOMONAS VAGINALIS (TV), TMA QST",12439001,LOCAL,87661,CPT,,,,,,Outpatient,,,157,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
CANDIDA GLABRATA QST,12433969,LOCAL,87481,CPT,,,,,,Outpatient,,,157.5,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,478.165,Based on EAPG RVU's
CANDIDA SPECIES QST,12433968,LOCAL,87481,CPT,,,,,,Outpatient,,,157.5,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,478.165,Based on EAPG RVU's
"CRYPTOSPORIDIUM ANTIGEN, EIA QSTC",12500635,LOCAL,87328,CPT,,,,,,Outpatient,,,157.5,16.58,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,13.82,Based on EAPG RVU's
"Kappa/LambdaLt Chains,Freew/Ratio,S QSTC",8853285,LOCAL,83521,CPT,,,,,,Outpatient,,,157.5,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,87.215,Based on EAPG RVU's
XR Bone Age Studies,1170014,LOCAL,77072,CPT,,,,,,Outpatient,,,157.72,84.98,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
Procalcitonin,8911929,LOCAL,84145,CPT,,,301,RC,,Outpatient,,,158,32.66,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,18.43,Based on EAPG RVU's
Procalcitonin Level,7938957,LOCAL,84145,CPT,,,301,RC,,Outpatient,,,158,32.66,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,18.43,Based on EAPG RVU's
BB REF ABO DISCREP (RH),6432002,LOCAL,86901,CPT,,,,,,Outpatient,,,159.75,3.59,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,35.88,Based on EAPG RVU's
REF ABO/Rh Discrep,13484121,LOCAL,86900,CPT,,,,,,Outpatient,,,159.75,3.59,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,117.85,Based on EAPG RVU's
"Ammonia, Plasma",7974187,LOCAL,82140,CPT,,,,,,Outpatient,,,160.34,17.48,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,22.62909091,Based on EAPG RVU's
97164 CIS Prgm PT Re-Evaluation 20 min,9650016,LOCAL,97164,CPT,,,,,GP|CQ,Outpatient,,,160.46,104,Blue Cross of AL,Blue Cross,349.89,,,,,,,Other,62.94,349.89,Based on EAPG RVU's
97164 RE-EVALUATION CHARGE,9410061,LOCAL,97164,CPT,,,,,GP,Outpatient,,,160.46,104,Blue Cross of AL,Blue Cross,349.89,,,,,,,Other,62.94,349.89,Based on EAPG RVU's
97164 RE-EVALUATION PT CHARGES,9640016,LOCAL,97164,CPT,,,,,GP,Outpatient,,,160.46,104,Blue Cross of AL,Blue Cross,349.89,,,,,,,Other,62.94,349.89,Based on EAPG RVU's
PT ReEval Time,7896016,LOCAL,97164,CPT,,,,,GP,Outpatient,,,160.46,104,Blue Cross of AL,Blue Cross,349.89,,,,,,,Other,62.94,349.89,Based on EAPG RVU's
Tobramycin Level Peak,1634889,LOCAL,80200,CPT,,,,,,Outpatient,,,163.2,19.36,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,16.13,Based on EAPG RVU's
Tobramycin Level Trough,1634890,LOCAL,80200,CPT,,,,,,Outpatient,,,163.2,19.36,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,16.13,Based on EAPG RVU's
11719 TRIM NAIL(S) ANY NUMBER WC CHARGE,8726774,LOCAL,11719,CPT,,,,,,Outpatient,,,163.39,106,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,54.31,863,Based on EAPG RVU's
"Methadone and Metabolite, Ur QSTC",13864431,LOCAL,80358,CPT,,,301,RC,,Outpatient,,,163.62,,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,7.16,Based on EAPG RVU's
.C-ANCA Titer QSTC,8764786,LOCAL,86037,CPT,,,,,,Outpatient,,,163.67,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.05,15.29,Based on EAPG RVU's
.P-ANCA Titer QSTC,6225794,LOCAL,86037,CPT,,,,,,Outpatient,,,163.67,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.05,15.29,Based on EAPG RVU's
"Methicillin Resistant Staphylococcus aureus,PCR QSTC",9630594,LOCAL,87641,CPT,,,,,,Outpatient,,,164.16,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
Volatiles QSTC,13864530,LOCAL,80320,CPT,,,301,RC,,Outpatient,,,164.43,,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,17.73,Based on EAPG RVU's
Bill Manual Tumor IM Histochem,14049347,LOCAL,88360,CPT,,,,,,Outpatient,,,164.92,,Blue Cross of AL,Blue Cross,59.06,,,,,,,Other,59.06,156.67,Based on EAPG RVU's
Bill SB Consult 1st TB w FS SGL SP,14048002,LOCAL,88331,CPT,,,,,,Outpatient,,,164.92,,Blue Cross of AL,Blue Cross,53.82,,,,,,,Other,53.82,156.67,Based on EAPG RVU's
Bill IHC Initial Antibody,14049345,LOCAL,88342,CPT,,,,,,Outpatient,,,164.98,,Blue Cross of AL,Blue Cross,59.06,,,,,,,Other,59.06,156.67,Based on EAPG RVU's
29105 - Long Arm Splint,9322359,LOCAL,29105,CPT,,,,,,Outpatient,,,165,158,Blue Cross of AL,Blue Cross,63.51,,,,,,,Other,63.51,863,Based on EAPG RVU's
Toxocara Ab (IgG) QSTC,13864452,LOCAL,86682,CPT,,,,,,Outpatient,,,165.38,15.61,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,13.01,15.29,Based on EAPG RVU's
Tissue Culture,633906,LOCAL,87070,CPT,,,,,,Outpatient,,,166.46,10.34,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,67.60639535,Based on EAPG RVU's
iSTAT CG4 Arterial POCT,14060625,LOCAL,82803,CPT,,,300,RC,,Outpatient,,,167.26,31.28,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,17.73,Based on EAPG RVU's
iSTAT CG4 Venous POCT,14060623,LOCAL,82803,CPT,,,300,RC,,Outpatient,,,167.26,31.28,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,17.73,Based on EAPG RVU's
97763 OT Orthotic Mgmt/Train Establish Charge,9650038,LOCAL,97763,CPT,,,,,GP|CQ,Outpatient,,,168.9,110,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,45.74,56.44,Based on EAPG RVU's
97763 OT Orthotic Mgmt/Train Established Assistant Units,9820206,LOCAL,97763,CPT,,,,,GO,Outpatient,,,168.9,110,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,45.74,56.44,Based on EAPG RVU's
97763 OT Orthotic/Prosthetic Mgmt/Training - each 15 min,9860206,LOCAL,97763,CPT,,,,,GO|CO,Outpatient,,,168.9,110,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,45.74,56.44,Based on EAPG RVU's
97763 PT ORTHO/PROST MNG/TRAIN EA 15,9410206,LOCAL,97763,CPT,,,,,GP,Outpatient,,,168.9,110,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,45.74,56.44,Based on EAPG RVU's
97763 PT Orthotic Mgmt/Train Establish Charge,9640038,LOCAL,97763,CPT,,,,,GP,Outpatient,,,168.9,110,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,45.74,56.44,Based on EAPG RVU's
OT Orthotic Mgmt/Train Est. Assit Units,7965332,LOCAL,97763,CPT,,,,,CQ,Outpatient,,,168.9,110,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,45.74,56.44,Based on EAPG RVU's
OT Orthotic Mgmt/Train Establish Charge,7965332,LOCAL,97763,CPT,,,,,GO,Outpatient,,,168.9,110,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,45.74,56.44,Based on EAPG RVU's
OT Orthotic Mgmt/Train Establish Rehab Units,7964942,LOCAL,97763,CPT,,,,,GO,Outpatient,,,168.9,110,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,45.74,56.44,Based on EAPG RVU's
PT Orthotic Mgmt/Train Establish Charge,7965252,LOCAL,97763,CPT,,,,,GP,Outpatient,,,168.9,110,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,45.74,56.44,Based on EAPG RVU's
"PT Orthotic/Prosthetic Manage,Train Assistant Units",9390462,LOCAL,97763,CPT,,,,,CQ,Outpatient,,,168.9,110,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,45.74,56.44,Based on EAPG RVU's
Total Glutathione QST,14799054,LOCAL,82978,CPT,,,,,,Outpatient,,,169,18.54,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,15.45,17.73,Based on EAPG RVU's
epoetin alfa-epbx 4000 units/mL preservative-free injectable solution 1 mL [CULL],11202396,LOCAL,Q5106,CPT,,,,,,Outpatient,1,ML,169.4208,,Blue Cross of AL,Blue Cross,525.49,,,,,,,Other,7.85,525.49,Based on EAPG RVU's
CT Heart Calcium Scoring,2424782,LOCAL,75571,CPT,,,,,,Outpatient,,,170,90.75,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,80.5,170.53,Based on EAPG RVU's
"Cortisol, LC/MS, Saliva QSTC",8853249,LOCAL,82530,CPT,,,,,,Outpatient,,,171,20.05,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,29.79,Based on EAPG RVU's
Factor V (Leiden) Mutation Analysis QSTC,8764652,LOCAL,81241,CPT,,,,,,Outpatient,,,171,88.04,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,63.34,73.37,Based on EAPG RVU's
"Lyme Disease Ab (IgM), Blot QSTC",8849718,LOCAL,86617,CPT,,,,,,Outpatient,,,171,18.59,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,15.49,Based on EAPG RVU's
"Lyme Disease Ab(IgG),Blot QSTC",8849707,LOCAL,86617,CPT,,,,,,Outpatient,,,171,18.59,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,15.49,Based on EAPG RVU's
Prothrombin Gene Analysis QSTC,8764653,LOCAL,81240,CPT,,,,,,Outpatient,,,171,78.83,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,63.34,65.69,Based on EAPG RVU's
Cholesterol HDL,3170344,LOCAL,83718,CPT,,,,,,Outpatient,,,172,9.83,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,8.19,Based on EAPG RVU's
Glucagon QSTC,13864528,LOCAL,82943,CPT,,,,,,Outpatient,,,173.7,17.15,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,14.29,18.43,Based on EAPG RVU's
CULL MG Wire Loc Needle,13721990,LOCAL,10035,CPT,A4648,HCPCS,,,,Outpatient,,,174.99,114,Blue Cross of AL,Blue Cross,1200.99,,,,,,,Other,643.26,1291,Based on EAPG RVU's
90912 - Bfb training 1st 15 min.,9442435,LOCAL,90912,CPT,,,,,,Outpatient,,,175,114,Blue Cross of AL,Blue Cross,233.61,,,,,,,Other,35.97,233.61,Based on EAPG RVU's
97129 Cognition Ther Intervent First 15 min,9850048,LOCAL,97129,CPT,,,,,GO,Outpatient,,,175,114,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,18.94,56.44,Based on EAPG RVU's
97129 Cognition Ther Intervent First 15 min Assistant Units,9860048,LOCAL,97129,CPT,,,,,GO|CO,Outpatient,,,175,114,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,18.94,56.44,Based on EAPG RVU's
97130 Cognition Ther Intervent Addlt 15 min,9850049,LOCAL,97130,CPT,,,,,GO,Outpatient,,,175,114,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,18.08,56.44,Based on EAPG RVU's
97130 Cognition Ther Intervent Addlt 15 min Assistant Units,9860049,LOCAL,97130,CPT,,,,,GO|CO,Outpatient,,,175,114,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,18.08,56.44,Based on EAPG RVU's
"OT Cog Ther Intervent, Addl 15 Min Asst",9401146,LOCAL,97130,CPT,,,,,CQ,Outpatient,,,175,114,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,18.08,56.44,Based on EAPG RVU's
"OT Cog Ther Intervent, Addl 15 Min Units",9401146,LOCAL,97130,CPT,,,,,GO,Outpatient,,,175,114,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,18.08,56.44,Based on EAPG RVU's
"OT Cog Ther Intervent, First 15 Min Asst",9401140,LOCAL,97129,CPT,,,,,CQ,Outpatient,,,175,114,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,18.94,56.44,Based on EAPG RVU's
"OT Cog Ther Intervent,First 15 Min Units",9401140,LOCAL,97129,CPT,,,,,GO,Outpatient,,,175,114,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,18.94,56.44,Based on EAPG RVU's
Bill Only Pheno Non-Rh EA/Ag,13517193,LOCAL,86905,CPT,,,,,,Outpatient,,,175.5,4.6,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,328.88,Based on EAPG RVU's
Bill Only REF Thawing,13514966,LOCAL,86927,CPT,,,,,,Outpatient,,,175.5,,Blue Cross of AL,Blue Cross,38.88,,,,,,,Other,38.88,156.67,Based on EAPG RVU's
Ref Hgb S,9527497,LOCAL,85660,CPT,,,,,,Outpatient,,,175.5,6.61,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,5.51,8.21,Based on EAPG RVU's
Yeast Identification QSTC,8873580,LOCAL,87106,CPT,,,301,RC,,Outpatient,,,175.5,12.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,10.57,Based on EAPG RVU's
Basic Metabolic Panel,633628,LOCAL,80048,CPT,,,,,,Outpatient,,,176.26,10.15,Blue Cross of AL,Blue Cross,12.14,,,,,,,Other,12.14,37.17170492,Based on EAPG RVU's
RT CHARGE PFT -> Diffusion (DLCO),5267130,LOCAL,94729,CPT,,,,,,Outpatient,,,176.44,115,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,47.24,76.09,Based on EAPG RVU's
E0773 Thawed FFP CPD,7267127,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,84.29,217.45,Based on EAPG RVU's
E1237 Thawed Aph FFP ACDA,7267133,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,84.29,217.45,Based on EAPG RVU's
E2701 Thawed Plasma CPD <24h,7267161,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,84.29,217.45,Based on EAPG RVU's
E2737 Thawed Plasma CP2D <24h,7267171,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,84.29,217.45,Based on EAPG RVU's
E4713 Thawed Aph FFP ACDA 1,7267173,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,84.29,217.45,Based on EAPG RVU's
E4717 Thawed Aph FFP ACDA 2,7267174,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,84.29,217.45,Based on EAPG RVU's
E4721 Thawed Aph FFP ACDA 3,7267175,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,177,115,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,84.29,217.45,Based on EAPG RVU's
Anti-Mullerian Hormone (AMH) Female QSTC,8972886,LOCAL,82166,CPT,,,,,,Outpatient,,,180,46.34,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,38.62,Based on EAPG RVU's
"Chlamydia Trachomatis RNA, TMA QST",14718336,LOCAL,87491,CPT,,,,,,Outpatient,,,180,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
"Chromogranin A, LC/MS/MS QSTC",10319690,LOCAL,86316,CPT,,,,,,Outpatient,,,180,24.97,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,100.2,Based on EAPG RVU's
"Estriol, Serum QSTC",9039351,LOCAL,82677,CPT,,,,,,Outpatient,,,180,29.02,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,24.18,Based on EAPG RVU's
H. pylori Urea Breath Test QSTC,8764622,LOCAL,83013,CPT,,,,,,Outpatient,,,180,80.83,Blue Cross of AL,Blue Cross,46.74,,,,,,,Other,46.74,123.01,Based on EAPG RVU's
"Metanephrines, Fract Free LCMSMS, P QSTC",8764672,LOCAL,83835,CPT,,,,,,Outpatient,,,180,20.33,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,98.305,Based on EAPG RVU's
Mycophenolic Acid QSTC,9039269,LOCAL,80180,CPT,,,,,,Outpatient,,,180,21.66,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,98.845,Based on EAPG RVU's
"Neisseria Gonorrhoeae RNA, TMA QST",14718337,LOCAL,87591,CPT,,,,,,Outpatient,,,180,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
Thinprep Review Cytotechnologist: QST,14718350,LOCAL,88175,CPT,,,,,,Outpatient,,,180,31.93,Blue Cross of AL,Blue Cross,25.25,,,,,,,Other,25.25,26.61,Based on EAPG RVU's
"Trichomonas vaginalis, Ql TMA, Pap QST",14718338,LOCAL,87661,CPT,,,,,,Outpatient,,,180,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
"Galactose-Alpha-1,3-Galactose IgE QSTC",8764840,LOCAL,86008,CPT,,,,,,Outpatient,,,180.09,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,17.93,Based on EAPG RVU's
HOLTER MONITOR  24H,8200090,LOCAL,93225,CPT,,,,,,Outpatient,,,182,198,Blue Cross of AL,Blue Cross,99.86,,,,,,,Other,99.86,117.85,Based on EAPG RVU's
FLUORO CENTRAL LINE PLACEMENT,8201221,LOCAL,77001,CPT,,,,,,Outpatient,,,184.82,177.38,Blue Cross of AL,Blue Cross,262.79,,,,,,,Other,70.92,262.79,Based on EAPG RVU's
Vitamin B12 Level,633871,LOCAL,82607,CPT,,,,,,Outpatient,,,184.82,18.1,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,82.43266533,Based on EAPG RVU's
XR Port Placement,10460170,LOCAL,77001,CPT,,,,,,Outpatient,,,184.82,177.38,Blue Cross of AL,Blue Cross,262.79,,,,,,,Other,70.92,262.79,Based on EAPG RVU's
RT CHARGE Chest Physiotherapy -> PEP Therapy Subsequent,8699751,LOCAL,94667,CPT,,,,,,Outpatient,,,184.89,120,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,117.85,Based on EAPG RVU's
RT CHARGE Mechanical Oscillation -> Yes,10417130,LOCAL,94667,CPT,,,,,,Outpatient,,,184.89,120,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,117.85,Based on EAPG RVU's
"Streptococcus pneumoniae Ag, Ur QSTC",13864418,LOCAL,87899,CPT,,,,,,Outpatient,,,185.22,19.28,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,16.07,Based on EAPG RVU's
"FVIII Act, Clotting QSTC",13873492,LOCAL,85240,CPT,,,,,,Outpatient,,,186.96,21.48,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,17.9,Based on EAPG RVU's
"PTT, Activated QSTC",13873491,LOCAL,85730,CPT,,,,,,Outpatient,,,186.96,7.21,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,1.648553055,5.42,Based on EAPG RVU's
Ristocetin Cofactor QSTC,13873494,LOCAL,85245,CPT,,,,,,Outpatient,,,186.96,27.53,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,22.94,Based on EAPG RVU's
von Willebrand Factor Ag QSTC,13873493,LOCAL,85246,CPT,,,,,,Outpatient,,,186.96,27.53,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,22.94,Based on EAPG RVU's
"vWf Ag, Multimeric QSTC",13873495,LOCAL,85247,CPT,,,,,,Outpatient,,,186.96,27.53,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,22.94,Based on EAPG RVU's
.T. pallidum Ab QSTC,13864522,LOCAL,86780,CPT,,,,,,Outpatient,,,189,15.89,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,13.24,15.29,Based on EAPG RVU's
"Nicotine and Cotinine, Urine QSTC",9039418,LOCAL,80323,CPT,,,301,RC,,Outpatient,,,189,,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,17.73,Based on EAPG RVU's
Syphilis Antibody Cascading Reflex QSTC,8972904,LOCAL,86780,CPT,,,,,,Outpatient,,,189,15.89,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,13.24,15.29,Based on EAPG RVU's
Acetaminophen Level,1503764,LOCAL,80307,CPT,,,301,RC,,Outpatient,,,190.94,74.57,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,160.4,Based on EAPG RVU's
"MAG-SGPG Ab IgM, EIA QSTC",13864465,LOCAL,83520,CPT,,,,,,Outpatient,,,191.75,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,117.3767568,Based on EAPG RVU's
"96366 IV INFUSION, MEDICATIONS, ADDITIONAL",7904532,LOCAL,96366,CPT,,,,,,Outpatient,,,193,125,Blue Cross of AL,Blue Cross,749.76,,,,,,,Other,42.18,749.76,Based on EAPG RVU's
"96366- IV tx, each additional hour",1928300,LOCAL,96366,CPT,,,,,,Outpatient,,,193,125,Blue Cross of AL,Blue Cross,749.76,,,,,,,Other,42.18,749.76,Based on EAPG RVU's
"96367 IV INFUSION, SEQUENTIAL, NEW OR DIFF",7904533,LOCAL,96367,CPT,,,,,,Outpatient,,,193,125,Blue Cross of AL,Blue Cross,442.94,,,,,,,Other,65.07,442.94,Based on EAPG RVU's
"96367- IV tx, sequential infusion",1928301,LOCAL,96367,CPT,,,,,,Outpatient,,,193,125,Blue Cross of AL,Blue Cross,442.94,,,,,,,Other,65.07,442.94,Based on EAPG RVU's
"96374- IV Injection, single/initial",1928305,LOCAL,96374,CPT,,,,,59,Outpatient,,,193,125,Blue Cross of AL,Blue Cross,64.56,,,,,,,Other,64.56,192.63,Based on EAPG RVU's
96374 IV PUSH MEDS INIT INJ 15 MIN OR LESS,7904536,LOCAL,96374,CPT,,,,,59,Outpatient,,,193,125,Blue Cross of AL,Blue Cross,64.56,,,,,,,Other,64.56,192.63,Based on EAPG RVU's
"96375- IV Injection, add new drug",1928306,LOCAL,96375,CPT,,,,,59,Outpatient,,,193,125,Blue Cross of AL,Blue Cross,64.56,,,,,,,Other,42.18,64.56,Based on EAPG RVU's
"96375 IV PUSH INJECTION ADD, NEW OR DIFF",7904537,LOCAL,96375,CPT,,,,,59,Outpatient,,,193,125,Blue Cross of AL,Blue Cross,64.56,,,,,,,Other,42.18,64.56,Based on EAPG RVU's
INJ IV PUSH THER/PROPH SUBSTANCE INTIAL,8210021,LOCAL,96374,CPT,,,,,59,Outpatient,,,193,125,Blue Cross of AL,Blue Cross,64.56,,,,,,,Other,64.56,192.63,Based on EAPG RVU's
"Beryllium, Serum/Plasma QSTC",10704808,LOCAL,83018,CPT,,,,,,Outpatient,,,194.5,26.35,Blue Cross of AL,Blue Cross,16.07,,,,,,,Other,16.07,21.96,Based on EAPG RVU's
9581626 EEG AWAKE/DROWSY PRO FEE CHARGES,8795941,LOCAL,95816,CPT,,,,,26,Outpatient,,,195,533,Blue Cross of AL,Blue Cross,466.96,,,,,,,Other,284.7,466.96,Based on EAPG RVU's
95819 EEG AWAKE AND ASLEEP PRO-FEE CHARGE,13508139,LOCAL,95819,CPT,,,,,26,Outpatient,,,195,599,Blue Cross of AL,Blue Cross,466.96,,,,,,,Other,284.7,466.96,Based on EAPG RVU's
95822 EEG COMA or SLEEP ONLY PRO,10049176,LOCAL,95822,CPT,,,,,26,Outpatient,,,195,499,Blue Cross of AL,Blue Cross,466.96,,,,,,,Other,284.7,466.96,Based on EAPG RVU's
Vitamin B3 QSTC,8972908,LOCAL,84591,CPT,,,,,,Outpatient,,,195.75,20.47,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.06,17.73,Based on EAPG RVU's
Thyroid Stimulating Hormone,633844,LOCAL,84443,CPT,,,,,,Outpatient,,,195.84,20.16,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,87.63697303,Based on EAPG RVU's
TSH with Reflex to FT4,7948309,LOCAL,84439,CPT,,,,,,Outpatient,,,195.84,10.82,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,28.58065455,Based on EAPG RVU's
"Mumps Virus Ab IgG, IgM, Diagnostic QSTC",13864479,LOCAL,86735,CPT,,,,,,Outpatient,,,196.07,15.66,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,13.05,15.29,Based on EAPG RVU's
Deoxycorticosterone QSTC,13864487,LOCAL,82633,CPT,,,,,,Outpatient,,,196.2,37.18,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,30.98,Based on EAPG RVU's
Q Fever Ab IgG IgM w/rfx Titers QSTC,13864460,LOCAL,86638,CPT,,,,,,Outpatient,,,196.56,14.54,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.12,15.29,Based on EAPG RVU's
G0108 Diabetes Management Treatment 30 Minutes CHARGE,10255367,LOCAL,,,G0108,HCPCS,,,,Outpatient,,,196.8,128,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,52.41,95.93,Based on EAPG RVU's
94799 Pulm Function Screen Charge,10440012,LOCAL,94799,CPT,,,,,,Outpatient,,,198.38,129,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,143.05,Based on EAPG RVU's
Blood Gas Capillary RT,8127184,LOCAL,82805,CPT,,,301,RC,,Outpatient,,,199.51,94.52,Blue Cross of AL,Blue Cross,46.74,,,,,,,Other,46.74,46.74,Based on EAPG RVU's
"96376- IV Injection, add same drug",1928307,LOCAL,96376,CPT,450,RC,,,59,Outpatient,,,200,130,Blue Cross of AL,Blue Cross,64.56,,,,,,,Other,64.56,64.56,Based on EAPG RVU's
"96376 IV PUSH, SAME MEDICATION AFTER 30 MIN",7904538,LOCAL,96376,CPT,260,RC,,,59,Outpatient,,,200,130,Blue Cross of AL,Blue Cross,64.56,,,,,,,Other,64.56,64.56,Based on EAPG RVU's
97168 CIS Prgm OT Re-Evaluation 30 min,9850016,LOCAL,97168,CPT,,,,,GO,Outpatient,,,200.91,131,Blue Cross of AL,Blue Cross,269.95,,,,,,,Other,63.82,269.95,Based on EAPG RVU's
97168 RE-EVALUATION CHARGE,9860016,LOCAL,97168,CPT,,,,,GO|CO,Outpatient,,,200.91,131,Blue Cross of AL,Blue Cross,269.95,,,,,,,Other,63.82,269.95,Based on EAPG RVU's
OT ReEval Units,7895298,LOCAL,97168,CPT,,,,,GO,Outpatient,,,200.91,131,Blue Cross of AL,Blue Cross,269.95,,,,,,,Other,63.82,269.95,Based on EAPG RVU's
OT ReEvaluation Units,7897819,LOCAL,97168,CPT,,,,,GO,Outpatient,,,200.91,131,Blue Cross of AL,Blue Cross,269.95,,,,,,,Other,63.82,269.95,Based on EAPG RVU's
Drug Screen Hair SO,13943973,LOCAL,80307,CPT,,,300,RC,,Outpatient,,,202.5,74.57,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,160.4,Based on EAPG RVU's
Gabapentin QSTC,8764562,LOCAL,80171,CPT,,,,,,Outpatient,,,202.5,26,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,111.87,Based on EAPG RVU's
TRAb (TSH Receptor Binding Ab) QSTC,8764674,LOCAL,83520,CPT,,,,,,Outpatient,,,202.5,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,117.3767568,Based on EAPG RVU's
"Coccidioides Ab, CF w/ ID, CSF QSTC",13864531,LOCAL,86635,CPT,,,,,,Outpatient,,,203.04,13.76,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,11.47,15.29,Based on EAPG RVU's
Body Fluid Culture,4122803,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,67.60639535,Based on EAPG RVU's
Ear Culture,633890,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,67.60639535,Based on EAPG RVU's
Eye Culture,633892,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,67.60639535,Based on EAPG RVU's
Medical Device Culture,633898,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,67.60639535,Based on EAPG RVU's
Nasal Culture,633900,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,67.60639535,Based on EAPG RVU's
"Porphyrins, Fract, Quant, Random Ur QSTC",13864457,LOCAL,84120,CPT,,,,,,Outpatient,,,203.18,17.65,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,14.71,17.73,Based on EAPG RVU's
Stool Culture,633904,LOCAL,87045,CPT,,,,,,Outpatient,,,203.18,11.33,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,79.665,Based on EAPG RVU's
Throat Culture,633905,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,67.60639535,Based on EAPG RVU's
Wound Culture,633908,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,67.60639535,Based on EAPG RVU's
Wound Culture Deep,8395521,LOCAL,87070,CPT,,,,,,Outpatient,,,203.18,10.34,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,67.60639535,Based on EAPG RVU's
micafungin 100 mg intravenous injection [CULL],11220353,LOCAL,J2248,CPT,,,,,,Outpatient,1,EA,203.7888,,Blue Cross of AL,Blue Cross,122.4,,,,,,,Other,0.249,122.4,Based on EAPG RVU's
Vitamin K QSTC,8972880,LOCAL,84597,CPT,,,,,,Outpatient,,,203.9,16.46,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,13.72,17.73,Based on EAPG RVU's
Drug Screen Hair SO,13938887,LOCAL,80307,CPT,,,300,RC,,Outpatient,,,205.5,74.57,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,160.4,Based on EAPG RVU's
PSA Diagnostic,1634882,LOCAL,84153,CPT,,,,,,Outpatient,,,206.86,22.07,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,104.8447059,Based on EAPG RVU's
PSA Screening,4123035,LOCAL,,,G0103,HCPCS,,,,Outpatient,,,206.86,134,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,19.31,Based on EAPG RVU's
Chromatin (Nucleosomal) Antibody QSTC,10148609,LOCAL,86235,CPT,,,,,,Outpatient,,,206.91,21.52,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,37.56575758,Based on EAPG RVU's
94640 UDN SPECIAL MED 2 CHARGE,13515633,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,185.95,Based on EAPG RVU's
94640 UDN SPECIAL MED CHARGE,13522003,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,185.95,Based on EAPG RVU's
RT CHARGE Aerosol Therapy -> Subsequent,5397112,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,185.95,Based on EAPG RVU's
RT CHARGE EZPAP -> Initial,9429159,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,185.95,Based on EAPG RVU's
RT CHARGE EZPAP -> Subsequent,9429160,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,185.95,Based on EAPG RVU's
RT CHARGE MDI -> Initial,12111660,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,185.95,Based on EAPG RVU's
RT CHARGE MDI -> Subsequent,12111659,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,185.95,Based on EAPG RVU's
RT CHARGE Suction -> BBG/Nasopharyngeal,6690655,LOCAL,31720,CPT,,,,,,Outpatient,,,208.54,136,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,863,Based on EAPG RVU's
RT Continuous Neb Subsequent CHARGE,8144096,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,185.95,Based on EAPG RVU's
RT IPV Subsequent CHARGE,8144062,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,185.95,Based on EAPG RVU's
Sputum Collection Method -> Cough,13657418,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,185.95,Based on EAPG RVU's
Sputum Collection Method -> ET tube,13657417,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,185.95,Based on EAPG RVU's
Sputum Collection Method -> Medication aerosol,8846461,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,185.95,Based on EAPG RVU's
Sputum Collection Method -> Nasal aspirate,13650046,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,185.95,Based on EAPG RVU's
Sputum Collection Method -> Nasal wash,13650044,LOCAL,94640,CPT,,,,,,Outpatient,,,208.54,136,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,185.95,Based on EAPG RVU's
REF Antibody Screen,7939320,LOCAL,86850,CPT,,,,,,Outpatient,,,211.5,11.72,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,48.85,Based on EAPG RVU's
US Unlisted Procedure,8733482,LOCAL,76999,CPT,,,,,,Outpatient,,,212.54,113.85,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,80.5,161.71,Based on EAPG RVU's
%CDT QSTC,13864781,LOCAL,82373,CPT,,,,,,Outpatient,,,213.75,21.67,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,18.06,Based on EAPG RVU's
Transferrin - QSTC,13864778,LOCAL,84466,CPT,,,,,,Outpatient,,,213.75,15.31,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,29.64248366,Based on EAPG RVU's
hyaluronidase 150 units/mL injectable solution 1 mL [CULL],11282257,LOCAL,J3470,CPT,,,,,,Outpatient,1,ML,214.272,,Blue Cross of AL,Blue Cross,122.4,,,,,,,Other,31.807,122.4,Based on EAPG RVU's
"96372 INJECTIONS (IM, SC) OP",7904535,LOCAL,96372,CPT,,,,,59,Outpatient,,,214.42,139,Blue Cross of AL,Blue Cross,64.56,,,,,,,Other,64.56,65.07,Based on EAPG RVU's
96372- Subq/IM Injection,1928303,LOCAL,96372,CPT,,,,,59,Outpatient,,,214.42,139,Blue Cross of AL,Blue Cross,64.56,,,,,,,Other,64.56,65.07,Based on EAPG RVU's
92522 EVAL OF SPEECH SOUND PRODUCTION CHARGE,9630057,LOCAL,92522,CPT,444,RC,,,GN,Outpatient,,,215.1,140,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,337.75,337.75,Based on EAPG RVU's
SLP Sound Production Eval Units,7897207,LOCAL,92522,CPT,444,RC,,,GN,Outpatient,,,215.1,140,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,337.75,337.75,Based on EAPG RVU's
Speech Sound Production Eval Charge,7897207,LOCAL,92522,CPT,444,RC,,,GN,Outpatient,,,215.1,140,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,337.75,337.75,Based on EAPG RVU's
Speech Sound Production Eval Minutes,7896898,LOCAL,92522,CPT,444,RC,,,GN,Outpatient,,,215.1,140,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,337.75,337.75,Based on EAPG RVU's
RT CHARGE PFT -> Lung Volume,9004829,LOCAL,94727,CPT,,,,,,Outpatient,,,215.73,140,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,143.05,Based on EAPG RVU's
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,90471,CPT,G0010,HCPCS,,,,Outpatient,,,216.15,140,Blue Cross of AL,Blue Cross,56.18,,,,,,,Other,42.18,65.07,Based on EAPG RVU's
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,G0010,CPT,,,,,,Outpatient,,,216.15,,Blue Cross of AL,Blue Cross,56.18,,,,,,,Other,42.18,65.07,Based on EAPG RVU's
CATH LAB US INTRAOPERATIVE,8200550,LOCAL,76998,CPT,,,,,,Outpatient,,,216.65,116.33,Blue Cross of AL,Blue Cross,165.47,,,,,,,Other,36.73,165.47,Based on EAPG RVU's
Bladder Scan,649589,LOCAL,51798,CPT,,,,,,Outpatient,,,216.87,59,Blue Cross of AL,Blue Cross,105.27,,,,,,,Other,54.31,863,Based on EAPG RVU's
DOPP LOWER EXT ARTERIAL/ABI,8200450,LOCAL,93922,CPT,,,,,,Outpatient,,,218,265,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,117.85,161.71,Based on EAPG RVU's
69209 REM IMPACT CERUMEN REQ IRRIGAT CHARGE,8020086,LOCAL,69209,CPT,,,,,,Outpatient,,,219.69,143,Blue Cross of AL,Blue Cross,162.41,,,,,,,Other,54.31,863,Based on EAPG RVU's
97550 CAREGIVER TRAINING 1ST 30 MIN,14015178,LOCAL,97550,CPT,,,,,,Outpatient,,,220,,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,38.85,95.93,Based on EAPG RVU's
97550 OT Caregiver Training Init 30 Mins,13649811,LOCAL,97550,CPT,,,,,,Outpatient,,,220,,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,38.85,95.93,Based on EAPG RVU's
97550 ST Caregiver Training 1st 30 min,14013233,LOCAL,97550,CPT,,,,,,Outpatient,,,220,,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,38.85,95.93,Based on EAPG RVU's
"SLP Caregiver Training, First 30 Min Time",14466884,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,220,,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,50.79,95.93,Based on EAPG RVU's
Bill Only ABSC,7936968,LOCAL,86850,CPT,,,,,,Outpatient,,,220.5,11.72,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,48.85,Based on EAPG RVU's
"Platelet Antibody Screen, Serum QSTC",10736090,LOCAL,86022,CPT,,,,,,Outpatient,,,220.5,22.04,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,18.37,Based on EAPG RVU's
92524 BEHAVIORAL AND QUALITATIVE ANALYSIS OF VOICE AND RESONANCE,9630059,LOCAL,92524,CPT,,,,,GN,Outpatient,,,222.2,144,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,103.27,337.75,Based on EAPG RVU's
Behav/Qual Analysis of Voice and Resonance Charge,7897211,LOCAL,92524,CPT,,,,,GN,Outpatient,,,222.2,144,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,103.27,337.75,Based on EAPG RVU's
SLP Analysis of Voice & Resonance Units,7897212,LOCAL,92524,CPT,,,,,GN,Outpatient,,,222.2,144,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,103.27,337.75,Based on EAPG RVU's
92597 EVAL FOR USE AND/OR FITTING OF VOICE PROSTHETIC TO SUPPLEMENT ORAL SPEECH,9630068,LOCAL,92597,CPT,,,,,GN,Outpatient,,,223.9,146,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,67.18,337.75,Based on EAPG RVU's
Eval for Use/Fitting of Voice Prosthetic Dvc Chg,1373846,LOCAL,92597,CPT,,,,,GN,Outpatient,,,223.9,146,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,67.18,337.75,Based on EAPG RVU's
"SLP Use,Fit Speech Prosthetic Eval Units",1373846,LOCAL,92597,CPT,,,,,GN,Outpatient,,,223.9,146,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,67.18,337.75,Based on EAPG RVU's
64418- Suprascapular nerve block,10452404,LOCAL,64418,CPT,,,,,,Outpatient,,,225,693,Blue Cross of AL,Blue Cross,636.45,,,,,,,Other,633.14,1291,Based on EAPG RVU's
75809 SHUNTOGRAM PREV PLCMNT INDWELLING NONVASC SHUNT,13650394,LOCAL,75809,CPT,,,,,,Outpatient,,,225,87.45,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,97.22,176.48,Based on EAPG RVU's
"Drug Abuse Panel 8, Serum QSTC",10449942,LOCAL,80307,CPT,,,301,RC,,Outpatient,,,225,74.57,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,160.4,Based on EAPG RVU's
"Hantavirus Antibody IgG,IgM QSTC",13864534,LOCAL,86790,CPT,,,,,,Outpatient,,,225,15.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.88,15.29,Based on EAPG RVU's
"Histoplasma Quantitative Antigen, EIA QSTC",9752803,LOCAL,87385,CPT,,,,,,Outpatient,,,225,15.9,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,13.25,Based on EAPG RVU's
"Potassium w/o Creatinine, Random Ur QSTC",9039260,LOCAL,84133,CPT,,,,,,Outpatient,,,225,5.68,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,19.32,Based on EAPG RVU's
Soluble Transferrin Receptor QSTC,9777250,LOCAL,84238,CPT,,,,,,Outpatient,,,225,43.88,Blue Cross of AL,Blue Cross,46.74,,,,,,,Other,36.57,46.74,Based on EAPG RVU's
XR Shunt Series,13650394,LOCAL,75809,CPT,,,,,,Outpatient,,,225,87.45,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,97.22,176.48,Based on EAPG RVU's
Dengue Fever Ab (IgG) QSTC,13873177,LOCAL,86790,CPT,,,,,,Outpatient,,,228,15.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.88,15.29,Based on EAPG RVU's
Dengue Fever Ab (IgM) QSTC,13873183,LOCAL,86790,CPT,,,,,,Outpatient,,,228,15.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.88,15.29,Based on EAPG RVU's
Dengue Virus NS1 Ag QSTC,13873171,LOCAL,87449,CPT,,,302,RC,,Outpatient,,,228,14.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,10.57,Based on EAPG RVU's
"Mycoplasma pneumoniae Ab (IgG, IgM) QSTC",8972832,LOCAL,86738,CPT,,,,,,Outpatient,,,228.83,15.89,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,13.24,15.29,Based on EAPG RVU's
REF DAT Polyspecific,7939270,LOCAL,86880,CPT,,,,,,Outpatient,,,229.5,6.47,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,54.31,Based on EAPG RVU's
92610  Bedside Swallowing Eval,9630082,LOCAL,92610,CPT,,,,,GN,Outpatient,,,231.76,151,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,55.89,337.75,Based on EAPG RVU's
Eval of Oral and Pharyngeal Swallowing Fx Chg  nd Pharyngeal Swallowing Fx Chg,7896918,LOCAL,92610,CPT,,,,,GN,Outpatient,,,231.76,151,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,55.89,337.75,Based on EAPG RVU's
Eval of Oral and Pharyngeal Swallowing Fx Chg  nd Pharyngeal Swallowing Fx Chg -> Yes,7896918,LOCAL,92610,CPT,,,,,GN,Outpatient,,,231.76,151,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,55.89,337.75,Based on EAPG RVU's
SLP Pharyngeal Swallow Eval Units,1373843,LOCAL,92610,CPT,,,,,GN,Outpatient,,,231.76,151,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,55.89,337.75,Based on EAPG RVU's
"diphtheria/pertussis, acellular/tetanus/polio, inactivated intramuscular suspension 0.5 mL [CULL]",11292061,LOCAL,90696,CPT,,,,,,Outpatient,0.5,ML,232.8032,,Blue Cross of AL,Blue Cross,39.58,,,,,,,Other,39.58,39.58,Based on EAPG RVU's
"Caregiver / patient demonstrates understanding of substance abuse, triggers, treatment",4517330,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,235,,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,50.79,95.93,Based on EAPG RVU's
"Caregiver / patient demonstrates understanding of substance abuse, triggers, treatment",4517330,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,235,,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,50.79,95.93,Based on EAPG RVU's
PT CAREGIVER TRAINING INT 30 MIN,4517330,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,235,,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,50.79,95.93,Based on EAPG RVU's
96523 FLUSH VAD CHARGE,8213318,LOCAL,96523,CPT,,,,,,Outpatient,,,235.66,153,Blue Cross of AL,Blue Cross,64.56,,,,,,,Other,54.31,64.56,Based on EAPG RVU's
97546 WORK CONDITIONING ADDL 1HR,9640076,LOCAL,97546,CPT,420,RC,,,GP,Outpatient,,,237.9,155,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,47.26,47.26,Based on EAPG RVU's
97546 Work hardening/conditioning; each additional hour,9650076,LOCAL,97546,CPT,420,RC,,,GP|CQ,Outpatient,,,237.9,155,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,47.26,47.26,Based on EAPG RVU's
PT Work Hardening-Each Addl Hour Assistant Units,9390456,LOCAL,97546,CPT,420,RC,,,CQ,Outpatient,,,237.9,155,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,47.26,47.26,Based on EAPG RVU's
Work Hardening Additional Hours Charge,7895940,LOCAL,97546,CPT,420,RC,,,GP,Outpatient,,,237.9,155,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,47.26,47.26,Based on EAPG RVU's
Follicle Stimulating Hormone Level,3170314,LOCAL,83001,CPT,,,,,,Outpatient,,,238.68,22.3,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,98.80384615,Based on EAPG RVU's
Antibody ID,634330,LOCAL,86870,CPT,,,,,,Outpatient,,,238.76,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,328.88,Based on EAPG RVU's
BB THAW FFP,6413062,LOCAL,86931,CPT,,,,,,Outpatient,,,238.76,,Blue Cross of AL,Blue Cross,38.88,,,,,,,Other,38.88,156.67,Based on EAPG RVU's
Bill IHC Multiplex Antibody,14048007,LOCAL,88344,CPT,,,,,,Outpatient,,,238.76,,Blue Cross of AL,Blue Cross,59.06,,,,,,,Other,59.06,328.88,Based on EAPG RVU's
"Bill Only Antigen Type, Patient",8872565,LOCAL,86905,CPT,,,,,,Outpatient,,,238.76,4.6,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,328.88,Based on EAPG RVU's
"Bill Only Antigen Type, Product",8872566,LOCAL,86902,CPT,,,,,,Outpatient,,,238.76,7.62,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,328.88,Based on EAPG RVU's
Bill Tissue Exam Level 5,14049344,LOCAL,88307,CPT,,,,,,Outpatient,,,238.76,,Blue Cross of AL,Blue Cross,59.06,,,,,,,Other,59.06,328.88,Based on EAPG RVU's
11732 AVULSION OF EACH ADDITIONAL NAIL PLATE,13029593,LOCAL,11732,CPT,,,,,,Outpatient,,,239.9,156,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,14.39,863,Based on EAPG RVU's
93463 Pharmacologic Agent Administration,8230065,LOCAL,93463,CPT,,,,,,Outpatient,,,240,156,Blue Cross of AL,Blue Cross,64.56,,,,,,,Other,64.56,863,Based on EAPG RVU's
36591 COLLECT BLOOD FROM IMPL VEN DEVICE CHARGE,10451346,LOCAL,36591,CPT,,,,,,Outpatient,,,241.46,157,Blue Cross of AL,Blue Cross,85.79,,,,,,,Other,85.79,863,Based on EAPG RVU's
Central Line Activity. -> Blood drawn,12856467,LOCAL,36592,CPT,,,,,,Outpatient,,,241.46,157,Blue Cross of AL,Blue Cross,85.79,,,,,,,Other,85.79,863,Based on EAPG RVU's
Anaerobic Culture,4122782,LOCAL,87075,CPT,,,,,,Outpatient,,,242.35,11.36,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,50.328,Based on EAPG RVU's
Bill Only ABID Panel,7936969,LOCAL,86870,CPT,,,,,,Outpatient,,,243,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,328.88,Based on EAPG RVU's
US OB Greater Than 14 Weeks,1169850,LOCAL,76805,CPT,,,,,,Outpatient,,,243,130.35,Blue Cross of AL,Blue Cross,148.61,,,,,,,Other,97.22,148.61,Based on EAPG RVU's
US OB Greater Than 14 Weeks,1169851,LOCAL,76805,CPT,,,,,,Outpatient,,,243,130.35,Blue Cross of AL,Blue Cross,148.61,,,,,,,Other,97.22,148.61,Based on EAPG RVU's
Blood Gas Arterial RT,8127157,LOCAL,82805,CPT,,,301,RC,,Outpatient,,,244.5,94.52,Blue Cross of AL,Blue Cross,46.74,,,,,,,Other,46.74,46.74,Based on EAPG RVU's
92507  Treatment of Speech,9630066,LOCAL,92507,CPT,440,RC,,,GN,Outpatient,,,244.9,159,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,337.75,337.75,Based on EAPG RVU's
SLP Auditory Processing Tx Units,1373841,LOCAL,92507,CPT,440,RC,,,GN,Outpatient,,,244.9,159,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,337.75,337.75,Based on EAPG RVU's
Speech/Language/Voice/Auditory Minutes,7896889,LOCAL,92507,CPT,444,RC,,,GN,Outpatient,,,244.9,159,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,337.75,337.75,Based on EAPG RVU's
Tx of Speech/Lang/Voice/Comm/Auditory Charge,1373841,LOCAL,92507,CPT,440,RC,,,GN,Outpatient,,,244.9,159,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,337.75,337.75,Based on EAPG RVU's
FLUOROSCOPY <1 HOUR,8210790,LOCAL,76000,CPT,,,,,,Outpatient,,,246.02,380.33,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,220.99,Based on EAPG RVU's
.Hep C Viral RNA Quant RealTime PCR QSTC,8764584,LOCAL,87522,CPT,,,,,,Outpatient,,,247.5,51.41,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,144.745,Based on EAPG RVU's
HCV RNA Quan Progress to Genotyping QSTC,9039270,LOCAL,87522,CPT,,,,,,Outpatient,,,247.5,51.41,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,144.745,Based on EAPG RVU's
"Hepatitis C, RNA, Quantitative, PCR QSTC",8764755,LOCAL,87522,CPT,,,,,,Outpatient,,,247.5,51.41,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,144.745,Based on EAPG RVU's
"HSV Type 1&2 DNA, Qual RT PCR QSTC",8873562,LOCAL,87529,CPT,,,,,,Outpatient,,,247.5,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
Pancreatic Elastase-1 QSTC,8764835,LOCAL,82653,CPT,,,,,,Outpatient,,,247.5,27.56,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,22.97,Based on EAPG RVU's
REF PLT Screening,13475613,LOCAL,86022,CPT,,,,,,Outpatient,,,247.5,22.04,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,18.37,Based on EAPG RVU's
RT CHARGE Aerosol Therapy -> Initial,12502774,LOCAL,94640,CPT,,,,,,Outpatient,,,247.86,136,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,185.95,Based on EAPG RVU's
RT Continuous Neb Initial CHARGE,8144200,LOCAL,94640,CPT,,,,,,Outpatient,,,247.86,136,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,185.95,Based on EAPG RVU's
RT IPV Initial CHARGE,8144187,LOCAL,94640,CPT,,,,,,Outpatient,,,247.86,136,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,185.95,Based on EAPG RVU's
96415 CHEMO IV INFUSION EA ADDL HR INF CHARGE,9665726,LOCAL,96415,CPT,,,,,,Outpatient,,,248.22,161,Blue Cross of AL,Blue Cross,749.76,,,,,,,Other,65.07,749.76,Based on EAPG RVU's
ABG wCOOX,10217289,LOCAL,82805,CPT,,,301,RC,,Outpatient,,,249.39,94.52,Blue Cross of AL,Blue Cross,46.74,,,,,,,Other,46.74,46.74,Based on EAPG RVU's
Blood Gas Venous RT,8127268,LOCAL,82805,CPT,,,301,RC,,Outpatient,,,249.39,94.52,Blue Cross of AL,Blue Cross,46.74,,,,,,,Other,46.74,46.74,Based on EAPG RVU's
Cord Blood Gas (Arterial),8108520,LOCAL,82805,CPT,,,301,RC,,Outpatient,,,249.39,94.52,Blue Cross of AL,Blue Cross,46.74,,,,,,,Other,46.74,46.74,Based on EAPG RVU's
Cord Blood Gas (Venous),8152173,LOCAL,82805,CPT,,,301,RC,,Outpatient,,,249.39,94.52,Blue Cross of AL,Blue Cross,46.74,,,,,,,Other,46.74,46.74,Based on EAPG RVU's
"Clobazam and Metabolite, Serum/Plasma QSTC",8764736,LOCAL,80299,CPT,,,,,,Outpatient,,,249.75,22.37,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,18.64,Based on EAPG RVU's
95977 - device analysis and complex programming,14685299,LOCAL,95977,CPT,,,,,,Outpatient,,,250,92,Blue Cross of AL,Blue Cross,214.22,,,,,,,Other,83.92,214.22,Based on EAPG RVU's
Hep Acute Pnl,633756,LOCAL,80074,CPT,,,,,,Outpatient,,,250,57.16,Blue Cross of AL,Blue Cross,12.14,,,,,,,Other,12.14,59.336,Based on EAPG RVU's
Hep Acute Pnl Post Exposure,9517262,LOCAL,80074,CPT,,,,,,Outpatient,,,250,57.16,Blue Cross of AL,Blue Cross,12.14,,,,,,,Other,12.14,59.336,Based on EAPG RVU's
Albumin Level,1620877,LOCAL,82040,CPT,,,,,,Outpatient,,,250.92,5.94,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,127.89,Based on EAPG RVU's
Luteinizing Hormone,4240834,LOCAL,83002,CPT,,,,,,Outpatient,,,250.92,22.22,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,18.52,Based on EAPG RVU's
Rufinamide QSTC,13864436,LOCAL,80210,CPT,,,,,,Outpatient,,,251.6,32.53,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,27.11,Based on EAPG RVU's
"Drug Screen Panel 5, Meconium QSTC",13864478,LOCAL,80307,CPT,,,301,RC,,Outpatient,,,252,74.57,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,160.4,Based on EAPG RVU's
XR Hand 2 Views Left,1170215,LOCAL,73120,CPT,,,,,LT,Outpatient,,,253.04,135.3,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
XR Hand 2 Views Right,1170217,LOCAL,73120,CPT,,,,,RT,Outpatient,,,253.04,135.3,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
XR Lower Extremity Infant 2 Views Bilat,8455866,LOCAL,73592,CPT,,,,,,Outpatient,,,253.13,136.13,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Lower Extremity Infant 2 Views Left,8455869,LOCAL,73592,CPT,,,,,LT,Outpatient,,,253.13,136.13,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Lower Extremity Infant 2 Views Right,8455872,LOCAL,73592,CPT,,,,,RT,Outpatient,,,253.13,136.13,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
hepatitis B adult vaccine 20 mcg/mL intramuscular suspension 1 mL [CULL],11202558,LOCAL,90746,CPT,,,,,,Outpatient,1,ML,253.80864,,Blue Cross of AL,Blue Cross,39.58,,,,,,,Other,39.58,75.145,Based on EAPG RVU's
XR Chest 1 View,8132832,LOCAL,71045,CPT,,,,,,Outpatient,,,253.82,136.13,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Elbow 1 View Left,13554981,LOCAL,73070,CPT,,,,,52|LT,Outpatient,,,254.32,136.13,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Elbow 1 View Right,13554984,LOCAL,73070,CPT,,,,,52|RT,Outpatient,,,254.32,136.13,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
69210 REM IMPACT CERUMEN REQ INSTRU CHARGE,8020194,LOCAL,69210,CPT,,,,,,Outpatient,,,255.9,166,Blue Cross of AL,Blue Cross,162.41,,,,,,,Other,54.31,863,Based on EAPG RVU's
Bill Only Computer Search EA/Ag,13517192,LOCAL,86902,CPT,,,,,,Outpatient,,,256.5,7.62,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,328.88,Based on EAPG RVU's
Bill Only Fresh Unit (<5 Days Old),13517198,LOCAL,86999,CPT,,,,,,Outpatient,,,256.5,,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,22.39,Based on EAPG RVU's
US Pelvic Ltd,8206967,LOCAL,76857,CPT,,,,,,Outpatient,,,257.05,137.78,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
RT CHARGE PFT -> Spirometry,5274349,LOCAL,94010,CPT,,,,,,Outpatient,,,258.58,168,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,143.05,Based on EAPG RVU's
97161  SB PT Eval Low Comp,9640014,LOCAL,97161,CPT,,,,,GP,Outpatient,,,262.16,170,Blue Cross of AL,Blue Cross,349.89,,,,,,,Other,46.04162662,349.89,Based on EAPG RVU's
97161 EVAL - LOW COMPLEXITY CHARGE,9410054,LOCAL,97161,CPT,,,,,GP,Outpatient,,,262.16,170,Blue Cross of AL,Blue Cross,349.89,,,,,,,Other,46.04162662,349.89,Based on EAPG RVU's
97161 PHYSICAL THERAPY EVALUATION CHARGE,9650014,LOCAL,97161,CPT,,,,,GP|CQ,Outpatient,,,262.16,170,Blue Cross of AL,Blue Cross,349.89,,,,,,,Other,46.04162662,349.89,Based on EAPG RVU's
PT Low Complex Units,7896010,LOCAL,97161,CPT,,,,,GP,Outpatient,,,262.16,170,Blue Cross of AL,Blue Cross,349.89,,,,,,,Other,46.04162662,349.89,Based on EAPG RVU's
"Lactoferrin, QL, Stool QSTC",9039266,LOCAL,83630,CPT,,,,,,Outpatient,,,263.25,23.64,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,19.7,Based on EAPG RVU's
"92521 EVALUATION OF SPEECH FLUENCY (STUTTERING, CLUTTERING)",9630056,LOCAL,92521,CPT,,,,,GN,Outpatient,,,263.99,172,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,125.86,337.75,Based on EAPG RVU's
SLP Speech Fluency Eval Units,7897205,LOCAL,92521,CPT,,,,,GN,Outpatient,,,263.99,172,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,125.86,337.75,Based on EAPG RVU's
Speech Fluency Eval Charge,7897205,LOCAL,92521,CPT,,,,,GN,Outpatient,,,263.99,172,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,125.86,337.75,Based on EAPG RVU's
92526  Treatment of Swallow,9630083,LOCAL,92526,CPT,,,,,GN,Outpatient,,,265.2,172,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,85.2525,Based on EAPG RVU's
SLP Swallow Dysfunction Oral Feed Units,1373842,LOCAL,92526,CPT,,,,,GN,Outpatient,,,265.2,172,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,85.2525,Based on EAPG RVU's
Treatment of Swallowing Dysfunction Charge,7896917,LOCAL,92526,CPT,,,,,GN,Outpatient,,,265.2,172,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,85.2525,Based on EAPG RVU's
Treatment of Swallowing Dysfunction Charge -> Yes,7896917,LOCAL,92526,CPT,,,,,GN,Outpatient,,,265.2,172,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,85.2525,Based on EAPG RVU's
RNA Polymerase III Antibody QSTC,10067478,LOCAL,83516,CPT,,,,,,Outpatient,,,265.5,13.84,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,11.53,17.73,Based on EAPG RVU's
XR Sinuses Paranasal < 3 Views,1170432,LOCAL,70210,CPT,,,,,,Outpatient,,,266.27,142.73,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Pelvis 1 or 2 Views,1170351,LOCAL,72170,CPT,,,,,,Outpatient,,,266.62,142.73,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
Zonisamide QSTC,8764609,LOCAL,80203,CPT,,,,,,Outpatient,,,267.53,15.9,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,13.25,15.38,Based on EAPG RVU's
"Iodine, U24 QSTC",13864440,LOCAL,82542,CPT,,,,,,Outpatient,,,267.8,28.91,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,24.09,Based on EAPG RVU's
.Atypical P-ANCA Titer QSTC,8764788,LOCAL,86037,CPT,,,,,,Outpatient,,,270,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.05,15.29,Based on EAPG RVU's
"Acylcarnitine, Plasma QSTC",9215425,LOCAL,82017,CPT,,,,,,Outpatient,,,270,20.24,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,16.87,17.73,Based on EAPG RVU's
C. difficile Toxin B Qual PCR QSTC,13864437,LOCAL,87493,CPT,,,,,,Outpatient,,,270,44.72,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,37.27,40.19,Based on EAPG RVU's
"Cytomegalovirus DNA, QN, Real-T PCR QSTC",8764608,LOCAL,87497,CPT,,,,,,Outpatient,,,270,51.41,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,42.84,Based on EAPG RVU's
"Kappa/Lambda Lght Chn, Free w Rat U QSTC",9039383,LOCAL,83883,CPT,,,,,,Outpatient,,,270,16.32,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,13.6,15.29,Based on EAPG RVU's
"Kappa/Lambda Light Chains, Tot Ur QSTC",9039383,LOCAL,83883,CPT,,,,,,Outpatient,,,270,16.32,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,13.6,15.29,Based on EAPG RVU's
"Mycoplasma Genitalium,R-T PCR QST",9773947,LOCAL,87624,CPT,,,,,,Outpatient,,,270,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,67.195,Based on EAPG RVU's
Reference Lab Crossmatch -> Compatible,8185614,LOCAL,86920,CPT,,,,,,Outpatient,,,270,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
Reference Lab Crossmatch -> Incompatible,8185613,LOCAL,86920,CPT,,,,,,Outpatient,,,270,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
Reference Lab Crossmatch -> Least Incompatible,8185612,LOCAL,86920,CPT,,,,,,Outpatient,,,270,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
von Willebrand Factor Ag QSTC,8764731,LOCAL,85246,CPT,,,,,,Outpatient,,,270,27.53,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,22.94,Based on EAPG RVU's
Drug Conf 9 SO,13940916,LOCAL,80307,CPT,,,301,RC,,Outpatient,,,270.9,74.57,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,160.4,Based on EAPG RVU's
XR Finger(s) 1 View Left,13554987,LOCAL,73140,CPT,,,,,52|LT,Outpatient,,,272.62,146.03,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Finger(s) 1 View Right,13554990,LOCAL,73140,CPT,,,,,52|RT,Outpatient,,,272.62,146.03,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
Electrocardiogram 12 Lead.,9696149,LOCAL,93005,CPT,,,,,,Outpatient,,,273.98,178,Blue Cross of AL,Blue Cross,38.53,,,,,,,Other,38.53,54.31,Based on EAPG RVU's
93242 Holter 3 to 7 Days Recording,90820010,LOCAL,93242,CPT,,,,,,Outpatient,,,275,179,Blue Cross of AL,Blue Cross,99.86,,,,,,,Other,35.88,99.86,Based on EAPG RVU's
Prolactin Level,3170316,LOCAL,84146,CPT,,,,,,Outpatient,,,275.4,23.26,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,19.38,Based on EAPG RVU's
XR Elbow 2 Views Left,1170121,LOCAL,73070,CPT,,,,,LT,Outpatient,,,275.53,136.13,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Elbow 2 Views Right,1170123,LOCAL,73070,CPT,,,,,RT,Outpatient,,,275.53,136.13,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
.TR Interpretation,1173781,LOCAL,86078,CPT,,,,,,Outpatient,,,277.85,,Blue Cross of AL,Blue Cross,38.88,,,,,,,Other,38.88,156.67,Based on EAPG RVU's
BB REF LAB PHYSICIAN INTERP,6413086,LOCAL,86077,CPT,,,,,,Outpatient,,,279,,Blue Cross of AL,Blue Cross,38.88,,,,,,,Other,22.39,38.88,Based on EAPG RVU's
Bill Only Crossmatch IS,8419033,LOCAL,86920,CPT,,,,,,Outpatient,,,279,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
Urine Fentanyl Screen,13840640,LOCAL,80307,CPT,,,301,RC,,Outpatient,,,279.63,74.57,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,160.4,Based on EAPG RVU's
Urine Fentanyl Screen,13840640,LOCAL,80307,CPT,,,300,RC,,Outpatient,,,279.63,74.57,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,160.4,Based on EAPG RVU's
hepatitis B immune globulin intramuscular solution 0.5 mL [CULL],11202561,LOCAL,J1571,CPT,,,,,,Outpatient,0.5,ML,280.064,,Blue Cross of AL,Blue Cross,771.25,,,,,,,Other,66.64,771.25,Based on EAPG RVU's
XR Spine 1 View Specify Level,8058789,LOCAL,72020,CPT,,,,,,Outpatient,,,281.44,150.98,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Knee 1 View Standing AP Bilateral,1170291,LOCAL,73565,CPT,,,,,,Outpatient,,,283.03,151.8,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
Iodine QSTC,13864439,LOCAL,82542,CPT,,,,,,Outpatient,,,283.32,28.91,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,24.09,Based on EAPG RVU's
XR Neck Soft Tissue,1170331,LOCAL,70360,CPT,,,,,,Outpatient,,,284.4,152.63,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
97162  SB PT Eval Mod Comp,9640015,LOCAL,97162,CPT,,,,,GP,Outpatient,,,287.16,187,Blue Cross of AL,Blue Cross,349.89,,,,,,,Other,42.68861429,349.89,Based on EAPG RVU's
97162 EVAL - MODERATE COMPLEXITY CHARGE,9410055,LOCAL,97162,CPT,,,,,GP,Outpatient,,,287.16,187,Blue Cross of AL,Blue Cross,349.89,,,,,,,Other,42.68861429,349.89,Based on EAPG RVU's
97162 PT EVAL MOD COMPLEX CHARGES,9650015,LOCAL,97162,CPT,,,,,GP|CQ,Outpatient,,,287.16,187,Blue Cross of AL,Blue Cross,349.89,,,,,,,Other,42.68861429,349.89,Based on EAPG RVU's
PT Moderate Complex Units,7896012,LOCAL,97162,CPT,,,,,GP,Outpatient,,,287.16,187,Blue Cross of AL,Blue Cross,349.89,,,,,,,Other,42.68861429,349.89,Based on EAPG RVU's
Soluble Liver Antigen (SLA) Autoantibody QSTC,10148492,LOCAL,83520,CPT,,,,,,Outpatient,,,288,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,117.3767568,Based on EAPG RVU's
XR Shoulder 1 View Left,1170409,LOCAL,73020,CPT,,,,,LT,Outpatient,,,289.86,155.1,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Shoulder 1 View Right,1170411,LOCAL,73020,CPT,,,,,RT,Outpatient,,,289.86,155.1,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR AC Joints Bilateral,1169922,LOCAL,73050,CPT,,,,,,Outpatient,,,289.94,155.1,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Calcaneus Limited Left,13554972,LOCAL,73650,CPT,,,,,52|LT,Outpatient,,,290.55,174.9,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Calcaneus Limited Right,13554975,LOCAL,73650,CPT,,,,,52|RT,Outpatient,,,290.55,174.9,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
BD Bone Density DEXA Vert Fracture Assmt,8206345,LOCAL,77086,CPT,,,,,,Outpatient,,,291.16,155.93,Blue Cross of AL,Blue Cross,116.02,,,,,,,Other,80.5,116.02,Based on EAPG RVU's
XR Foreign Body Localization Child 1 Vw,1170207,LOCAL,76010,CPT,,,,,,Outpatient,,,291.16,155.93,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
"Cytomegalovirus DNA, QL R-T PCR QSTC",9777223,LOCAL,87496,CPT,,,,,,Outpatient,,,292.5,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
"Factor IX Activity,Clotting [352X]  QSTC",12534660,LOCAL,85250,CPT,,,,,,Outpatient,,,292.5,22.85,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,19.04,Based on EAPG RVU's
"HIV-1 RNA, QN, Real-Time PCR QSTC",8764763,LOCAL,87536,CPT,,,,,,Outpatient,,,292.5,102.12,Blue Cross of AL,Blue Cross,158.39,,,,,,,Other,85.1,158.39,Based on EAPG RVU's
XR Chest Decubitus,1170049,LOCAL,71046,CPT,,,,,,Outpatient,,,292.6,212.85,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
"Factor VIII Inhibitor, EIA QSTC",13873092,LOCAL,85335,CPT,,,,,,Outpatient,,,294.75,15.44,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,12.87,Based on EAPG RVU's
"FVIII Act, Clotting QSTC",13873093,LOCAL,85240,CPT,,,,,,Outpatient,,,294.75,21.48,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,17.9,Based on EAPG RVU's
XR Upper Extremity Infant 2 Views Left,8455878,LOCAL,73092,CPT,,,,,LT,Outpatient,,,296.99,159.23,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
XR Upper Extremity Infant 2 Views Right,8455881,LOCAL,73092,CPT,,,,,RT,Outpatient,,,296.99,159.23,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
Ref Rh Phenotyping,9527485,LOCAL,86906,CPT,,,,,,Outpatient,,,297,9.3,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,35.88,Based on EAPG RVU's
92611 ST VIDEOFLUOR SWALLOW CHARGE,9630067,LOCAL,92611,CPT,,,,,GN,Outpatient,,,297.49,193,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,189.9866667,Based on EAPG RVU's
Fluoroscopic Evaluation of Swallow Function Charge,7896919,LOCAL,92611,CPT,,,,,GN,Outpatient,,,297.49,193,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,189.9866667,Based on EAPG RVU's
SLP Fluoroscopic Evaluation Units,1373839,LOCAL,92611,CPT,,,,,GN,Outpatient,,,297.49,193,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,189.9866667,Based on EAPG RVU's
97165 EVAL -  LOW COMPLEXITY CHARGE,9850014,LOCAL,97165,CPT,,,,,GO,Outpatient,,,297.74,194,Blue Cross of AL,Blue Cross,269.95,,,,,,,Other,94.3,269.95,Based on EAPG RVU's
97165 OT Evaluation Low Complexity 30 min,9860014,LOCAL,97165,CPT,,,,,GO|CO,Outpatient,,,297.74,194,Blue Cross of AL,Blue Cross,269.95,,,,,,,Other,94.3,269.95,Based on EAPG RVU's
OT Evaluation Low Complexity Units,7897807,LOCAL,97165,CPT,,,,,GO,Outpatient,,,297.74,194,Blue Cross of AL,Blue Cross,269.95,,,,,,,Other,94.3,269.95,Based on EAPG RVU's
OT Low Complex Units,7895291,LOCAL,97165,CPT,,,,,GO,Outpatient,,,297.74,194,Blue Cross of AL,Blue Cross,269.95,,,,,,,Other,94.3,269.95,Based on EAPG RVU's
"Aspergillus Antigen, EIA, Serum QSTC",9777227,LOCAL,87305,CPT,,,,,,Outpatient,,,298,14.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,11.98,Based on EAPG RVU's
29581 PT Lower Extremity Application of Strapping,9640079,LOCAL,29581,CPT,,,,,GP,Outpatient,,,300,195,Blue Cross of AL,Blue Cross,275.28,,,,,,,Other,144.26,863,Based on EAPG RVU's
PT Lymphedema Wrap below Knee Charge,7895901,LOCAL,29581,CPT,,,,,GP,Outpatient,,,300,195,Blue Cross of AL,Blue Cross,275.28,,,,,,,Other,144.26,863,Based on EAPG RVU's
Lacosamide QSTC,8764635,LOCAL,80235,CPT,,,,,,Outpatient,,,301.5,32.53,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,27.11,Based on EAPG RVU's
tetanus/diphth/pertussis (Tdap) adult/adol 5 units-2 units-15.5 mcg/0.5 mL intramuscular suspension 0.5 mL [CULL],11202346,LOCAL,90714,CPT,,,,,,Outpatient,0.5,ML,301.632,,Blue Cross of AL,Blue Cross,39.58,,,,,,,Other,14.45070423,39.58,Based on EAPG RVU's
XR Toe(s) 2 PLUS Views Right,1170522,LOCAL,73660,CPT,,,,,RT,Outpatient,,,301.78,161.7,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Toe(s) 2+ Views Left,1170520,LOCAL,73660,CPT,,,,,LT,Outpatient,,,301.78,161.7,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
influenza vaccine (Fluzone HD) vaccine 2025-2026 [CULL],11292055,LOCAL,90662,CPT,,,,,,Outpatient,0.5,ML,303.5392,,Blue Cross of AL,Blue Cross,39.58,,,,,,,Other,39.58,86.13,Based on EAPG RVU's
CV Holter Monitor Recording up to 48 Hrs,8230053,LOCAL,93225,CPT,,,,,,Outpatient,,,304,198,Blue Cross of AL,Blue Cross,99.86,,,,,,,Other,99.86,117.85,Based on EAPG RVU's
Holter Monitor 48 Hr,8230053,LOCAL,93225,CPT,,,,,,Outpatient,,,304,198,Blue Cross of AL,Blue Cross,99.86,,,,,,,Other,99.86,117.85,Based on EAPG RVU's
Bill Only Rh Phenotyping,7936966,LOCAL,86906,CPT,,,,,,Outpatient,,,306,9.3,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,35.88,Based on EAPG RVU's
COV19/Flu/RSV (GeneXpert Plus),10791321,LOCAL,87637,CPT,,,,,,Outpatient,,,306,171.16,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,69.4761107,Based on EAPG RVU's
US OB Less Than 14 Weeks,8206952,LOCAL,76801,CPT,,,,,,Outpatient,,,307,165,Blue Cross of AL,Blue Cross,148.61,,,,,,,Other,97.22,148.61,Based on EAPG RVU's
Chlamydia/Chlamydophila Ab 2 IgM QSTC,13864537,LOCAL,86632,CPT,,,,,,Outpatient,,,307.13,15.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.68,15.29,Based on EAPG RVU's
Comprehensive Metabolic Panel,633709,LOCAL,80053,CPT,,,,,,Outpatient,,,307.22,12.67,Blue Cross of AL,Blue Cross,12.14,,,,,,,Other,12.14,82.75523053,Based on EAPG RVU's
XR Ankle 1 View Left,13554963,LOCAL,73600,CPT,,,,,52|LT,Outpatient,,,307.85,165,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Ankle 1 View Right,13554966,LOCAL,73600,CPT,,,,,52|RT,Outpatient,,,307.85,165,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Foot 2 Views Left,1170185,LOCAL,73620,CPT,,,,,LT,Outpatient,,,309.19,165.83,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Foot 2 Views Right,1170187,LOCAL,73620,CPT,,,,,RT,Outpatient,,,309.19,165.83,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
"Bill Only ABID Panel, Enzyme (Ab)",13517190,LOCAL,86870,CPT,,,,,,Outpatient,,,310.5,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,328.88,Based on EAPG RVU's
"Bill Only ABID Panel, Enzyme (Ezym)",13517194,LOCAL,86971,CPT,,,,,,Outpatient,,,310.5,,Blue Cross of AL,Blue Cross,38.88,,,,,,,Other,38.88,156.67,Based on EAPG RVU's
Insulin Autoantibody QSTC,8764818,LOCAL,86337,CPT,,,,,,Outpatient,,,310.5,25.69,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,21.41,Based on EAPG RVU's
XR Finger(s) 2 Plus Views Left,1170151,LOCAL,73140,CPT,,,,,LT,Outpatient,,,311.14,146.03,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Finger(s) 2 Plus Views Right,1170153,LOCAL,73140,CPT,,,,,RT,Outpatient,,,311.14,146.03,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
97163  SB PT Eval High Comp,9640017,LOCAL,97163,CPT,,,,,GP,Outpatient,,,312.16,203,Blue Cross of AL,Blue Cross,349.89,,,,,,,Other,92.25,349.89,Based on EAPG RVU's
97163 EVAL - HIGH COMPLEXITY CHARGE,9410062,LOCAL,97163,CPT,,,,,GP,Outpatient,,,312.16,203,Blue Cross of AL,Blue Cross,349.89,,,,,,,Other,92.25,349.89,Based on EAPG RVU's
97163 IND EDUCATION EVAL CHARGE,9650017,LOCAL,97163,CPT,,,,,GP|CQ,Outpatient,,,312.16,203,Blue Cross of AL,Blue Cross,349.89,,,,,,,Other,92.25,349.89,Based on EAPG RVU's
PT High Complex Units,7896014,LOCAL,97163,CPT,,,,,GP,Outpatient,,,312.16,203,Blue Cross of AL,Blue Cross,349.89,,,,,,,Other,92.25,349.89,Based on EAPG RVU's
Factor II Activity QSTC,8972859,LOCAL,85210,CPT,,,,,,Outpatient,,,312.8,15.58,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,12.98,Based on EAPG RVU's
MG Mammo Implant Screening Lt w/ Tomo.,8146654,LOCAL,77067,CPT,,,,,LT,Outpatient,,,313.11,363,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,79.68,Based on EAPG RVU's
MG Mammo Implant Screening Rt w/ Tomo.,8146657,LOCAL,77067,CPT,,,,,RT,Outpatient,,,313.11,363,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,79.68,Based on EAPG RVU's
MG Mammo Screening Left w/ Tomo.,8146660,LOCAL,77067,CPT,,,,,LT,Outpatient,,,313.11,363,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,79.68,Based on EAPG RVU's
MG Mammo Screening Right w/ Tomo.,8146663,LOCAL,77067,CPT,,,,,RT,Outpatient,,,313.11,363,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,79.68,Based on EAPG RVU's
92609 ST USE OF SPEECH DEVICE SERVICES,9636008,LOCAL,92609,CPT,,,,,GN,Outpatient,,,314.48,204,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,95.88,Based on EAPG RVU's
SLP Speech-Gen Dev Prog and Mod,7896913,LOCAL,92609,CPT,,,,,GN,Outpatient,,,314.48,204,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,95.88,Based on EAPG RVU's
SLP Speech-Gen Dev Prog and Mod Time,1373849,LOCAL,92609,CPT,,,,,GN,Outpatient,,,314.48,204,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,95.88,Based on EAPG RVU's
SLP Tx Generating Device Units,1373849,LOCAL,92609,CPT,,,,,GN,Outpatient,,,314.48,204,Blue Cross of AL,Blue Cross,56.44,,,,,,,Other,56.44,95.88,Based on EAPG RVU's
"Factor V Activity, Clotting QSTC",9777239,LOCAL,85220,CPT,,,,,,Outpatient,,,315,21.18,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,17.65,Based on EAPG RVU's
Hepatitis B Virus DNA Qnt RT PCR QSTC,8764549,LOCAL,87517,CPT,,,,,,Outpatient,,,315,51.41,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,178.495,Based on EAPG RVU's
Inhibin A QSTC,8972775,LOCAL,86336,CPT,,,,,,Outpatient,,,315,18.71,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,15.59,Based on EAPG RVU's
"Viral Respiratory, Rapid Culture with Reflex QST",12126195,LOCAL,87140,CPT,,,,,,Outpatient,,,315,6.68,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,5.57,10.57,Based on EAPG RVU's
"Porphyrins, Total QSTC",13864419,LOCAL,82542,CPT,,,,,,Outpatient,,,315.9,28.91,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,24.09,Based on EAPG RVU's
"73040 Radiologic examination, shoulder, arthrography: AddOn",14917589,LOCAL,73040,CPT,,,,,,Outpatient,,,316.12,777.98,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,326.51,Based on EAPG RVU's
XR Forearm 1 View Left,13554993,LOCAL,73090,CPT,,,,,52|LT,Outpatient,,,318.62,170.78,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Forearm 1 View Right,13554996,LOCAL,73090,CPT,,,,,52|RT,Outpatient,,,318.62,170.78,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Ankle 2 Views Left,1169936,LOCAL,73600,CPT,,,,,LT,Outpatient,,,318.65,165,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Ankle 2 Views Right,1169938,LOCAL,73600,CPT,,,,,RT,Outpatient,,,318.65,165,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
Complement Component C1q QSTC,8972752,LOCAL,86160,CPT,,,,,,Outpatient,,,322.65,14.4,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,36.909,Based on EAPG RVU's
97166  SB OT Eval Mod Comp,9860015,LOCAL,97166,CPT,,,,,GO|CO,Outpatient,,,322.74,210,Blue Cross of AL,Blue Cross,269.95,,,,,,,Other,94.3,269.95,Based on EAPG RVU's
97166 EVAL -  MODERATE COMPLEXITY CHARGE,9850015,LOCAL,97166,CPT,,,,,GO,Outpatient,,,322.74,210,Blue Cross of AL,Blue Cross,269.95,,,,,,,Other,94.3,269.95,Based on EAPG RVU's
OT Evaluation Moderate Complexity Units,7897808,LOCAL,97166,CPT,,,,,GO,Outpatient,,,322.74,210,Blue Cross of AL,Blue Cross,269.95,,,,,,,Other,94.3,269.95,Based on EAPG RVU's
OT Moderate Complex Units,7895293,LOCAL,97166,CPT,,,,,GO,Outpatient,,,322.74,210,Blue Cross of AL,Blue Cross,269.95,,,,,,,Other,94.3,269.95,Based on EAPG RVU's
XR Calcaneus Left,1170032,LOCAL,73650,CPT,,,,,LT,Outpatient,,,325.42,174.9,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Calcaneus Right,1170034,LOCAL,73650,CPT,,,,,RT,Outpatient,,,325.42,174.9,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
94618 PULM STRESS TEST - 6 MIN WALK CHARGE,10470023,LOCAL,94618,CPT,,,,,59,Outpatient,,,326.86,212,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,117.85,Based on EAPG RVU's
94618 PULMONARY STRESS TEST CHARGE,10470022,LOCAL,94618,CPT,,,,,,Outpatient,,,326.86,212,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,117.85,Based on EAPG RVU's
XR Hips 2 Views w/AP Pelvis Bilat,7520609,LOCAL,73521,CPT,,,,,,Outpatient,,,327.27,175.73,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
"Neutrophil Funct, Oxidative Burst QSTC",13864519,LOCAL,82657,CPT,,,,,,Outpatient,,,327.6,26.6,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,22.17,Based on EAPG RVU's
XR Clavicle Limited Left,13554978,LOCAL,73000,CPT,,,,,52|LT,Outpatient,,,330.84,198.83,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Clavicle Limited Right,13575896,LOCAL,73000,CPT,,,,,52|RT,Outpatient,,,330.84,198.83,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR CV Line Injection,10153535,LOCAL,77001,CPT,,,,,,Outpatient,,,330.88,177.38,Blue Cross of AL,Blue Cross,262.79,,,,,,,Other,70.92,262.79,Based on EAPG RVU's
XR Portogram,8602535,LOCAL,36598,CPT,,,,,,Outpatient,,,330.88,587,Blue Cross of AL,Blue Cross,442.76,,,,,,,Other,192.63,863,Based on EAPG RVU's
"Neuron Specific Enolase, CSF QSTC",13864472,LOCAL,86316,CPT,,,,,,Outpatient,,,335.25,24.97,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,100.2,Based on EAPG RVU's
XR Sternum 2+ Views,1170496,LOCAL,71120,CPT,,,,,,Outpatient,,,335.51,179.85,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
"Borrelia species DNA, QL RT PCR QSTC",13864432,LOCAL,87801,CPT,,,,,,Outpatient,,,337.5,84.24,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,70.2,Based on EAPG RVU's
"Calprotectin, Stool QSTC",8764641,LOCAL,83993,CPT,,,,,,Outpatient,,,337.5,23.56,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,19.63,Based on EAPG RVU's
"Factor VII Activity, Clotting QSTC",12530023,LOCAL,85230,CPT,,,,,,Outpatient,,,337.5,21.48,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,17.9,Based on EAPG RVU's
"Rheumatoid Factor (IgA, IgG, IgM) QSTC",9743436,LOCAL,83520,CPT,,,,,,Outpatient,,,337.5,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,117.3767568,Based on EAPG RVU's
SURESWAB(R) ADV BV QST,12432150,LOCAL,81513,CPT,,,,,,Outpatient,,,338,171.16,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,63.34,142.63,Based on EAPG RVU's
"Estrogens, Fractionated, LC/MS QSTC",8972883,LOCAL,82671,CPT,,,,,,Outpatient,,,340.29,38.76,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,185.975,Based on EAPG RVU's
"diphtheria/hepatitis B/pertussis,acellular/polio/tetanus intramuscular suspension 0.5 mL [CULL]",11202562,LOCAL,90723,CPT,,,,,,Outpatient,0.5,ML,341.31456,,Blue Cross of AL,Blue Cross,39.58,,,,,,,Other,39.58,39.58,Based on EAPG RVU's
"86617-Lyme Disease Abs (IgG, IgM) IBL CSF QSTC",14825580,LOCAL,86617,CPT,,,,,,Outpatient,,,342,18.59,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,15.49,Based on EAPG RVU's
"BK Virus DNA, Quant, RT PCR QSTC",8853280,LOCAL,87799,CPT,,,,,,Outpatient,,,342,51.41,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,42.84,Based on EAPG RVU's
"Lyme Disease Ab Rfx Blot IgG, IgM QSTC",8764732,LOCAL,86618,CPT,,,,,,Outpatient,,,342,20.44,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,17.03,Based on EAPG RVU's
"Lyme Disease Abs (IgG, IgM) IBL CSF QSTC",14114578,LOCAL,86617,CPT,,,,,,Outpatient,,,342,18.59,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,15.49,Based on EAPG RVU's
"Lyme Disease Antibodies (IgG, IgM), Immunoblot, CSF QST",6232109,LOCAL,86617,CPT,,,,,,Outpatient,,,342,18.59,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,15.49,Based on EAPG RVU's
sodium thiosulfate 25% intravenous solution 50 mL [CULL],11260081,LOCAL,J0208,CPT,,,,,,Outpatient,50,ML,342.4,,Blue Cross of AL,Blue Cross,7537.07,,,,,,,Other,95.11,7537.07,Based on EAPG RVU's
Chlamydia/Chlamydophila Ab 1 IgG QSTC,13864536,LOCAL,86631,CPT,,,,,,Outpatient,,,342.9,14.18,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,11.82,15.29,Based on EAPG RVU's
"TRICHOMONAS VAGINALIS (TV), TMA QST",12432301,LOCAL,87661,CPT,,,,,,Outpatient,,,343.11,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
CANDIDA GLABRATA QST,12432300,LOCAL,87481,CPT,,,,,,Outpatient,,,343.13,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,478.165,Based on EAPG RVU's
CANDIDA SPECIES QST,12432293,LOCAL,87481,CPT,,,,,,Outpatient,,,343.13,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,478.165,Based on EAPG RVU's
CANDIDA SPECIES QST,12432299,LOCAL,87481,CPT,,,,,,Outpatient,,,343.13,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,478.165,Based on EAPG RVU's
SURESWAB(R) ADV BV QST,12432298,LOCAL,81513,CPT,,,,,,Outpatient,,,343.13,171.16,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,63.34,142.63,Based on EAPG RVU's
measles/mumps/rubella virus vaccine injection [CULL],11202828,LOCAL,90707,CPT,,,,,,Outpatient,1,ML,343.6448,,Blue Cross of AL,Blue Cross,39.58,,,,,,,Other,39.58,39.58,Based on EAPG RVU's
"EBV DNA, QN PCR QSTC",8764620,LOCAL,87799,CPT,,,,,,Outpatient,,,344.25,51.41,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,42.84,Based on EAPG RVU's
XR Wrist 2 Views Left,1170606,LOCAL,73100,CPT,,,,,LT,Outpatient,,,344.56,184.8,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Wrist 2 Views Right,1170608,LOCAL,73100,CPT,,,,,RT,Outpatient,,,344.56,184.8,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
REF LAB IAT CROSSMATCH,13797753,LOCAL,86922,CPT,,,,,,Outpatient,,,347,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
XR Forearm 2 Views Left,1170197,LOCAL,73090,CPT,,,,,LT,Outpatient,,,347.3,170.78,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Forearm 2 Views Right,1170199,LOCAL,73090,CPT,,,,,RT,Outpatient,,,347.3,170.78,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
"Benzodiazepines, Conf QSTC",13864504,LOCAL,80346,CPT,,,301,RC,,Outpatient,,,347.49,,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,17.73,Based on EAPG RVU's
97167 EVAL -  HIGH COMPLEXITY CHARGE,9850017,LOCAL,97167,CPT,,,,,GO,Outpatient,,,347.74,226,Blue Cross of AL,Blue Cross,269.95,,,,,,,Other,94.3,269.95,Based on EAPG RVU's
97167 IND EDUCATION EVAL CHARGE,9860017,LOCAL,97167,CPT,,,,,GO|CO,Outpatient,,,347.74,226,Blue Cross of AL,Blue Cross,269.95,,,,,,,Other,94.3,269.95,Based on EAPG RVU's
OT Evaluation High Complexity Units,7897809,LOCAL,97167,CPT,,,,,GO,Outpatient,,,347.74,226,Blue Cross of AL,Blue Cross,269.95,,,,,,,Other,94.3,269.95,Based on EAPG RVU's
OT High Complex Units,7895295,LOCAL,97167,CPT,,,,,GO,Outpatient,,,347.74,226,Blue Cross of AL,Blue Cross,269.95,,,,,,,Other,94.3,269.95,Based on EAPG RVU's
XR Scapula Left,1170401,LOCAL,73010,CPT,,,,,LT,Outpatient,,,348.57,187.28,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
XR Scapula Right,1170403,LOCAL,73010,CPT,,,,,RT,Outpatient,,,348.57,187.28,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
Mycobacterium Slow Grower MIC QST,13864520,LOCAL,87186,CPT,,,,,,Outpatient,,,348.75,10.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,35.67132075,Based on EAPG RVU's
Mycobacterium Slow Grower MIC QSTC,13864520,LOCAL,87186,CPT,,,,,,Outpatient,,,348.75,10.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,35.67132075,Based on EAPG RVU's
CPAP Charge -> Subsequent,8365858,LOCAL,94660,CPT,,,,,,Outpatient,,,348.84,279,Blue Cross of AL,Blue Cross,181.37,,,,,,,Other,181.37,185.95,Based on EAPG RVU's
17110 CRYOSURGERY REMOVAL OF LESIONS CHARGE,9038957,LOCAL,17110,CPT,,,,,,Outpatient,,,350,228,Blue Cross of AL,Blue Cross,239.03,,,,,,,Other,181.66,863,Based on EAPG RVU's
94625 PHY/QHP OP PULM RHB W/O MNTR,10470028,LOCAL,94625,CPT,,,,,,Outpatient,,,350,407,Blue Cross of AL,Blue Cross,51.98,,,,,,,Other,51.98,54.31,Based on EAPG RVU's
11730 AVULSION OF NAIL PLATE SINGLE,8715870,LOCAL,11730,CPT,,,,,,Outpatient,,,350.01,228,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,95.93,863,Based on EAPG RVU's
94618 PULMONARY STRESS TEST 6 MINUTE WALK,10440014,LOCAL,94618,CPT,,,,,,Outpatient,,,351.07,212,Blue Cross of AL,Blue Cross,76.09,,,,,,,Other,76.09,117.85,Based on EAPG RVU's
RT CHARGE PFT -> Bedside Spirometry,8860673,LOCAL,94060,CPT,,,,,,Outpatient,,,353.43,230,Blue Cross of AL,Blue Cross,149.57,,,,,,,Other,149.57,284.7,Based on EAPG RVU's
RT CHARGE PFT -> Spirometry before & after,5267139,LOCAL,94060,CPT,,,,,,Outpatient,,,353.43,230,Blue Cross of AL,Blue Cross,149.57,,,,,,,Other,149.57,284.7,Based on EAPG RVU's
Alpha Subunit QSTC,9849271,LOCAL,83520,CPT,,,,,,Outpatient,,,354.33,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,117.3767568,Based on EAPG RVU's
rotavirus vaccine pentavalent oral suspension 2 mL [CULL],11212439,LOCAL,90680,CPT,,,,,,Outpatient,2,ML,357.3664,,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,160.4,Based on EAPG RVU's
XR Spine Thoracic 2 Views,1170484,LOCAL,72070,CPT,,,,,,Outpatient,,,358.33,192.23,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
micafungin 50 mg intravenous injection [CULL],11220352,LOCAL,J2248,CPT,,,,,,Outpatient,1,EA,359.232,,Blue Cross of AL,Blue Cross,122.4,,,,,,,Other,0.249,122.4,Based on EAPG RVU's
Acetylcholine Recept. Modulating Ab QSTC,13864533,LOCAL,86043,CPT,,,,,,Outpatient,,,360,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.05,15.29,Based on EAPG RVU's
Adenovirus DNA Qual RT PCR QSTC,10100374,LOCAL,87798,CPT,,,,,,Outpatient,,,360,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
"B.pertussis/para DNA,Ql Rl-Time PCR QSTC",8873570,LOCAL,87798,CPT,,,,,,Outpatient,,,360,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
"Bartonella Sp Ab IgG,IgM w/rf Titer QSTC",9777261,LOCAL,86611,CPT,,,,,,Outpatient,,,360,12.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,10.18,15.29,Based on EAPG RVU's
Copeptin QSTC,9039409,LOCAL,86255,CPT,,,,,,Outpatient,,,360,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.05,15.29,Based on EAPG RVU's
Hepatitis C Viral RNA Genotype LiPA QSTC,8764578,LOCAL,87902,CPT,,,,,,Outpatient,,,360,308.94,Blue Cross of AL,Blue Cross,158.39,,,,,,,Other,158.39,257.45,Based on EAPG RVU's
Histamine QSTC,13864456,LOCAL,83088,CPT,,,,,,Outpatient,,,360,35.44,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,29.53,Based on EAPG RVU's
HSV 1 QST,9775428,LOCAL,87529,CPT,,,,,,Outpatient,,,360,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
HSV 2 QST,9775429,LOCAL,87529,CPT,,,,,,Outpatient,,,360,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
Mycobacterium Avium Complex MIC QST,13344174,LOCAL,87186,CPT,,,,,,Outpatient,,,360,10.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,35.67132075,Based on EAPG RVU's
XR Mandible Less Than 4 Views,1170303,LOCAL,70100,CPT,,,,,,Outpatient,,,362.58,194.7,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
Babesia microti Ab (IgG) QSTC,13872991,LOCAL,86753,CPT,,,,,,Outpatient,,,367.5,14.87,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.39,15.29,Based on EAPG RVU's
Ehrlichia chaffeensis Ab IgG QSTC,13872999,LOCAL,86753,CPT,,,,,,Outpatient,,,367.5,14.87,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.39,15.29,Based on EAPG RVU's
Lyme Ab Screen QSTC,13872998,LOCAL,86618,CPT,,,,,,Outpatient,,,367.5,20.44,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,17.03,Based on EAPG RVU's
XR Clavicle Left,1170075,LOCAL,73000,CPT,,,,,LT,Outpatient,,,370.53,198.83,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Clavicle Right,1170077,LOCAL,73000,CPT,,,,,RT,Outpatient,,,370.53,198.83,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Humerus Limited Left,13554999,LOCAL,73060,CPT,,,,,52|LT,Outpatient,,,372.34,223.58,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Humerus Limited Right,13555002,LOCAL,73060,CPT,,,,,52|RT,Outpatient,,,372.34,223.58,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
Reptilase Clotting Time QSTC,13864513,LOCAL,85635,CPT,,,,,,Outpatient,,,372.42,11.82,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,8.21,9.85,Based on EAPG RVU's
XR Tibia/Fibula Left,1170516,LOCAL,73590,CPT,,,,,LT,Outpatient,,,373.27,200.48,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Tibia/Fibula Right,1170518,LOCAL,73590,CPT,,,,,RT,Outpatient,,,373.27,200.48,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
27095 INJ PROC FOR HIP ARTHROGRAPHY W/ ANESTH,5661071,LOCAL,27095,CPT,,,,,,Outpatient,,,373.99,,Blue Cross of AL,Blue Cross,442.76,,,,,,,Other,64.91,863,Based on EAPG RVU's
"64454 - Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imagin",12897048,LOCAL,64454,CPT,,,,,,Outpatient,,,375,244,Blue Cross of AL,Blue Cross,636.45,,,,,,,Other,633.14,1291,Based on EAPG RVU's
"64454 Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging",9520502,LOCAL,64454,CPT,,,,,,Outpatient,,,375,244,Blue Cross of AL,Blue Cross,636.45,,,,,,,Other,633.14,1291,Based on EAPG RVU's
"Drug Monitor, PEth, B QSTC",13864423,LOCAL,80321,CPT,,,301,RC,,Outpatient,,,376.16,,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,17.73,Based on EAPG RVU's
"Bill Only Adsorption (Pheno, Rest, Wrm)",13517195,LOCAL,86978,CPT,,,,,,Outpatient,,,378,,Blue Cross of AL,Blue Cross,38.88,,,,,,,Other,38.88,54.31,Based on EAPG RVU's
"Bill Only Rare Unit, Outside Search",13517199,LOCAL,86999,CPT,,,,,,Outpatient,,,378,,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,22.39,Based on EAPG RVU's
tuberculin purified protein derivative 5 tuberculin units/0.1 mL intradermal solution 1 mL [CULL],11200764,LOCAL,86580,CPT,,,,,,Outpatient,1,ML,379.84,,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,22.39,Based on EAPG RVU's
"SureSwab(R) Trich. Vag. RNA,QL TMA QSTC",8853247,LOCAL,87661,CPT,,,,,,Outpatient,,,382.5,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
"Trichomonas Vaginalis RNA, Ql, TMA QST",8853247,LOCAL,87661,CPT,,,,,,Outpatient,,,382.5,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
XR Femur 1 View Left,7520564,LOCAL,73551,CPT,,,,,LT,Outpatient,,,382.59,205.43,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Femur 1 View Right,7520567,LOCAL,73551,CPT,,,,,RT,Outpatient,,,382.59,205.43,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
Hereditary Hemochroma DNA Mut Analy QSTC,8764601,LOCAL,81256,CPT,,,,,,Outpatient,,,387,78.43,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,63.34,65.36,Based on EAPG RVU's
Bill Only Absorption,7967780,LOCAL,86978,CPT,,,,,,Outpatient,,,391.5,,Blue Cross of AL,Blue Cross,38.88,,,,,,,Other,38.88,54.31,Based on EAPG RVU's
Food and Tree Nut Allergy Panel QSTC,14884175,LOCAL,86003,CPT,,,,,,Outpatient,,,393.21,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
93797 Cardiac Rehab without ECG monitoring,10411210,LOCAL,93797,CPT,,,,,,Outpatient,,,394.32,256,Blue Cross of AL,Blue Cross,219.28,,,,,,,Other,115.11,219.28,Based on EAPG RVU's
93798 Cardiac Rehab Phase II,10411000,LOCAL,93798,CPT,,,,,,Outpatient,,,394.32,256,Blue Cross of AL,Blue Cross,219.28,,,,,,,Other,115.11,219.28,Based on EAPG RVU's
DUP ARTERIAL & VENOUS MAPPING UNI,8200502,LOCAL,93986,CPT,,,,,,Outpatient,,,395.6,257,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Vein Mapping Lower Extremity Left,12175098,LOCAL,93986,CPT,,,,,LT,Outpatient,,,395.6,257,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Vein Mapping Lower Extremity Right,12175101,LOCAL,93986,CPT,,,,,RT,Outpatient,,,395.6,257,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Vein Mapping Upper Extremity Left,12175107,LOCAL,93986,CPT,,,,,LT,Outpatient,,,395.6,257,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Vein Mapping Upper Extremity Right,12175110,LOCAL,93986,CPT,,,,,RT,Outpatient,,,395.6,257,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
71046 XR Chest 2 Views: AddOn,13632841,LOCAL,71046,CPT,,,,,,Outpatient,,,397.38,212.85,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Chest 2 Views,689607,LOCAL,71046,CPT,,,,,,Outpatient,,,397.38,212.85,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
Heparin Anti-Xa QSTC,8972922,LOCAL,85520,CPT,,,,,,Outpatient,,,400.5,15.71,Blue Cross of AL,Blue Cross,5.42,,,,,,,Other,5.42,13.09,Based on EAPG RVU's
XR Abdomen KUB 1 View,1169926,LOCAL,74018,CPT,,,,,,Outpatient,,,401.12,215.33,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Knee 1 or 2 Views Left,1170263,LOCAL,73560,CPT,,,,,LT,Outpatient,,,401.12,215.33,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Knee 1 or 2 Views Right,1170265,LOCAL,73560,CPT,,,,,RT,Outpatient,,,401.12,215.33,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
21- Hydroxylase Antibody QSTC,9708927,LOCAL,83516,CPT,,,,,,Outpatient,,,402.53,13.84,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,11.53,17.73,Based on EAPG RVU's
"96360 - Hydration, first hour",1928297,LOCAL,96360,CPT,,,,,,Outpatient,,,403.29,262,Blue Cross of AL,Blue Cross,442.94,,,,,,,Other,192.63,442.94,Based on EAPG RVU's
"96360 IV HYDRATION, INITIAL 31-90 MINS",7904529,LOCAL,96360,CPT,,,,,,Outpatient,,,403.29,262,Blue Cross of AL,Blue Cross,442.94,,,,,,,Other,192.63,442.94,Based on EAPG RVU's
Inhibin B QSTC,6210082,LOCAL,83520,CPT,,,,,,Outpatient,,,405,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,117.3767568,Based on EAPG RVU's
Rituxan Sensitivity (CD20) QSTC,13864421,LOCAL,86356,CPT,,,,,,Outpatient,,,405,32.14,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,26.78,Based on EAPG RVU's
XR Hip 1 View Left,1170225,LOCAL,73501,CPT,,,,,LT,Outpatient,,,407.12,218.63,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Hip 1 View Right,1170227,LOCAL,73501,CPT,,,,,RT,Outpatient,,,407.12,218.63,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
A. phagocytophilum Ab IgG IgM QSTC,13864527,LOCAL,86666,CPT,,,,,,Outpatient,,,407.25,12.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,10.18,15.29,Based on EAPG RVU's
XR Bone Length Studies Scanograms,1170016,LOCAL,77073,CPT,,,,,,Outpatient,,,407.59,218.63,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
DOP ABI-ANKLE BRACHIAL INDEX,8230017,LOCAL,93922,CPT,,,,,,Outpatient,,,408.25,265,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,117.85,161.71,Based on EAPG RVU's
US ABI,8206802,LOCAL,93922,CPT,,,,,,Outpatient,,,408.25,265,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,117.85,161.71,Based on EAPG RVU's
US Segmental Pressures LE 1-2 Lvls Bilat,1169757,LOCAL,93922,CPT,,,,,,Outpatient,,,408.25,265,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,117.85,161.71,Based on EAPG RVU's
XR Sacrum/Coccyx 2+ Views,1170391,LOCAL,72220,CPT,,,,,,Outpatient,,,408.83,219.45,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Sniff Test,8602547,LOCAL,71046,CPT,,,,,,Outpatient,,,409.11,212.85,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Sternoclavicular Joint(s),1170494,LOCAL,71130,CPT,,,,,,Outpatient,,,411.41,220.28,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
Bill Only Antigen Type Group 1,13517191,LOCAL,86902,CPT,,,,,,Outpatient,,,414,7.62,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,328.88,Based on EAPG RVU's
Proinsulin QSTC,8972777,LOCAL,84206,CPT,,,,,,Outpatient,,,414,32.03,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,26.69,Based on EAPG RVU's
XR Elbow Complete 3+ Views Left,1170127,LOCAL,73080,CPT,,,,,LT,Outpatient,,,414.29,221.93,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Elbow Complete 3+ Views Right,1170129,LOCAL,73080,CPT,,,,,RT,Outpatient,,,414.29,221.93,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
DOPP ART EXT BIL MULTIPLE,8200300,LOCAL,93923,CPT,,,,,,Outpatient,,,414.94,401,Blue Cross of AL,Blue Cross,244.97,,,,,,,Other,143.05,244.97,Based on EAPG RVU's
DOPP ART EXT BIL W/EXERCISE,8200310,LOCAL,93924,CPT,,,,,,Outpatient,,,414.94,302,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,143.05,161.71,Based on EAPG RVU's
XR Shoulder Complete 2 Plus Views Left,1170415,LOCAL,73030,CPT,,,,,LT,Outpatient,,,416.12,222.75,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Shoulder Complete 2 Plus Views Right,1170417,LOCAL,73030,CPT,,,,,RT,Outpatient,,,416.12,222.75,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Femur 2 Views Left,7520570,LOCAL,73552,CPT,,,,,LT,Outpatient,,,417.02,223.58,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Femur 2 Views Right,7520573,LOCAL,73552,CPT,,,,,RT,Outpatient,,,417.02,223.58,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Humerus Left,1170245,LOCAL,73060,CPT,,,,,LT,Outpatient,,,417.02,223.58,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Humerus Right,1170247,LOCAL,73060,CPT,,,,,RT,Outpatient,,,417.02,223.58,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Hip 1 View w/ AP Pelvis Left,7520576,LOCAL,73501,CPT,,,,,LT,Outpatient,,,418.32,218.63,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Hip 1 View w/ AP Pelvis Right,7520579,LOCAL,73501,CPT,,,,,RT,Outpatient,,,418.32,218.63,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
15272 APP SKN SUB GRFT TAL 100 SQ CM ADDT FAC CHARGE,12831013,LOCAL,15272,CPT,,,,,,Outpatient,,,419.53,273,Blue Cross of AL,Blue Cross,2862.92,,,,,,,Other,13.68,2862.92,Based on EAPG RVU's
"epoetin alfa-epbx 10,000 units/mL preservative-free injectable solution 1 mL [CULL]",11202387,LOCAL,Q5105,CPT,,,,,,Outpatient,1,ML,423.552,,Blue Cross of AL,Blue Cross,122.4,,,,,,,Other,0.79,233.26,Based on EAPG RVU's
"11055 BENIGN LESION PARING/CUTTING, SINGLE",13043366,LOCAL,11055,CPT,,,,,,Outpatient,,,426.97,278,Blue Cross of AL,Blue Cross,239.03,,,,,,,Other,181.66,863,Based on EAPG RVU's
"Enterovirus RNA, QL Real-Time PCR QSTC",8873564,LOCAL,87498,CPT,,,,,,Outpatient,,,427.5,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
CULL US Echo Dop w/ Spectr Ltd,13734793,LOCAL,93321,CPT,,,,,,Outpatient,,,428.24,278,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,15.78,678.38,Based on EAPG RVU's
ECHO DOP W/SPECTR LTD,8200175,LOCAL,93321,CPT,,,,,,Outpatient,,,428.24,278,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,15.78,678.38,Based on EAPG RVU's
CPAP Charge -> Initial,8365859,LOCAL,94660,CPT,,,,,,Outpatient,,,429.93,279,Blue Cross of AL,Blue Cross,181.37,,,,,,,Other,181.37,185.95,Based on EAPG RVU's
"S. pneumoniae Ab (IgG), MAID QSTC",13864418,LOCAL,87899,CPT,,,,,,Outpatient,,,431.1,19.28,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,16.07,Based on EAPG RVU's
XR Foot Complete 3 Plus Views Left,1170191,LOCAL,73630,CPT,,,,,LT,Outpatient,,,431.43,231,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Foot Complete 3 plus Views Right,1170193,LOCAL,73630,CPT,,,,,RT,Outpatient,,,431.43,231,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
ER US VASCULAR ACCESS GUIDANCE,8200565,LOCAL,76937,CPT,,,,,,Outpatient,,,431.69,231.83,Blue Cross of AL,Blue Cross,165.47,,,,,,,Other,23.28,165.47,Based on EAPG RVU's
US VASCULAR ACCESS GUIDANCE,8200560,LOCAL,76937,CPT,,,,,,Outpatient,,,431.69,231.83,Blue Cross of AL,Blue Cross,165.47,,,,,,,Other,23.28,165.47,Based on EAPG RVU's
E0181 RBC CPD 500 LR,7266548,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,182,217.45,Based on EAPG RVU's
E0226 RBC CPDA1 500 LR,7266556,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,182,217.45,Based on EAPG RVU's
E0366 RBC CP2D AS3 500,7266579,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,182,217.45,Based on EAPG RVU's
E0382 RBC CP2D AS3 500 LR,7266659,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,182,217.45,Based on EAPG RVU's
E0424 RBC CPD AS5 500 LR,7266667,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,182,217.45,Based on EAPG RVU's
E4531 Aph RBC ACDA AS1 LR,7266601,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,182,217.45,Based on EAPG RVU's
E4532 Aph RBC ACDA AS1 LR 1,7266602,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,182,217.45,Based on EAPG RVU's
E4533 Aph RBC ACDA AS1 LR 2,7266603,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,182,217.45,Based on EAPG RVU's
E4543 Aph RBC ACDA AS3 LR,7266613,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,182,217.45,Based on EAPG RVU's
E4544 Aph RBC ACDA AS3 LR 1,7266614,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,182,217.45,Based on EAPG RVU's
E4545 Aph RBC ACDA AS3 LR 2,7266615,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,182,217.45,Based on EAPG RVU's
E5157 RBC CPD AS1 LR LV,8069011,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,434,282,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,182,217.45,Based on EAPG RVU's
XR Hip 2-3 Views Left,7520582,LOCAL,73502,CPT,,,,,LT,Outpatient,,,434.37,232.65,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Hip 2-3 Views Right,7520585,LOCAL,73502,CPT,,,,,RT,Outpatient,,,434.37,232.65,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Ankle Complete 3 Plus Views Left,1169942,LOCAL,73610,CPT,,,,,LT,Outpatient,,,434.8,233.48,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Ankle Complete 3 Plus Views Right,1169944,LOCAL,73610,CPT,,,,,RT,Outpatient,,,434.8,233.48,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
"Hypoglycemic Panel, Serum/Plasma QSTC",8764558,LOCAL,80377,CPT,,,301,RC,,Outpatient,,,436.5,,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,17.73,Based on EAPG RVU's
XR Hand Complete 3 Plus Views Right,1170223,LOCAL,73130,CPT,,,,,RT,Outpatient,,,438.91,235.13,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Hand Complete 3 Views Left,1170221,LOCAL,73130,CPT,,,,,LT,Outpatient,,,438.91,235.13,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
E0336 RBC CPD AS1 500 LR,7266574,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,439,282,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,182,217.45,Based on EAPG RVU's
11056 BENIGN LESION PARING(2-4),13029575,LOCAL,11056,CPT,,,,,,Outpatient,,,439.05,285,Blue Cross of AL,Blue Cross,239.03,,,,,,,Other,181.66,863,Based on EAPG RVU's
11103 TANGENTIAL BIOP EA ADDT CHARGE,9322081,LOCAL,11103,CPT,,,,,,Outpatient,,,439.05,285,Blue Cross of AL,Blue Cross,651.39,,,,,,,Other,16.62,863,Based on EAPG RVU's
11721 DEBRIDE NAIL 6 OR MORE WC CHARGE,8726776,LOCAL,11721,CPT,,,,,,Outpatient,,,439.05,285,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,54.31,863,Based on EAPG RVU's
97602 DEBRIDE MAGGOT THERAPY NON-EXC,11633062,LOCAL,97602,CPT,,,,,,Outpatient,,,439.05,285,Blue Cross of AL,Blue Cross,549.61,,,,,,,Other,181.66,549.61,Based on EAPG RVU's
97605 Wound VAC <=50 sq cm,10015643,LOCAL,97605,CPT,,,,,,Outpatient,,,439.05,285,Blue Cross of AL,Blue Cross,273.27,,,,,,,Other,181.66,273.27,Based on EAPG RVU's
XR Sacroiliac Joints 3+ Views,1170387,LOCAL,72202,CPT,,,,,,Outpatient,,,440.26,235.95,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
Procalcitonin QSTC,8972809,LOCAL,84145,CPT,,,301,RC,,Outpatient,,,441,32.66,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,18.43,Based on EAPG RVU's
BD Bone Density DEXA Axial w/Frac Assess,5017920,LOCAL,77085,CPT,,,,,,Outpatient,,,442.63,237.6,Blue Cross of AL,Blue Cross,116.02,,,,,,,Other,97.22,116.02,Based on EAPG RVU's
US PSEUDOANEURYSM COMPRESSION,8200520,LOCAL,76936,CPT,,,,,,Outpatient,,,443.14,237.6,Blue Cross of AL,Blue Cross,262.79,,,,,,,Other,262.79,284.7,Based on EAPG RVU's
US Pseudoaneurysm Compression Repair,7936316,LOCAL,76936,CPT,,,,,,Outpatient,,,443.14,237.6,Blue Cross of AL,Blue Cross,262.79,,,,,,,Other,262.79,284.7,Based on EAPG RVU's
XR Sinuses Paranasal Complete,1170434,LOCAL,70220,CPT,,,,,,Outpatient,,,445.06,238.43,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
92523 SPEECH SOUND LANGUAGE COMPREHENS CHARGE,9630058,LOCAL,92523,CPT,,,,,GN,Outpatient,,,445.57,290,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,214.08,337.75,Based on EAPG RVU's
SLP Analysis of Voice & Resonance Minutes,7897211,LOCAL,92523,CPT,,,,,GN,Outpatient,,,445.57,290,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,103.27,337.75,Based on EAPG RVU's
SLP Sound Prod w/ Lang Comp Eval Units,7897209,LOCAL,92523,CPT,,,,,GN,Outpatient,,,445.57,290,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,214.08,337.75,Based on EAPG RVU's
Speech Sound Prod w/ Language Charge,7896929,LOCAL,92523,CPT,,,,,GN,Outpatient,,,445.57,290,Blue Cross of AL,Blue Cross,337.75,,,,,,,Other,214.08,337.75,Based on EAPG RVU's
XR Hip 2-3 Views w/AP Pelvis Left,7520588,LOCAL,73502,CPT,,,,,LT,Outpatient,,,446.32,232.65,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Hip 2-3 Views w/AP Pelvis Right,7520591,LOCAL,73502,CPT,,,,,RT,Outpatient,,,446.32,232.65,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
US Breast Limited Left.,8068444,LOCAL,76642,CPT,,,,,LT,Outpatient,,,449.55,240.9,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,80.5,161.71,Based on EAPG RVU's
US Breast Limited Right.,8068447,LOCAL,76642,CPT,,,,,RT,Outpatient,,,449.55,240.9,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,80.5,161.71,Based on EAPG RVU's
pneumococcal 23-polyvalent vaccine injectable solution 0.5 mL [CULL],11212160,LOCAL,90732,CPT,,,,,,Outpatient,0.5,ML,449.59104,,Blue Cross of AL,Blue Cross,39.58,,,,,,,Other,39.58,133.472,Based on EAPG RVU's
Adalimumab Level for IBD QSTC,13864453,LOCAL,80145,CPT,,,,,,Outpatient,,,450,46.28,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,38.57,Based on EAPG RVU's
"Amino Acid Analysis, Plasma QSTC",9039235,LOCAL,82139,CPT,,,,,,Outpatient,,,450,20.24,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,16.87,17.73,Based on EAPG RVU's
"BK Virus DNA, Quant, RT PCR, Ur QSTC",8764640,LOCAL,87799,CPT,,,,,,Outpatient,,,450,51.41,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,42.84,Based on EAPG RVU's
Histamine Release Chronic Urticaria QSTC,8764646,LOCAL,86343,CPT,,,,,,Outpatient,,,450,14.95,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.46,15.29,Based on EAPG RVU's
Infliximab Anti-drug Antibody for IBD QSTC,12552286,LOCAL,83520,CPT,,,,,,Outpatient,,,450,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,117.3767568,Based on EAPG RVU's
Infliximab Level for IBD QSTC,13864454,LOCAL,80230,CPT,,,,,,Outpatient,,,450,46.28,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,38.57,Based on EAPG RVU's
"Interleukin-6 (IL-6), Serum QSTC",9708918,LOCAL,83529,CPT,,,,,,Outpatient,,,450,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.27,17.73,Based on EAPG RVU's
"VZV DNA, QL RT PCR QSTC",9777241,LOCAL,87798,CPT,,,,,,Outpatient,,,450,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
12001 SIMPLE REPAIR OF WOUND TRUNK,13029607,LOCAL,12001,CPT,,,,,,Outpatient,,,454.38,295,Blue Cross of AL,Blue Cross,273.27,,,,,,,Other,181.66,863,Based on EAPG RVU's
CHOLANGIO W EXIST CATH S&I,8210339,LOCAL,47531,CPT,,,,,,Outpatient,,,458,298,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2599,3226.48,Based on EAPG RVU's
Pregabalin QSTC,8853245,LOCAL,80299,CPT,,,,,,Outpatient,,,459,22.37,Blue Cross of AL,Blue Cross,15.38,,,,,,,Other,15.38,18.64,Based on EAPG RVU's
29580 Application of a Paste Boot (Bilateral),12642335,LOCAL,29580,CPT,,,,,,Outpatient,,,462.53,301,Blue Cross of AL,Blue Cross,275.28,,,,,,,Other,144.26,863,Based on EAPG RVU's
29580 PT UNNA BOOT APPL,9410275,LOCAL,29580,CPT,,,,,GP,Outpatient,,,462.53,301,Blue Cross of AL,Blue Cross,275.28,,,,,,,Other,144.26,863,Based on EAPG RVU's
US EXT NONVASC COMPLETE,8230013,LOCAL,76881,CPT,,,,,,Outpatient,,,462.67,248.33,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US EXT NONVASC LIMITED ANATOMIC SPEC,8230014,LOCAL,76882,CPT,,,,,,Outpatient,,,462.67,248.33,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
Bill Only Elution,7967778,LOCAL,86860,CPT,,,,,,Outpatient,,,463.5,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,156.67,Based on EAPG RVU's
XR Pelvis Complete 3+ Views,1170353,LOCAL,72190,CPT,,,,,,Outpatient,,,463.51,248.33,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
DOP ART - LEA W/ TREADMILL,8230021,LOCAL,93924,CPT,,,,,,Outpatient,,,465.08,302,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,143.05,161.71,Based on EAPG RVU's
US Lower Ext Doppler w/ Stress Test,1169765,LOCAL,93924,CPT,,,,,,Outpatient,,,465.08,302,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,143.05,161.71,Based on EAPG RVU's
XR Osseous Survey Infant,1170020,LOCAL,77076,CPT,,,,,,Outpatient,,,466.03,249.98,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
XR Facial Bones < 3 Views,1170139,LOCAL,70140,CPT,,,,,,Outpatient,,,471.62,253.28,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Orbits Limited,13555005,LOCAL,70140,CPT,,,,,,Outpatient,,,471.62,253.28,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
US Hips Infant Limited/Static,8206871,LOCAL,76886,CPT,,,,,,Outpatient,,,472.34,253.28,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,80.5,161.71,Based on EAPG RVU's
US Spinal Canal,1169879,LOCAL,76800,CPT,,,,,,Outpatient,,,472.34,253.28,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
Bill Only Rare Donor Fee,13517197,LOCAL,86999,CPT,,,,,,Outpatient,,,472.5,,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,22.39,Based on EAPG RVU's
96373- Intra-Arterial Injection,1928304,LOCAL,96373,CPT,,,,,59,Outpatient,,,473.98,308,Blue Cross of AL,Blue Cross,64.56,,,,,,,Other,64.56,192.63,Based on EAPG RVU's
96373 S-INJ NON CHEMO IA CHARGE,8049127,LOCAL,96373,CPT,,,,,59,Outpatient,,,473.98,308,Blue Cross of AL,Blue Cross,64.56,,,,,,,Other,64.56,192.63,Based on EAPG RVU's
97545 WORK CONDITIONING INIT 2HR,9650075,LOCAL,97545,CPT,420,RC,,,GP|CQ,Outpatient,,,474.44,308,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,47.26,47.26,Based on EAPG RVU's
97545 WORK HARDENING INITIAL 2 HRS CHARGE,9640075,LOCAL,97545,CPT,420,RC,,,GP,Outpatient,,,474.44,308,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,47.26,47.26,Based on EAPG RVU's
PT Work Hardening Initial 2 Hours Assistant Units,9390454,LOCAL,97545,CPT,420,RC,,,CQ,Outpatient,,,474.44,308,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,47.26,47.26,Based on EAPG RVU's
Work Hardening Initial Charge,7895939,LOCAL,97545,CPT,420,RC,,,GP,Outpatient,,,474.44,308,Blue Cross of AL,Blue Cross,47.26,,,,,,,Other,47.26,47.26,Based on EAPG RVU's
DOP VENOUS LOWER EXT UNILATERAL,8200430,LOCAL,93971,CPT,,,,,,Outpatient,,,476.32,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
DOP VENOUS UPPER EXT UNI OR LTD,8200431,LOCAL,93971,CPT,,,,,,Outpatient,,,476.32,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
DUP AO IVC ILIAC LIMITED,8200531,LOCAL,93979,CPT,,,,,,Outpatient,,,476.32,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Aorta IVC Iliac Duplex Limited,1169579,LOCAL,93979,CPT,,,,,,Outpatient,,,476.32,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Lower Ext Venous Duplex Left,1169771,LOCAL,93971,CPT,,,,,LT,Outpatient,,,476.32,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Lower Ext Venous Duplex Right,1169773,LOCAL,93971,CPT,,,,,RT,Outpatient,,,476.32,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Upper Ext Venous Duplex Left,1169903,LOCAL,93971,CPT,,,,,LT,Outpatient,,,476.32,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Upper Ext Venous Duplex Right,1169905,LOCAL,93971,CPT,,,,,RT,Outpatient,,,476.32,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
DUP AV FISTULA OR DIALYSIS GRAFT,8200500,LOCAL,93990,CPT,,,,,,Outpatient,,,476.33,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
DUPLEX ARTERAL UPPER EXT UNI OR LTD,8200490,LOCAL,93931,CPT,,,,,,Outpatient,,,476.33,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
DUPLEX ARTERIAL LOWER EXT UNI OR LTD,8200470,LOCAL,93926,CPT,,,,,,Outpatient,,,476.33,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Hemodialysis Duplex Access Lt,8206865,LOCAL,93990,CPT,,,,,,Outpatient,,,476.33,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Hemodialysis Duplex Access Rt,8206868,LOCAL,93990,CPT,,,,,RT,Outpatient,,,476.33,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Lower Ext Arterial Duplex Left,1169761,LOCAL,93926,CPT,,,,,LT,Outpatient,,,476.33,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Lower Ext Arterial Duplex Right,1169763,LOCAL,93926,CPT,,,,,RT,Outpatient,,,476.33,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Upper Ext Arterial Duplex Left,1169897,LOCAL,93931,CPT,,,,,LT,Outpatient,,,476.33,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Upper Ext Arterial Duplex Right,1169899,LOCAL,93931,CPT,,,,,RT,Outpatient,,,476.33,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
DAPTOmycin 500 mg intravenous injection [CULL],11210536,LOCAL,J0878,CPT,,,,,,Outpatient,1,EA,480,480,Blue Cross of AL,Blue Cross,122.4,,,,,,,Other,0.01,122.4,Based on EAPG RVU's
CULL MG Needle/Wire Loc Breast,13720943,LOCAL,19281,CPT,,,,,,Outpatient,,,481.51,313,Blue Cross of AL,Blue Cross,1200.99,,,,,,,Other,1200.99,1496,Based on EAPG RVU's
MG Mammo Guided Needle Loc Left,8206592,LOCAL,19281,CPT,,,,,LT,Outpatient,,,481.51,313,Blue Cross of AL,Blue Cross,1200.99,,,,,,,Other,1200.99,1496,Based on EAPG RVU's
MG Mammo Guided Needle Loc Right,8206595,LOCAL,19281,CPT,,,,,RT,Outpatient,,,481.51,313,Blue Cross of AL,Blue Cross,1200.99,,,,,,,Other,1200.99,1496,Based on EAPG RVU's
Bill Tissue Exam Level 6,14048000,LOCAL,88309,CPT,,,,,,Outpatient,,,485.96,,Blue Cross of AL,Blue Cross,59.06,,,,,,,Other,59.06,746.86,Based on EAPG RVU's
IA-2 Antibody QSTC,9039410,LOCAL,86341,CPT,,,,,,Outpatient,,,486,28.28,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,23.57,Based on EAPG RVU's
sincalide 5 mcg injection [CULL],11210302,LOCAL,J2805,CPT,,,,,,Outpatient,1,EA,486.3872,,Blue Cross of AL,Blue Cross,122.4,,,,,,,Other,122.4,122.4,Based on EAPG RVU's
eptifibatide 2 mg/mL intravenous solution 10 mL [CULL],11201706,LOCAL,J1327,CPT,,,,,,Outpatient,10,ML,487.168,,Blue Cross of AL,Blue Cross,91.38,,,,,,,Other,91.38,91.38,Based on EAPG RVU's
"Brivaracetam, Serum/Plasma QST",14800761,LOCAL,80375,CPT,,,301,RC,,Outpatient,,,488,,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,17.73,Based on EAPG RVU's
96422 CHEMO ARTERIAL INFUS UP TO 1HR CHARGE,9404492,LOCAL,96422,CPT,,,,,,Outpatient,,,488.94,318,Blue Cross of AL,Blue Cross,442.94,,,,,,,Other,303.25,442.94,Based on EAPG RVU's
Bill Only Reticulocyte Separation,8629513,LOCAL,86972,CPT,,,,,,Outpatient,,,490.5,,Blue Cross of AL,Blue Cross,38.88,,,,,,,Other,38.88,156.67,Based on EAPG RVU's
"11105 Punch Biopsy of Skin, Ea Separate/Additional CRRH_GA",13243078,LOCAL,11105,CPT,,,,,,Outpatient,,,491.38,319,Blue Cross of AL,Blue Cross,651.39,,,,,,,Other,19.82,863,Based on EAPG RVU's
A. phagocytophilum/E chaffeensis Ab QSTC,13864420,LOCAL,86666,CPT,,,,,,Outpatient,,,492.75,12.22,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,10.18,15.29,Based on EAPG RVU's
XR Spine Cervical 2 or 3 Views,1170452,LOCAL,72040,CPT,,,,,,Outpatient,,,496.68,266.48,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
96125 ST-COGNITIVE TEST PER 1HR,9630086,LOCAL,96125,CPT,,,,,GN,Outpatient,,,497.34,323,Blue Cross of AL,Blue Cross,846.56,,,,,,,Other,96.7,846.56,Based on EAPG RVU's
SLP Cognitive Test Units,7897180,LOCAL,96125,CPT,,,,,GN,Outpatient,,,497.34,323,Blue Cross of AL,Blue Cross,846.56,,,,,,,Other,96.7,846.56,Based on EAPG RVU's
Standardized Cognitive Eval Charge,7897180,LOCAL,96125,CPT,,,,,GN,Outpatient,,,497.34,323,Blue Cross of AL,Blue Cross,846.56,,,,,,,Other,96.7,846.56,Based on EAPG RVU's
"45300 PROCTOSIGMOIDOSCOPY, RIGID, DIAGNOSTIC, W OR W/O COLLECTION BY BRUSHING OR WASHING",8934255,LOCAL,45300,CPT,,,,,,Outpatient,,,498,129,Blue Cross of AL,Blue Cross,1419.32,,,,,,,Other,833.54,1419.32,Based on EAPG RVU's
BD Bone Density DEXA Axial Skeleton,1167839,LOCAL,77080,CPT,,,,,,Outpatient,,,499.09,267.3,Blue Cross of AL,Blue Cross,116.02,,,,,,,Other,97.22,116.02,Based on EAPG RVU's
IVUS ADDL VESSEL,8230049,LOCAL,92979,CPT,,,,,,Outpatient,,,506,329,Blue Cross of AL,Blue Cross,262.79,,,,,,,Other,130.59,863,Based on EAPG RVU's
"Susceptibility Aerobic Bacteria,MIC QSTC",9039459,LOCAL,87186,CPT,,,,,,Outpatient,,,506.25,10.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,35.67132075,Based on EAPG RVU's
"Susceptibility, Aerobic Bacterium QST",8389539,LOCAL,87186,CPT,,,,,,Outpatient,,,506.25,10.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,35.67132075,Based on EAPG RVU's
Administration of Blood (Bridge),8019084,LOCAL,36430,CPT,,,,,,Outpatient,,,509,99,Blue Cross of AL,Blue Cross,672.96,,,,,,,Other,399.7,863,Based on EAPG RVU's
TRANSFUSE Fresh Frozen Plasma (Bridge),8482691,LOCAL,36430,CPT,,,,,,Outpatient,,,509,99,Blue Cross of AL,Blue Cross,672.96,,,,,,,Other,399.7,863,Based on EAPG RVU's
TRANSFUSE Platelet Product (Bridge),8482692,LOCAL,36430,CPT,,,,,,Outpatient,,,509,99,Blue Cross of AL,Blue Cross,672.96,,,,,,,Other,399.7,863,Based on EAPG RVU's
TRANSFUSE Red Blood Cells Leukoreduced (Bridge),8482690,LOCAL,36430,CPT,,,,,,Outpatient,,,509,99,Blue Cross of AL,Blue Cross,672.96,,,,,,,Other,399.7,863,Based on EAPG RVU's
XR Nasal Bones 3+ Views,1170329,LOCAL,70160,CPT,,,,,,Outpatient,,,510.81,273.9,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
"Bill Only RBC Pretreatment, Chemicals",8629511,LOCAL,86970,CPT,,,,,,Outpatient,,,513,,Blue Cross of AL,Blue Cross,38.88,,,,,,,Other,38.88,54.31,Based on EAPG RVU's
"Bill Only RBC Pretreatment, Enyzme",8629512,LOCAL,86971,CPT,,,,,,Outpatient,,,513,,Blue Cross of AL,Blue Cross,38.88,,,,,,,Other,38.88,156.67,Based on EAPG RVU's
XR Arthrogram Injection Ankle Left,1169950,LOCAL,20605,CPT,,,,,LT,Outpatient,,,517.48,336,Blue Cross of AL,Blue Cross,351.64,,,,,,,Other,269.88,863,Based on EAPG RVU's
XR Arthrogram Injection Ankle Right,1169952,LOCAL,20605,CPT,,,,,RT,Outpatient,,,517.48,336,Blue Cross of AL,Blue Cross,351.64,,,,,,,Other,269.88,863,Based on EAPG RVU's
XR Arthrogram Injection Elbow Right,1169958,LOCAL,20605,CPT,,,,,RT,Outpatient,,,517.48,336,Blue Cross of AL,Blue Cross,351.64,,,,,,,Other,269.88,863,Based on EAPG RVU's
XR Arthrogram Injection Wrist Left,1169996,LOCAL,20605,CPT,,,,,LT,Outpatient,,,517.48,336,Blue Cross of AL,Blue Cross,351.64,,,,,,,Other,269.88,863,Based on EAPG RVU's
XR Arthrogram Injection Wrist Right,1169998,LOCAL,20605,CPT,,,,,RT,Outpatient,,,517.48,336,Blue Cross of AL,Blue Cross,351.64,,,,,,,Other,269.88,863,Based on EAPG RVU's
ECHO DOP COLOR FLOW MAPPING,8200220,LOCAL,93325,CPT,,,,,,Outpatient,,,517.63,336,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,17.83,161.71,Based on EAPG RVU's
XR Spine Lumbosacral 2 or 3 Views,1170470,LOCAL,72100,CPT,,,,,,Outpatient,,,520.24,278.85,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
"G0399 HOME SLEEP STUDY, CHARGE",8303751,LOCAL,,,G0399,HCPCS,,,,Outpatient,,,523.26,340,Blue Cross of AL,Blue Cross,206.62,,,,,,,Other,143.05,206.62,Based on EAPG RVU's
11057 BENIGN LESION PARING(4+),13029576,LOCAL,11057,CPT,,,,,,Outpatient,,,523.3,340,Blue Cross of AL,Blue Cross,239.03,,,,,,,Other,181.66,863,Based on EAPG RVU's
16030 Dressing/Debridement Large More than one ext or >10% total body,9400041,LOCAL,16030,CPT,,,,,,Outpatient,,,523.3,863,Blue Cross of AL,Blue Cross,549.61,,,,,,,Other,365.27,863,Based on EAPG RVU's
15276 APPL-HC SKSB GRT F/N/H/G-AD 25CM CHARGE,9709030,LOCAL,15276,CPT,,,,,,Outpatient,,,526.26,342,Blue Cross of AL,Blue Cross,2862.92,,,,,,,Other,20.61,2862.92,Based on EAPG RVU's
XR Knee 3 Views Left,1170269,LOCAL,73562,CPT,,,,,LT,Outpatient,,,527.77,282.98,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Knee 3 Views Right,1170271,LOCAL,73562,CPT,,,,,RT,Outpatient,,,527.77,282.98,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Barium Swallow,9756897,LOCAL,74220,CPT,,,,,,Outpatient,,,527.78,282.98,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,162.76,Based on EAPG RVU's
XR Swallowing Function w/ Speech,1170500,LOCAL,74230,CPT,,,,,,Outpatient,,,527.78,282.98,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,162.76,176.48,Based on EAPG RVU's
RT CHARGE PFT -> Bronchoprovocation,5267129,LOCAL,94070,CPT,,,,,,Outpatient,,,530,345,Blue Cross of AL,Blue Cross,149.57,,,,,,,Other,149.57,284.7,Based on EAPG RVU's
XR Mandible Complete 4+ Views,1170301,LOCAL,70110,CPT,,,,,,Outpatient,,,533.23,286.28,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
XR Facial Bones 3+ Views,1170141,LOCAL,70150,CPT,,,,,,Outpatient,,,533.25,286.28,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
XR Skull < 4 Views,1170436,LOCAL,70250,CPT,,,,,,Outpatient,,,533.25,286.28,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
XR Hips 3-4 Views Bilat,7520612,LOCAL,73522,CPT,,,,,,Outpatient,,,534.2,286.28,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
XR Hips 3-4 Views w/AP Pelvis Bilat,7520615,LOCAL,73522,CPT,,,,,,Outpatient,,,534.2,286.28,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
93799 INPATIENT TEACH CARDIAC REHAB CHARGE,8230066,LOCAL,93799,CPT,,,,,,Outpatient,,,535.14,348,Blue Cross of AL,Blue Cross,38.53,,,,,,,Other,38.53,863,Based on EAPG RVU's
XR Wrist Complete 3 Plus Views Right,1170614,LOCAL,73110,CPT,,,,,RT,Outpatient,,,538.7,288.75,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Wrist Complete 3+ Views Left,1170612,LOCAL,73110,CPT,,,,,LT,Outpatient,,,538.7,288.75,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
"COVID-19, Respiratory Panel 2.1(Biofire)",9624028,LOCAL,0202U,CPT,,,,,,Outpatient,,,540,500.14,Blue Cross of AL,Blue Cross,173.68,,,,,,,Other,173.68,443.38,Based on EAPG RVU's
Bill Only Antigen Type Group 2,10312940,LOCAL,86902,CPT,,,,,,Outpatient,,,544.5,7.62,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,328.88,Based on EAPG RVU's
XR Abdomen 2 Views,8132826,LOCAL,74019,CPT,,,,,,Outpatient,,,546.49,292.88,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
96132 NEUROPSYCH TESTING EVAL; FIRST HOUR CHARGE,9496220,LOCAL,96132,CPT,,,,,,Outpatient,,,549.45,357,Blue Cross of AL,Blue Cross,846.56,,,,,,,Other,485.11,846.56,Based on EAPG RVU's
XR Spine Cervical 4 or 5 Views,1170454,LOCAL,72050,CPT,,,,,,Outpatient,,,552.95,296.18,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
albumin human 25% intravenous solution 100 mL [CULL],11281015,LOCAL,P9047,CPT,,,,,,Outpatient,100,ML,552.96,,Blue Cross of AL,Blue Cross,217.45,,,,,,,Other,53.077,217.45,Based on EAPG RVU's
meningococcal conjugate vaccine [CULL],11202845,LOCAL,90734,CPT,,,,,,Outpatient,1,ML,553.184,,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,160.4,Based on EAPG RVU's
G0277 HBO Full Body 30 Min Interval,10015694,LOCAL,,,G0277,HCPCS,,,,Outpatient,,,553.52,360,Blue Cross of AL,Blue Cross,549.61,,,,,,,Other,126.08,549.61,Based on EAPG RVU's
XR Knee Complete 4 Plus Views Left,1170287,LOCAL,73564,CPT,,,,,LT,Outpatient,,,554.16,297,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
XR Knee Complete 4 Plus Views Right,1170289,LOCAL,73564,CPT,,,,,RT,Outpatient,,,554.16,297,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
"penicillin G benzathine 600,000 units/mL intramuscular suspension 1 mL [CULL]",11202082,LOCAL,J0561,CPT,,,,,,Outpatient,1,ML,558.848,,Blue Cross of AL,Blue Cross,122.4,,,,,,,Other,30.01,122.4,Based on EAPG RVU's
ADAMTS13 Activity w/Rfx Inhibitor QSTC,9777262,LOCAL,85397,CPT,,,,,,Outpatient,,,562.5,37.03,Blue Cross of AL,Blue Cross,26.47,,,,,,,Other,26.47,30.86,Based on EAPG RVU's
"Chromosome Analysis, Blood QSTC",8848485,LOCAL,88262,CPT,,,,,,Outpatient,,,562.5,150.59,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,63.34,125.49,Based on EAPG RVU's
Clinical Indication: QSTC,8848484,LOCAL,88230,CPT,,,,,,Outpatient,,,562.5,139.79,Blue Cross of AL,Blue Cross,58.01,,,,,,,Other,58.01,116.49,Based on EAPG RVU's
Kleihauer-Betke Stain QSTC,9956031,LOCAL,85460,CPT,,,,,,Outpatient,,,562.5,9.28,Blue Cross of AL,Blue Cross,8.21,,,,,,,Other,7.73,8.21,Based on EAPG RVU's
Respirat. Allergy Profile Region VI QSTC,9039268,LOCAL,86003,CPT,,,,,,Outpatient,,,564.39,6.26,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,5.22,15.29,Based on EAPG RVU's
Respirat. Allergy Profile Region VI QSTC,9041102,LOCAL,82785,CPT,,,,,,Outpatient,,,564.39,19.75,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,203.9616667,Based on EAPG RVU's
Respiratory Allergy Panel Region VI with Reflexes QSTC,14884176,LOCAL,82785,CPT,,,,,,Outpatient,,,564.39,19.75,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,203.9616667,Based on EAPG RVU's
XR Spine Thoracic 3 Views,1170486,LOCAL,72072,CPT,,,,,,Outpatient,,,567.43,304.43,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
XR Ribs 2 Views Left,1170371,LOCAL,71100,CPT,,,,,LT,Outpatient,,,567.44,304.43,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Ribs 2 Views Right,1170373,LOCAL,71100,CPT,,,,,RT,Outpatient,,,567.44,304.43,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
US Breast ABUS Left,8746657,LOCAL,76641,CPT,,,,,LT,Outpatient,,,571.63,306.9,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Breast ABUS Left.,8567804,LOCAL,76641,CPT,,,,,LT,Outpatient,,,571.63,306.9,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Breast ABUS Right.,8567807,LOCAL,76641,CPT,,,,,RT,Outpatient,,,571.63,306.9,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Breast Complete Left.,8068438,LOCAL,76641,CPT,,,,,LT,Outpatient,,,571.63,306.9,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Breast Complete Right.,8068441,LOCAL,76641,CPT,,,,,RT,Outpatient,,,571.63,306.9,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
Electrocardiogram 12 Lead,2322786,LOCAL,93005,CPT,,,,,,Outpatient,,,573,178,Blue Cross of AL,Blue Cross,38.53,,,,,,,Other,38.53,54.31,Based on EAPG RVU's
pneumococcal 21-valent conjugate vaccine (cvx 327) - Sus [CULL],11200021,LOCAL,90684,CPT,,,,,,Outpatient,0.5,ML,579.792,,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,344.252,Based on EAPG RVU's
29581 APPL MULTLAY COMPRS LWR LEG,9739188,LOCAL,29581,CPT,,,,,,Outpatient,,,580.2,195,Blue Cross of AL,Blue Cross,275.28,,,,,,,Other,144.26,863,Based on EAPG RVU's
XR Ribs 3 Views Bilateral,1170375,LOCAL,71110,CPT,,,,,,Outpatient,,,580.49,311.03,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
XR Spine Thoracic 4+ Views,1170488,LOCAL,72074,CPT,,,,,,Outpatient,,,581.11,311.85,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
XR Sinus Tract SI,2425614,LOCAL,76080,CPT,,,,,,Outpatient,,,583.56,312.68,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,501.29,Based on EAPG RVU's
Bill Only Rare Unit,8196052,LOCAL,86999,CPT,,,,,,Outpatient,,,585,,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,22.39,Based on EAPG RVU's
Oviduct chromotubation 58350,9093091,LOCAL,58350,CPT,,,,,,Outpatient,,,585,4936,Blue Cross of AL,Blue Cross,3321.58,,,,,,,Other,2599,4513.2,Based on EAPG RVU's
ER ECHOCARDIOGRAM 2D LIMITED,8200203,LOCAL,93308,CPT,,,,,,Outpatient,,,586,564,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,220.99,678.38,Based on EAPG RVU's
TRANSPAC REUSABLE CABLE 42661-03,8200204,LOCAL,93308,CPT,,,,,,Outpatient,,,586,564,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,220.99,678.38,Based on EAPG RVU's
64445 NERV BLOCK SCIATIC,5661029,LOCAL,64445,CPT,,,,,,Outpatient,,,587.24,382,Blue Cross of AL,Blue Cross,636.45,,,,,,,Other,633.14,1291,Based on EAPG RVU's
"FISH, Chromosome Specific 1 Pr QSTC",13864683,LOCAL,88271,CPT,,,,,,Outpatient,,,587.34,25.7,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,21.42,63.34,Based on EAPG RVU's
Specimen Source: FISH Chrom Pr x1 QSTC,13864676,LOCAL,88273,CPT,,,,,,Outpatient,,,587.34,41.77,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,34.81,63.34,Based on EAPG RVU's
REF Antibody ID,7032173,LOCAL,86870,CPT,,,,,,Outpatient,,,589.5,,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,328.88,Based on EAPG RVU's
US Head Newborn,8206862,LOCAL,76506,CPT,,,,,,Outpatient,,,590.44,316.8,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
Very Long Chain Fatty Acids QSTC,8764801,LOCAL,82726,CPT,,,,,,Outpatient,,,590.63,23.7,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,19.75,Based on EAPG RVU's
US Fetal Biophysical Profile w/ Non-Str,1169687,LOCAL,76818,CPT,,,,,,Outpatient,,,591.07,316.8,Blue Cross of AL,Blue Cross,148.61,,,,,,,Other,97.22,148.61,Based on EAPG RVU's
Blood Culture ID (Biofire) 2,12011068,LOCAL,87154,CPT,,,300,RC,,Outpatient,,,597.92,261.67,Blue Cross of AL,Blue Cross,158.39,,,,,,,Other,158.39,158.39,Based on EAPG RVU's
meningococcal polysaccharide tetanus toxoid conjugate vaccine group ACYW intramuscular solution 0.5 mL [CULL],11202845,LOCAL,90734,CPT,,,,,,Outpatient,1,ML,598.976,,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,160.4,Based on EAPG RVU's
"Creatinine, Random, Ur QSTC",13873086,LOCAL,82570,CPT,,,,,,Outpatient,,,599.63,6.22,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,40.97514925,Based on EAPG RVU's
"N-Methylhistamine, Random, Ur QSTC",13873083,LOCAL,82542,CPT,,,,,,Outpatient,,,599.63,28.91,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,24.09,Based on EAPG RVU's
XR Ribs w/ PA Chest Bilateral,1170377,LOCAL,71111,CPT,,,,,,Outpatient,,,601.59,322.58,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
36010 INTRO CATH SUP/INF VENA CAVA,8266890,LOCAL,36010,CPT,,,,,,Outpatient,,,604.59,393,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,87.95,929.12,Based on EAPG RVU's
INTRO CATH VENA CAVA,8267101,LOCAL,36010,CPT,,,,,,Outpatient,,,604.59,393,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,87.95,929.12,Based on EAPG RVU's
Antenatal Testing Type -> Contraction stress test,10446024,LOCAL,59020,CPT,,,,,,Outpatient,,,607.55,94,Blue Cross of AL,Blue Cross,269.34,,,,,,,Other,183.92,863,Based on EAPG RVU's
97597 ACTIVE WOUND CARE MANAGEMENT FIRST 20 CM,13048047,LOCAL,97597,CPT,,,,,59,Outpatient,,,608.25,395,Blue Cross of AL,Blue Cross,273.27,,,,,,,Other,181.66,863,Based on EAPG RVU's
97597 DEBRIDE SCISSOR/SCAPEL 20SQ CM,9410251,LOCAL,97597,CPT,,,,,GP,Outpatient,,,608.25,395,Blue Cross of AL,Blue Cross,273.27,,,,,,,Other,181.66,863,Based on EAPG RVU's
97597 DEBRIDEMENT,9866113,LOCAL,97597,CPT,,,,,GO|CO,Outpatient,,,608.25,395,Blue Cross of AL,Blue Cross,273.27,,,,,,,Other,181.66,863,Based on EAPG RVU's
97597 OT SELECT DEBRIDE ME CHARGE,9856113,LOCAL,97597,CPT,,,,,GO,Outpatient,,,608.25,395,Blue Cross of AL,Blue Cross,273.27,,,,,,,Other,181.66,863,Based on EAPG RVU's
97598 Debrid Open wound > 20 sq cm charge,12511973,LOCAL,97598,CPT,,,,,,Outpatient,,,608.25,395,Blue Cross of AL,Blue Cross,1466.58,,,,,,,Other,20.42,1466.58,Based on EAPG RVU's
OT Removal Devitalized Tissue < 20 cm Units,7897756,LOCAL,97597,CPT,,,,,GO,Outpatient,,,608.25,395,Blue Cross of AL,Blue Cross,273.27,,,,,,,Other,181.66,863,Based on EAPG RVU's
OT Removal Tissue <20 Assist Units,7897756,LOCAL,97597,CPT,,,,,CQ,Outpatient,,,608.25,395,Blue Cross of AL,Blue Cross,273.27,,,,,,,Other,181.66,863,Based on EAPG RVU's
OT Selective Debridement Charge,7895252,LOCAL,97597,CPT,,,,,GO,Outpatient,,,608.25,395,Blue Cross of AL,Blue Cross,273.27,,,,,,,Other,181.66,863,Based on EAPG RVU's
Selective Debridement Charge,7895942,LOCAL,97597,CPT,,,,,GP,Outpatient,,,608.25,395,Blue Cross of AL,Blue Cross,273.27,,,,,,,Other,181.66,863,Based on EAPG RVU's
"Selective Debridement Charge -> Yes, total wound surface area, first 20 sq cm or less",8968080,LOCAL,97597,CPT,,,,,GP,Outpatient,,,608.25,395,Blue Cross of AL,Blue Cross,273.27,,,,,,,Other,181.66,863,Based on EAPG RVU's
XR Cystogram Limited,13703435,LOCAL,74430,CPT,,,,,52,Outpatient,,,612.55,554.4,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,326.51,Based on EAPG RVU's
US Chest,1169635,LOCAL,76604,CPT,,,,,,Outpatient,,,612.93,328.35,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
XR Ribs w/ PA Chest Left,1170379,LOCAL,71101,CPT,,,,,LT,Outpatient,,,615.08,330,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
XR Ribs w/ PA Chest Right,1170381,LOCAL,71101,CPT,,,,,RT,Outpatient,,,615.08,330,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
Strep Pneumoniae Ab IgG 23 Serotypes QST,10217037,LOCAL,86581,CPT,,,,,,Outpatient,,,615.83,,Blue Cross of AL,Blue Cross,44.29,,,,,,,Other,44.29,92.03,Based on EAPG RVU's
"Strep pneumoniae IgG Abs, 23 Serotypes QST",14006318,LOCAL,86581,CPT,,,,,,Outpatient,,,615.83,,Blue Cross of AL,Blue Cross,44.29,,,,,,,Other,44.29,92.03,Based on EAPG RVU's
DUP ARTERIAL & VENOUS MAPPING BIL,8200501,LOCAL,93985,CPT,,,,,,Outpatient,,,616.92,401,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,161.71,220.99,Based on EAPG RVU's
US Vein Mapping Lower Extremity Bilat,12175095,LOCAL,93985,CPT,,,,,,Outpatient,,,616.92,401,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,161.71,220.99,Based on EAPG RVU's
US Vein Mapping Upper Extremity Bilat,12175104,LOCAL,93985,CPT,,,,,,Outpatient,,,616.92,401,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,161.71,220.99,Based on EAPG RVU's
US Vessel Mapping for Hemo Access Bilat,10216429,LOCAL,93985,CPT,,,,,,Outpatient,,,616.92,401,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,161.71,220.99,Based on EAPG RVU's
DOP ART-LEA WITH ABI SEG PRESSURES,8230018,LOCAL,93923,CPT,,,,,,Outpatient,,,617.64,401,Blue Cross of AL,Blue Cross,244.97,,,,,,,Other,143.05,244.97,Based on EAPG RVU's
DOP ART-UEA W/ PRESSURES UPPER,8230064,LOCAL,93923,CPT,,,,,,Outpatient,,,617.64,401,Blue Cross of AL,Blue Cross,244.97,,,,,,,Other,143.05,244.97,Based on EAPG RVU's
US Segmental Pressures LE 3+ Lvls Bilat,1169755,LOCAL,93923,CPT,,,,,,Outpatient,,,617.64,401,Blue Cross of AL,Blue Cross,244.97,,,,,,,Other,143.05,244.97,Based on EAPG RVU's
US Segmental Pressures UE 3+ Lvls Bilat,9759154,LOCAL,93923,CPT,,,,,,Outpatient,,,617.64,401,Blue Cross of AL,Blue Cross,244.97,,,,,,,Other,143.05,244.97,Based on EAPG RVU's
MG Mammo Diagnostic Left w/ Tomo.,8058649,LOCAL,77065,CPT,,,,,LT,Outpatient,,,623.77,334.13,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,75.3,Based on EAPG RVU's
MG Mammo Diagnostic Right w/ Tomo.,8058652,LOCAL,77065,CPT,,,,,RT,Outpatient,,,623.77,334.13,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,75.3,Based on EAPG RVU's
MG Mammo Digital Diagnostic Left.,7918560,LOCAL,77065,CPT,,,,,LT,Outpatient,,,623.77,334.13,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,75.3,Based on EAPG RVU's
MG Mammo Digital Diagnostic Right.,7918563,LOCAL,77065,CPT,,,,,RT,Outpatient,,,623.77,334.13,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,75.3,Based on EAPG RVU's
MG Mammo Implant Diag Left w/ Tomo.,8058658,LOCAL,77065,CPT,,,,,LT,Outpatient,,,623.77,334.13,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,75.3,Based on EAPG RVU's
MG Mammo Implant Diag Right w/ Tomo.,8058661,LOCAL,77065,CPT,,,,,RT,Outpatient,,,623.77,334.13,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,75.3,Based on EAPG RVU's
MG Mammo Implant Digital Diag Left.,8058667,LOCAL,77065,CPT,,,,,LT,Outpatient,,,623.77,334.13,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,75.3,Based on EAPG RVU's
MG Mammo Implant Digital Diag Right.,8058670,LOCAL,77065,CPT,,,,,RT,Outpatient,,,623.77,334.13,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,75.3,Based on EAPG RVU's
XR Osseous Survey Limited,1170022,LOCAL,77074,CPT,,,,,,Outpatient,,,626.27,335.78,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
94625 OUTPATIENT PULMONARY REHAB W/O CONTINIOUS MONITORING,10470029,LOCAL,94625,CPT,,,,,,Outpatient,,,626.86,407,Blue Cross of AL,Blue Cross,51.98,,,,,,,Other,51.98,54.31,Based on EAPG RVU's
Newborn Screen,8165282,LOCAL,84035,CPT,,,,,,Outpatient,,,629.03,4.78,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,3.98,7.16,Based on EAPG RVU's
"Phenylketonuria, Blood SO",9565050,LOCAL,84030,CPT,,,,,,Outpatient,,,629.03,6.6,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,5.5,7.16,Based on EAPG RVU's
"Susceptibility, Yeast, Comp. Panel QSTC",6250013,LOCAL,87186,CPT,,,,,,Outpatient,,,630,10.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,35.67132075,Based on EAPG RVU's
US OB Limited,1169856,LOCAL,76815,CPT,,,,,,Outpatient,,,632.6,339.08,Blue Cross of AL,Blue Cross,148.61,,,,,,,Other,97.22,148.61,Based on EAPG RVU's
CULL US Echo Dop w/ Spectral Complete,13736513,LOCAL,93320,CPT,,,,,,Outpatient,,,636.3,414,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,29.71,678.38,Based on EAPG RVU's
ECHO DOP W/SPECTRAL COMPLETE,8200180,LOCAL,93320,CPT,,,,,,Outpatient,,,636.3,414,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,29.71,678.38,Based on EAPG RVU's
"epoetin alfa 10,000 units/mL preservative-free Sol 1 mL [CULL]",11202387,LOCAL,J0885,CPT,,,,,,Outpatient,1,ML,636.672,,Blue Cross of AL,Blue Cross,233.26,,,,,,,Other,0.79,233.26,Based on EAPG RVU's
74248 XR Small Bowel Follow Thru: AddOn,13626886,LOCAL,74248,CPT,,,,,,Outpatient,,,636.99,341.55,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,41.4,176.48,Based on EAPG RVU's
CULL XR Small Bowel Follow Thru,13626886,LOCAL,74248,CPT,,,,,,Outpatient,,,636.99,341.55,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,41.4,176.48,Based on EAPG RVU's
64486 TAP BLOCK UNILATERAL BY INJECTION(S),5661023,LOCAL,64486,CPT,,,,,,Outpatient,,,637.75,415,Blue Cross of AL,Blue Cross,636.45,,,,,,,Other,46.33,863,Based on EAPG RVU's
INTRO CATH RT HEART PA,8267102,LOCAL,36013,CPT,,,,,,Outpatient,,,638.52,415,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,104.34,929.12,Based on EAPG RVU's
alteplase 2 mg injection [CULL],11201047,LOCAL,J2997,CPT,,,,,,Outpatient,1,EA,644.928,,Blue Cross of AL,Blue Cross,122.4,,,,,,,Other,94.45,122.4,Based on EAPG RVU's
"Supersaturation, U24 SO",13938669,LOCAL,83945,CPT,,,,,,Outpatient,,,645.39,17.34,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,24.085,Based on EAPG RVU's
10060 DRAINAGE OF SKIN ABSCESS CHARGE,9704026,LOCAL,10060,CPT,,,,,,Outpatient,,,646.72,420,Blue Cross of AL,Blue Cross,239.03,,,,,,,Other,181.66,863,Based on EAPG RVU's
10061 I & D COMPLEX,13048116,LOCAL,10061,CPT,,,,,,Outpatient,,,646.72,420,Blue Cross of AL,Blue Cross,239.03,,,,,,,Other,239.03,863,Based on EAPG RVU's
Bill Prostate Biopsy,14048008,LOCAL,,,G0416,HCPCS,,,,Outpatient,,,646.83,,Blue Cross of AL,Blue Cross,59.06,,,,,,,Other,59.06,328.88,Based on EAPG RVU's
XR Spine Thoracolumbar 2 Views,1170490,LOCAL,72080,CPT,,,,,,Outpatient,,,651.93,349.8,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
"11102 Tangential Biopsy of Skin, 1 lesion",9620037,LOCAL,11102,CPT,,,,,,Outpatient,,,656.43,427,Blue Cross of AL,Blue Cross,651.39,,,,,,,Other,181.66,863,Based on EAPG RVU's
16020 BURN DEBRIDEMENT/DRESSING INITIAL OR SUB,13043448,LOCAL,16020,CPT,,,,,,Outpatient,,,656.43,427,Blue Cross of AL,Blue Cross,273.27,,,,,,,Other,181.66,863,Based on EAPG RVU's
16020 Chemical Canterizaiton,9400039,LOCAL,16020,CPT,,,,,,Outpatient,,,656.43,427,Blue Cross of AL,Blue Cross,273.27,,,,,,,Other,181.66,863,Based on EAPG RVU's
17250 CAUTERY OF WOUND (ELECTRICAL),13033473,LOCAL,17250,CPT,,,,,,Outpatient,,,656.43,427,Blue Cross of AL,Blue Cross,239.03,,,,,,,Other,181.66,863,Based on EAPG RVU's
97606 Wound VAC >50 sq cm HBO,10015644,LOCAL,97606,CPT,,,,,,Outpatient,,,656.43,427,Blue Cross of AL,Blue Cross,549.61,,,,,,,Other,365.27,549.61,Based on EAPG RVU's
REF ABO Discrep (ABSC),13481254,LOCAL,86850,CPT,,,,,,Outpatient,,,657,11.72,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,48.85,Based on EAPG RVU's
TELEMETRY DAILY CHARGE,9341351,LOCAL,93229,CPT,,,,,,Outpatient,,,659,311,Blue Cross of AL,Blue Cross,99.86,,,,,,,Other,99.86,284.7,Based on EAPG RVU's
13133 >  Each additional 5 cm or less (List separately in addition to primary procedure),12788295,LOCAL,13133,CPT,,,,,,Outpatient,,,660,,Blue Cross of AL,Blue Cross,651.39,,,,,,,Other,95.58,863,Based on EAPG RVU's
"13133-Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; e",14746903,LOCAL,13133,CPT,,,,,,Outpatient,,,660,,Blue Cross of AL,Blue Cross,651.39,,,,,,,Other,95.58,863,Based on EAPG RVU's
82570 QST,14798876,LOCAL,82570,CPT,,,,,,Outpatient,,,662,6.22,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,40.97514925,Based on EAPG RVU's
"Leukotriene E4, Random, Urine QST",14798876,LOCAL,82542,CPT,,,,,,Outpatient,,,662.05,28.91,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,7.16,40.97514925,Based on EAPG RVU's
Bill Only Antigen Type Group 3,10312933,LOCAL,86902,CPT,,,,,,Outpatient,,,666,7.62,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,328.88,Based on EAPG RVU's
"JC Polyoma Virus DNA, Qual PCR CSF QSTC",10170129,LOCAL,87798,CPT,,,,,,Outpatient,,,666,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
varicella virus vaccine - Pow [CULL],11212438,LOCAL,90716,CPT,,,,,,Outpatient,1,ML,669.40032,,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,160.4,Based on EAPG RVU's
XR Skull Complete,1170438,LOCAL,70260,CPT,,,,,,Outpatient,,,672.73,360.53,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
Bill Only REF Washing,13514969,LOCAL,86999,CPT,,,,,,Outpatient,,,675,,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,22.39,Based on EAPG RVU's
"Gastrointestinal Path Panel, RT PCR QSTC",13864469,LOCAL,87506,CPT,,,301,RC,,Outpatient,,,675,315.59,Blue Cross of AL,Blue Cross,158.39,,,,,,,Other,158.39,158.39,Based on EAPG RVU's
US AAA Screening,8058767,LOCAL,76706,CPT,,,,,,Outpatient,,,675.12,362.18,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Abdomen Limited,1169569,LOCAL,76705,CPT,,,,,,Outpatient,,,675.12,362.18,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Renal,7936319,LOCAL,76770,CPT,,,,,,Outpatient,,,675.12,362.18,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,97.22,245.49,Based on EAPG RVU's
US Retroperitoneal Complete,1169867,LOCAL,76770,CPT,,,,,,Outpatient,,,675.12,362.18,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,97.22,245.49,Based on EAPG RVU's
MG Mammo Digital Screening Bilateral.,7918566,LOCAL,77067,CPT,,,,,,Outpatient,,,676.43,363,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,79.68,Based on EAPG RVU's
MG Mammo Digital Screening Left.,7949062,LOCAL,77067,CPT,,,,,52|LT,Outpatient,,,676.43,363,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,79.68,Based on EAPG RVU's
MG Mammo Digital Screening Right.,7949065,LOCAL,77067,CPT,,,,,52|RT,Outpatient,,,676.43,363,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,79.68,Based on EAPG RVU's
MG Mammo Implant Digital Screening Bil.,8058673,LOCAL,77067,CPT,,,,,,Outpatient,,,676.43,363,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,79.68,Based on EAPG RVU's
MG Mammo Implant Screening Bil w/ Tomo.,8058682,LOCAL,77067,CPT,,,,,,Outpatient,,,676.43,363,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,79.68,Based on EAPG RVU's
MG Mammo Screening Bilateral w/ Tomo.,8058685,LOCAL,77067,CPT,,,,,,Outpatient,,,676.43,363,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,79.68,Based on EAPG RVU's
64450 INJECTION PERIPHERAL NERVE OR BRANCH,5661030,LOCAL,64450,CPT,,,,,,Outpatient,,,680,1613,Blue Cross of AL,Blue Cross,636.45,,,,,,,Other,633.14,1291,Based on EAPG RVU's
57105 - BIOPSY VAGINAL MUCOSA EXTENSIVE,14749499,LOCAL,57105,CPT,,,,,,Outpatient,,,685,3180,Blue Cross of AL,Blue Cross,3558.77,,,,,,,Other,2315,3558.77,Based on EAPG RVU's
"Immunoglobulins Panel, CSF QSTC",13864507,LOCAL,82784,CPT,,,,,,Outpatient,,,687.2,11.16,Blue Cross of AL,Blue Cross,7.16,,,,,,,Other,7.16,34.958,Based on EAPG RVU's
US Fetal Biophysical Profile w/o N-Str,1169689,LOCAL,76819,CPT,,,,,,Outpatient,,,688.53,369.6,Blue Cross of AL,Blue Cross,148.61,,,,,,,Other,97.22,148.61,Based on EAPG RVU's
"FISH, Prenatal Scr Interp QSTC",13864670,LOCAL,88274,CPT,,,,,,Outpatient,,,690.75,50.86,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,42.38,63.34,Based on EAPG RVU's
"FISH, Prenatal Screen QSTC",13864673,LOCAL,88271,CPT,,,,,,Outpatient,,,690.75,25.7,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,21.42,63.34,Based on EAPG RVU's
11104 Punch Biopsy,10017193,LOCAL,11104,CPT,,,,,,Outpatient,,,691.38,449,Blue Cross of AL,Blue Cross,651.39,,,,,,,Other,365.27,863,Based on EAPG RVU's
XR Abdomen Series Chest 1 View,1169932,LOCAL,74022,CPT,,,,,,Outpatient,,,691.86,53.63,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
XR Osseous Survey Complete,1170018,LOCAL,77075,CPT,,,,,,Outpatient,,,694.85,372.9,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,97.22,176.48,Based on EAPG RVU's
XR Spine Cervical 6+ Views,1170461,LOCAL,72052,CPT,,,,,,Outpatient,,,701.96,376.2,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
"96365 IV INFUSION, MEDS, INITIAL 16-90 MINS",7904531,LOCAL,96365,CPT,,,,,,Outpatient,,,702.66,457,Blue Cross of AL,Blue Cross,442.94,,,,,,,Other,192.63,442.94,Based on EAPG RVU's
"96365- IV tx, first hour",1928299,LOCAL,96365,CPT,,,,,,Outpatient,,,702.66,457,Blue Cross of AL,Blue Cross,442.94,,,,,,,Other,192.63,442.94,Based on EAPG RVU's
US Aorta,7936256,LOCAL,76775,CPT,,,,,,Outpatient,,,702.79,377.03,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Retroperitoneal Limited,1169869,LOCAL,76775,CPT,,,,,,Outpatient,,,702.79,377.03,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
F/U EMBOLIZATION/INFUSION,8210730,LOCAL,75898,CPT,,,,,,Outpatient,,,707.78,379.5,Blue Cross of AL,Blue Cross,1231.66,,,,,,,Other,1231.66,2877.63,Based on EAPG RVU's
US Extremity Nonvascular Limited Left,2425338,LOCAL,76882,CPT,,,,,LT,Outpatient,,,708.51,248.33,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Extremity Nonvascular Limited Right,2425341,LOCAL,76882,CPT,,,,,RT,Outpatient,,,708.51,248.33,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Head/Neck Soft Tissue,1169729,LOCAL,76536,CPT,,,,,,Outpatient,,,708.51,380.33,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
76000 XR Fluoroscopy Under 1 Hour: AddOn,13658083,LOCAL,76000,CPT,,,,,,Outpatient,,,709.31,380.33,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,220.99,Based on EAPG RVU's
64495 - INJ PARAVERT F JNT L/S 3 LEV,5661079,LOCAL,64495,CPT,,,,,,Outpatient,,,710.23,462,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,42.72,1250.53,Based on EAPG RVU's
INTRO CAROTID VERTEBRAL ARTERY,8267188,LOCAL,36100,CPT,,,,,,Outpatient,,,710.94,462,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,122.25,929.12,Based on EAPG RVU's
XR Urography Retrograde,10454609,LOCAL,74420,CPT,,,,,,Outpatient,,,714.75,383.63,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,326.51,Based on EAPG RVU's
97607 Disp NP Wound Tx <=50 Sq Cm.,10017200,LOCAL,97607,CPT,,,,,,Outpatient,,,716.42,466,Blue Cross of AL,Blue Cross,549.61,,,,,,,Other,365.27,549.61,Based on EAPG RVU's
".Thyroglobulin, LC/MS/MS QSTC",13864486,LOCAL,84432,CPT,,,,,,Outpatient,,,720,19.27,Blue Cross of AL,Blue Cross,18.43,,,,,,,Other,18.43,46.235,Based on EAPG RVU's
93017 CARDIAC STRESS TEST CHARGE,7938407,LOCAL,93017,CPT,,,,,,Outpatient,,,721.43,469,Blue Cross of AL,Blue Cross,244.97,,,,,,,Other,244.97,284.7,Based on EAPG RVU's
CARDIAC STRESS W/TRACING,8200041,LOCAL,93017,CPT,,,,,,Outpatient,,,721.43,469,Blue Cross of AL,Blue Cross,244.97,,,,,,,Other,244.97,284.7,Based on EAPG RVU's
NM Stress Test Trace,2426005,LOCAL,93017,CPT,,,,,,Outpatient,,,721.43,469,Blue Cross of AL,Blue Cross,244.97,,,,,,,Other,244.97,284.7,Based on EAPG RVU's
64405 Occipital Nerve Block Unilateral,5661077,LOCAL,64405,CPT,,,,,,Outpatient,,,724.33,879,Blue Cross of AL,Blue Cross,636.45,,,,,,,Other,269.88,863,Based on EAPG RVU's
Bill Only REF Thawing & Washing RBC,13514967,LOCAL,86931,CPT,,,,,,Outpatient,,,733.5,,Blue Cross of AL,Blue Cross,38.88,,,,,,,Other,38.88,156.67,Based on EAPG RVU's
REF HLA ABSC,13484120,LOCAL,86829,CPT,,,,,,Outpatient,,,733.5,77.03,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,64.19,Based on EAPG RVU's
REF HPA-1 Typing,13481256,LOCAL,81105,CPT,,,,,,Outpatient,,,733.5,146.66,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,63.34,122.22,Based on EAPG RVU's
93571 Cor Flow Wire 1st Measure,8230055,LOCAL,93571,CPT,,,,,,Outpatient,,,734.27,477,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,143.66,2669.67,Based on EAPG RVU's
XR Arthrocentesis Asp/Inj Intmed Jt Lt,14807134,LOCAL,20605,CPT,,,,,LT,Outpatient,,,740,336,Blue Cross of AL,Blue Cross,351.64,,,,,,,Other,269.88,863,Based on EAPG RVU's
XR Arthrocentesis Asp/Inj Intmed Jt Rt,14807137,LOCAL,20605,CPT,,,,,RT,Outpatient,,,740,336,Blue Cross of AL,Blue Cross,351.64,,,,,,,Other,269.88,863,Based on EAPG RVU's
XR Arthrocentesis Asp/Inj Major Jt Bilat,14807140,LOCAL,20610,CPT,,,,,50,Outpatient,,,740,650,Blue Cross of AL,Blue Cross,351.64,,,,,,,Other,269.88,863,Based on EAPG RVU's
XR Arthrocentesis Asp/Inj Major Jt Lt,14807143,LOCAL,20610,CPT,,,,,LT,Outpatient,,,740,650,Blue Cross of AL,Blue Cross,351.64,,,,,,,Other,269.88,863,Based on EAPG RVU's
XR Arthrocentesis Asp/Inj Major Jt Rt,14807146,LOCAL,20610,CPT,,,,,RT,Outpatient,,,740,650,Blue Cross of AL,Blue Cross,351.64,,,,,,,Other,269.88,863,Based on EAPG RVU's
XR Arthrocentesis Asp/Inj Small Jt Lt,14807149,LOCAL,20600,CPT,,,,,LT,Outpatient,,,740,295,Blue Cross of AL,Blue Cross,351.64,,,,,,,Other,269.88,863,Based on EAPG RVU's
XR Arthrocentesis Asp/Inj Small Jt Rt,14807152,LOCAL,20600,CPT,,,,,RT,Outpatient,,,740,295,Blue Cross of AL,Blue Cross,351.64,,,,,,,Other,269.88,863,Based on EAPG RVU's
XR Colon Barium Enema,9427624,LOCAL,74270,CPT,,,,,,Outpatient,,,740.46,396.83,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,162.76,176.48,Based on EAPG RVU's
DOP VENOUS LOWER EXT BILATERAL,8200420,LOCAL,93970,CPT,,,,,,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
DOP VENOUS UPPER EXT BIL,8200421,LOCAL,93970,CPT,,,,,,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
DUP AO IVC ILIAC COMPLETE,8200530,LOCAL,93978,CPT,,,,,,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
DUP CAROTID BILATERAL,8200370,LOCAL,93880,CPT,,,,,,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
DUP CAROTID UNI,8200380,LOCAL,93882,CPT,,,,,,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
DUP HEPATOPORTAL INFLOW/OUTFLOW COMP,8200434,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
DUP MESENTERIC/CELIAC ARTERY IN/OUT COMP,8200433,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
DUP RENAL ARTERIES INFLOW/OUTFLOW COMP,8200432,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
DUPLEX ARTERIAL LOWER EXT BIL,8200460,LOCAL,93925,CPT,,,,,,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
DUPLEX ARTERIAL UPPER EXT BIL,8200480,LOCAL,93930,CPT,,,,,,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,161.71,220.99,Based on EAPG RVU's
US Abdomen Vascular Limited,8206811,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
US Aorta IVC Iliac Duplex Complete,1169577,LOCAL,93978,CPT,,,,,,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
US Art/Vein Abd/Pelvis/Scrotal Complete,1169581,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
US Carotid Duplex Bilateral,1169631,LOCAL,93880,CPT,,,,,,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
US Carotid Duplex Left,8814383,LOCAL,93882,CPT,,,,,LT,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Carotid Duplex Right,8814386,LOCAL,93882,CPT,,,,,RT,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US Lower Ext Arterial Duplex Bilateral,1169759,LOCAL,93925,CPT,,,,,,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
US Lower Ext Venous Duplex Bilateral,1169769,LOCAL,93970,CPT,,,,,,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
US Renal Artery Duplex Bilateral,4246822,LOCAL,93975,CPT,,,,,,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
US Upper Ext Arterial Duplex Bilateral,1169895,LOCAL,93930,CPT,,,,,,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,161.71,220.99,Based on EAPG RVU's
US Upper Ext Venous Duplex Bilateral,1169901,LOCAL,93970,CPT,,,,,,Outpatient,,,742.12,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
DUP RENAL ARTERIES UNI,8200585,LOCAL,93976,CPT,,,,,,Outpatient,,,742.13,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,97.22,245.49,Based on EAPG RVU's
US Renal Artery Duplex Left,4246828,LOCAL,93976,CPT,,,,,LT,Outpatient,,,742.13,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,97.22,245.49,Based on EAPG RVU's
US Renal Artery Duplex Right,4246843,LOCAL,93976,CPT,,,,,RT,Outpatient,,,742.13,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,97.22,245.49,Based on EAPG RVU's
Acetylcholine Receptor Binding Ab QSTC,8853232,LOCAL,86041,CPT,,,,,,Outpatient,,,743,22.08,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,18.4,Based on EAPG RVU's
XR Small Bowel Series,12908279,LOCAL,74250,CPT,,,,,,Outpatient,,,748.74,401.78,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,162.76,176.48,Based on EAPG RVU's
Chlamydophila pneumoniae QSTC,9727429,LOCAL,87486,CPT,,,,,,Outpatient,,,750,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
Human RSV A QSTC,9727398,LOCAL,87633,CPT,,,,,,Outpatient,,,750,500.14,Blue Cross of AL,Blue Cross,158.39,,,,,,,Other,158.39,610.305625,Based on EAPG RVU's
Mycoplasma pneumoniae QSTC,9727431,LOCAL,87581,CPT,,,,,,Outpatient,,,750,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
REF Antibody Titer,7943112,LOCAL,86886,CPT,,,,,,Outpatient,,,756,6.22,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,156.67,Based on EAPG RVU's
"Comp Drug Screen, Umb Cord QSTC",13864562,LOCAL,80307,CPT,,,301,RC,,Outpatient,,,760.5,74.57,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,160.4,Based on EAPG RVU's
64494 - INJ PARAVERT F JNT L/S 2 LEV,5661036,LOCAL,64494,CPT,,,,,,Outpatient,,,761,495,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,41.55,1250.53,Based on EAPG RVU's
REF HLA PLT ABSC,13479160,LOCAL,86829,CPT,,,,,,Outpatient,,,767.25,77.03,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,64.19,Based on EAPG RVU's
REF PLT ABSC,13484122,LOCAL,86022,CPT,,,,,,Outpatient,,,767.25,22.04,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,18.37,Based on EAPG RVU's
95822 EEG COMA OR SLEEP ONLY CHARGE,8687098,LOCAL,95822,CPT,,,,,,Outpatient,,,768.44,499,Blue Cross of AL,Blue Cross,466.96,,,,,,,Other,284.7,466.96,Based on EAPG RVU's
EEG EXTENDED 41-60 MINUTES CHARGE,13515636,LOCAL,95812,CPT,,,,,,Outpatient,,,768.44,499,Blue Cross of AL,Blue Cross,740.58,,,,,,,Other,284.7,740.58,Based on EAPG RVU's
MG Mammo Diagnostic Bilateral w/ Tomo.,8058646,LOCAL,77066,CPT,,,,,,Outpatient,,,770.81,413.33,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,96.53,Based on EAPG RVU's
MG Mammo Digital Diagnostic Bilat.,7918557,LOCAL,77066,CPT,,,,,,Outpatient,,,770.81,413.33,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,96.53,Based on EAPG RVU's
MG Mammo Implant Diag Bilateral w/ Tomo.,8058655,LOCAL,77066,CPT,,,,,,Outpatient,,,770.81,413.33,Blue Cross of AL,Blue Cross,74,,,,,,,Other,11.11,96.53,Based on EAPG RVU's
MG Mammo Implant Diag Bilateral w/ Tomo.,8058655,LOCAL,G0279,CPT,,,,,,Outpatient,,,770.81,,Blue Cross of AL,Blue Cross,74,,,,,,,Other,11.11,96.53,Based on EAPG RVU's
MG Mammo Implant Digital Diag Bilateral.,8058664,LOCAL,77066,CPT,,,,,,Outpatient,,,770.81,413.33,Blue Cross of AL,Blue Cross,74,,,,,,,Other,74,96.53,Based on EAPG RVU's
Pen G Benz/Proc (Bicillin CR) [CULL],11202075,LOCAL,J0558,CPT,,,,,,Outpatient,2,ML,771.5488,,Blue Cross of AL,Blue Cross,122.4,,,,,,,Other,19.52,122.4,Based on EAPG RVU's
97608 Disp NP Wound Tx >50 Sq Cm.,10017187,LOCAL,97608,CPT,,,,,,Outpatient,,,777.46,505,Blue Cross of AL,Blue Cross,549.61,,,,,,,Other,365.27,549.61,Based on EAPG RVU's
Bill Only Antigen Type Group 4,10312939,LOCAL,86902,CPT,,,,,,Outpatient,,,778.5,7.62,Blue Cross of AL,Blue Cross,6.29,,,,,,,Other,6.29,328.88,Based on EAPG RVU's
64491 INJ PARAVER CERV/THOR 2ND LEVEL,5661064,LOCAL,64491,CPT,,,,,,Outpatient,,,782.44,509,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,48.01,1250.53,Based on EAPG RVU's
64492 FACET CERV/THOR 3RD ADDTL LEVEL CHARGE,5661080,LOCAL,64492,CPT,,,,,,Outpatient,,,782.44,509,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,48.5,1250.53,Based on EAPG RVU's
"FISH, Locus Specific X2 100 QSTC",13864693,LOCAL,88271,CPT,,,,,,Outpatient,,,787.5,25.7,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,21.42,63.34,Based on EAPG RVU's
"Liver Fibrosis, Fibro-ActiTest Pnl QSTC",8764813,LOCAL,81596,CPT,,,,,,Outpatient,,,787.5,86.63,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,63.34,429.125,Based on EAPG RVU's
Specimen Source: FISH Locus Pr x2 QSTC,13864687,LOCAL,88275,CPT,,,,,,Outpatient,,,787.5,61.43,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,51.19,63.34,Based on EAPG RVU's
ICD DFT TESTING,8231015,LOCAL,93641,CPT,,,,,,Outpatient,,,788,512,Blue Cross of AL,Blue Cross,9059.73,,,,,,,Other,205.74,9059.73,Based on EAPG RVU's
36593 DECLOT IMPLANT DEVICE/CATHETER CHARGE,8700839,LOCAL,36593,CPT,,,,,,Outpatient,,,794.92,517,Blue Cross of AL,Blue Cross,442.94,,,,,,,Other,303.25,863,Based on EAPG RVU's
64590  Insertion or replacement of peripheral or gastric neurostimulator pulse generator,8529396,LOCAL,64590,CPT,,,,,,Outpatient,,,798,519,Blue Cross of AL,Blue Cross,30196.67,,,,,,,Other,9233,30196.67,Based on EAPG RVU's
US Transvaginal Non-OB,1169889,LOCAL,76830,CPT,,,,,,Outpatient,,,798,428.18,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
"meningococcal B vaccine recombinant, OMV, adjuvanted intramuscular suspension 0.5 mL [CULL]",11202846,LOCAL,90620,CPT,,,,,,Outpatient,0.5,ML,808.59648,,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,160.4,Based on EAPG RVU's
Fungitell (1-3)-B-D-Glucan Assay QSTC,8972810,LOCAL,87449,CPT,,,301,RC,,Outpatient,,,810,14.38,Blue Cross of AL,Blue Cross,10.57,,,,,,,Other,10.57,10.57,Based on EAPG RVU's
JAK2 V617F Mutation Analysis QSTC,9039438,LOCAL,81270,CPT,,,,,,Outpatient,,,810,109.99,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,63.34,449.915,Based on EAPG RVU's
TPMT Genotype QSTC,10168397,LOCAL,81335,CPT,,,,,,Outpatient,,,810,209.77,Blue Cross of AL,Blue Cross,173.68,,,,,,,Other,173.68,174.81,Based on EAPG RVU's
95816 EEG AWAKE AND DROWSY CHARGE,8303772,LOCAL,95816,CPT,,,,,,Outpatient,,,820.05,533,Blue Cross of AL,Blue Cross,466.96,,,,,,,Other,284.7,466.96,Based on EAPG RVU's
ADD'L ART 2ND/3RD ABD,8267115,LOCAL,36248,CPT,,,,,,Outpatient,,,820.1,533,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,39.09,929.12,Based on EAPG RVU's
XR Spine Lumbosacral 4 Plus Views,1170476,LOCAL,72110,CPT,,,,,,Outpatient,,,823.1,441.38,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
"GAD65, IA-2 and Insulin Autoantibody QSTC",14105691,LOCAL,86337,CPT,,,,,,Outpatient,,,823.5,25.69,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,21.41,Based on EAPG RVU's
"GAD65, IA-2 and Insulin Autoantibody QSTC.",14621959,LOCAL,86337,CPT,,,,,,Outpatient,,,823.5,25.69,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,21.41,Based on EAPG RVU's
92978 Cath IVUS First Vessel,8230048,LOCAL,92978,CPT,,,,,,Outpatient,,,828.2,538,Blue Cross of AL,Blue Cross,262.79,,,,,,,Other,164.22,863,Based on EAPG RVU's
"Rho D Immune Globulin, Human, full dose, 300 micrograms, INJ",90620010,LOCAL,90384,CPT,,,302,RC,,Outpatient,,,829.08,539,Blue Cross of AL,Blue Cross,122.4,,,,,,,Other,80.532,122.4,Based on EAPG RVU's
"Rho D Immune Globulin, Human, full dose, 300 micrograms, INJ",90620010,LOCAL,J2790,CPT,,,,,,Outpatient,,,829.08,,Blue Cross of AL,Blue Cross,122.4,,,,,,,Other,80.532,122.4,Based on EAPG RVU's
XR Arthrogram Knee SI Left,2425410,LOCAL,73580,CPT,,,,,LT,Outpatient,,,834.05,447.15,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,326.51,Based on EAPG RVU's
XR Arthrogram Knee SI Right,2425413,LOCAL,73580,CPT,,,,,RT,Outpatient,,,834.05,447.15,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,326.51,Based on EAPG RVU's
Abeta 40 - QST,13874686,LOCAL,82233,CPT,,,,,,Outpatient,,,844,,Blue Cross of AL,Blue Cross,173.68,,,,,,,Other,128.92,173.68,Based on EAPG RVU's
Abeta 42 - QST,13874685,LOCAL,82234,CPT,,,,,,Outpatient,,,844,,Blue Cross of AL,Blue Cross,173.68,,,,,,,Other,128.92,173.68,Based on EAPG RVU's
"epoetin alfa-epbx 20,000 units/mL injectable solution 1 mL [CULL]",11202388,LOCAL,Q5106,CPT,,,,,,Outpatient,1,ML,847.104,,Blue Cross of AL,Blue Cross,525.49,,,,,,,Other,7.85,525.49,Based on EAPG RVU's
36005 Venogram Injection,8212037,LOCAL,36005,CPT,,,,,,Outpatient,,,847.39,551,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,38.76,929.12,Based on EAPG RVU's
levothyroxine 40 mcg (0.04 mg)/mL intravenous solution 5 mL [CULL],11202740,LOCAL,J0650,CPT,,,,,,Outpatient,5,ML,851.392,,Blue Cross of AL,Blue Cross,122.4,,,,,,,Other,5.983,122.4,Based on EAPG RVU's
XR Upper GI w/ Air Contrast,1170566,LOCAL,74246,CPT,,,,,,Outpatient,,,862.77,492.53,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,162.76,176.48,Based on EAPG RVU's
XR Upper GI w/ Air w/ Small Bowel,1170570,LOCAL,74246,CPT,,,,,,Outpatient,,,862.77,492.53,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,162.76,176.48,Based on EAPG RVU's
US Scrotum (Contents),8206982,LOCAL,76870,CPT,,,,,,Outpatient,,,864.82,463.65,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
US OB Transvaginal,1169861,LOCAL,76817,CPT,,,,,,Outpatient,,,865.47,464.48,Blue Cross of AL,Blue Cross,148.61,,,,,,,Other,97.22,148.61,Based on EAPG RVU's
93308 LMTD STUDENT ECHOCARDIOGRAM CHARGE,6011002,LOCAL,93308,CPT,,,,,,Outpatient,,,867.64,564,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,220.99,678.38,Based on EAPG RVU's
ECHO 2D LTD,8200150,LOCAL,93308,CPT,,,,,,Outpatient,,,867.64,564,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,220.99,678.38,Based on EAPG RVU's
US Echo 2D Limited,8071400,LOCAL,93308,CPT,,,,,,Outpatient,,,867.64,564,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,220.99,678.38,Based on EAPG RVU's
Pneumonia Panel (Biofire),9594219,LOCAL,87633,CPT,,,,,,Outpatient,,,868.73,500.14,Blue Cross of AL,Blue Cross,158.39,,,,,,,Other,158.39,610.305625,Based on EAPG RVU's
tbo-filgrastim 300 mcg/0.5 mL subcutaneous solution 0.5 mL [CULL],11202449,LOCAL,J1447,CPT,,,,,,Outpatient,0.5,ML,872.2368,,Blue Cross of AL,Blue Cross,525.49,,,,,,,Other,0.28,525.49,Based on EAPG RVU's
XR Colon Barium Enema w/ Air Contrast,9427627,LOCAL,74280,CPT,,,,,,Outpatient,,,872.33,467.78,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,162.76,176.48,Based on EAPG RVU's
NM Thyroid Imaging,2426008,LOCAL,78013,CPT,A9512,HCPCS,,,,Outpatient,,,879.12,471.08,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,367.38,560.96,Based on EAPG RVU's
92612 - ENDOSCOPY SWALLOW TST (FEES),9636010,LOCAL,92612,CPT,,,,,GN,Outpatient,,,884,575,Blue Cross of AL,Blue Cross,162.41,,,,,,,Other,52.01,162.41,Based on EAPG RVU's
92612 Fiber Endo Eval Swallow Video Charge,9410192,LOCAL,92612,CPT,,,,,GN,Outpatient,,,884,575,Blue Cross of AL,Blue Cross,162.41,,,,,,,Other,52.01,162.41,Based on EAPG RVU's
SLP Fiberoptic Swallow Eval Units,1373844,LOCAL,92612,CPT,,,,,GN,Outpatient,,,884,575,Blue Cross of AL,Blue Cross,162.41,,,,,,,Other,52.01,162.41,Based on EAPG RVU's
Speech Fiberoptic Swallow Eval Charge,1373844,LOCAL,92612,CPT,,,,,GN,Outpatient,,,884,575,Blue Cross of AL,Blue Cross,162.41,,,,,,,Other,52.01,162.41,Based on EAPG RVU's
3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase (HMGCR) Antibody (IgG) QSTC,13864471,LOCAL,83520,CPT,,,,,,Outpatient,,,888.75,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,117.3767568,Based on EAPG RVU's
XR Hips 5+ Views Bilat,7520618,LOCAL,73523,CPT,,,,,,Outpatient,,,890.34,477.68,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
XR Hips 5+ Views w/AP Pelvis Bilat,7520621,LOCAL,73523,CPT,,,,,,Outpatient,,,890.34,477.68,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
XR Barium Swallow w/ Upper GI + KUB,8912828,LOCAL,74240,CPT,,,,,,Outpatient,,,891.48,477.68,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,162.76,176.48,Based on EAPG RVU's
XR Upper GI,1170562,LOCAL,74240,CPT,,,,,,Outpatient,,,891.48,477.68,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,162.76,176.48,Based on EAPG RVU's
XR Upper GI w/ Small Bowel,1170574,LOCAL,74240,CPT,,,,,,Outpatient,,,891.48,477.68,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,162.76,176.48,Based on EAPG RVU's
ceftaroline 600 mg intravenous injection [CULL],11201425,LOCAL,J0712,CPT,,,,,,Outpatient,1,EA,896.73216,,Blue Cross of AL,Blue Cross,233.26,,,,,,,Other,4.23,233.26,Based on EAPG RVU's
"ANNA3 Ab, IFA, CSF QSTC",13873554,LOCAL,86255,CPT,,,,,,Outpatient,,,900,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.05,15.29,Based on EAPG RVU's
"GAD65 Ab, IFA, CSF QSTC",13873575,LOCAL,86341,CPT,,,,,,Outpatient,,,900,28.28,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,23.57,Based on EAPG RVU's
TPMT Activity QSTC,8764663,LOCAL,84433,CPT,,,,,,Outpatient,,,900,26.6,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,22.17,Based on EAPG RVU's
CATH PL 1ST ORDER VENOUS,8267186,LOCAL,36011,CPT,,,,,,Outpatient,,,908.34,590,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,126.74,929.12,Based on EAPG RVU's
VENOGRAM INJ BILATERAL,8267755,LOCAL,36005,CPT,,,,,,Outpatient,,,914.51,551,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,38.76,929.12,Based on EAPG RVU's
XR Barium Swallow w/ Upper GI w/ Air,13554969,LOCAL,74246,CPT,,,,,,Outpatient,,,918.22,492.53,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,162.76,176.48,Based on EAPG RVU's
95819 EEG AWAKE & ASLEEP CHARGE,8704890,LOCAL,95819,CPT,,,,,,Outpatient,,,922.13,599,Blue Cross of AL,Blue Cross,466.96,,,,,,,Other,284.7,466.96,Based on EAPG RVU's
US Biopsy Abdomen/Retroperitoneal Mass,8565247,LOCAL,76942,CPT,,,,,,Outpatient,,,927.16,497.48,Blue Cross of AL,Blue Cross,165.47,,,,,,,Other,28.54,165.47,Based on EAPG RVU's
US Biopsy Liver,1169599,LOCAL,76942,CPT,,,,,,Outpatient,,,927.16,497.48,Blue Cross of AL,Blue Cross,165.47,,,,,,,Other,28.54,165.47,Based on EAPG RVU's
US Breast Needle Loc Left,7936259,LOCAL,19285,CPT,,,,,LT,Outpatient,,,927.16,603,Blue Cross of AL,Blue Cross,1200.99,,,,,,,Other,643.26,1291,Based on EAPG RVU's
US Breast Needle Loc Right,7936262,LOCAL,19285,CPT,,,,,RT,Outpatient,,,927.16,603,Blue Cross of AL,Blue Cross,1200.99,,,,,,,Other,643.26,1291,Based on EAPG RVU's
US NEEDLE PLACEMENT CVS,8200510,LOCAL,76942,CPT,,,,,,Outpatient,,,927.16,497.48,Blue Cross of AL,Blue Cross,165.47,,,,,,,Other,28.54,165.47,Based on EAPG RVU's
XR Cholangiogram T-Tube Check,8207012,LOCAL,47531,CPT,,,,,,Outpatient,,,927.38,298,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2599,3226.48,Based on EAPG RVU's
XR Arthrogram Elbow SI Left,2425398,LOCAL,73085,CPT,,,,,LT,Outpatient,,,934.13,500.78,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,326.51,Based on EAPG RVU's
XR Arthrogram Elbow SI Right,2425401,LOCAL,73085,CPT,,,,,RT,Outpatient,,,934.13,500.78,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,326.51,Based on EAPG RVU's
"Bartonella DNA, Qual, RT PCR QSTC",13864512,LOCAL,87471,CPT,,,,,,Outpatient,,,940.5,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
BiPAP Charge -> Subsequent,2678299,LOCAL,94003,CPT,,,,,,Outpatient,,,943.5,613,Blue Cross of AL,Blue Cross,941,,,,,,,Other,604.42,941,Based on EAPG RVU's
NM Lung Perfusion Imaging,1169328,LOCAL,78580,CPT,A9540,HCPCS,,,,Outpatient,,,948.45,508.2,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,367.38,1409.71,Based on EAPG RVU's
64999 PERI-INFILTRATION HARDWARE,5661083,LOCAL,64999,CPT,,,,,,Outpatient,,,953.35,620,Blue Cross of AL,Blue Cross,636.45,,,,,,,Other,269.88,863,Based on EAPG RVU's
"penicillin G benzathine 1,200,000 units/2 mL intramuscular suspension 2 mL [CULL]",11202076,LOCAL,J0561,CPT,,,,,,Outpatient,2,ML,967.8944,,Blue Cross of AL,Blue Cross,122.4,,,,,,,Other,30.01,122.4,Based on EAPG RVU's
ADD'L ART 2ND/3RD THORAC,8267111,LOCAL,36218,CPT,,,,,,Outpatient,,,970.36,631,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,42.55,929.12,Based on EAPG RVU's
CATH PLACE SEG SUBSEG PA,8267104,LOCAL,36015,CPT,,,,,,Outpatient,,,980.22,637,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,139.57,929.12,Based on EAPG RVU's
US Abdomen Complete,1169567,LOCAL,76700,CPT,,,,,,Outpatient,,,984.47,528,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,97.22,245.49,Based on EAPG RVU's
BiPAP Charge -> Initial,2678300,LOCAL,94002,CPT,,,,,,Outpatient,,,990,663,Blue Cross of AL,Blue Cross,941,,,,,,,Other,604.42,941,Based on EAPG RVU's
BiPAP/CPAP Mode -> NIMV,2678300,LOCAL,94002,CPT,,,,,,Outpatient,,,990,663,Blue Cross of AL,Blue Cross,941,,,,,,,Other,604.42,941,Based on EAPG RVU's
ECHOCARDIOGRAM 2D W/STRESS,8200440,LOCAL,93350,CPT,,,,,,Outpatient,,,990,644,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,501.29,678.38,Based on EAPG RVU's
16025 DRESS AN/OR DEBMT BURN INI MED CHARGE,8020080,LOCAL,16025,CPT,,,,,,Outpatient,,,991.5,644,Blue Cross of AL,Blue Cross,273.27,,,,,,,Other,181.66,863,Based on EAPG RVU's
CT Angio Heart/Coronary Arteries,9515210,LOCAL,75574,CPT,,,,,,Outpatient,,,992.21,532.13,Blue Cross of AL,Blue Cross,565.59,,,,,,,Other,326.51,565.59,Based on EAPG RVU's
20610 INJECT MAJOR JOINT,5661087,LOCAL,20610,CPT,,,,,,Outpatient,,,1000,650,Blue Cross of AL,Blue Cross,351.64,,,,,,,Other,269.88,863,Based on EAPG RVU's
NM Parathyroid Imaging w/ Spect Inj/Scan,2425984,LOCAL,78071,CPT,A9500,HCPCS,,,,Outpatient,,,1004.58,331.65,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,367.38,560.96,Based on EAPG RVU's
XR Arthrogram Hip SI Left,2425404,LOCAL,73525,CPT,,,,,LT,Outpatient,,,1004.84,538.73,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,326.51,Based on EAPG RVU's
XR Arthrogram Hip SI Right,2425407,LOCAL,73525,CPT,,,,,RT,Outpatient,,,1004.84,538.73,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,326.51,Based on EAPG RVU's
INTRO EXTREMITY ARTERY,8267105,LOCAL,36140,CPT,,,,,,Outpatient,,,1022.12,664,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,72.34,929.12,Based on EAPG RVU's
PERC CHANGE TUBE OR DRAINAGE CATH S&I,8210742,LOCAL,75984,CPT,,,,,,Outpatient,,,1029.19,551.93,Blue Cross of AL,Blue Cross,262.79,,,,,,,Other,49.58,262.79,Based on EAPG RVU's
XR Drainage Perc Cath Replace,9343679,LOCAL,75984,CPT,,,,,,Outpatient,,,1029.19,551.93,Blue Cross of AL,Blue Cross,262.79,,,,,,,Other,49.58,262.79,Based on EAPG RVU's
11107 INCAL BX SKN EA SEP/ADDL CHARGE,9704096,LOCAL,11107,CPT,,,,,,Outpatient,,,1030.62,670,Blue Cross of AL,Blue Cross,651.39,,,,,,,Other,23.51,863,Based on EAPG RVU's
human papillomavirus vaccine 9-valent intramuscular suspension 0.5 mL [CULL],11292048,LOCAL,90651,CPT,,,,,,Outpatient,0.5,ML,1031.6096,,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,160.4,Based on EAPG RVU's
CYSTOGRAM S&I,8211185,LOCAL,74430,CPT,,,,,,Outpatient,,,1033.41,554.4,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,326.51,Based on EAPG RVU's
XR Cystogram,4126362,LOCAL,74430,CPT,,,,,,Outpatient,,,1033.41,554.4,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,326.51,Based on EAPG RVU's
US Joint/Bursa Lw Int Arth/Asp/Inj Left,3148332,LOCAL,20606,CPT,,,,,LT,Outpatient,,,1035.43,673,Blue Cross of AL,Blue Cross,720.05,,,,,,,Other,633.14,1291,Based on EAPG RVU's
US Joint/Bursa Lw Int Arth/Asp/Inj Right,3148335,LOCAL,20606,CPT,,,,,RT,Outpatient,,,1035.43,673,Blue Cross of AL,Blue Cross,720.05,,,,,,,Other,633.14,1291,Based on EAPG RVU's
US Joint/Bursa Lw Maj Arth/Asp/Inj Left,3148338,LOCAL,20611,CPT,,,,,LT,Outpatient,,,1035.43,673,Blue Cross of AL,Blue Cross,720.05,,,,,,,Other,269.88,863,Based on EAPG RVU's
US Joint/Bursa Lw Maj Arth/Asp/Inj Right,3148341,LOCAL,20611,CPT,,,,,RT,Outpatient,,,1035.43,673,Blue Cross of AL,Blue Cross,720.05,,,,,,,Other,269.88,863,Based on EAPG RVU's
US Joint/Bursa Lw Sm Arth/Asp/Inj Left,6130396,LOCAL,20604,CPT,,,,,LT,Outpatient,,,1035.43,673,Blue Cross of AL,Blue Cross,720.05,,,,,,,Other,269.88,863,Based on EAPG RVU's
US Joint/Bursa Lw Sm Arth/Asp/Inj Right,6130399,LOCAL,20604,CPT,,,,,RT,Outpatient,,,1035.43,673,Blue Cross of AL,Blue Cross,720.05,,,,,,,Other,269.88,863,Based on EAPG RVU's
US Joint/Bursa Up Int Arth/Asp/Inj Left,2425353,LOCAL,20606,CPT,,,,,LT,Outpatient,,,1035.43,673,Blue Cross of AL,Blue Cross,720.05,,,,,,,Other,633.14,1291,Based on EAPG RVU's
US Joint/Bursa Up Int Arth/Asp/Inj Right,2425356,LOCAL,20606,CPT,,,,,RT,Outpatient,,,1035.43,673,Blue Cross of AL,Blue Cross,720.05,,,,,,,Other,633.14,1291,Based on EAPG RVU's
US Joint/Bursa Up Maj Arth/Asp/Inj Left,2425359,LOCAL,20611,CPT,,,,,LT,Outpatient,,,1035.43,673,Blue Cross of AL,Blue Cross,720.05,,,,,,,Other,269.88,863,Based on EAPG RVU's
US Joint/Bursa Up Maj Arth/Asp/Inj Right,2425362,LOCAL,20611,CPT,,,,,RT,Outpatient,,,1035.43,673,Blue Cross of AL,Blue Cross,720.05,,,,,,,Other,269.88,863,Based on EAPG RVU's
US Joint/Bursa Up Sm Arth/Asp/Inj Left,6130402,LOCAL,20604,CPT,,,,,LT,Outpatient,,,1035.43,673,Blue Cross of AL,Blue Cross,720.05,,,,,,,Other,269.88,863,Based on EAPG RVU's
US Joint/Bursa Up Sm Arth/Asp/Inj Right,6130405,LOCAL,20604,CPT,,,,,RT,Outpatient,,,1035.43,673,Blue Cross of AL,Blue Cross,720.05,,,,,,,Other,269.88,863,Based on EAPG RVU's
GASTRO-JEJUNOSTOMY TUBE REPLACEMENT,8200254,LOCAL,49452,CPT,,,,,,Outpatient,,,1040.53,676,Blue Cross of AL,Blue Cross,983.02,,,,,,,Other,857.17,1496,Based on EAPG RVU's
"Chikungunya Virus RNA, Qual RT PCR QSTC",13864475,LOCAL,87798,CPT,,,,,,Outpatient,,,1050.75,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
ARTERIAL LINE PLACEMENT,8210320,LOCAL,36620,CPT,,,,,,Outpatient,,,1052.64,684,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,38.92,929.12,Based on EAPG RVU's
NM Hepatobiliary Imaging,2425957,LOCAL,78226,CPT,,,,,,Outpatient,,,1059,567.6,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,367.38,560.96,Based on EAPG RVU's
DART FIRE EDGE SCREW,4810328,LOCAL,,,C1716,HCPCS,,,,Outpatient,,,1062.93,,Blue Cross of AL,Blue Cross,612.6,,,,,,,Other,612.6,868.33,Based on EAPG RVU's
NEPHROSTOGRAM S&I,8212039,LOCAL,74425,CPT,,,,,,Outpatient,,,1072.47,575.03,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,326.51,Based on EAPG RVU's
glucagon 1 mg injection [CULL],11282210,LOCAL,J1610,CPT,,,,,,Outpatient,1,EA,1075.2,,Blue Cross of AL,Blue Cross,233.26,,,,,,,Other,182.45,233.26,Based on EAPG RVU's
"Leptospira DNA, Qual RT PCR QSTC",13864445,LOCAL,87798,CPT,,,,,,Outpatient,,,1096.88,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
"Fungal Sequencing, ITS Region QSTC",13864438,LOCAL,87153,CPT,,,,,,Outpatient,,,1102.5,138.43,Blue Cross of AL,Blue Cross,158.39,,,,,,,Other,115.36,158.39,Based on EAPG RVU's
"Cortisol, Free, LC/MS, Serum QSTC",8972878,LOCAL,82530,CPT,,,,,,Outpatient,,,1104.43,20.05,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,29.79,Based on EAPG RVU's
"Pneumocystis jirovecii,Qual Real-Time PCR QSTC",9215420,LOCAL,87798,CPT,,,,,,Outpatient,,,1120.91,42.11,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,35.09,40.19,Based on EAPG RVU's
CATH PL 2ND ORDER VENOUS,8267187,LOCAL,36012,CPT,,,,,,Outpatient,,,1122.44,730,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,142.32,929.12,Based on EAPG RVU's
NM Gastrointestinal Blood Loss Imaging,1169242,LOCAL,78278,CPT,A9512,HCPCS,,,,Outpatient,,,1123.93,603.08,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,367.38,1409.71,Based on EAPG RVU's
"RSV vaccine, preF A-preF B, recombinant preservative-free 60 mcg-60 mcg Inj [CULL]",11200215,LOCAL,90678,CPT,,,,,,Outpatient,1,ML,1132.8,,Blue Cross of AL,Blue Cross,39.58,,,,,,,Other,39.58,39.58,Based on EAPG RVU's
Bird Fancier's Precipitin Panel I QSTC,13864443,LOCAL,86331,CPT,,,,,,Outpatient,,,1133.1,14.38,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,11.98,15.29,Based on EAPG RVU's
US Breast ABUS Bilateral.,13939856,LOCAL,76641,CPT,,,,,50,Outpatient,,,1143.26,306.9,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
XR ERCP Biliary,8649296,LOCAL,74328,CPT,,,,,,Outpatient,,,1143.36,612.98,Blue Cross of AL,Blue Cross,262.79,,,,,,,Other,121.3,262.79,Based on EAPG RVU's
XR ERCP Pancreatic,8649299,LOCAL,74329,CPT,,,,,,Outpatient,,,1143.36,612.98,Blue Cross of AL,Blue Cross,262.79,,,,,,,Other,23.05,262.79,Based on EAPG RVU's
amphotericin B liposomal 50 mg intravenous injection [CULL],11202015,LOCAL,J0289,CPT,,,,,,Outpatient,1,EA,1152.16,,Blue Cross of AL,Blue Cross,1293.51,,,,,,,Other,21.48,1293.51,Based on EAPG RVU's
GUIDED PERC DRAIN W CATH S&I,8210333,LOCAL,75989,CPT,,,,,,Outpatient,,,1153.62,618.75,Blue Cross of AL,Blue Cross,262.79,,,,,,,Other,50.75,262.79,Based on EAPG RVU's
US Pelvic Comp,8206964,LOCAL,76856,CPT,,,,,,Outpatient,,,1159.45,622.05,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,97.22,245.49,Based on EAPG RVU's
29445 APPL RIGID LEG CAST,9739196,LOCAL,29445,CPT,,,,,,Outpatient,,,1160.76,266,Blue Cross of AL,Blue Cross,275.28,,,,,,,Other,242.81,863,Based on EAPG RVU's
NM Hyperthyroid Therapy,8567789,LOCAL,79005,CPT,A9517,HCPCS,,,,Outpatient,,,1161.71,622.88,Blue Cross of AL,Blue Cross,456.65,,,,,,,Other,23.13,456.65,Based on EAPG RVU's
XR Spine Scoliosis 1 View,7520627,LOCAL,72081,CPT,,,,,,Outpatient,,,1170.74,627.83,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,80.5,83.69,Based on EAPG RVU's
XR Arthrogram Wrist SI Left,2425422,LOCAL,73115,CPT,,,,,LT,Outpatient,,,1176.56,631.13,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,326.51,Based on EAPG RVU's
XR Arthrogram Wrist SI Right,2425425,LOCAL,73115,CPT,,,,,RT,Outpatient,,,1176.56,631.13,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,326.51,Based on EAPG RVU's
E3077 Aph Plt ACDA LR,7266775,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Blue Cross of AL,Blue Cross,546.55,,,,,,,Other,487.1,546.55,Based on EAPG RVU's
E3087 Aph Plt ACDA LR 1,7266780,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Blue Cross of AL,Blue Cross,546.55,,,,,,,Other,487.1,546.55,Based on EAPG RVU's
E3088 Aph Plt ACDA LR 2,7266781,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Blue Cross of AL,Blue Cross,546.55,,,,,,,Other,487.1,546.55,Based on EAPG RVU's
E3089 Aph Plt ACDA LR 3,7266782,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Blue Cross of AL,Blue Cross,546.55,,,,,,,Other,487.1,546.55,Based on EAPG RVU's
E4643 Aph Plt ACDA LR <3E11,7266909,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Blue Cross of AL,Blue Cross,546.55,,,,,,,Other,487.1,546.55,Based on EAPG RVU's
E5030 Aph Plt ACDA LR BM,8058823,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Blue Cross of AL,Blue Cross,546.55,,,,,,,Other,487.1,546.55,Based on EAPG RVU's
E5032 Aph Plt ACDA LR BM 2,8029134,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Blue Cross of AL,Blue Cross,546.55,,,,,,,Other,487.1,546.55,Based on EAPG RVU's
E5033 Aph Plt ACDA LR BM 3,8058812,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Blue Cross of AL,Blue Cross,546.55,,,,,,,Other,487.1,546.55,Based on EAPG RVU's
E5036 Aph Plt ACDA LR Irr BM 2,8029108,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Blue Cross of AL,Blue Cross,546.55,,,,,,,Other,487.1,546.55,Based on EAPG RVU's
E5075 Aph Plt ACDA LR <3E11 BM,8058809,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Blue Cross of AL,Blue Cross,546.55,,,,,,,Other,487.1,546.55,Based on EAPG RVU's
E9232 Aph Plt ACDA LR BT6,10074919,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1182,768,Blue Cross of AL,Blue Cross,546.55,,,,,,,Other,487.1,546.55,Based on EAPG RVU's
E5031  Aph Plt ACDA LR BM 1,8029138,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,1188,768,Blue Cross of AL,Blue Cross,546.55,,,,,,,Other,487.1,546.55,Based on EAPG RVU's
64480 CERVICAL THORACIC TRANSFORAMINAL EACH AD,5661052,LOCAL,64480,CPT,,,,,,Outpatient,,,1193.14,776,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,50.22,1250.53,Based on EAPG RVU's
95824 EEG CEREBRAL DEATH EVALUATION ONLY CHARGE,9646722,LOCAL,95824,CPT,,,,,,Outpatient,,,1194.07,776,Blue Cross of AL,Blue Cross,466.96,,,,,,,Other,466.96,485.11,Based on EAPG RVU's
"RT CHARGE Ventilator Restart, Ongoing -> Yes",12109384,LOCAL,94003,CPT,,,,,,Outpatient,,,1224,613,Blue Cross of AL,Blue Cross,941,,,,,,,Other,604.42,941,Based on EAPG RVU's
"Prostaglandin D2 (Pg D2), Urine QST",12667576,LOCAL,84150,CPT,,,,,,Outpatient,,,1230,50.12,Blue Cross of AL,Blue Cross,47.35,,,,,,,Other,41.77,47.35,Based on EAPG RVU's
15274 App Skin Sub Graft (TWSA>100cm2) t/s/l ; add 100 cm 2,12642329,LOCAL,15274,CPT,,,,,,Outpatient,,,1230.36,800,Blue Cross of AL,Blue Cross,2862.92,,,,,,,Other,35.4,2862.92,Based on EAPG RVU's
15278 APPL-HC SKSB GRT F/N/H/G-KD A100 CHARGE,9709036,LOCAL,15278,CPT,,,,,,Outpatient,,,1230.36,800,Blue Cross of AL,Blue Cross,2862.92,,,,,,,Other,44.7,2862.92,Based on EAPG RVU's
11106 INCAL BX SKN SINGLE LES CHARGE,9704095,LOCAL,11106,CPT,,,,,,Outpatient,,,1230.62,800,Blue Cross of AL,Blue Cross,651.39,,,,,,,Other,559.65,1291,Based on EAPG RVU's
"Aquaporin-4 (AQP4) (NMO-IgG) Antibody with Reflex to Titer, Serum QSTC",10041610,LOCAL,86052,CPT,,,,,,Outpatient,,,1237.5,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.05,15.29,Based on EAPG RVU's
"JC Polyoma Virus DNA, Qnt PCR, Serum QSTC",10274092,LOCAL,87799,CPT,,,,,,Outpatient,,,1237.5,51.41,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,42.84,Based on EAPG RVU's
"NMO Spectrum Eval (AQP4 w/Rflx toMOG), Serum QSTC",10274088,LOCAL,86052,CPT,,,,,,Outpatient,,,1237.5,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.05,15.29,Based on EAPG RVU's
"64520 Injection Lumbar or Thoracic, Paravertebral Sympathetic",5661043,LOCAL,64520,CPT,,,,,,Outpatient,,,1239.7,806,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,813.96,1291,Based on EAPG RVU's
96413 CHEMO IV INFUSION 1ST HR INF CHARGE,9665725,LOCAL,96413,CPT,,,,,,Outpatient,,,1244.66,809,Blue Cross of AL,Blue Cross,442.94,,,,,,,Other,303.25,442.94,Based on EAPG RVU's
REF Genetic RBC Phenotyping,13481257,LOCAL,81403,CPT,,,,,,Outpatient,,,1246.5,222.24,Blue Cross of AL,Blue Cross,173.68,,,,,,,Other,173.68,185.2,Based on EAPG RVU's
NM Liver/Spleen Imaging Injection/Scan,1169286,LOCAL,78215,CPT,A9541,HCPCS,,,,Outpatient,,,1248.36,669.08,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,367.38,1409.71,Based on EAPG RVU's
"CBFB/MYH11 inv(16), Quant RT PCR QSTC",13864502,LOCAL,81401,CPT,,,,,,Outpatient,,,1260,164.4,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,63.34,137,Based on EAPG RVU's
REF PLT Crossmatch,13481259,LOCAL,86022,CPT,,,,,,Outpatient,,,1269,22.04,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,18.37,Based on EAPG RVU's
epoetin alfa 20000 units/mL Sol 1 mL [CULL],11202388,LOCAL,J0885,CPT,,,,,,Outpatient,1,ML,1273.344,,Blue Cross of AL,Blue Cross,233.26,,,,,,,Other,7.85,525.49,Based on EAPG RVU's
Admark Phospho Tau/Ttl Ab42 Comments QST,13877904,LOCAL,83520,CPT,,,,,,Outpatient,,,1277.25,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,117.3767568,Based on EAPG RVU's
Admark Phospho Tau/Ttl Ab42 Interp QST,13877902,LOCAL,83520,CPT,,,,,,Outpatient,,,1277.25,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,117.3767568,Based on EAPG RVU's
Admark Phospho Tau/Ttl Ab42 Methods QST,13877905,LOCAL,83520,CPT,,,,,,Outpatient,,,1277.25,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,117.3767568,Based on EAPG RVU's
62320 Cervical/Thoracic Epidural without Fluor,5661014,LOCAL,62320,CPT,,,,,,Outpatient,,,1284.42,835,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,633.14,1291,Based on EAPG RVU's
11042 DEB SQ TISSUE-1ST 20SQCM/< CHARGE,9704056,LOCAL,11042,CPT,,,,,,Outpatient,,,1286.64,836,Blue Cross of AL,Blue Cross,549.61,,,,,,,Other,365.27,863,Based on EAPG RVU's
11043 DEB MUS/FASCIA-1ST 20SQCM/< CHARGE,9704059,LOCAL,11043,CPT,,,,,,Outpatient,,,1286.64,836,Blue Cross of AL,Blue Cross,549.61,,,,,,,Other,549.61,863,Based on EAPG RVU's
11045 Debrid bone 1st 20 sq cm charge,12510099,LOCAL,11045,CPT,,,,,,Outpatient,,,1286.64,836,Blue Cross of AL,Blue Cross,1466.58,,,,,,,Other,20.61,1466.58,Based on EAPG RVU's
11045 Debrid Sub Tissue > 20 sq cm charge,12511974,LOCAL,11045,CPT,,,,,,Outpatient,,,1286.64,836,Blue Cross of AL,Blue Cross,1466.58,,,,,,,Other,20.61,1466.58,Based on EAPG RVU's
11046 DEB MUS/FASCIA-EA ADDL 20SQCM CHARGE,9704068,LOCAL,11046,CPT,,,,,,Outpatient,,,1286.64,836,Blue Cross of AL,Blue Cross,1466.58,,,,,,,Other,44.01,1466.58,Based on EAPG RVU's
XR Urethrocystography Retrograde,1170578,LOCAL,74450,CPT,,,,,,Outpatient,,,1300.84,697.95,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,220.99,Based on EAPG RVU's
MTB Complex Rifampin Resist PCR Sput QSTC,8873578,LOCAL,87801,CPT,,,,,,Outpatient,,,1316.25,84.24,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,70.2,Based on EAPG RVU's
US OB Greater Than 14 Weeks Single,8583651,LOCAL,76805,CPT,,,,,,Outpatient,,,1319.46,130.35,Blue Cross of AL,Blue Cross,148.61,,,,,,,Other,97.22,148.61,Based on EAPG RVU's
NM Parathyroid Imaging Injection/Scan,1169316,LOCAL,78070,CPT,A9500,HCPCS,,,,Outpatient,,,1324.92,710.33,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,367.38,1409.71,Based on EAPG RVU's
NM Bone Marrow Imaging Whole Body,1169186,LOCAL,78104,CPT,A9541,HCPCS,,,,Outpatient,,,1327.01,711.98,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,367.38,560.96,Based on EAPG RVU's
16030 DRESS AN/OR DEBMT BURN INI LG CHARGE,8020081,LOCAL,16030,CPT,,,,,,Outpatient,,,1328,863,Blue Cross of AL,Blue Cross,549.61,,,,,,,Other,365.27,863,Based on EAPG RVU's
93660 STRESS TILT TABLE CHARGE,8200435,LOCAL,93660,CPT,,,,,,Outpatient,,,1338.01,870,Blue Cross of AL,Blue Cross,244.97,,,,,,,Other,244.97,863,Based on EAPG RVU's
JEJUNOSTOMY PERC,8200251,LOCAL,49441,CPT,,,,,,Outpatient,,,1339,870,Blue Cross of AL,Blue Cross,983.02,,,,,,,Other,983.02,1734.34,Based on EAPG RVU's
Bacterial 16S rDNA Sequencing QSTC,8873571,LOCAL,87153,CPT,,,,,,Outpatient,,,1344.6,138.43,Blue Cross of AL,Blue Cross,158.39,,,,,,,Other,115.36,158.39,Based on EAPG RVU's
64620 DESTR INTERCOSTAL NERVE,5661066,LOCAL,64620,CPT,,,,,,Outpatient,,,1345.12,874,Blue Cross of AL,Blue Cross,1695.82,,,,,,,Other,813.96,1695.82,Based on EAPG RVU's
64634 DESTR FACET CRV/THR EA ADL LVL,5661058,LOCAL,64634,CPT,,,,,,Outpatient,,,1345.12,874,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,54.71,1250.53,Based on EAPG RVU's
15002 SITE PREP -100 SQCM(TAL),12625535,LOCAL,15002,CPT,,,,,,Outpatient,,,1348.68,877,Blue Cross of AL,Blue Cross,1466.58,,,,,,,Other,1466.58,1672.39,Based on EAPG RVU's
64405 OCCIPITAL - BILATERAL CHARGE,5661078,LOCAL,64405,CPT,,,,,,Outpatient,,,1352.9,879,Blue Cross of AL,Blue Cross,636.45,,,,,,,Other,269.88,863,Based on EAPG RVU's
conjugated estrogens 25 mg injection [CULL],11201516,LOCAL,J1410,CPT,,,,,,Outpatient,1,EA,1372.1472,,Blue Cross of AL,Blue Cross,233.26,,,,,,,Other,233.26,392.06,Based on EAPG RVU's
10120 Incision & removal of Foreign Body Simple,9620024,LOCAL,10120,CPT,,,,,,Outpatient,,,1373.45,893,Blue Cross of AL,Blue Cross,239.03,,,,,,,Other,239.03,863,Based on EAPG RVU's
62321 CERVICAL THORACIC EPIDURAL,5661016,LOCAL,62321,CPT,,,,,,Outpatient,,,1375.34,894,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,633.14,1291,Based on EAPG RVU's
64520 LUMBAR OR THORACIC Sympathetic Charge,5661033,LOCAL,64520,CPT,,,,,,Outpatient,,,1375.34,806,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,813.96,1291,Based on EAPG RVU's
64490 INJ PARAVER CERV/THOR 1ST LEVEL,5661063,LOCAL,64490,CPT,,,,,,Outpatient,,,1376.78,895,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,813.96,1291,Based on EAPG RVU's
INTRO CATH AORTA,8267107,LOCAL,36200,CPT,,,,,,Outpatient,,,1379.82,897,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,112.42,929.12,Based on EAPG RVU's
tbo-filgrastim 480 mcg/0.8 mL subcutaneous solution 0.8 mL [CULL],11202451,LOCAL,J1447,CPT,,,,,,Outpatient,0.8,ML,1395.9776,,Blue Cross of AL,Blue Cross,525.49,,,,,,,Other,0.28,525.49,Based on EAPG RVU's
64479 CERVICAL THORACIC TRANSFORAMINAL EPIDRL,5661051,LOCAL,64479,CPT,,,,,,Outpatient,,,1397.93,909,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,813.96,1291,Based on EAPG RVU's
62323 LUMBAR OR CAUDAL EPIDURAL,5661015,LOCAL,62323,CPT,,,,,,Outpatient,,,1408.03,915,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,633.14,1291,Based on EAPG RVU's
PERC ASPIRATION DISC,8230054,LOCAL,62267,CPT,,,,,,Outpatient,,,1409.73,916,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,643.26,1291,Based on EAPG RVU's
64510 NERV BLK STELLATE GANGLION,5661032,LOCAL,64510,CPT,,,,,,Outpatient,,,1418.86,922,Blue Cross of AL,Blue Cross,1695.82,,,,,,,Other,813.96,1695.82,Based on EAPG RVU's
"64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when per",9520503,LOCAL,64624,CPT,,,,,,Outpatient,,,1425,926,Blue Cross of AL,Blue Cross,1695.82,,,,,,,Other,1695.82,2315,Based on EAPG RVU's
64640 DESTR OTH PERIPHERAL NERVE/BRCH,5661065,LOCAL,64640,CPT,,,,,,Outpatient,,,1425.83,927,Blue Cross of AL,Blue Cross,1695.82,,,,,,,Other,813.96,1695.82,Based on EAPG RVU's
62290 INJ DISKOGRAPH LUMBAR EA LVL,5661062,LOCAL,62290,CPT,,,,,,Outpatient,,,1432.9,931,Blue Cross of AL,Blue Cross,442.76,,,,,,,Other,134.34,863,Based on EAPG RVU's
11400 EXC BENIGN LES-T/A/L 0.5CM OR < CHARGE FACILITY,9704107,LOCAL,11400,CPT,,,,,,Outpatient,,,1438,935,Blue Cross of AL,Blue Cross,651.39,,,,,,,Other,643.26,1291,Based on EAPG RVU's
PLACE ART 2ND ABD & BELOW,8267113,LOCAL,36246,CPT,,,,,,Outpatient,,,1441.95,937,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,203.35,929.12,Based on EAPG RVU's
NM Kidney Imaging Single w/ Pharm,1169262,LOCAL,78708,CPT,A9562,HCPCS,,,,Outpatient,,,1446.62,775.5,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,492.12,560.96,Based on EAPG RVU's
"92950 Cardiopulmonary resuscitation (eg, in cardiac arrest)",7968980,LOCAL,92950,CPT,,,,,,Outpatient,,,1448.28,941,Blue Cross of AL,Blue Cross,1328.28,,,,,,,Other,284.7,1328.28,Based on EAPG RVU's
92950 Cardiopulmonary Resuscitation Cath Lab,8212013,LOCAL,92950,CPT,,,,,,Outpatient,,,1448.28,941,Blue Cross of AL,Blue Cross,1328.28,,,,,,,Other,284.7,1328.28,Based on EAPG RVU's
92950 CARDIOPULMONARY RESUSCITATION CHARGE,8207219,LOCAL,92950,CPT,,,,,,Outpatient,,,1448.28,941,Blue Cross of AL,Blue Cross,1328.28,,,,,,,Other,284.7,1328.28,Based on EAPG RVU's
RT CHARGE Ventilator Initiate -> Yes,12109383,LOCAL,94002,CPT,,,,,,Outpatient,,,1453.5,663,Blue Cross of AL,Blue Cross,941,,,,,,,Other,604.42,941,Based on EAPG RVU's
NM Inflammation Loc Limited,1226092,LOCAL,78800,CPT,,,,,,Outpatient,,,1461.78,783.75,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,367.38,1409.71,Based on EAPG RVU's
NM Inflammation Loc Limited - Ceretec,1169144,LOCAL,78800,CPT,A9521,HCPCS,,,,Outpatient,,,1461.78,783.75,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,802.34,1409.71,Based on EAPG RVU's
REF Extended Rh Genotyping,13475612,LOCAL,81479,CPT,,,302,RC,,Outpatient,,,1467,,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,63.34,63.34,Based on EAPG RVU's
11402 EXC BENIGN LES-T/A/L 1.1-2.0 CM CHARGE,9704151,LOCAL,11402,CPT,,,,,,Outpatient,,,1481.17,963,Blue Cross of AL,Blue Cross,651.39,,,,,,,Other,643.26,1291,Based on EAPG RVU's
62273 BLOOD PATCH,5661017,LOCAL,62273,CPT,,,,,,Outpatient,,,1494.18,971,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,633.14,1291,Based on EAPG RVU's
"13131-Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1",14749500,LOCAL,13131,CPT,,,,,,Outpatient,,,1505,400,Blue Cross of AL,Blue Cross,651.39,,,,,,,Other,365.27,863,Based on EAPG RVU's
REF ABO Genotyping,13481258,LOCAL,81479,CPT,,,302,RC,,Outpatient,,,1512,,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,63.34,63.34,Based on EAPG RVU's
MRI Fingers w/ Contrast Left,9343664,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Fingers w/ Contrast Right,9343667,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Forearm w/ Contrast Left,8206725,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Forearm w/ Contrast Right,8206727,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Hand w/ Contrast Left,1168924,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Hand w/ Contrast Right,1168926,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Humerus w/ Contrast Left,8206756,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Humerus w/ Contrast Right,8206758,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Scapula w/ Contrast Left,12912778,LOCAL,73219,CPT,,,,,LT,Outpatient,,,1516.46,813.45,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Scapula w/ Contrast Right,12912781,LOCAL,73219,CPT,,,,,RT,Outpatient,,,1516.46,813.45,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
immune globulin (Octagam) 10% intravenous solution 5 g [CULL],11205113,LOCAL,J1599,CPT,,,,,,Outpatient,50,ML,1523.2,,Blue Cross of AL,Blue Cross,1641.22,,,,,,,Other,1641.22,1641.22,Based on EAPG RVU's
NM Intestine Imaging Meckels,1169254,LOCAL,78290,CPT,A9512,HCPCS,,,,Outpatient,,,1535.86,823.35,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,367.38,560.96,Based on EAPG RVU's
eptifibatide 2 mg/mL intravenous solution 100 mL [CULL],11201709,LOCAL,J1327,CPT,,,,,,Outpatient,100,ML,1536,,Blue Cross of AL,Blue Cross,91.38,,,,,,,Other,91.38,91.38,Based on EAPG RVU's
XR Spine Scoliosis 2-3 Views,7520630,LOCAL,72082,CPT,,,,,,Outpatient,,,1542.91,827.48,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
XR ERCP Biliary and Pancreatic,8207021,LOCAL,74330,CPT,,,,,,Outpatient,,,1543.36,827.48,Blue Cross of AL,Blue Cross,262.79,,,,,,,Other,151.62,262.79,Based on EAPG RVU's
XR IVP,1170251,LOCAL,74400,CPT,,,,,,Outpatient,,,1550,831.6,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,162.76,176.48,Based on EAPG RVU's
64493 - INJ PARAVERT F JNT L/S 1 LEV,5661035,LOCAL,64493,CPT,,,,,,Outpatient,,,1563.68,1016,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,813.96,1291,Based on EAPG RVU's
G0260 INJ SACRO JNT ARTHR ANEST/STER,8132863,LOCAL,G0260,CPT,,,,,,Outpatient,,,1564.95,1017,Blue Cross of AL,Blue Cross,720.05,,,,,,,Other,633.14,1291,Based on EAPG RVU's
NM Bone Imaging Limited Injection,1169176,LOCAL,78300,CPT,,,,,,Outpatient,,,1566.92,839.85,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,367.38,560.96,Based on EAPG RVU's
"62272 SPINAL PUNC, THERAP",5661019,LOCAL,62272,CPT,,,,,,Outpatient,,,1587.32,693,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,633.14,1291,Based on EAPG RVU's
64425 NERV BLK ILIOINGUINAL,5661024,LOCAL,64425,CPT,,,,,,Outpatient,,,1587.32,1032,Blue Cross of AL,Blue Cross,636.45,,,,,,,Other,633.14,1291,Based on EAPG RVU's
64483 TRANS INJ LUMB/SACR-UNILATERAL CHARGE,5661053,LOCAL,64483,CPT,,,,,,Outpatient,,,1587.72,1812,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,813.96,1291,Based on EAPG RVU's
64484 TRANS INJ LUMB/SACR EA ADD UIL CHARGE,5661054,LOCAL,64484,CPT,,,,,,Outpatient,,,1587.72,1812,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,41.55,1250.53,Based on EAPG RVU's
ECHO COMPLETE W/ DOPPLER,8200137,LOCAL,93306,CPT,,,,,,Outpatient,,,1593.2,1036,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,501.29,678.38,Based on EAPG RVU's
ECHOCARDIOGRAM 2D COMPLETE,8200140,LOCAL,93307,CPT,,,,,,Outpatient,,,1593.2,1036,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,220.99,678.38,Based on EAPG RVU's
US Echo Doppler Complete,7936277,LOCAL,93306,CPT,,,,,,Outpatient,,,1593.2,1036,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,501.29,678.38,Based on EAPG RVU's
XR Spine Scoliosis 4-5 Views,7520624,LOCAL,72083,CPT,,,,,,Outpatient,,,1597.41,856.35,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
phentolamine 5 mg injection [CULL],11211090,LOCAL,J2760,CPT,,,,,,Outpatient,1,EA,1605.12,,Blue Cross of AL,Blue Cross,122.4,,,,,,,Other,122.4,432.02,Based on EAPG RVU's
64636 DESTR FACET LUM/SAC EA ADL LVL,5661056,LOCAL,64636,CPT,,,,,,Outpatient,,,1614.14,1049,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,48.01,1250.53,Based on EAPG RVU's
"12020 SIMP CLOSURE, SUPERF WOUND CHARGE",9303466,LOCAL,12020,CPT,,,,,,Outpatient,,,1615.12,1050,Blue Cross of AL,Blue Cross,549.61,,,,,,,Other,549.61,863,Based on EAPG RVU's
"rabies vaccine, human diploid cell 2.5 intl units intramuscular injection [CULL]",11212261,LOCAL,90675,CPT,,,,,,Outpatient,1,EA,1633.664,328,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,313.68,Based on EAPG RVU's
BAL Fluid Count with Differential,12449847,LOCAL,0202U,CPT,,,,,,Outpatient,,,1642.5,500.14,Blue Cross of AL,Blue Cross,173.68,,,,,,,Other,173.68,443.38,Based on EAPG RVU's
XR Spine Scoliosis 6+ Views,7520633,LOCAL,72084,CPT,,,,,,Outpatient,,,1651.91,886.05,Blue Cross of AL,Blue Cross,83.69,,,,,,,Other,83.69,97.22,Based on EAPG RVU's
NM Non-Cardiac Vascular Flow Imaging,1169314,LOCAL,78445,CPT,,,,,,Outpatient,,,1652.88,886.05,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,367.38,560.96,Based on EAPG RVU's
63650 IMPLANT NEURSTIM ELEC EPIDURAL,10283945,LOCAL,63650,CPT,,,,,,Outpatient,,,1660,6563,Blue Cross of AL,Blue Cross,8672.71,,,,,,,Other,5787,8672.71,Based on EAPG RVU's
63650 IMPLANT NEURSTIM ELEC EPIDURAL,8132877,LOCAL,63650,CPT,,,,,,Outpatient,,,1660,6563,Blue Cross of AL,Blue Cross,8672.71,,,,,,,Other,5787,8672.71,Based on EAPG RVU's
63650-IMPLANT NEURSTIM ELEC EPIDURAL,8132877,LOCAL,63650,CPT,,,,,,Outpatient,,,1660,6563,Blue Cross of AL,Blue Cross,8672.71,,,,,,,Other,5787,8672.71,Based on EAPG RVU's
"rabies vaccine, human diploid cell 2.5 intl units Pow [CULL]",11212261,LOCAL,90675,CPT,,,,,,Outpatient,1,EA,1665.824,328,Blue Cross of AL,Blue Cross,160.4,,,,,,,Other,160.4,313.68,Based on EAPG RVU's
XR Nephrostogram,8115644,LOCAL,50430,CPT,,,,,,Outpatient,,,1670,1389,Blue Cross of AL,Blue Cross,555.55,,,,,,,Other,555.55,1291,Based on EAPG RVU's
XR Nephrostogram Existing Access,10454588,LOCAL,50431,CPT,,,,,,Outpatient,,,1670,1389,Blue Cross of AL,Blue Cross,555.55,,,,,,,Other,555.55,1291,Based on EAPG RVU's
36568 INTRO CATH VENA CAVA PICC CHARGE,13709100,LOCAL,36568,CPT,,,,,,Outpatient,,,1678,1091,Blue Cross of AL,Blue Cross,1644.1,,,,,,,Other,1291,1644.1,Based on EAPG RVU's
REPOSITION CVL UNDER FLUORO,8210300,LOCAL,36597,CPT,,,,,,Outpatient,,,1678,1091,Blue Cross of AL,Blue Cross,1068.64,,,,,,,Other,1068.64,1420.25,Based on EAPG RVU's
omadacycline 100 mg injection [CULL],11290183,LOCAL,J0121,CPT,,,,,,Outpatient,1,EA,1678.2144,,Blue Cross of AL,Blue Cross,2110.36,,,,,,,Other,4.02,2110.36,Based on EAPG RVU's
15271 APP SKN SUB GRFT T/A/L 100 SQ CM FAC CHARGE,12831012,LOCAL,15271,CPT,,,,,,Outpatient,,,1680.09,1092,Blue Cross of AL,Blue Cross,2862.92,,,,,,,Other,1496,2862.92,Based on EAPG RVU's
"15275 App Skin Sub Graft (TWSA<100cm2) f/a/h-ft/aig; 1""25 sp cm",12641291,LOCAL,15275,CPT,,,,,,Outpatient,,,1680.09,1092,Blue Cross of AL,Blue Cross,2862.92,,,,,,,Other,1496,2862.92,Based on EAPG RVU's
"Zika Virus RNA, Qual TMA QSTC",13864496,LOCAL,87662,CPT,,,,,,Outpatient,,,1687.5,61.57,Blue Cross of AL,Blue Cross,40.19,,,,,,,Other,40.19,51.31,Based on EAPG RVU's
CATH LAB STRESS ECHO,8200161,LOCAL,93351,CPT,,,,,,Outpatient,,,1697.74,1104,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,501.29,678.38,Based on EAPG RVU's
US Stress Echo,7936322,LOCAL,93351,CPT,,,,,,Outpatient,,,1697.74,1104,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,501.29,678.38,Based on EAPG RVU's
64581 Incision for implantation of neurostimulator electrode array; sacral nerve,8603595,LOCAL,64581,CPT,,,,,,Outpatient,,,1704,1108,Blue Cross of AL,Blue Cross,8672.71,,,,,,,Other,6000.2,8672.71,Based on EAPG RVU's
CASPR2 Ab QSTC,13864490,LOCAL,86255,CPT,,,,,,Outpatient,,,1704.38,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.05,15.29,Based on EAPG RVU's
"KIT D816, Mutation Analysis  QSTC",13864489,LOCAL,81273,CPT,,,,,,Outpatient,,,1721.25,149.84,Blue Cross of AL,Blue Cross,63.34,,,,,,,Other,63.34,124.87,Based on EAPG RVU's
Ganglioside Ab Panel 6 QSTC,13864481,LOCAL,83520,CPT,,,,,,Outpatient,,,1734.26,20.72,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,117.3767568,Based on EAPG RVU's
64418 - suprascapular nerve block,10452404,LOCAL,64418,CPT,,,,,,Outpatient,,,1735,693,Blue Cross of AL,Blue Cross,636.45,,,,,,,Other,633.14,1291,Based on EAPG RVU's
64420 NERV BLK INTERCSTL NERV SNGL,5661025,LOCAL,64420,CPT,,,,,,Outpatient,,,1735,693,Blue Cross of AL,Blue Cross,636.45,,,,,,,Other,633.14,1291,Based on EAPG RVU's
64454 Genicular block,13776911,LOCAL,64454,CPT,,,,,,Outpatient,,,1735,244,Blue Cross of AL,Blue Cross,636.45,,,,,,,Other,633.14,1291,Based on EAPG RVU's
64461 THORACIC PARAVERTEBRAL BLOCK,13786726,LOCAL,64461,CPT,,,,,,Outpatient,,,1735,50,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,633.14,1291,Based on EAPG RVU's
Injection Blood Patch Epidural,7633812,LOCAL,62273,CPT,,,,,,Outpatient,,,1735,971,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,633.14,1291,Based on EAPG RVU's
LGI1 Ab QSTC,13864491,LOCAL,86255,CPT,,,,,,Outpatient,,,1738.13,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.05,15.29,Based on EAPG RVU's
PULM ANGIO DURING CORONARIES,8230012,LOCAL,93568,CPT,,,,,,Outpatient,,,1744,1134,Blue Cross of AL,Blue Cross,442.76,,,,,,,Other,37.1,863,Based on EAPG RVU's
92960 ELEC CARDIOVERSION/DEFIBRILATION OP Tech Fee,7969852,LOCAL,92960,CPT,,,,,,Outpatient,,,1759.91,1144,Blue Cross of AL,Blue Cross,944.49,,,,,,,Other,598.27,1291,Based on EAPG RVU's
Perc Cor Stent-Drug Eluding LD,4221012,LOCAL,92960,CPT,,,,,,Outpatient,,,1759.91,1144,Blue Cross of AL,Blue Cross,944.49,,,,,,,Other,598.27,1291,Based on EAPG RVU's
10030 FLUID DRAIN SOFT TIS PERC GUID,8266849,LOCAL,10030,CPT,,,,,,Outpatient,,,1760,704,Blue Cross of AL,Blue Cross,1605.05,,,,,,,Other,643.26,1605.05,Based on EAPG RVU's
NM Thyroid Uptake Single/Multi,2426011,LOCAL,78014,CPT,,,,,,Outpatient,,,1775.09,952.05,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,367.38,560.96,Based on EAPG RVU's
NM Thyroid w/ Uptake Single,12109219,LOCAL,78014,CPT,A9516,HCPCS,,,,Outpatient,,,1775.09,952.05,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,482.3325,560.96,Based on EAPG RVU's
MG Surgical Specimen,9437784,LOCAL,76098,CPT,,,,,,Outpatient,,,1778.77,953.7,Blue Cross of AL,Blue Cross,176.48,,,,,,,Other,176.48,501.29,Based on EAPG RVU's
GASTROSTOMY TUBE REPLACEMENT,8200253,LOCAL,49450,CPT,,,,,,Outpatient,,,1793.73,1166,Blue Cross of AL,Blue Cross,983.02,,,,,,,Other,857.17,1496,Based on EAPG RVU's
JEJUNOSTOMY REPLACEMENT PERC,8200252,LOCAL,49451,CPT,,,,,,Outpatient,,,1793.73,1166,Blue Cross of AL,Blue Cross,983.02,,,,,,,Other,857.17,1496,Based on EAPG RVU's
"13132 -Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet;",14751269,LOCAL,13132,CPT,,,,,,Outpatient,,,1830,612,Blue Cross of AL,Blue Cross,651.39,,,,,,,Other,559.65,863,Based on EAPG RVU's
NM Myocardial Planar Single Study,2425978,LOCAL,78481,CPT,A9500,HCPCS,,,,Outpatient,,,1832.02,982.58,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,492.12,560.96,Based on EAPG RVU's
MRI Breast w/o Contrast Left.,9386272,LOCAL,77046,CPT,,,,,LT,Outpatient,,,1833.89,983.4,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Breast w/o Contrast Right.,9386275,LOCAL,77046,CPT,,,,,RT,Outpatient,,,1833.89,983.4,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
CULL US OB Greater Than 14 Wks Add'l Gest,13579115,LOCAL,76810,CPT,,,,,,Outpatient,,,1847.31,990.83,Blue Cross of AL,Blue Cross,148.61,,,,,,,Other,36.14,148.61,Based on EAPG RVU's
US OB Greater Than 14 Weeks Multi,8108499,LOCAL,76810,CPT,,,,,,Outpatient,,,1847.31,990.83,Blue Cross of AL,Blue Cross,148.61,,,,,,,Other,36.14,148.61,Based on EAPG RVU's
NM Tumor Loc Limited,1169410,LOCAL,78800,CPT,,,,,,Outpatient,,,1850.54,783.75,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,367.38,1409.71,Based on EAPG RVU's
NM Tumor Loc Multiple Areas,1169412,LOCAL,78801,CPT,,,,,,Outpatient,,,1850.54,2895.75,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,367.38,1409.71,Based on EAPG RVU's
PARACENTESIS ABDOMINAL WITH IMAGING,8267134,LOCAL,49083,CPT,,,,,,Outpatient,,,1857.81,1208,Blue Cross of AL,Blue Cross,1080.43,,,,,,,Other,857.17,1496,Based on EAPG RVU's
NM Cardiac MUGA,1169208,LOCAL,78472,CPT,A9512,HCPCS,,,,Outpatient,,,1861.6,998.25,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,560.96,1118.045,Based on EAPG RVU's
Meningitis Panel (BioFire),7909558,LOCAL,87483,CPT,,,,,,Outpatient,,,1875.71,500.14,Blue Cross of AL,Blue Cross,158.39,,,,,,,Other,158.39,416.78,Based on EAPG RVU's
PLACE ART 1ST ABD & BELOW,8267112,LOCAL,36245,CPT,,,,,,Outpatient,,,1882.73,1224,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,191.24,929.12,Based on EAPG RVU's
PLACE ART 1ST THORAC/BRAC,8267108,LOCAL,36215,CPT,,,,,,Outpatient,,,1917.07,1246,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,175.13,929.12,Based on EAPG RVU's
PLACE ART 2ND THORAC/BRAC,8267109,LOCAL,36216,CPT,,,,,,Outpatient,,,1917.07,1246,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,222.85,929.12,Based on EAPG RVU's
PLACE ART 3RD THORAC/BRAC,8267110,LOCAL,36217,CPT,,,,,,Outpatient,,,1917.07,1246,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,273.71,929.12,Based on EAPG RVU's
NM Lung Vent/Perf Imaging,2425966,LOCAL,78582,CPT,A9540,HCPCS,,,,Outpatient,,,1919.6,1029.6,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,492.12,1409.71,Based on EAPG RVU's
PLACE ART 3RD ABD & BELOW,8267114,LOCAL,36247,CPT,,,,,,Outpatient,,,1927.08,1253,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,240.87,929.12,Based on EAPG RVU's
NM Lymphoscintigraphy Injection/Scan,1169292,LOCAL,78195,CPT,,,,,,Outpatient,,,1928.84,1034.55,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,492.12,1409.71,Based on EAPG RVU's
Alpha-Globin Gene Deletion/Dupl. QSTC,13864435,LOCAL,81269,CPT,,,,,,Outpatient,,,1940.63,242.88,Blue Cross of AL,Blue Cross,173.68,,,,,,,Other,173.68,202.4,Based on EAPG RVU's
NM Kidney Imaging Single w/o Pharm,1169264,LOCAL,78707,CPT,A9562,HCPCS,,,,Outpatient,,,1959.43,1051.05,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,492.12,560.96,Based on EAPG RVU's
REF HLA Antibody ID,13479161,LOCAL,86830,CPT,,,,,,Outpatient,,,1962,114.62,Blue Cross of AL,Blue Cross,38.27,,,,,,,Other,38.27,95.52,Based on EAPG RVU's
PERICARDIOCENTESIS INITIAL,8230050,LOCAL,33016,CPT,,,,,,Outpatient,,,1966.67,1278,Blue Cross of AL,Blue Cross,1392.67,,,,,,,Other,1291,1420.25,Based on EAPG RVU's
REMOVAL BILIARY DRAIN CATH,8200538,LOCAL,47537,CPT,,,,,,Outpatient,,,1966.67,1278,Blue Cross of AL,Blue Cross,291.97,,,,,,,Other,291.97,1496,Based on EAPG RVU's
"Apolipoprotein E Isoform, CSF QST",12677744,LOCAL,82542,CPT,,,,,,Outpatient,,,1975.5,28.91,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,24.09,Based on EAPG RVU's
CULL Selective Add'l Vessel S&I,13635231,LOCAL,75774,CPT,,,,,,Outpatient,,,1975.99,1059.3,Blue Cross of AL,Blue Cross,6018.68,,,,,,,Other,44.32,6018.68,Based on EAPG RVU's
SELECTIVE ADD'L VESSEL S&I,8210640,LOCAL,75774,CPT,,,,,,Outpatient,,,1975.99,1059.3,Blue Cross of AL,Blue Cross,6018.68,,,,,,,Other,44.32,6018.68,Based on EAPG RVU's
CATH PLACE LT RT PA,8267103,LOCAL,36014,CPT,,,,,,Outpatient,,,1986.67,1291,Blue Cross of AL,Blue Cross,929.12,,,,,,,Other,121.59,929.12,Based on EAPG RVU's
remdesivir 100 mg Injection [CULL],11201128,LOCAL,J0248,CPT,,,,,,Outpatient,1,EA,1996.8,,Blue Cross of AL,Blue Cross,771.25,,,,,,,Other,6.73,771.25,Based on EAPG RVU's
ECHO LIMITED WITH CONTRAST,8200178,LOCAL,,,C8924,HCPCS,,,,Outpatient,,,2022.58,1315,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,326.51,678.38,Based on EAPG RVU's
US Echo 2D Limited w/ Contrast,7936274,LOCAL,93308,CPT,C8924,HCPCS,,,,Outpatient,,,2022.58,564,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,326.51,678.38,Based on EAPG RVU's
".MOG Ab, CBA, Serum QSTC",10274091,LOCAL,86362,CPT,,,,,,Outpatient,,,2025,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.05,15.29,Based on EAPG RVU's
"Myelin Oligodendrocyte Glycoprotein w/Rfx Titer, Serum QSTC",12613098,LOCAL,86362,CPT,,,,,,Outpatient,,,2025,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.05,15.29,Based on EAPG RVU's
36589 - Removal of tunneled central venous catheter,12431092,LOCAL,36589,CPT,,,,,,Outpatient,,,2025.12,1316,Blue Cross of AL,Blue Cross,1068.64,,,,,,,Other,565.25,1291,Based on EAPG RVU's
37253 Invasc US Each Addl Vessel,8230057,LOCAL,37253,CPT,,,,,,Outpatient,,,2035,1323,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,57.61,2669.67,Based on EAPG RVU's
"64449 N BLOCK INJ, LUMBAR PLEXUS",8882246,LOCAL,64449,CPT,,,,,,Outpatient,,,2035,890,Blue Cross of AL,Blue Cross,1695.82,,,,,,,Other,813.96,1695.82,Based on EAPG RVU's
"CRMP5/CV2 Ab, LB QSTC",13873513,LOCAL,84182,CPT,,,,,,Outpatient,,,2036.25,35.05,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,29.21,Based on EAPG RVU's
"GAD65 Ab, LB QSTC",13873519,LOCAL,86341,CPT,,,,,,Outpatient,,,2036.25,28.28,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,23.57,Based on EAPG RVU's
tocilizumab 20 mg/mL Sol 4 mL [CULL],11260558,LOCAL,J3262,CPT,,,,,,Outpatient,4,ML,2039.6544,,Blue Cross of AL,Blue Cross,1641.22,,,,,,,Other,5.71,1641.22,Based on EAPG RVU's
92953 TRANSCUTANEOUS PACING TechFee,8057710,LOCAL,92953,CPT,,,,,,Outpatient,,,2060.2,1339,Blue Cross of AL,Blue Cross,944.49,,,,,,,Other,598.27,1291,Based on EAPG RVU's
92953-Temp transcutaneous pacing Charge,8212036,LOCAL,92953,CPT,,,,,,Outpatient,,,2060.2,1339,Blue Cross of AL,Blue Cross,944.49,,,,,,,Other,598.27,1291,Based on EAPG RVU's
EXTERNAL PACER,4221033,LOCAL,92953,CPT,,,,,,Outpatient,,,2060.2,1339,Blue Cross of AL,Blue Cross,944.49,,,,,,,Other,598.27,1291,Based on EAPG RVU's
NM Testicular Imaging w/ Vasc Flow,8733473,LOCAL,78761,CPT,A9512,HCPCS,,,,Outpatient,,,2063.03,1106.33,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,367.38,560.96,Based on EAPG RVU's
11750 EXCISION NAIL MATRIX PERMANENT CHARGE,9303447,LOCAL,11750,CPT,,,,,,Outpatient,,,2064.41,1342,Blue Cross of AL,Blue Cross,651.39,,,,,,,Other,365.27,863,Based on EAPG RVU's
33967 Insertion Intra-aortic Percutaneous Device Charge,8211150,LOCAL,33967,CPT,,,,,,Outpatient,,,2102.51,1367,Blue Cross of AL,Blue Cross,12132.94,,,,,,,Other,205.15,12132.94,Based on EAPG RVU's
ibutilide 0.1 mg/mL intravenous solution 10 mL [CULL],11201842,LOCAL,J1742,CPT,,,,,,Outpatient,10,ML,2107.584,,Blue Cross of AL,Blue Cross,233.26,,,,,,,Other,172.31,233.26,Based on EAPG RVU's
NM Hepatobiliary Imaging w/ Drug,2425957,LOCAL,78226,CPT,A9537,HCPCS,,,,Outpatient,,,2134.97,567.6,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,367.38,560.96,Based on EAPG RVU's
NM Hepatobiliary Imaging w/ EF,12894248,LOCAL,78227,CPT,A9537,HCPCS,,,,Outpatient,,,2134.97,1145.1,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,560.96,1384.5568,Based on EAPG RVU's
VENOGRAM BILATERAL EXT S&I,8211110,LOCAL,75822,CPT,,,,,,Outpatient,,,2159,1157.48,Blue Cross of AL,Blue Cross,1231.66,,,,,,,Other,1231.66,1420.25,Based on EAPG RVU's
XR Venogram Extremity Bilateral,13085158,LOCAL,75822,CPT,,,,,,Outpatient,,,2159,1157.48,Blue Cross of AL,Blue Cross,1231.66,,,,,,,Other,1231.66,1420.25,Based on EAPG RVU's
64633 DESTR FACET CERV/THOR SNG LVL,5661057,LOCAL,64633,CPT,,,,,,Outpatient,,,2179,1416,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,1250.53,2315,Based on EAPG RVU's
64635 DESTR FACET LUM/SAC SINGLE LVL,5661055,LOCAL,64635,CPT,,,,,,Outpatient,,,2179,1416,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,1250.53,2315,Based on EAPG RVU's
93567 Inj Supra Aortography,8230011,LOCAL,93567,CPT,,,,,,Outpatient,,,2187.66,1422,Blue Cross of AL,Blue Cross,442.76,,,,,,,Other,29.54,863,Based on EAPG RVU's
NM Gastric Emptying Study,1169236,LOCAL,78264,CPT,,,,,,Outpatient,,,2193.29,1176.45,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,367.38,560.96,Based on EAPG RVU's
NM Bone Spect,1169188,LOCAL,78803,CPT,,,,,,Outpatient,,,2202.35,1181.4,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,1193.55,1409.71,Based on EAPG RVU's
APPLY SKIN SUB 1ST 255Q CM LEG UP TO 100,13531303,LOCAL,15271,CPT,,,,,25,Outpatient,,,2221.65,1092,Blue Cross of AL,Blue Cross,2862.92,,,,,,,Other,1496,2862.92,Based on EAPG RVU's
CT Ankle w/o Contrast Left,1167903,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Ankle w/o Contrast Right,1167905,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Clavicle w/o Contrast Left,12885310,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Clavicle w/o Contrast Right,12885313,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Elbow w/o Contrast Left,1168002,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Elbow w/o Contrast Right,1168004,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Femur w/o Contrast Left,8202922,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Femur w/o Contrast Right,8202924,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Foot w/o Contrast Left,1168040,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Foot w/o Contrast Right,1168042,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Forearm w/o Contrast Left,8202950,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Forearm w/o Contrast Right,8202952,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Hand w/o Contrast Left,1168086,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Hand w/o Contrast Right,1168088,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Hip w/o Contrast Left,1168116,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Hip w/o Contrast Right,1168118,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Humerus w/o Contrast Left,8202997,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Humerus w/o Contrast Right,8202999,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Knee w/o Contrast Left,1168158,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Knee w/o Contrast Right,1168160,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Shoulder w/o Contrast Left,1168220,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Shoulder w/o Contrast Right,1168222,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Tibia/Fibula w/o Contrast Left,8203045,LOCAL,73700,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Tibia/Fibula w/o Contrast Right,8203047,LOCAL,73700,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Wrist w/o Contrast Left,1168341,LOCAL,73200,CPT,,,,,LT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Wrist w/o Contrast Right,1168343,LOCAL,73200,CPT,,,,,RT,Outpatient,,,2221.86,1191.3,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Angio Abdomen Aorta + Iliofemoral,1167851,LOCAL,75635,CPT,,,,,,Outpatient,,,2242.64,1202.85,Blue Cross of AL,Blue Cross,565.59,,,,,,,Other,162.76,565.59,Based on EAPG RVU's
37252 Invasc US Initial Vessel,8230056,LOCAL,37252,CPT,,,,,,Outpatient,,,2252.25,1464,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,72.79,2669.67,Based on EAPG RVU's
15277 App Skin Sub Graft(TWSA>100cm2 f/a/h-ft diag add 100 cm2,12635466,LOCAL,15277,CPT,,,,,,Outpatient,,,2263.33,1471,Blue Cross of AL,Blue Cross,2862.92,,,,,,,Other,1496,2862.92,Based on EAPG RVU's
93312 TEE 2D MM COMPLETE WO CHARGE,8200160,LOCAL,93312,CPT,,,,,,Outpatient,,,2279.37,1482,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,501.29,678.38,Based on EAPG RVU's
US Echo Transesophageal,7936283,LOCAL,93312,CPT,,,,,,Outpatient,,,2279.37,1482,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,501.29,678.38,Based on EAPG RVU's
G0278-CL ILIAC/FEM ANGIO FOR CLOSURE Charge,8212025,LOCAL,,,G0278,HCPCS,,,,Outpatient,,,2301.79,1496,Blue Cross of AL,Blue Cross,6018.68,,,,,,,Other,10.66,6018.68,Based on EAPG RVU's
NM Gastric Emptying w/ SB,10110882,LOCAL,78265,CPT,,,,,,Outpatient,,,2302.29,1234.2,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,367.38,560.96,Based on EAPG RVU's
onabotulinumtoxinA 100 units injection [CULL],11212323,LOCAL,J0585,CPT,,,,,,Outpatient,1,EA,2307.84,,Blue Cross of AL,Blue Cross,771.25,,,,,,,Other,6.5,771.25,Based on EAPG RVU's
MRI Brachial Plexus w/o Contrast Lt,8784911,LOCAL,73221,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Brachial Plexus w/o Contrast Rt,8784914,LOCAL,73221,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Clavicle w/o Contrast Left,9647312,LOCAL,71550,CPT,,,,,LT,Outpatient,,,2317.56,1765.5,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Clavicle w/o Contrast Right,9647315,LOCAL,71550,CPT,,,,,RT,Outpatient,,,2317.56,1765.5,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Fingers w/o Contrast Left,8513078,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Fingers w/o Contrast Right,8513081,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Forearm w/o Contrast Lt,8058719,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Forearm w/o Contrast Rt,8058722,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Hand w/o Contrast Left,1168930,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Hand w/o Contrast Right,1168932,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Humerus w/o Contrast Left,8203080,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Humerus w/o Contrast Right,8203082,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Scapula w/o Contrast Left,9647339,LOCAL,73218,CPT,,,,,LT,Outpatient,,,2317.56,1242.45,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Scapula w/o Contrast Right,9647342,LOCAL,73218,CPT,,,,,RT,Outpatient,,,2317.56,1242.45,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRA Neck w/o Contrast,1168683,LOCAL,70547,CPT,,,,,,Outpatient,,,2317.57,1242.45,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,220.99,729.93,Based on EAPG RVU's
MRA Pelvis w/o Contrast,1168691,LOCAL,72198,CPT,,,,,,Outpatient,,,2338.16,1767.15,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,220.99,729.93,Based on EAPG RVU's
MRA Pelvis w/o Contrast,1168691,LOCAL,C8919,CPT,,,,,,Outpatient,,,2338.16,,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,220.99,729.93,Based on EAPG RVU's
XR Myelogram Cervical Spine,1170319,LOCAL,62302,CPT,,,,,,Outpatient,,,2349.36,1527,Blue Cross of AL,Blue Cross,857.13,,,,,,,Other,722.32,1291,Based on EAPG RVU's
XR Myelogram Thoracic Spine,1170327,LOCAL,62303,CPT,,,,,,Outpatient,,,2349.36,1527,Blue Cross of AL,Blue Cross,857.13,,,,,,,Other,722.32,1291,Based on EAPG RVU's
MRI Spine Thoracic w/o Contrast,1169066,LOCAL,72146,CPT,,,,,,Outpatient,,,2365.31,1268.03,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
ILR REMOVAL,8267777,LOCAL,33286,CPT,,,,,,Outpatient,,,2381.18,1548,Blue Cross of AL,Blue Cross,2484.2,,,,,,,Other,643.26,2484.2,Based on EAPG RVU's
CT Spine Lumbar w/o Contrast,1168246,LOCAL,72131,CPT,,,,,,Outpatient,,,2398.23,1286.18,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
NM Bone Three Phase Study Injection/Scan,1169190,LOCAL,78315,CPT,,,,,,Outpatient,,,2428.11,1301.85,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,367.38,560.96,Based on EAPG RVU's
36002 Pseudoanrsm Repair W Thrombin Us Gud,8212049,LOCAL,36002,CPT,,,,,,Outpatient,,,2429.28,1579,Blue Cross of AL,Blue Cross,1231.66,,,,,,,Other,565.25,1291,Based on EAPG RVU's
AV FISTULAGRAM S&I,8210332,LOCAL,36901,CPT,,,,,,Outpatient,,,2442.76,1588,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,1420.25,2669.67,Based on EAPG RVU's
"CRMP5/CV2 Ab, LB, CSF QSTC",13873605,LOCAL,84182,CPT,,,,,,Outpatient,,,2443.5,35.05,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,29.21,Based on EAPG RVU's
"GAD65 Ab, LB, CSF QSTC",13873611,LOCAL,86341,CPT,,,,,,Outpatient,,,2443.5,28.28,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,23.57,Based on EAPG RVU's
INTERNAL MAMMARY S&I,8210631,LOCAL,75756,CPT,,,,,,Outpatient,,,2455.14,1316.7,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2669.67,2877.63,Based on EAPG RVU's
PULMONARY NONSELECTIVE S&I,8210620,LOCAL,75746,CPT,,,,,,Outpatient,,,2455.14,1316.7,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2669.67,2877.63,Based on EAPG RVU's
CT Angio Pelvis,1167881,LOCAL,72191,CPT,,,,,,Outpatient,,,2457.05,1317.53,Blue Cross of AL,Blue Cross,565.59,,,,,,,Other,162.76,565.59,Based on EAPG RVU's
CT Thoracentesis w/ CT Guidance,2424869,LOCAL,77012,CPT,,,,,,Outpatient,,,2458.4,1318.35,Blue Cross of AL,Blue Cross,136.03,,,,,,,Other,48.7,136.03,Based on EAPG RVU's
CT Neck Soft Tissue w/o Contrast,1168234,LOCAL,70490,CPT,,,,,,Outpatient,,,2479.06,1329.08,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
64450 INJECTION ANESTHETIC AGENT PERIPHERAL NE,13437921,LOCAL,64450,CPT,,,,,,Outpatient,,,2482.29,1613,Blue Cross of AL,Blue Cross,636.45,,,,,,,Other,633.14,1291,Based on EAPG RVU's
tetanus immune globulin 250 units/mL intramuscular solution 1 mL [CULL],11212346,LOCAL,J1670,CPT,,,,,,Outpatient,1,ML,2492.8,,Blue Cross of AL,Blue Cross,525.49,,,,,,,Other,525.49,593,Based on EAPG RVU's
CT Ankle w/ Contrast Left,1167897,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Ankle w/ Contrast Right,1167899,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Clavicle w/ Contrast Left,12885304,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
CT Clavicle w/ Contrast Right,12885307,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
CT Elbow w/ Contrast Left,1167996,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
CT Elbow w/ Contrast Right,1167998,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
CT Femur w/ Contrast Left,8202918,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Femur w/ Contrast Right,8202920,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Foot w/ Contrast Left,1168034,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Foot w/ Contrast Right,1168036,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Forearm w/ Contrast Left,8202943,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
CT Forearm w/ Contrast Right,8202945,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
CT Hand w/ Contrast Left,1168080,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
CT Hand w/ Contrast Right,1168082,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
CT Hip w/ Contrast Left,1168110,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Hip w/ Contrast Right,1168112,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Humerus w/ Contrast Left,8202990,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
CT Humerus w/ Contrast Right,8202992,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
CT Knee w/ Contrast Left,1168152,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Knee w/ Contrast Right,1168154,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Shoulder w/ Contrast Left,1168214,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
CT Shoulder w/ Contrast Right,1168216,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
CT Tibia/Fibula w/ Contrast Left,8203041,LOCAL,73701,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Tibia/Fibula w/ Contrast Right,8203043,LOCAL,73701,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Wrist w/ Contrast Left,1168335,LOCAL,73201,CPT,,,,,LT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
CT Wrist w/ Contrast Right,1168337,LOCAL,73201,CPT,,,,,RT,Outpatient,,,2495.32,1338.15,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
64454 - Injection of anesthetic agent into genicular nerve branches including imaging guidance.,14144343,LOCAL,64454,CPT,,,,,,Outpatient,,,2500,244,Blue Cross of AL,Blue Cross,636.45,,,,,,,Other,633.14,1291,Based on EAPG RVU's
"64624 Destruction by neurolytic agent, genicular nerve branches",9487180,LOCAL,64624,CPT,,,,,,Outpatient,,,2500,926,Blue Cross of AL,Blue Cross,1695.82,,,,,,,Other,1695.82,2315,Based on EAPG RVU's
64421 NERVE BLOCK INTERCOSTAL MULTIPLE NERVES,5661026,LOCAL,64421,CPT,,,,,,Outpatient,,,2501.54,890,Blue Cross of AL,Blue Cross,1695.82,,,,,,,Other,813.96,1695.82,Based on EAPG RVU's
15273 ACELLULAR DERM REPL LTH 100 SQ CM,8716218,LOCAL,15273,CPT,,,,,,Outpatient,,,2508.54,1631,Blue Cross of AL,Blue Cross,2862.92,,,,,,,Other,2599,3347.08,Based on EAPG RVU's
dimethyl sulfoxide 50% irrigation solution 50 mL [CULL],11205390,LOCAL,J1212,CPT,,,,,,Outpatient,50,ML,2541.664,,Blue Cross of AL,Blue Cross,525.49,,,,,,,Other,525.49,748.85,Based on EAPG RVU's
INJ PERC CHOL W EXIS CATH,8210336,LOCAL,47531,CPT,,,,,,Outpatient,,,2566.23,298,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2599,3226.48,Based on EAPG RVU's
MRI Elbow w/o Contrast Left,1168848,LOCAL,73221,CPT,,,,,LT,Outpatient,,,2584.17,1242.45,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Elbow w/o Contrast Right,1168850,LOCAL,73221,CPT,,,,,RT,Outpatient,,,2584.17,1242.45,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Shoulder w/o Contrast Left,1169044,LOCAL,73221,CPT,,,,,LT,Outpatient,,,2584.17,1242.45,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Shoulder w/o Contrast Right,1169046,LOCAL,73221,CPT,,,,,RT,Outpatient,,,2584.17,1242.45,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Wrist w/o Contrast Left,1169140,LOCAL,73221,CPT,,,,,LT,Outpatient,,,2584.17,1242.45,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Wrist w/o Contrast Right,1169142,LOCAL,73221,CPT,,,,,RT,Outpatient,,,2584.17,1242.45,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
ASPIRATION / INJECTION OF RENAL PELVIS,8210655,LOCAL,50390,CPT,,,,,,Outpatient,,,2587.86,1682,Blue Cross of AL,Blue Cross,555.55,,,,,,,Other,555.55,1291,Based on EAPG RVU's
MRI Femur w/o Contrast Lt,8058707,LOCAL,73718,CPT,,,,,LT,Outpatient,,,2591.03,1389.3,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Femur w/o Contrast Rt,8058710,LOCAL,73718,CPT,,,,,RT,Outpatient,,,2591.03,1389.3,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Foot w/o Contrast Left,1168890,LOCAL,73718,CPT,,,,,LT,Outpatient,,,2591.03,1389.3,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Foot w/o Contrast Right,1168892,LOCAL,73718,CPT,,,,,RT,Outpatient,,,2591.03,1389.3,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Tibia/Fibula w/o Contrast Left,8206789,LOCAL,73718,CPT,,,,,LT,Outpatient,,,2591.03,1389.3,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Tibia/Fibula w/o Contrast Right,8206791,LOCAL,73718,CPT,,,,,RT,Outpatient,,,2591.03,1389.3,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRA Neck w/ Contrast,1168681,LOCAL,70548,CPT,,,,,,Outpatient,,,2591.04,1389.3,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,326.51,729.93,Based on EAPG RVU's
IR Venogram Cava Superior1,8071895,LOCAL,75827,CPT,,,,,,Outpatient,,,2596.75,1392.6,Blue Cross of AL,Blue Cross,1231.66,,,,,,,Other,1231.66,1420.25,Based on EAPG RVU's
SUPERIOR VENA CAVA S&I,8210670,LOCAL,75827,CPT,,,,,,Outpatient,,,2596.75,1392.6,Blue Cross of AL,Blue Cross,1231.66,,,,,,,Other,1231.66,1420.25,Based on EAPG RVU's
VENOGRAM UNILATERAL EXT S&I,8211100,LOCAL,75820,CPT,,,,,,Outpatient,,,2596.75,1392.6,Blue Cross of AL,Blue Cross,1231.66,,,,,,,Other,1231.66,1420.25,Based on EAPG RVU's
XR Venogram Extremity Left,8115647,LOCAL,75820,CPT,,,,,LT,Outpatient,,,2596.75,1392.6,Blue Cross of AL,Blue Cross,1231.66,,,,,,,Other,1231.66,1420.25,Based on EAPG RVU's
XR Venogram Extremity Right,8115650,LOCAL,75820,CPT,,,,,RT,Outpatient,,,2596.75,1392.6,Blue Cross of AL,Blue Cross,1231.66,,,,,,,Other,1231.66,1420.25,Based on EAPG RVU's
Procedure Performed. -> Paracentesis,9739222,LOCAL,49082,CPT,,,,,,Outpatient,,,2601.5,1691,Blue Cross of AL,Blue Cross,1080.43,,,,,,,Other,857.17,1496,Based on EAPG RVU's
MRA Pelvis w/ Contrast,1168689,LOCAL,72198,CPT,,,,,,Outpatient,,,2611.62,1767.15,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,222.29,729.93,Based on EAPG RVU's
MRA Pelvis w/ Contrast,1168689,LOCAL,C8918,CPT,,,,,,Outpatient,,,2611.62,,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,222.29,729.93,Based on EAPG RVU's
NM Bone Imaging Whole Body Injection,1169180,LOCAL,78306,CPT,,,,,,Outpatient,,,2623.86,1407.45,Blue Cross of AL,Blue Cross,560.96,,,,,,,Other,367.38,560.96,Based on EAPG RVU's
CT Angio Lower Extremity Bilateral,8058637,LOCAL,73706,CPT,,,,,,Outpatient,,,2637.85,1414.88,Blue Cross of AL,Blue Cross,565.59,,,,,,,Other,162.76,565.59,Based on EAPG RVU's
CT Angio Lower Extremity Left,1167875,LOCAL,73706,CPT,,,,,LT,Outpatient,,,2637.85,1414.88,Blue Cross of AL,Blue Cross,565.59,,,,,,,Other,162.76,565.59,Based on EAPG RVU's
CT Angio Lower Extremity Right,1167877,LOCAL,73706,CPT,,,,,RT,Outpatient,,,2637.85,1414.88,Blue Cross of AL,Blue Cross,565.59,,,,,,,Other,162.76,565.59,Based on EAPG RVU's
MRI Spine Thoracic w/ Contrast,1169064,LOCAL,72147,CPT,,,,,,Outpatient,,,2638.77,1414.88,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
C8925 TEE COMPLETE 2D WWO CHARGE,8200184,LOCAL,,,C8925,HCPCS,,,,Outpatient,,,2643.51,1718,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,678.38,722.32,Based on EAPG RVU's
ECHO COMPLETE WITH DOP/CONTRAST,8200176,LOCAL,,,C8929,HCPCS,,,,Outpatient,,,2643.51,1718,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,678.38,722.32,Based on EAPG RVU's
US Echo Doppler Complete w/ Contrast,13780988,LOCAL,93306,CPT,C8929,HCPCS,,,,Outpatient,,,2643.51,1036,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,678.38,722.32,Based on EAPG RVU's
95805 MAINTENANCE OF WAKEFULNESS CHARGE,9569825,LOCAL,95805,CPT,,,,,,Outpatient,,,2652.34,1724,Blue Cross of AL,Blue Cross,1113.98,,,,,,,Other,485.11,1113.98,Based on EAPG RVU's
95805 MSLT CHARGES,8795717,LOCAL,95805,CPT,,,,,,Outpatient,,,2652.34,1724,Blue Cross of AL,Blue Cross,1113.98,,,,,,,Other,485.11,1113.98,Based on EAPG RVU's
95805 MSLT/MWT CHARGES,9442365,LOCAL,95805,CPT,,,,,,Outpatient,,,2652.34,1724,Blue Cross of AL,Blue Cross,1113.98,,,,,,,Other,485.11,1113.98,Based on EAPG RVU's
".MOG Ab, Titer QSTC",13864468,LOCAL,86362,CPT,,,,,,Outpatient,,,2653.38,14.46,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,12.05,15.29,Based on EAPG RVU's
CT Spine Lumbar w/ Contrast,1168244,LOCAL,72132,CPT,,,,,,Outpatient,,,2671.69,1433.03,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
MRA Brain/Head w/o Contrast,1168653,LOCAL,70544,CPT,,,,,,Outpatient,,,2690.84,1442.93,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,220.99,729.93,Based on EAPG RVU's
MRA Lower Extremity w/ + w/o Cnt Left,1168663,LOCAL,73725,CPT,,,,,LT,Outpatient,,,2690.84,1442.93,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,222.29,729.93,Based on EAPG RVU's
MRA Lower Extremity w/ + w/o Cnt Right,1168665,LOCAL,73725,CPT,,,,,RT,Outpatient,,,2690.84,1442.93,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,222.29,729.93,Based on EAPG RVU's
MRV Head w/o Contrast,8450965,LOCAL,70544,CPT,,,,,,Outpatient,,,2690.84,1442.93,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,220.99,729.93,Based on EAPG RVU's
CT Clavicle w/ + w/o Contrast Left,12885298,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Clavicle w/ + w/o Contrast Right,12885301,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Elbow w/ + w/o Contrast Left,8202901,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Elbow w/ + w/o Contrast Right,8202903,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Forearm w/ + w/o Contrast Left,8202936,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Forearm w/ + w/o Contrast Right,8202938,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Hand w/ + w/o Contrast Left,8202957,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Hand w/ + w/o Contrast Right,8202959,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Humerus w/ + w/o Contrast Left,8202983,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Humerus w/ + w/o Contrast Right,8202985,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Shoulder w/ + w/o Contrast Left,8203023,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Shoulder w/ + w/o Contrast Right,8203025,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Wrist w/ + w/o Contrast Left,8203057,LOCAL,73202,CPT,,,,,LT,Outpatient,,,2695.32,1445.4,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Wrist w/ + w/o Contrast Right,8203059,LOCAL,73202,CPT,,,,,RT,Outpatient,,,2695.32,1445.4,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Spine Thoracic w/o Contrast,1168252,LOCAL,72128,CPT,,,,,,Outpatient,,,2704.58,1450.35,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Spine Cervical w/o Contrast,1168240,LOCAL,72125,CPT,,,,,,Outpatient,,,2712.02,1454.48,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Abdomen w/ Oral Contrast Only,8206354,LOCAL,74150,CPT,,,,,,Outpatient,,,2720.92,1459.43,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Abdomen w/o Contrast,1167849,LOCAL,74150,CPT,,,,,,Outpatient,,,2720.92,1459.43,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Pelvis w/ Oral Contrast Only,8206452,LOCAL,72192,CPT,,,,,,Outpatient,,,2720.92,1459.43,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Pelvis w/o Contrast,1168198,LOCAL,72192,CPT,,,,,,Outpatient,,,2720.92,1459.43,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
MRI Ankle w/o Contrast Left,1168750,LOCAL,73721,CPT,,,,,LT,Outpatient,,,2733.23,1466.03,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Ankle w/o Contrast Right,1168752,LOCAL,73721,CPT,,,,,RT,Outpatient,,,2733.23,1466.03,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Hip w/o Contrast Left,1168948,LOCAL,73721,CPT,,,,,LT,Outpatient,,,2733.23,1466.03,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Hip w/o Contrast Right,1168950,LOCAL,73721,CPT,,,,,RT,Outpatient,,,2733.23,1466.03,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Knee w/o Contrast Left,1168984,LOCAL,73721,CPT,,,,,LT,Outpatient,,,2733.23,1466.03,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Knee w/o Contrast Right,1168986,LOCAL,73721,CPT,,,,,RT,Outpatient,,,2733.23,1466.03,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
CT Neck Soft Tissue w/ Contrast,1168232,LOCAL,70491,CPT,,,,,,Outpatient,,,2752.53,1475.93,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
MRA Abdomen w/o Contrast,1168639,LOCAL,74185,CPT,,,,,,Outpatient,,,2786.55,2017.13,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,221.41,729.93,Based on EAPG RVU's
64483 TRANS INJ LUMB/SACR-BILATERAL CHARGE,5661040,LOCAL,64483,CPT,,,,,,Outpatient,,,2788.44,1812,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,813.96,1291,Based on EAPG RVU's
64484 TRANS INJ LUMB/SACR EA ADD BIL CHARGE,5661049,LOCAL,64484,CPT,,,,,,Outpatient,,,2788.44,1812,Blue Cross of AL,Blue Cross,1250.53,,,,,,,Other,41.55,1250.53,Based on EAPG RVU's
MRA Chest w/o Contrast,1168647,LOCAL,71555,CPT,,,,,,Outpatient,,,2794.75,1645.05,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,220.24,729.93,Based on EAPG RVU's
MRA Chest w/o Contrast,1168647,LOCAL,C8910,CPT,,,,,,Outpatient,,,2794.75,,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,220.24,729.93,Based on EAPG RVU's
MRI Abdomen w/o Contrast,1168734,LOCAL,74181,CPT,,,,,,Outpatient,,,2804.32,1503.98,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI MRCP w/o Contrast,8203102,LOCAL,74181,CPT,,,,,,Outpatient,,,2804.32,1503.98,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Spine Cervical w/o Contrast,1169054,LOCAL,72141,CPT,,,,,,Outpatient,,,2804.32,1503.98,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Spine Lumbar w/o Contrast,1169060,LOCAL,72148,CPT,,,,,,Outpatient,,,2804.32,1503.98,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
CT Brain/Head Stroke Alert,8202967,LOCAL,70450,CPT,,,,,,Outpatient,,,2816.63,1510.58,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,97.22,461.98,Based on EAPG RVU's
CT Brain/Head w/o Contrast,1168094,LOCAL,70450,CPT,,,,,,Outpatient,,,2816.63,1510.58,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,97.22,461.98,Based on EAPG RVU's
PLACE CENTRAL VENOUS LINE,8210290,LOCAL,36556,CPT,,,,,,Outpatient,,,2850.87,1853,Blue Cross of AL,Blue Cross,1644.1,,,,,,,Other,1291,2877.63,Based on EAPG RVU's
MRI Brachial Plexus w/ Contrast Lt,10558521,LOCAL,73222,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,652.35,722.32,Based on EAPG RVU's
MRI Brachial Plexus w/ Contrast Rt,10558524,LOCAL,73222,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,652.35,722.32,Based on EAPG RVU's
MRI Clavicle w/ Contrast Left,12912772,LOCAL,71551,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,652.35,722.32,Based on EAPG RVU's
MRI Clavicle w/ Contrast Right,12912775,LOCAL,71551,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,652.35,722.32,Based on EAPG RVU's
MRI Elbow w/ Contrast Left,1168842,LOCAL,73222,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,652.35,722.32,Based on EAPG RVU's
MRI Elbow w/ Contrast Right,1168844,LOCAL,73222,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,652.35,722.32,Based on EAPG RVU's
MRI Shoulder w/ Contrast Left,1169038,LOCAL,73222,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,652.35,722.32,Based on EAPG RVU's
MRI Shoulder w/ Contrast Right,1169040,LOCAL,73222,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,652.35,722.32,Based on EAPG RVU's
MRI Wrist w/ Contrast Left,1169134,LOCAL,73222,CPT,,,,,LT,Outpatient,,,2857.63,1532.03,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,652.35,722.32,Based on EAPG RVU's
MRI Wrist w/ Contrast Right,1169136,LOCAL,73222,CPT,,,,,RT,Outpatient,,,2857.63,1532.03,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,652.35,722.32,Based on EAPG RVU's
MRI Femur w/ Contrast Left,8206704,LOCAL,73719,CPT,,,,,LT,Outpatient,,,2864.49,1536.15,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Femur w/ Contrast Right,8206706,LOCAL,73719,CPT,,,,,RT,Outpatient,,,2864.49,1536.15,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Foot w/ Contrast Left,1168884,LOCAL,73719,CPT,,,,,LT,Outpatient,,,2864.49,1536.15,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Foot w/ Contrast Right,1168886,LOCAL,73719,CPT,,,,,RT,Outpatient,,,2864.49,1536.15,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Tibia/Fibula w/ Contrast Left,8206783,LOCAL,73719,CPT,,,,,LT,Outpatient,,,2864.49,1536.15,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Tibia/Fibula w/ Contrast Right,8206785,LOCAL,73719,CPT,,,,,RT,Outpatient,,,2864.49,1536.15,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
CT Angio Chest,1167863,LOCAL,71275,CPT,,,,,,Outpatient,,,2871.32,1539.45,Blue Cross of AL,Blue Cross,565.59,,,,,,,Other,162.76,565.59,Based on EAPG RVU's
20220 BIOPSY BONE TROC/NDL SUPERFICL CHARGE,9709066,LOCAL,20220,CPT,,,,,,Outpatient,,,2874.06,1868,Blue Cross of AL,Blue Cross,923.18,,,,,,,Other,923.18,1481.32,Based on EAPG RVU's
CT Orbit Sella etc. or IAC w/o Cont,8362458,LOCAL,70480,CPT,,,,,,Outpatient,,,2874.06,1541.1,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
Antenatal Testing Type -> Non-Stress test,9848446,LOCAL,59025,CPT,,,,,,Outpatient,,,2886.2,1876,Blue Cross of AL,Blue Cross,269.34,,,,,,,Other,183.92,863,Based on EAPG RVU's
Non Stress Test Charge,9919812,LOCAL,59025,CPT,,,,,,Outpatient,,,2886.2,1876,Blue Cross of AL,Blue Cross,269.34,,,,,,,Other,183.92,863,Based on EAPG RVU's
Abeta 40 QST,13873829,LOCAL,82542,CPT,,,,,,Outpatient,,,2925,28.91,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,24.09,Based on EAPG RVU's
Abeta 42/40 Ratio QST,13873830,LOCAL,82172,CPT,,,,,,Outpatient,,,2925,25.31,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,37.515,Based on EAPG RVU's
MRI Pelvis w/o Contrast,1169028,LOCAL,72195,CPT,,,,,,Outpatient,,,2958.83,1586.48,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRA Lower Extremity w/o Contrast Left,1168675,LOCAL,73725,CPT,,,,,LT,Outpatient,,,2964.3,1442.93,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,222.29,729.93,Based on EAPG RVU's
MRA Lower Extremity w/o Contrast Right,1168677,LOCAL,73725,CPT,,,,,RT,Outpatient,,,2964.3,1442.93,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,222.29,729.93,Based on EAPG RVU's
CT Angio Abdomen,1167853,LOCAL,74175,CPT,,,,,,Outpatient,,,2965.92,1590.6,Blue Cross of AL,Blue Cross,565.59,,,,,,,Other,162.76,565.59,Based on EAPG RVU's
MRI TMJ,1169068,LOCAL,70336,CPT,,,,,,Outpatient,,,2973.87,1594.73,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
CT Spine Thoracic w/ Contrast,1168250,LOCAL,72129,CPT,,,,,,Outpatient,,,2978.05,1597.2,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Spine Cervical w/ Contrast,1168238,LOCAL,72126,CPT,,,,,,Outpatient,,,2985.5,1601.33,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
NM Cisternography Injection,1169226,LOCAL,78630,CPT,A9548,HCPCS,,,,Outpatient,,,2985.52,1601.33,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,715.29,1409.71,Based on EAPG RVU's
CT Angio Brain/Head,1167871,LOCAL,70496,CPT,,,,,,Outpatient,,,2990.01,1603.8,Blue Cross of AL,Blue Cross,565.59,,,,,,,Other,162.76,565.59,Based on EAPG RVU's
CT Angio Upper Extremity Bilateral,8058640,LOCAL,73206,CPT,,,,,,Outpatient,,,2990.01,1603.8,Blue Cross of AL,Blue Cross,565.59,,,,,,,Other,162.76,565.59,Based on EAPG RVU's
CT Angio Upper Extremity Left,1167885,LOCAL,73206,CPT,,,,,LT,Outpatient,,,2990.01,1603.8,Blue Cross of AL,Blue Cross,565.59,,,,,,,Other,162.76,565.59,Based on EAPG RVU's
CT Angio Upper Extremity Right,1167887,LOCAL,73206,CPT,,,,,RT,Outpatient,,,2990.01,1603.8,Blue Cross of AL,Blue Cross,565.59,,,,,,,Other,162.76,565.59,Based on EAPG RVU's
CT Abdomen w/ Contrast,1167847,LOCAL,74160,CPT,,,,,,Outpatient,,,2994.38,1605.45,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Abdomen w/ Contrast + Oral,13452972,LOCAL,74160,CPT,,,,,,Outpatient,,,2994.38,1605.45,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Pelvis w/ Contrast,1168196,LOCAL,72193,CPT,,,,,,Outpatient,,,2994.38,1605.45,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Pelvis w/ Contrast + Oral,13554960,LOCAL,72193,CPT,,,,,,Outpatient,,,2994.38,1605.45,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
MRI Ankle w/ Contrast Left,1168744,LOCAL,73722,CPT,,,,,LT,Outpatient,,,3006.69,1612.05,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,652.35,722.32,Based on EAPG RVU's
MRI Ankle w/ Contrast Right,1168746,LOCAL,73722,CPT,,,,,RT,Outpatient,,,3006.69,1612.05,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,652.35,722.32,Based on EAPG RVU's
MRI Hip w/ Contrast Left,1168942,LOCAL,73722,CPT,,,,,LT,Outpatient,,,3006.69,1612.05,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,652.35,722.32,Based on EAPG RVU's
MRI Hip w/ Contrast Right,1168944,LOCAL,73722,CPT,,,,,RT,Outpatient,,,3006.69,1612.05,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,652.35,722.32,Based on EAPG RVU's
MRI Knee w/ Contrast Left,1168978,LOCAL,73722,CPT,,,,,LT,Outpatient,,,3006.69,1612.05,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,652.35,722.32,Based on EAPG RVU's
MRI Knee w/ Contrast Right,1168980,LOCAL,73722,CPT,,,,,RT,Outpatient,,,3006.69,1612.05,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,652.35,722.32,Based on EAPG RVU's
CT Angio Neck,1167879,LOCAL,70498,CPT,,,,,,Outpatient,,,3039.77,1630.2,Blue Cross of AL,Blue Cross,565.59,,,,,,,Other,162.76,565.59,Based on EAPG RVU's
immune globulin (Octogam) 10% intravenous solution 10 g [CULL],11205114,LOCAL,J1599,CPT,,,,,,Outpatient,100,ML,3046.4,,Blue Cross of AL,Blue Cross,1641.22,,,,,,,Other,1641.22,1641.22,Based on EAPG RVU's
CT Chest High Resolution,8658939,LOCAL,71250,CPT,,,,,,Outpatient,,,3049.07,1635.15,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,461.98,Based on EAPG RVU's
CT Chest High Resolution w/o Contrast,8658939,LOCAL,71250,CPT,,,,,,Outpatient,,,3049.07,1635.15,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,461.98,Based on EAPG RVU's
CT Chest w/o Contrast,8071395,LOCAL,71250,CPT,,,,,,Outpatient,,,3049.07,1635.15,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
CT Low Dose Lung Screening,8090304,LOCAL,71271,CPT,,,,,,Outpatient,,,3049.07,1635.15,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
MRA Abdomen w/ Contrast,1168637,LOCAL,74185,CPT,,,,,,Outpatient,,,3060.01,2017.13,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,221.41,729.93,Based on EAPG RVU's
MRA Chest w/ Contrast,1168645,LOCAL,71555,CPT,,,,,,Outpatient,,,3068.21,1645.05,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,220.24,729.93,Based on EAPG RVU's
MRA Chest w/ Contrast,1168645,LOCAL,C8909,CPT,,,,,,Outpatient,,,3068.21,,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,220.24,729.93,Based on EAPG RVU's
MRI Abdomen w/ Contrast,1168732,LOCAL,74182,CPT,,,,,,Outpatient,,,3077.78,1650.83,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Spine Cervical w/ Contrast,1169052,LOCAL,72142,CPT,,,,,,Outpatient,,,3077.78,1650.83,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Spine Lumbar w/ Contrast,1169058,LOCAL,72149,CPT,,,,,,Outpatient,,,3077.78,1650.83,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
CT Brain/Head w/ Contrast,1168092,LOCAL,70460,CPT,,,,,,Outpatient,,,3090.07,1657.43,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
immune globulin intravenous and subcutaneous 10% injectable solution 50 mL [CULL],11205108,LOCAL,J1561,CPT,,,,,,Outpatient,50,ML,3099.84,,Blue Cross of AL,Blue Cross,2110.36,,,,,,,Other,48.96,2110.36,Based on EAPG RVU's
CT Maxillofacial w/o Contrast,1168186,LOCAL,70486,CPT,,,,,,Outpatient,,,3131.11,1678.88,Blue Cross of AL,Blue Cross,170.53,,,,,,,Other,97.22,170.53,Based on EAPG RVU's
Central Line Access Type. -> Peripherally inserted central catheter (PICC),9344166,LOCAL,36569,CPT,,,,,,Outpatient,,,3141.6,2042,Blue Cross of AL,Blue Cross,1644.1,,,,,,,Other,1291,1644.1,Based on EAPG RVU's
CT Orbit Sella etc. or IAC w/ Cont,8362455,LOCAL,70481,CPT,,,,,,Outpatient,,,3147.52,1687.95,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
NM Tumor Loc Whole Body 2+ Days,1169416,LOCAL,78804,CPT,,,,,,Outpatient,,,3150.27,1689.6,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,1193.55,1409.71,Based on EAPG RVU's
NM Tumor Loc Whole Body 2+ Days Gallium,1169418,LOCAL,78804,CPT,A9556,HCPCS,,,,Outpatient,,,3150.27,1689.6,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,1193.55,1409.71,Based on EAPG RVU's
CT Ankle w/ + w/o Contrast Left,8202894,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Ankle w/ + w/o Contrast Right,8202896,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Femur w/ + w/o Contrast Left,8202914,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Femur w/ + w/o Contrast Right,8202916,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Foot w/ + w/o Contrast Left,8202926,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Foot w/ + w/o Contrast Right,8202928,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Hip w/ + w/o Contrast Left,8202973,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Hip w/ + w/o Contrast Right,8202975,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Knee w/ + w/o Contrast Left,8203007,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Knee w/ + w/o Contrast Right,8203009,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Tibia/Fibula w/ + w/o Contrast Left,8203037,LOCAL,73702,CPT,,,,,LT,Outpatient,,,3178.96,1704.45,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Tibia/Fibula w/ + w/o Contrast Right,8203039,LOCAL,73702,CPT,,,,,RT,Outpatient,,,3178.96,1704.45,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CHOLECYSTOSTOMY DRAIN PLACEMENT,8267773,LOCAL,47490,CPT,,,,,,Outpatient,,,3200,2080,Blue Cross of AL,Blue Cross,3682.65,,,,,,,Other,2599,3682.65,Based on EAPG RVU's
immune globulin (Privigen) 10% intravenous solution 5 g [CULL],11205119,LOCAL,J1599,CPT,,,,,,Outpatient,50,ML,3215.424,,Blue Cross of AL,Blue Cross,1641.22,,,,,,,Other,1641.22,1641.22,Based on EAPG RVU's
"11047  Debridement Sub-Q, bone each add l 20sq cm",10013082,LOCAL,11047,CPT,,,,,,Outpatient,,,3218.96,2092,Blue Cross of AL,Blue Cross,1466.58,,,,,,,Other,78.26,1466.58,Based on EAPG RVU's
11047 Debrid bone > 20 sq cm charge,12508109,LOCAL,11047,CPT,,,,,,Outpatient,,,3218.96,2092,Blue Cross of AL,Blue Cross,1466.58,,,,,,,Other,78.26,1466.58,Based on EAPG RVU's
CT Guided Perc Drain/Placement,7936217,LOCAL,75989,CPT,,,,,,Outpatient,,,3232.87,618.75,Blue Cross of AL,Blue Cross,262.79,,,,,,,Other,50.75,262.79,Based on EAPG RVU's
XR Drainage Perc Cath Placement,8058781,LOCAL,75989,CPT,,,,,,Outpatient,,,3232.87,618.75,Blue Cross of AL,Blue Cross,262.79,,,,,,,Other,50.75,262.79,Based on EAPG RVU's
MRA Neck w/ + w/o Contrast,1168679,LOCAL,70549,CPT,,,,,,Outpatient,,,3274.68,1756.43,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,326.51,729.93,Based on EAPG RVU's
MRI Brachial Plexus w/ + w/o Contrast Lt,8784905,LOCAL,73223,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Brachial Plexus w/ + w/o Contrast Rt,8784908,LOCAL,73223,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Clavicle w/ + w/o Contrast Left,9647306,LOCAL,71552,CPT,,,,,LT,Outpatient,,,3274.68,2131.8,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Clavicle w/ + w/o Contrast Right,9647309,LOCAL,71552,CPT,,,,,RT,Outpatient,,,3274.68,2131.8,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Fingers w/ + w/o Contrast Left,8513072,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Fingers w/ + w/o Contrast Right,8513075,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Forearm w/ + w/o Contrast Lt,8058713,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Forearm w/ + w/o Contrast Rt,8058716,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Hand w/ + w/o Contrast Left,1168918,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Hand w/ + w/o Contrast Right,1168920,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Humerus w/ + w/o Contrast Left,8203076,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Humerus w/ + w/o Contrast Right,8203078,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Scapula w/ + w/o Contrast Left,9647333,LOCAL,73220,CPT,,,,,LT,Outpatient,,,3274.68,1756.43,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Scapula w/ + w/o Contrast Right,9647336,LOCAL,73220,CPT,,,,,RT,Outpatient,,,3274.68,1756.43,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
XR Myelogram 2 or More Regions,10386814,LOCAL,62305,CPT,,,,,,Outpatient,,,3282.36,2134,Blue Cross of AL,Blue Cross,857.13,,,,,,,Other,722.32,1291,Based on EAPG RVU's
MRI Chest w/o Contrast,1168824,LOCAL,71550,CPT,,,,,,Outpatient,,,3292.3,1765.5,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRA Pelvis w/ + w/o Contrast,1168687,LOCAL,72198,CPT,,,,,,Outpatient,,,3295.27,1767.15,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,222.29,729.93,Based on EAPG RVU's
MRA Pelvis w/ + w/o Contrast,1168687,LOCAL,C8920,CPT,,,,,,Outpatient,,,3295.27,,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,222.29,729.93,Based on EAPG RVU's
US Echo Transesophag w/ Cont,13770878,LOCAL,93312,CPT,C8925,HCPCS,,,,Outpatient,,,3329.37,1482,Blue Cross of AL,Blue Cross,678.38,,,,,,,Other,678.38,722.32,Based on EAPG RVU's
PERC PLEURAL INSERTION/DRAINAGE AND S&I,8230068,LOCAL,32557,CPT,,,,,,Outpatient,,,3332.77,2166,Blue Cross of AL,Blue Cross,1392.67,,,,,,,Other,1291,1420.25,Based on EAPG RVU's
CT Spine Lumbar w/ + w/o Contrast,1168242,LOCAL,72133,CPT,,,,,,Outpatient,,,3355.34,1799.33,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
"Poliovirus 1, 3 Ab, Neutralization QSTC",13864497,LOCAL,86382,CPT,,,,,,Outpatient,,,3375,20.29,Blue Cross of AL,Blue Cross,15.29,,,,,,,Other,15.29,16.91,Based on EAPG RVU's
MRA Lower Extremity w/ Contrast Left,90720012,LOCAL,73725,CPT,,,,,LT,Outpatient,,,3383,1442.93,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,222.29,729.93,Based on EAPG RVU's
MRA Lower Extremity w/ Contrast Right,90720013,LOCAL,73725,CPT,,,,,RT,Outpatient,,,3383,1442.93,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,222.29,729.93,Based on EAPG RVU's
MRA Upper Extremity w/ Contrast Left,90720010,LOCAL,73225,CPT,,,,,LT,Outpatient,,,3383,2038.58,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,214.69,729.93,Based on EAPG RVU's
MRA Upper Extremity w/ Contrast Right,90720011,LOCAL,73225,CPT,,,,,RT,Outpatient,,,3383,2038.58,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,214.69,729.93,Based on EAPG RVU's
MRI Face Neck Orbit w/o Contrast,1168856,LOCAL,70540,CPT,,,,,,Outpatient,,,3383.36,1814.18,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
CT Maxillofacial w/ Contrast,1168184,LOCAL,70487,CPT,,,,,,Outpatient,,,3404.57,1825.73,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
TRANSCATH EMBOLIZATION S&I,8267120,LOCAL,75894,CPT,,,,,,Outpatient,,,3428.95,1838.93,Blue Cross of AL,Blue Cross,262.79,,,,,,,Other,165.4,262.79,Based on EAPG RVU's
CT Neck Soft Tissue w/ + w/o Contrast,1168230,LOCAL,70492,CPT,,,,,,Outpatient,,,3436.18,1843.05,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Parathyroid 4-Phase Study,13554957,LOCAL,70492,CPT,,,,,,Outpatient,,,3436.18,1843.05,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
MRI Brain + IAC w/o Contrast,9427804,LOCAL,70551,CPT,,,,,,Outpatient,,,3446.61,1848,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Brain w/o Contrast,1168800,LOCAL,70551,CPT,,,,,,Outpatient,,,3446.61,1848,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
MRI Pituitary w/o Contrast,8203111,LOCAL,70551,CPT,,,,,,Outpatient,,,3446.61,1848,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
DISKOGRAM LUMBAR S & I,8299004,LOCAL,72295,CPT,,,,,,Outpatient,,,3452,1851.3,Blue Cross of AL,Blue Cross,857.13,,,,,,,Other,857.13,1785.34,Based on EAPG RVU's
NM Tumor Loc Spect,1169408,LOCAL,78803,CPT,,,,,,Outpatient,,,3466,1181.4,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,1193.55,1409.71,Based on EAPG RVU's
NM Tumor Loc Whole Body 1 Day,1169414,LOCAL,78802,CPT,,,,,,Outpatient,,,3466,2870.18,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,1193.55,1409.71,Based on EAPG RVU's
28090 EXCISION GANGLION CYST FOOT,13436341,LOCAL,28090,CPT,,,,,,Outpatient,,,3532.98,2296,Blue Cross of AL,Blue Cross,3153.58,,,,,,,Other,1463.19,3153.58,Based on EAPG RVU's
ICD REMOVAL SC/DC LEAD TV EXTRACT,8231010,LOCAL,33244,CPT,,,,,,Outpatient,,,3541,2302,Blue Cross of AL,Blue Cross,2484.2,,,,,,,Other,2484.2,3327.27,Based on EAPG RVU's
MRI Elbow w/ + w/o Contrast Left,1168836,LOCAL,73223,CPT,,,,,LT,Outpatient,,,3541.3,1756.43,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Elbow w/ + w/o Contrast Right,1168838,LOCAL,73223,CPT,,,,,RT,Outpatient,,,3541.3,1756.43,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Shoulder w/ + w/o Contrast Left,1169032,LOCAL,73223,CPT,,,,,LT,Outpatient,,,3541.3,1756.43,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Shoulder w/ + w/o Contrast Right,1169034,LOCAL,73223,CPT,,,,,RT,Outpatient,,,3541.3,1756.43,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Wrist w/ + w/o Contrast Left,1169128,LOCAL,73223,CPT,,,,,LT,Outpatient,,,3541.3,1756.43,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Wrist w/ + w/o Contrast Right,1169130,LOCAL,73223,CPT,,,,,RT,Outpatient,,,3541.3,1756.43,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Femur w/ + w/o Contrast Lt,8058701,LOCAL,73720,CPT,,,,,LT,Outpatient,,,3548.14,1902.45,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Femur w/ + w/o Contrast Rt,8058704,LOCAL,73720,CPT,,,,,RT,Outpatient,,,3548.14,1902.45,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Foot w/ + w/o Contrast Left,1168878,LOCAL,73720,CPT,,,,,LT,Outpatient,,,3548.14,1902.45,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Foot w/ + w/o Contrast Right,1168880,LOCAL,73720,CPT,,,,,RT,Outpatient,,,3548.14,1902.45,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Tibia/Fibula w/ + w/o Contrast Left,8206777,LOCAL,73720,CPT,,,,,LT,Outpatient,,,3548.14,1902.45,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Tibia/Fibula w/ + w/o Contrast Right,8206779,LOCAL,73720,CPT,,,,,RT,Outpatient,,,3548.14,1902.45,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
11044 DEBRID BONE FIRST 20SQ CM OR < CHARGE,8019965,LOCAL,11044,CPT,,,,,,Outpatient,,,3581.67,2328,Blue Cross of AL,Blue Cross,1466.58,,,,,,,Other,1291,1481.32,Based on EAPG RVU's
MRI Face Neck Orbit w/ Contrast,1168854,LOCAL,70542,CPT,,,,,,Outpatient,,,3633.36,1948.65,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
bivalirudin 250 mg intravenous injection [CULL],11220339,LOCAL,J0583,CPT,,,,,,Outpatient,1,EA,3639.2608,,Blue Cross of AL,Blue Cross,233.26,,,,,,,Other,0.157,233.26,Based on EAPG RVU's
MRI Pelvis w/ + w/o Contrast,1169024,LOCAL,72197,CPT,,,,,,Outpatient,,,3642.47,1953.6,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Prostate w/ + w/o Contrast,4126347,LOCAL,72197,CPT,,,,,,Outpatient,,,3642.47,1953.6,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
CT Spine Thoracic w/ + w/o Contrast,1168248,LOCAL,72130,CPT,,,,,,Outpatient,,,3661.7,1963.5,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
MRI Breast w/o Contrast Bilateral.,8784923,LOCAL,77047,CPT,,,,,,Outpatient,,,3667.77,1966.8,Blue Cross of AL,Blue Cross,372.26,,,,,,,Other,220.99,372.26,Based on EAPG RVU's
CT Spine Cervical w/ + w/o Contrast,1168236,LOCAL,72127,CPT,,,,,,Outpatient,,,3669.14,1967.63,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Abdomen w/ + w/o Contrast,1167845,LOCAL,74170,CPT,,,,,,Outpatient,,,3678.03,1972.58,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Pelvis w/ + w/o Contrast,1168194,LOCAL,72194,CPT,,,,,,Outpatient,,,3678.03,1972.58,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
28190 Appy Rigid Leg Cast (Professional Charge only if Provider Applies),12642333,LOCAL,28190,CPT,,,,,,Outpatient,,,3680.71,2392,Blue Cross of AL,Blue Cross,651.39,,,,,,,Other,643.26,1291,Based on EAPG RVU's
MRI Ankle w/ + w/o Contrast Left,1168738,LOCAL,73723,CPT,,,,,LT,Outpatient,,,3690.34,1979.18,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Ankle w/ + w/o Contrast Right,1168740,LOCAL,73723,CPT,,,,,RT,Outpatient,,,3690.34,1979.18,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Hip w/ + w/o Contrast Left,1168936,LOCAL,73723,CPT,,,,,LT,Outpatient,,,3690.34,1979.18,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Hip w/ + w/o Contrast Right,1168938,LOCAL,73723,CPT,,,,,RT,Outpatient,,,3690.34,1979.18,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Knee w/ + w/o Contrast Left,1168972,LOCAL,73723,CPT,,,,,LT,Outpatient,,,3690.34,1979.18,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Knee w/ + w/o Contrast Right,1168974,LOCAL,73723,CPT,,,,,RT,Outpatient,,,3690.34,1979.18,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRA Brain/Head w/ + w/o Contrast,1168649,LOCAL,70546,CPT,,,,,,Outpatient,,,3690.84,1979.18,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,326.51,729.93,Based on EAPG RVU's
MRI Brain + IAC w/ Contrast,9427801,LOCAL,70552,CPT,,,,,,Outpatient,,,3720.07,1994.85,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Brain w/ Contrast,1168798,LOCAL,70552,CPT,,,,,,Outpatient,,,3720.07,1994.85,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRA Abdomen w/ + w/o Contrast,1168635,LOCAL,74185,CPT,,,,,,Outpatient,,,3761.43,2017.13,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,221.41,729.93,Based on EAPG RVU's
MRI Abdomen w/ + w/o Contrast,1168730,LOCAL,74183,CPT,,,,,,Outpatient,,,3761.43,2017.13,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
CT Brain/Head w/ + w/o Contrast,1168090,LOCAL,70470,CPT,,,,,,Outpatient,,,3773.72,2023.73,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
10140 DRAINAGE OF HEMATOMA,8715913,LOCAL,10140,CPT,,,,,,Outpatient,,,3775.02,2454,Blue Cross of AL,Blue Cross,1605.05,,,,,,,Other,1481.32,1605.05,Based on EAPG RVU's
MRA Upper Extremity w/ + w/o Cnt Left,1168704,LOCAL,73225,CPT,,,,,LT,Outpatient,,,3801.65,2038.58,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,214.69,729.93,Based on EAPG RVU's
MRA Upper Extremity w/ + w/o Cnt Left,1168704,LOCAL,C8936,CPT,,,,,LT,Outpatient,,,3801.65,,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,214.69,729.93,Based on EAPG RVU's
MRA Upper Extremity w/ + w/o Cnt Right,1168707,LOCAL,73225,CPT,,,,,RT,Outpatient,,,3801.65,2038.58,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,214.69,729.93,Based on EAPG RVU's
MRA Upper Extremity w/ + w/o Cnt Right,1168707,LOCAL,C8936,CPT,,,,,RT,Outpatient,,,3801.65,,Blue Cross of AL,Blue Cross,729.93,,,,,,,Other,214.69,729.93,Based on EAPG RVU's
CT Orbit Sella etc. or IAC w/ + w/o Cont,8362452,LOCAL,70482,CPT,,,,,,Outpatient,,,3831.16,2054.25,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
CT Abdomen and Pelvis w/ Oral Contrast,8206351,LOCAL,74176,CPT,,,,,,Outpatient,,,3869.45,2074.88,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,220.99,461.98,Based on EAPG RVU's
CT Abdomen and Pelvis w/o Contrast,2424650,LOCAL,74176,CPT,,,,,,Outpatient,,,3869.45,2074.88,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,220.99,461.98,Based on EAPG RVU's
11404 EXCISION BENIGN LESION 3.1 CM TO 4.0 CM CHARGE,8726719,LOCAL,11404,CPT,,,,,,Outpatient,,,3913.86,2544,Blue Cross of AL,Blue Cross,1679.75,,,,,,,Other,1481.32,1679.75,Based on EAPG RVU's
MRI Chest w/ + w/o Contrast,1168820,LOCAL,71552,CPT,,,,,,Outpatient,,,3975.96,2131.8,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
CT Chest High Resolution w/ + w/o Contrast,8658939,LOCAL,71270,CPT,,,,,,Outpatient,,,4006.18,2148.3,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,97.22,461.98,Based on EAPG RVU's
CT Chest w/ + w/o Contrast,8071389,LOCAL,71270,CPT,,,,,,Outpatient,,,4006.18,2148.3,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
MRI Breast w/ + w/o Contrast Left.,8784917,LOCAL,77048,CPT,,,,,LT,Outpatient,,,4030.86,2161.5,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,207.49,652.35,Based on EAPG RVU's
MRI Breast w/ + w/o Contrast Left.,8784917,LOCAL,C8905,CPT,,,,,LT,Outpatient,,,4030.86,,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,207.49,652.35,Based on EAPG RVU's
MRI Breast w/ + w/o Contrast Right.,8784920,LOCAL,77048,CPT,,,,,RT,Outpatient,,,4030.86,2161.5,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,207.49,652.35,Based on EAPG RVU's
MRI Breast w/ + w/o Contrast Right.,8784920,LOCAL,C8905,CPT,,,,,RT,Outpatient,,,4030.86,,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,207.49,652.35,Based on EAPG RVU's
PACEMAKER POCKET,8210140,LOCAL,33222,CPT,,,,,,Outpatient,,,4031.48,2620,Blue Cross of AL,Blue Cross,2484.2,,,,,,,Other,1496,2484.2,Based on EAPG RVU's
MRI Face Neck Orbit w/ + w/o Contrast,1168852,LOCAL,70543,CPT,,,,,,Outpatient,,,4067.02,2181.3,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
CT Maxillofacial w/ + w/o Contrast,1168182,LOCAL,70488,CPT,,,,,,Outpatient,,,4088.22,2192.03,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,162.76,461.98,Based on EAPG RVU's
"64625 Radiofrequency ablation, nerves innervating the SI joint",5661090,LOCAL,64625,CPT,,,,,,Outpatient,,,4100,2665,Blue Cross of AL,Blue Cross,2010.86,,,,,,,Other,1785.34,2315,Based on EAPG RVU's
CT Abdomen and Pelvis w/ Contrast,2424647,LOCAL,74177,CPT,,,,,,Outpatient,,,4142.9,2221.73,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
CT Abdomen and Pelvis w/ Contrast + Oral,13452969,LOCAL,74177,CPT,,,,,,Outpatient,,,4142.9,2221.73,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
95808 SLEEP STAGING CHARGE,13485403,LOCAL,95808,CPT,,,,,,Outpatient,,,4155.71,2701,Blue Cross of AL,Blue Cross,1113.98,,,,,,,Other,930.16,1113.98,Based on EAPG RVU's
"Beta Amyloid 42/40 Ratio, CSF QST",13873765,LOCAL,82542,CPT,,,,,,Outpatient,,,4168.13,28.91,Blue Cross of AL,Blue Cross,17.73,,,,,,,Other,17.73,24.09,Based on EAPG RVU's
INSERTION OF INTRAPERITONEAL CATHETER,8267131,LOCAL,49418,CPT,,,,,,Outpatient,,,4189,2723,Blue Cross of AL,Blue Cross,5444.44,,,,,,,Other,2599,5444.44,Based on EAPG RVU's
US Insert Tun IP Cath Perc,10460131,LOCAL,49418,CPT,,,,,,Outpatient,,,4189,2723,Blue Cross of AL,Blue Cross,5444.44,,,,,,,Other,2599,5444.44,Based on EAPG RVU's
MRI Breast w/ + w/o Contrast Bilateral.,8145272,LOCAL,77049,CPT,,,,,,Outpatient,,,4351.43,2333.1,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,204.56,652.35,Based on EAPG RVU's
IR Nephro Plcmt New Access W Cath,8267190,LOCAL,50432,CPT,,,,,,Outpatient,,,4351.75,2829,Blue Cross of AL,Blue Cross,2206.55,,,,,,,Other,1872.87,2315,Based on EAPG RVU's
NEPHROSTOGRAM CATHETER PLACEMENT S&I,8267190,LOCAL,50432,CPT,,,,,,Outpatient,,,4351.75,2829,Blue Cross of AL,Blue Cross,2206.55,,,,,,,Other,1872.87,2315,Based on EAPG RVU's
EXCHANGE NEPHROSTOMY TUBE,8212021,LOCAL,50435,CPT,,,,,,Outpatient,,,4357.87,2833,Blue Cross of AL,Blue Cross,2206.55,,,,,,,Other,1291,2206.55,Based on EAPG RVU's
ACTIGRAFT PRO-RD2301,10510000,LOCAL,,,G0460,HCPCS,,,,Outpatient,,,4400,,Blue Cross of AL,Blue Cross,1466.58,,,,,,,Other,1466.58,1672.39,Based on EAPG RVU's
MRI Brain + IAC w/ + w/o Contrast,9427798,LOCAL,70553,CPT,,,,,,Outpatient,,,4403.72,2361.15,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Brain w/ + w/o Contrast,1168796,LOCAL,70553,CPT,,,,,,Outpatient,,,4403.72,2361.15,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
MRI Pituitary w/ + w/o Contrast,8058740,LOCAL,70553,CPT,,,,,,Outpatient,,,4403.72,2361.15,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
PULMONARY UNILATERAL S&I,8210600,LOCAL,75741,CPT,,,,,,Outpatient,,,4485,2404.88,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2669.67,2877.63,Based on EAPG RVU's
VENOUS SAMPLING WO/W ANGIO,8210720,LOCAL,75893,CPT,,,,,,Outpatient,,,4485,2404.88,Blue Cross of AL,Blue Cross,6018.68,,,,,,,Other,4942.22,6018.68,Based on EAPG RVU's
VISCERAL S&I,8210570,LOCAL,75726,CPT,,,,,,Outpatient,,,4485,2404.88,Blue Cross of AL,Blue Cross,6018.68,,,,,,,Other,4942.22,6018.68,Based on EAPG RVU's
CT Angio Abdomen and Pelvis,2424686,LOCAL,74174,CPT,,,,,,Outpatient,,,4538.98,2433.75,Blue Cross of AL,Blue Cross,565.59,,,,,,,Other,326.51,565.59,Based on EAPG RVU's
PTA URETERAL STRICTURE WITH IMAGING,8267792,LOCAL,50706,CPT,,,,,,Outpatient,,,4747.36,3086,Blue Cross of AL,Blue Cross,10138.5,,,,,,,Other,147.16,10138.5,Based on EAPG RVU's
MRI Spine Cervical w/ + w/o Contrast,1169050,LOCAL,72156,CPT,,,,,,Outpatient,,,4747.92,2545.95,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
CT Abdomen and Pelvis w/ + w/o Contrast,2424644,LOCAL,74178,CPT,,,,,,Outpatient,,,4826.55,2588.03,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
CT Urogram,8203051,LOCAL,74178,CPT,,,,,,Outpatient,,,4826.55,2588.03,Blue Cross of AL,Blue Cross,461.98,,,,,,,Other,326.51,461.98,Based on EAPG RVU's
NM Inflammation Loc Spect,1169158,LOCAL,78803,CPT,,,,,,Outpatient,,,5051.75,1181.4,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,1193.55,1409.71,Based on EAPG RVU's
antivenin (Crotalidae equine) polyvalent intravenous injection [CULL],11250856,LOCAL,J0841,CPT,,,,,,Outpatient,1,EA,5068.8,,Blue Cross of AL,Blue Cross,11608.84,,,,,,,Other,1045.15,11608.84,Based on EAPG RVU's
tocilizumab 20 mg/mL Sol 10 mL [CULL],11260565,LOCAL,J3262,CPT,,,,,,Outpatient,10,ML,5099.1744,,Blue Cross of AL,Blue Cross,1641.22,,,,,,,Other,5.71,1641.22,Based on EAPG RVU's
MRI Spine Thoracic w/ + w/o Contrast,1169062,LOCAL,72157,CPT,,,,,,Outpatient,,,5102.75,2736.53,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
CATH LAB INSERTION OF PLEURAL CATHETER,8230067,LOCAL,32550,CPT,,,,,,Outpatient,,,5132.46,3336,Blue Cross of AL,Blue Cross,1392.67,,,,,,,Other,1392.67,3226.48,Based on EAPG RVU's
95782 PEDI POLYSOMNOGRAPHY (<6YO) CHARGE,9303178,LOCAL,95782,CPT,,,,,,Outpatient,,,5141.48,3342,Blue Cross of AL,Blue Cross,1113.98,,,,,,,Other,930.16,1113.98,Based on EAPG RVU's
95810 POLYSOMNOGRAPHY CHARGE.,8303749,LOCAL,95810,CPT,,,,,,Outpatient,,,5141.48,3342,Blue Cross of AL,Blue Cross,1113.98,,,,,,,Other,930.16,1113.98,Based on EAPG RVU's
NM Cardiac Amyloid PYP Spect,9955566,LOCAL,78803,CPT,A9538,HCPCS,,,,Outpatient,,,5230.76,1181.4,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,1193.55,1409.71,Based on EAPG RVU's
MRI Spine Lumbar w/ + w/o Contrast,1169056,LOCAL,72158,CPT,,,,,,Outpatient,,,5301.01,2842.95,Blue Cross of AL,Blue Cross,652.35,,,,,,,Other,326.51,652.35,Based on EAPG RVU's
95783 POLYSOM <6 YRS SLP W/CPAP CHARGE,10732463,LOCAL,95783,CPT,,,,,,Outpatient,,,5349.1,3477,Blue Cross of AL,Blue Cross,1113.98,,,,,,,Other,930.16,1113.98,Based on EAPG RVU's
NM Inflammation Loc Whole Body - Ceretec,1169152,LOCAL,78802,CPT,A9521,HCPCS,,,,Outpatient,,,5351.75,2870.18,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,802.34,1409.71,Based on EAPG RVU's
NM Inflammation Loc Limited - Indium,1169148,LOCAL,78801,CPT,,,,,,Outpatient,,,5399.5,2895.75,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,367.38,1409.71,Based on EAPG RVU's
NM Inflammation Loc Multi,12113627,LOCAL,78801,CPT,,,,,,Outpatient,,,5399.5,2895.75,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,367.38,1409.71,Based on EAPG RVU's
THROMBECTOMY VENOUS ADDL,8210394,LOCAL,37188,CPT,,,,,,Outpatient,,,5419.5,3523,Blue Cross of AL,Blue Cross,5228.12,,,,,,,Other,2599,5228.12,Based on EAPG RVU's
NEW ACCESS NEPHROSTOMY TUBE,8200537,LOCAL,50433,CPT,,,,,,Outpatient,,,5454.2,3545,Blue Cross of AL,Blue Cross,4301.28,,,,,,,Other,2315,4301.28,Based on EAPG RVU's
PTA RENAL ARTERY (ADD'L),8210240,LOCAL,37247,CPT,,,,,,Outpatient,,,5488.12,3567,Blue Cross of AL,Blue Cross,8616.54,,,,,,,Other,140.82,8616.54,Based on EAPG RVU's
27603 DRAIN LOWER LEG LESION,13043453,LOCAL,27603,CPT,,,,,LT,Outpatient,,,5526.21,3592,Blue Cross of AL,Blue Cross,2550.42,,,,,,,Other,2315,2616.66,Based on EAPG RVU's
NM Myocardial Planar Rest and Stress,2425972,LOCAL,78454,CPT,A9500,HCPCS,,,,Outpatient,,,5593.52,2999.7,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,1193.55,1409.71,Based on EAPG RVU's
REVISION REPLACE GENERATOR  BLADDER,8268108,LOCAL,64595,CPT,,,,,,Outpatient,,,5690.13,3699,Blue Cross of AL,Blue Cross,5487.33,,,,,,,Other,2599,5487.33,Based on EAPG RVU's
REVISION REPLACE LEAD BLADDER STIMULATOR,8268107,LOCAL,64585,CPT,,,,,,Outpatient,,,5690.13,3699,Blue Cross of AL,Blue Cross,5487.33,,,,,,,Other,2599,5487.33,Based on EAPG RVU's
INTRO AV SHUNT W S&I,8267106,LOCAL,36902,CPT,,,,,,Outpatient,,,5734.69,11107,Blue Cross of AL,Blue Cross,5228.12,,,,,,,Other,5212.67,5787,Based on EAPG RVU's
15120 SKN SPLT A-GRFT FAC/NCK/HF/G 100 SQ CM/1% BA,10006441,LOCAL,15120,CPT,,,,,,Outpatient,,,5746.86,3735,Blue Cross of AL,Blue Cross,2862.92,,,,,,,Other,2599,3347.08,Based on EAPG RVU's
REPOSITION IVC FILTER,8267129,LOCAL,37192,CPT,,,,,,Outpatient,,,5771.49,3751,Blue Cross of AL,Blue Cross,5228.12,,,,,,,Other,2599,5228.12,Based on EAPG RVU's
VENOUS PTA EACH ADD'L,8267100,LOCAL,37249,CPT,,,,,,Outpatient,,,5876.95,3820,Blue Cross of AL,Blue Cross,8616.54,,,,,,,Other,118.76,8616.54,Based on EAPG RVU's
Central Line Access Type. -> Tunneled,13449753,LOCAL,36810,CPT,,,,,,Outpatient,,,5960.36,3874,Blue Cross of AL,Blue Cross,3211.33,,,,,,,Other,2599,3211.33,Based on EAPG RVU's
prothrombin complex - Pow [CULL],11220535,LOCAL,J7168,CPT,,,,,,Outpatient,1,EA,6048,,Blue Cross of AL,Blue Cross,3347.61,,,,,,,Other,2.14,3347.61,Based on EAPG RVU's
immune globulin (Octagam) 10% intravenous solution 20 gL [CULL],11205110,LOCAL,J1599,CPT,,,,,,Outpatient,200,ML,6092.8,,Blue Cross of AL,Blue Cross,1641.22,,,,,,,Other,1641.22,1641.22,Based on EAPG RVU's
33215 Reposition Pacing Defibrillator Lead,8212027,LOCAL,33215,CPT,,,,,,Outpatient,,,6104.24,3968,Blue Cross of AL,Blue Cross,2484.2,,,,,,,Other,2484.2,2877.63,Based on EAPG RVU's
ICD REMOVAL ONLY,8231005,LOCAL,33241,CPT,,,,,,Outpatient,,,6104.24,3968,Blue Cross of AL,Blue Cross,10220.8,,,,,,,Other,2599,10220.8,Based on EAPG RVU's
EXTREMITY UNILATERAL S&I,8210530,LOCAL,75710,CPT,,,,,,Outpatient,,,6132.32,3288.45,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2669.67,2877.63,Based on EAPG RVU's
XR Angio Extremity in OR SI Left,2425383,LOCAL,75710,CPT,,,,,LT,Outpatient,,,6132.32,3288.45,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2669.67,2877.63,Based on EAPG RVU's
XR Angio Extremity in OR SI Right,2425386,LOCAL,75710,CPT,,,,,RT,Outpatient,,,6132.32,3288.45,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2669.67,2877.63,Based on EAPG RVU's
immune globulin intravenous and subcutaneous 10% injectable solution 100 mL [CULL],11205089,LOCAL,J1561,CPT,,,,,,Outpatient,100,ML,6199.68,,Blue Cross of AL,Blue Cross,2110.36,,,,,,,Other,48.96,2110.36,Based on EAPG RVU's
TRANSCATH THER.ART.INF.(FINAL DAY),8210027,LOCAL,37214,CPT,,,,,,Outpatient,,,6313.68,4104,Blue Cross of AL,Blue Cross,5228.12,,,,,,,Other,1291,5228.12,Based on EAPG RVU's
93503 INSERTION OF SWAN GANZ CHARGE,8210870,LOCAL,93503,CPT,,,,,,Outpatient,,,6394.68,4157,Blue Cross of AL,Blue Cross,1644.1,,,,,,,Other,1291,1644.1,Based on EAPG RVU's
PA CATHETER SV02,4221129,LOCAL,93503,CPT,,,,,,Outpatient,,,6394.68,4157,Blue Cross of AL,Blue Cross,1644.1,,,,,,,Other,1291,1644.1,Based on EAPG RVU's
immune globulin (Privigen) 10% intravenous solution 10 g [CULL],11205115,LOCAL,J1599,CPT,,,,,,Outpatient,100,ML,6430.848,,Blue Cross of AL,Blue Cross,1641.22,,,,,,,Other,1641.22,1641.22,Based on EAPG RVU's
GENERATOR REMOVAL ONLY,8210160,LOCAL,33233,CPT,,,,,,Outpatient,,,6446.76,4190,Blue Cross of AL,Blue Cross,10220.8,,,,,,,Other,2599,10220.8,Based on EAPG RVU's
fomepizole 1 g/mL intravenous solution 1.5 mL [CULL],11290124,LOCAL,J1451,CPT,,,,,,Outpatient,1.5,ML,6649.376,,Blue Cross of AL,Blue Cross,525.49,,,,,,,Other,6.28,525.49,Based on EAPG RVU's
NM Myocardial SPECT Drug Stress Multi,8567792,LOCAL,78452,CPT,,,,,,Outpatient,,,6759.97,3625.05,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,1193.55,1409.71,Based on EAPG RVU's
NM Myocardial SPECT Rest and Stress,2425975,LOCAL,78452,CPT,,,,,,Outpatient,,,6759.97,3625.05,Blue Cross of AL,Blue Cross,1409.71,,,,,,,Other,1193.55,1409.71,Based on EAPG RVU's
dalbavancin 500 mg Pow [CULL],11287452,LOCAL,J0875,CPT,,,,,,Outpatient,1,UN,6831.8592,4440,Blue Cross of AL,Blue Cross,5685.74,,,,,,,Other,0.21,5685.74,Based on EAPG RVU's
PERC URETERAL STENT REMOVAL & REPLACE,8210741,LOCAL,50382,CPT,,,,,,Outpatient,,,6922.86,4500,Blue Cross of AL,Blue Cross,2206.55,,,,,,,Other,1872.87,2315,Based on EAPG RVU's
"BRCAvantage(R), Comprehensive QSTC",9039435,LOCAL,81162,CPT,,,,,,Outpatient,,,7200,2189.86,Blue Cross of AL,Blue Cross,590.67,,,,,,,Other,590.67,1824.88,Based on EAPG RVU's
THROMBECTOMY ARTERIAL SECONDARY PERC,8210390,LOCAL,37186,CPT,,,,,,Outpatient,,,7383.75,4799,Blue Cross of AL,Blue Cross,16037.41,,,,,,,Other,199.65,16037.41,Based on EAPG RVU's
"15100 AUTO-SPLIT THICK T/A/L, 1ST 100 SQCM CHARGE",12816476,LOCAL,15100,CPT,,,,,,Outpatient,,,7387.97,4802,Blue Cross of AL,Blue Cross,2862.92,,,,,,,Other,1496,2862.92,Based on EAPG RVU's
THROMBECTOMY VENOUS PRIMARY,8210393,LOCAL,37187,CPT,,,,,,Outpatient,,,7579,4926,Blue Cross of AL,Blue Cross,5228.12,,,,,,,Other,5228.12,10368.23,Based on EAPG RVU's
EXCHANGE OF BILIARY DRAIN CATH,8267769,LOCAL,47536,CPT,,,,,,Outpatient,,,7882.57,5124,Blue Cross of AL,Blue Cross,3682.65,,,,,,,Other,2599,3682.65,Based on EAPG RVU's
PLACEMENT BILIARY DRAIN CATH INT/EXT,8201219,LOCAL,47534,CPT,,,,,,Outpatient,,,7882.57,5124,Blue Cross of AL,Blue Cross,3682.65,,,,,,,Other,2599,3682.65,Based on EAPG RVU's
36253 Insertion Of Cath Renal Arterial 2Nd Unilateral,8212045,LOCAL,36253,CPT,,,,,,Outpatient,,,8050.63,5233,Blue Cross of AL,Blue Cross,6018.68,,,,,,,Other,4942.22,6018.68,Based on EAPG RVU's
CERVICOCEREBRAL S&I,8201615,LOCAL,36221,CPT,,,,,,Outpatient,,,8050.63,5233,Blue Cross of AL,Blue Cross,6018.68,,,,,,,Other,2599,6018.68,Based on EAPG RVU's
COMMON CAROTID UNI S&I,8201600,LOCAL,36223,CPT,,,,,,Outpatient,,,8050.63,5233,Blue Cross of AL,Blue Cross,6018.68,,,,,,,Other,4942.22,6018.68,Based on EAPG RVU's
EXTERNAL CAROTID UNI S&I,8201610,LOCAL,36222,CPT,,,,,,Outpatient,,,8050.63,5233,Blue Cross of AL,Blue Cross,6018.68,,,,,,,Other,2599,6018.68,Based on EAPG RVU's
INFERIOR VENA CAVA S&I,8210660,LOCAL,75825,CPT,,,,,,Outpatient,,,8050.63,4317.23,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2669.67,2877.63,Based on EAPG RVU's
IR Angio Pulmonary Bilateral,7949335,LOCAL,75743,CPT,,,,,,Outpatient,,,8050.63,4317.23,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2669.67,2877.63,Based on EAPG RVU's
PULMONARY BILATERAL S&I,8210610,LOCAL,75743,CPT,,,,,,Outpatient,,,8050.63,4317.23,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2669.67,2877.63,Based on EAPG RVU's
RENAL UNILATERAL PLACEMENT & SI,8210550,LOCAL,36251,CPT,,,,,,Outpatient,,,8050.63,5233,Blue Cross of AL,Blue Cross,6018.68,,,,,,,Other,2599,6018.68,Based on EAPG RVU's
VERTEBRAL SUBCLAVIAN OR INNOMINATE,8201625,LOCAL,36225,CPT,,,,,,Outpatient,,,8050.63,5233,Blue Cross of AL,Blue Cross,6018.68,,,,,,,Other,2599,6018.68,Based on EAPG RVU's
XR Venogram Cava Inferior,10386826,LOCAL,75825,CPT,,,,,,Outpatient,,,8050.63,4317.23,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2669.67,2877.63,Based on EAPG RVU's
25040 FOREIGN BODY REMOVAL FOREARM LEFT,13416875,LOCAL,25040,CPT,,,,,LT,Outpatient,,,8076.78,5250,Blue Cross of AL,Blue Cross,2528.75,,,,,,,Other,2528.75,2966.42,Based on EAPG RVU's
FOREIGN BODY RETRIEVAL,8201630,LOCAL,37197,CPT,,,,,,Outpatient,,,8080.32,5252,Blue Cross of AL,Blue Cross,5228.12,,,,,,,Other,2599,5228.12,Based on EAPG RVU's
FOREIGN BODY RETRIEVAL S&I,8201635,LOCAL,37197,CPT,,,,,,Outpatient,,,8080.32,5252,Blue Cross of AL,Blue Cross,5228.12,,,,,,,Other,2599,5228.12,Based on EAPG RVU's
REMOVAL IVC FILTER,8267130,LOCAL,37193,CPT,,,,,,Outpatient,,,8080.32,5252,Blue Cross of AL,Blue Cross,5228.12,,,,,,,Other,2599,5228.12,Based on EAPG RVU's
PERC INTRO CATH/STENT URETERAL PREEXIST,8200532,LOCAL,50693,CPT,,,,,,Outpatient,,,8122.9,5280,Blue Cross of AL,Blue Cross,4301.28,,,,,,,Other,2599,4301.28,Based on EAPG RVU's
PERC INTRO URETERAL NEW ACCESS W CATH,8200534,LOCAL,50695,CPT,,,,,,Outpatient,,,8122.9,5280,Blue Cross of AL,Blue Cross,4301.28,,,,,,,Other,2599,4301.28,Based on EAPG RVU's
PERC INTRO URETERAL NEW ACCESS WO CATH,8200533,LOCAL,50694,CPT,,,,,,Outpatient,,,8122.9,5280,Blue Cross of AL,Blue Cross,4301.28,,,,,,,Other,2599,4301.28,Based on EAPG RVU's
VERTEBROPLASTY ADDL THOR/LUMB,8267765,LOCAL,22512,CPT,,,,,,Outpatient,,,8365.99,5438,Blue Cross of AL,Blue Cross,6803.47,,,,,,,Other,167.55,6803.47,Based on EAPG RVU's
VERTEBROPLASTY LUMBAR,8211170,LOCAL,22511,CPT,,,,,,Outpatient,,,8365.99,5438,Blue Cross of AL,Blue Cross,6803.47,,,,,,,Other,2599,6803.47,Based on EAPG RVU's
VERTEBROPLASTY THORACIC,8211160,LOCAL,22510,CPT,,,,,,Outpatient,,,8365.99,5438,Blue Cross of AL,Blue Cross,6803.47,,,,,,,Other,2599,6803.47,Based on EAPG RVU's
RENAL BILATERAL PLACEMENT & SI,8210560,LOCAL,36252,CPT,,,,,,Outpatient,,,8539.16,5550,Blue Cross of AL,Blue Cross,6018.68,,,,,,,Other,2599,6018.68,Based on EAPG RVU's
93452 Left Heart Cath,8230003,LOCAL,93452,CPT,,,,,,Outpatient,,,8778,5706,Blue Cross of AL,Blue Cross,3441.53,,,,,,,Other,2940.64,4325,Based on EAPG RVU's
TEMP SACRAL ELECTRODE WITH IMAGING,8268102,LOCAL,64561,CPT,,,,,,Outpatient,,,8900,5785,Blue Cross of AL,Blue Cross,8672.71,,,,,,,Other,5787,8672.71,Based on EAPG RVU's
27372 FOREIGN BODY REMOVAL KNEE,13435628,LOCAL,27372,CPT,,,,,,Outpatient,,,8946.89,5815,Blue Cross of AL,Blue Cross,2550.42,,,,,,,Other,2315,2616.66,Based on EAPG RVU's
75630-IR Aortogram Abdominal + Iliofemoral1,8071871,LOCAL,75630,CPT,,,,,,Outpatient,,,9016.7,4835.33,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2669.67,2877.63,Based on EAPG RVU's
AORTO ABD+ILIOFEMORAL SERIAL,8210430,LOCAL,75630,CPT,,,,,,Outpatient,,,9016.7,4835.33,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2669.67,2877.63,Based on EAPG RVU's
AORTOGRAM THORACIC S&I,8210410,LOCAL,75605,CPT,,,,,,Outpatient,,,9016.7,4835.33,Blue Cross of AL,Blue Cross,6018.68,,,,,,,Other,4942.22,6018.68,Based on EAPG RVU's
EXTREMITY BILATERAL S&I,8210540,LOCAL,75716,CPT,,,,,,Outpatient,,,9016.7,4835.33,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2669.67,2877.63,Based on EAPG RVU's
IR Aortogram Thoracic w/ Serialography,7949377,LOCAL,75605,CPT,,,,,,Outpatient,,,9016.7,4835.33,Blue Cross of AL,Blue Cross,6018.68,,,,,,,Other,4942.22,6018.68,Based on EAPG RVU's
XR Angio Extremity in OR SI Bilat,9343676,LOCAL,75716,CPT,,,,,,Outpatient,,,9016.7,4835.33,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2669.67,2877.63,Based on EAPG RVU's
20240 BIOPSY BONE EXCISIONAL SUPERFI CHARGE,8020082,LOCAL,20240,CPT,,,,,,Outpatient,,,9171.4,5961,Blue Cross of AL,Blue Cross,2550.42,,,,,,,Other,2315,2616.66,Based on EAPG RVU's
20240-BIOPSY BONE EXCISIONAL SUPERFI CHARGE,8020082,LOCAL,20240,CPT,,,,,,Outpatient,,,9171.4,5961,Blue Cross of AL,Blue Cross,2550.42,,,,,,,Other,2315,2616.66,Based on EAPG RVU's
"93451 Catheterization, Right Heart",8230000,LOCAL,93451,CPT,,,,,,Outpatient,,,9609.02,6246,Blue Cross of AL,Blue Cross,3441.53,,,,,,,Other,2940.64,4325,Based on EAPG RVU's
93453 Combined Left and Right Heart Cath,8230006,LOCAL,93453,CPT,,,,,,Outpatient,,,9609.02,6246,Blue Cross of AL,Blue Cross,3441.53,,,,,,,Other,2940.64,4325,Based on EAPG RVU's
THROMBECTOMY ARTERIAL ADDL,8210392,LOCAL,37185,CPT,,,,,,Outpatient,,,9751.88,6339,Blue Cross of AL,Blue Cross,8616.54,,,,,,,Other,130.9,8616.54,Based on EAPG RVU's
93454 HT Left Heart Cath WO LV,8210890,LOCAL,93454,CPT,,,,,,Outpatient,,,9833.36,6392,Blue Cross of AL,Blue Cross,3441.53,,,,,,,Other,2940.64,4325,Based on EAPG RVU's
92973 PTC Thromebectomy Add On,8200030,LOCAL,92973,CPT,,,,,,Outpatient,,,9838.19,6395,Blue Cross of AL,Blue Cross,12572.64,,,,,,,Other,74.32,12572.64,Based on EAPG RVU's
TRANSCATH THER ART INFUSION FOR THROM,8210026,LOCAL,37211,CPT,,,,,,Outpatient,,,10140.58,6591,Blue Cross of AL,Blue Cross,5228.12,,,,,,,Other,4942.22,5787,Based on EAPG RVU's
CATH LAB IVC FILTER PLACEMENT,8210330,LOCAL,37191,CPT,,,,,,Outpatient,,,10180.79,6618,Blue Cross of AL,Blue Cross,5228.12,,,,,,,Other,4942.22,5787,Based on EAPG RVU's
INSERTION IVC FILTER,8267128,LOCAL,37191,CPT,,,,,,Outpatient,,,10180.79,6618,Blue Cross of AL,Blue Cross,5228.12,,,,,,,Other,4942.22,5787,Based on EAPG RVU's
PERC PLACE IVC FILTER S&I,8210740,LOCAL,37191,CPT,,,,,,Outpatient,,,10180.79,6618,Blue Cross of AL,Blue Cross,5228.12,,,,,,,Other,4942.22,5787,Based on EAPG RVU's
leuprolide 45 mg/6 months Pow [CULL],11299002,LOCAL,J9217,CPT,,,,,,Outpatient,1,ML,10406.8992,,Blue Cross of AL,Blue Cross,733.68,,,,,,,Other,176.45,733.68,Based on EAPG RVU's
THROMBECTOMY ARTERIAL PRIMARY,8210391,LOCAL,37184,CPT,,,,,,Outpatient,,,10806,7024,Blue Cross of AL,Blue Cross,8616.54,,,,,,,Other,5787,16417.11,Based on EAPG RVU's
AORTOGRAM ABDOMEN S&I,8210420,LOCAL,75625,CPT,,,,,,Outpatient,,,10898.6,5844.3,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2669.67,2877.63,Based on EAPG RVU's
IR Aortogram Abdominal w/ Serialography1,8071874,LOCAL,75625,CPT,,,,,,Outpatient,,,10898.6,5844.3,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2669.67,2877.63,Based on EAPG RVU's
XR Aorta Abdomen Catheter in OR SI,2425389,LOCAL,75625,CPT,,,,,,Outpatient,,,10898.6,5844.3,Blue Cross of AL,Blue Cross,2669.67,,,,,,,Other,2669.67,2877.63,Based on EAPG RVU's
TRANSCATH STENT CERV CAROTID WITH DEVICE,8210025,LOCAL,37215,CPT,,,,,,Outpatient,,,11474.94,7459,Blue Cross of AL,Blue Cross,16429.41,,,,,,,Other,802.87,16429.41,Based on EAPG RVU's
VERTEBRAL CERVICAL/CRANIAL S&I,8201620,LOCAL,36226,CPT,,,,,,Outpatient,,,11520.61,7488,Blue Cross of AL,Blue Cross,6018.68,,,,,,,Other,4942.22,6018.68,Based on EAPG RVU's
LEAD REPLACEMENT DUAL,8210110,LOCAL,33217,CPT,,,,,,Outpatient,,,11951.06,7768,Blue Cross of AL,Blue Cross,2484.2,,,,,,,Other,2484.2,7566.4,Based on EAPG RVU's
LEAD REPLACEMENT SGL,8210100,LOCAL,33216,CPT,,,,,,Outpatient,,,11951.06,7768,Blue Cross of AL,Blue Cross,2484.2,,,,,,,Other,2484.2,7566.4,Based on EAPG RVU's
calcitonin 200 intl units/mL Sol [CULL],J0630,CPT,,,,,,,,Outpatient,200,ML,12023.04,,Blue Cross of AL,Blue Cross,2110.36,,,,,,,Other,484.97,2110.36,Based on EAPG RVU's
93455 HT Left Cath W Cor Inj WO LV,8230002,LOCAL,93455,CPT,,,,,,Outpatient,,,12026.07,7817,Blue Cross of AL,Blue Cross,3441.53,,,,,,,Other,2940.64,4325,Based on EAPG RVU's
immune globulin intravenous and subcutaneous 10% injectable solution 200 mL [CULL],11205107,LOCAL,J1561,CPT,,,,,,Outpatient,200,ML,12399.36,,Blue Cross of AL,Blue Cross,2110.36,,,,,,,Other,48.96,2110.36,Based on EAPG RVU's
93458 HT Cath Left W LV and Cor Angio,8230004,LOCAL,93458,CPT,,,,,,Outpatient,,,12512.89,8133,Blue Cross of AL,Blue Cross,3441.53,,,,,,,Other,2940.64,4325,Based on EAPG RVU's
93460 HT Cath L or R W LV and Cor Angio,8230007,LOCAL,93460,CPT,,,,,,Outpatient,,,12512.89,8133,Blue Cross of AL,Blue Cross,3441.53,,,,,,,Other,2940.64,4325,Based on EAPG RVU's
33210 INSERTION TEMP PACEMAKER SINGLE CHAMBER CHARGE,13707085,LOCAL,33210,CPT,,,,,,Outpatient,,,12542.69,8153,Blue Cross of AL,Blue Cross,2484.2,,,,,,,Other,2484.2,7566.4,Based on EAPG RVU's
TEMP PACEMAKER SGL CHAMBER,8210050,LOCAL,33210,CPT,,,,,,Outpatient,,,12542.69,8153,Blue Cross of AL,Blue Cross,2484.2,,,,,,,Other,2484.2,7566.4,Based on EAPG RVU's
92920 PTCA 1st Vessel,8201256,LOCAL,92920,CPT,,,,,,Outpatient,,,12766.62,8298,Blue Cross of AL,Blue Cross,12572.64,,,,,,,Other,5212.67,12572.64,Based on EAPG RVU's
PTA RENAL ARTERY (INITIAL),8267124,LOCAL,37246,CPT,,,,,,Outpatient,,,12766.62,17592,Blue Cross of AL,Blue Cross,5228.12,,,,,,,Other,5212.67,5787,Based on EAPG RVU's
immune globulin (Privigen) 10% intravenous solution 20 g [CULL],11205116,LOCAL,J1599,CPT,,,,,,Outpatient,200,ML,12861.696,,Blue Cross of AL,Blue Cross,1641.22,,,,,,,Other,1641.22,1641.22,Based on EAPG RVU's
93459 HT Cath Left W LV and Cor Grf Angio,8230005,LOCAL,93459,CPT,,,,,,Outpatient,,,13484.51,8765,Blue Cross of AL,Blue Cross,3441.53,,,,,,,Other,2940.64,4325,Based on EAPG RVU's
93461 HT Cath L or R W LV Cor Grf Angio,8230008,LOCAL,93461,CPT,,,,,,Outpatient,,,13484.51,8765,Blue Cross of AL,Blue Cross,3441.53,,,,,,,Other,2940.64,4325,Based on EAPG RVU's
riTUXimab pvvr 10 mg/mL Sol 50 mL [CULL],11211085,LOCAL,Q5119,CPT,,,,,,Outpatient,50,ML,13762.56,,Blue Cross of AL,Blue Cross,7537.07,,,,,,,Other,27.85,7537.07,Based on EAPG RVU's
"C1 esterase inhibitor, human 500 intl units intravenous kit [CULL]",11201256,LOCAL,J0597,CPT,,,,,,Outpatient,1,EA,13903.4496,,Blue Cross of AL,Blue Cross,5685.74,,,,,,,Other,75.86,5685.74,Based on EAPG RVU's
ATHERECTOMY ABD AORTA,8230043,LOCAL,0236T,CPT,,,,,,Outpatient,,,14443,9388,Blue Cross of AL,Blue Cross,16037.41,,,,,,,Other,6417,16037.41,Based on EAPG RVU's
ATHERECTOMY BRACHIOCEPHALIC & BRANCHES,8230044,LOCAL,0237T,CPT,,,,,,Outpatient,,,14443,9388,Blue Cross of AL,Blue Cross,16037.41,,,,,,,Other,6417,16037.41,Based on EAPG RVU's
ATHERECTOMY ILIAC EACH,8230045,LOCAL,0238T,CPT,,,,,,Outpatient,,,14443,12175,Blue Cross of AL,Blue Cross,16037.41,,,,,,,Other,6417,16417.11,Based on EAPG RVU's
ATHERECTOMY RENAL,8230041,LOCAL,0234T,CPT,,,,,,Outpatient,,,14443,9388,Blue Cross of AL,Blue Cross,26140.53,,,,,,,Other,6417,26140.53,Based on EAPG RVU's
ATHERECTOMY VISCERAL,8230042,LOCAL,0235T,CPT,,,,,,Outpatient,,,14443,9388,Blue Cross of AL,Blue Cross,8616.54,,,,,,,Other,515.34,8616.54,Based on EAPG RVU's
INTERNAL CAROTID UNI S&I,8201636,LOCAL,36224,CPT,,,,,,Outpatient,,,14812.21,9628,Blue Cross of AL,Blue Cross,6018.68,,,,,,,Other,4942.22,6018.68,Based on EAPG RVU's
37239 STENT ANGIO VEIN EA ADDL CHARGE,8230063,LOCAL,37239,CPT,,,,,,Outpatient,,,15683.4,10194,Blue Cross of AL,Blue Cross,16037.41,,,,,,,Other,121.17,16037.41,Based on EAPG RVU's
ARTERY STENT ADD'L (NONCORONARY),8230061,LOCAL,37237,CPT,,,,,,Outpatient,,,15683.4,10194,Blue Cross of AL,Blue Cross,16037.41,,,,,,,Other,171.21,16037.41,Based on EAPG RVU's
93456 Right Heart Catheterization With Angiography,8230009,LOCAL,93456,CPT,,,,,,Outpatient,,,16019.61,10413,Blue Cross of AL,Blue Cross,3441.53,,,,,,,Other,2940.64,4325,Based on EAPG RVU's
33285 Implant Pt Activated Cardiac Event Recorder,8267776,LOCAL,33285,CPT,,,,,,Outpatient,,,16029.82,10419,Blue Cross of AL,Blue Cross,12132.94,,,,,,,Other,6417,12132.94,Based on EAPG RVU's
92928 Trnscath Plcmnt Metal Single,8201254,LOCAL,92928,CPT,,,,,,Outpatient,,,16620.58,10803,Blue Cross of AL,Blue Cross,12572.64,,,,,,,Other,5787,12572.64,Based on EAPG RVU's
alteplase 50 mg intravenous injection [CULL],11201048,LOCAL,J2997,CPT,,,,,,Outpatient,1,ML,16896.704,,Blue Cross of AL,Blue Cross,122.4,,,,,,,Other,94.45,122.4,Based on EAPG RVU's
93457 Right or Left Heart Cath with No LV Gram Charge,8230010,LOCAL,93457,CPT,,,,,,Outpatient,,,16991.23,11044,Blue Cross of AL,Blue Cross,3441.53,,,,,,,Other,2940.64,4325,Based on EAPG RVU's
AV FISTULAGRAM WITH ANGIOPLASTY,8210331,LOCAL,36902,CPT,,,,,,Outpatient,,,17087.76,11107,Blue Cross of AL,Blue Cross,5228.12,,,,,,,Other,5212.67,5787,Based on EAPG RVU's
"C9764 Revasculation, Endovascular, With Intravascular Lithotripsy, Includes Angioplasty",8230070,LOCAL,,,C9764,HCPCS,,,,Outpatient,,,17339,11270,Blue Cross of AL,Blue Cross,5228.12,,,,,,,Other,5228.12,10368.23,Based on EAPG RVU's
digoxin immune FAB 40 mg intravenous injection [CULL],11201675,LOCAL,J1162,CPT,,,,,,Outpatient,1,EA,17660.16,,Blue Cross of AL,Blue Cross,7537.07,,,,,,,Other,5168.23,7537.07,Based on EAPG RVU's
GENERATOR ONLY SGL CHAMBER INSERTION,8210070,LOCAL,33212,CPT,,,,,,Outpatient,,,17985.84,11691,Blue Cross of AL,Blue Cross,12132.94,,,,,,,Other,6417,12132.94,Based on EAPG RVU's
PACEMAKER REMOVAL SINGLE,8210171,LOCAL,33227,CPT,,,,,,Outpatient,,,17985.84,11691,Blue Cross of AL,Blue Cross,12132.94,,,,,,,Other,6417,12132.94,Based on EAPG RVU's
immune globulin intravenous and subcutaneous 10% injectable solution 300 mL [CULL],11205109,LOCAL,J1561,CPT,,,,,,Outpatient,300,ML,18599.04,,Blue Cross of AL,Blue Cross,2110.36,,,,,,,Other,48.96,2110.36,Based on EAPG RVU's
0238T Iliac Athrectomy with or without PTA,8230069,LOCAL,0238T,CPT,,,,,,Outpatient,,,18730.19,12175,Blue Cross of AL,Blue Cross,16037.41,,,,,,,Other,6417,16417.11,Based on EAPG RVU's
INSERTION NEUROSTIMULATOR GENERATOR,8268101,LOCAL,64590,CPT,,,,,,Outpatient,,,19804,519,Blue Cross of AL,Blue Cross,30196.67,,,,,,,Other,9233,30196.67,Based on EAPG RVU's
GENERATOR REMOVAL AND REPLACEMENT DUAL,8210172,LOCAL,33228,CPT,,,,,,Outpatient,,,20984.23,13640,Blue Cross of AL,Blue Cross,12132.94,,,,,,,Other,6417,12132.94,Based on EAPG RVU's
C9604 Revasc thru Bypass Single Vessel w DES (M'care),8201640,LOCAL,,,C9604,HCPCS,,,,Outpatient,,,21116.1,13725,Blue Cross of AL,Blue Cross,12572.64,,,,,,,Other,6417,12572.64,Based on EAPG RVU's
C9605 DES Coronary Revasc CABG Each Addl,8201643,LOCAL,,,C9605,HCPCS,481,RC,,Outpatient,,,21116.1,13725,Blue Cross of AL,Blue Cross,12572.64,,,,,,,Other,863,12572.64,Based on EAPG RVU's
C9606 Revasc During MI w DES (M'care),8201641,LOCAL,,,C9606,HCPCS,481,RC,,Outpatient,,,21116.1,13725,Blue Cross of AL,Blue Cross,12572.64,,,,,,,Other,1496,12572.64,Based on EAPG RVU's
C9607 Revasc CTO Single Vessel w DES (M'care),8201642,LOCAL,,,C9607,HCPCS,,,,Outpatient,,,21116.1,13725,Blue Cross of AL,Blue Cross,12572.64,,,,,,,Other,6417,16417.11,Based on EAPG RVU's
PERQ BM STENT ADD ON  RAMUS,8201252,LOCAL,,,C9600,HCPCS,,,,Outpatient,,,21116.1,13725,Blue Cross of AL,Blue Cross,12572.64,,,,,,,Other,6417,12572.64,Based on EAPG RVU's
PERQ BM STENT INITIAL  LM,8201253,LOCAL,,,C9601,HCPCS,,,,Outpatient,,,21116.1,13725,Blue Cross of AL,Blue Cross,12572.64,,,,,,,Other,863,12572.64,Based on EAPG RVU's
TIB/PER REVASC W/ATHER ADD ON  LT,8210020,LOCAL,33206,CPT,,,,,,Outpatient,,,21534.36,13997,Blue Cross of AL,Blue Cross,12132.94,,,,,,,Other,6417,12132.94,Based on EAPG RVU's
C9772 Revasc Lithotrip Tibi/Peroneal Artery (Shockwave IVL),8230074,LOCAL,,,C9772,HCPCS,,,,Outpatient,,,22157.75,14403,Blue Cross of AL,Blue Cross,8616.54,,,,,,,Other,6417,10368.23,Based on EAPG RVU's
PTA VENOUS PERC W S&I,8267099,LOCAL,37248,CPT,,,,,,Outpatient,,,22271.43,14476,Blue Cross of AL,Blue Cross,5228.12,,,,,,,Other,5212.67,5787,Based on EAPG RVU's
VENTRICULAR PACEMAKER IMPLANT INS OR REP,8210030,LOCAL,33207,CPT,,,,,,Outpatient,,,22386.25,14551,Blue Cross of AL,Blue Cross,12132.94,,,,,,,Other,6417,12132.94,Based on EAPG RVU's
VASC EMBOLIZE OCCLUDE ARTERY,8210362,LOCAL,37242,CPT,,,,,,Outpatient,,,23819.19,15482,Blue Cross of AL,Blue Cross,16037.41,,,,,,,Other,6417,16417.11,Based on EAPG RVU's
VASC EMBOLIZE OCCLUDE BLEED,8210364,LOCAL,37244,CPT,,,,,,Outpatient,,,23819.19,15482,Blue Cross of AL,Blue Cross,16037.41,,,,,,,Other,6417,16037.41,Based on EAPG RVU's
VASC EMBOLIZE OCCLUDE ORGAN,8210363,LOCAL,37243,CPT,,,,,,Outpatient,,,23819.19,15482,Blue Cross of AL,Blue Cross,16037.41,,,,,,,Other,6417,16037.41,Based on EAPG RVU's
VASC EMBOLIZE OCCLUDE VENOUS,8210361,LOCAL,37241,CPT,,,,,,Outpatient,,,23819.19,15482,Blue Cross of AL,Blue Cross,16037.41,,,,,,,Other,6417,16037.41,Based on EAPG RVU's
37238 STENT ANGIO VEIN INITIAL CHARGE,8230062,LOCAL,37238,CPT,,,,,,Outpatient,,,24322.23,15809,Blue Cross of AL,Blue Cross,16037.41,,,,,,,Other,6417,16037.41,Based on EAPG RVU's
37236 Stent Angioplasty Artery Int,8230060,LOCAL,37236,CPT,,,,,,Outpatient,,,24565.45,15968,Blue Cross of AL,Blue Cross,16037.41,,,,,,,Other,6417,16037.41,Based on EAPG RVU's
SACRAL NERVE (TRANSFORAMINAL PLACEMENT),8268100,LOCAL,64581,CPT,,,,,,Outpatient,,,25121.42,1108,Blue Cross of AL,Blue Cross,8672.71,,,,,,,Other,6000.2,8672.71,Based on EAPG RVU's
PTA BRACHIOCEPHALIC TRUNK W S&I,8210280,LOCAL,37246,CPT,,,,,,Outpatient,,,27065.23,17592,Blue Cross of AL,Blue Cross,5228.12,,,,,,,Other,5212.67,5787,Based on EAPG RVU's
A V PACEMAKER IMPLANT INS OR REPLACE,8210040,LOCAL,33208,CPT,,,,,,Outpatient,,,27707.8,18010,Blue Cross of AL,Blue Cross,12132.94,,,,,,,Other,8379,12132.94,Based on EAPG RVU's
UPGRADE SGL DUAL LEAD/CHAMBER,8210090,LOCAL,33214,CPT,,,,,,Outpatient,,,27707.8,18010,Blue Cross of AL,Blue Cross,12132.94,,,,,,,Other,8379,12132.94,Based on EAPG RVU's
C9773 Revasc Lithotrip-Stent Tib/Peroneal Atr (Shockwave IVL),8230075,LOCAL,,,C9773,HCPCS,,,,Outpatient,,,28353.6,18430,Blue Cross of AL,Blue Cross,16037.41,,,,,,,Other,6417,16417.11,Based on EAPG RVU's
C9774 Revasc Lithotr-Ather Tib/Peroneal Atr (Shockwave IVL),8230076,LOCAL,,,C9774,HCPCS,,,,Outpatient,,,28353.6,18430,Blue Cross of AL,Blue Cross,16037.41,,,,,,,Other,6417,16417.11,Based on EAPG RVU's
C9775 Revasc Lithotr-Stent-Ather-Peroneal Atr (Shockwave IVL),8230077,LOCAL,,,C9775,HCPCS,,,,Outpatient,,,28353.6,18430,Blue Cross of AL,Blue Cross,16037.41,,,,,,,Other,6417,16417.11,Based on EAPG RVU's
"C9765 Revasculation, Endovascular, With Intravascular Lithotripsy, With Stent Placement Includes Ang",8230071,LOCAL,,,C9765,HCPCS,,,,Outpatient,,,29724,19321,Blue Cross of AL,Blue Cross,8616.54,,,,,,,Other,6417,16417.11,Based on EAPG RVU's
"C9766 Revasculation, Endovascular, With Intravascular Lithotripsy, Includes Atherectomy",8230072,LOCAL,,,C9766,HCPCS,,,,Outpatient,,,29724,19321,Blue Cross of AL,Blue Cross,8616.54,,,,,,,Other,6417,16417.11,Based on EAPG RVU's
tenecteplase 50 mg intravenous injection [CULL],11211269,LOCAL,J3101,CPT,,,,,,Outpatient,1,EA,31861.472,,Blue Cross of AL,Blue Cross,7537.07,,,,,,,Other,172.22,7537.07,Based on EAPG RVU's
alteplase 100 mg intravenous injection [CULL],11201042,LOCAL,J2997,CPT,,,,,,Outpatient,1,ML,33793.376,,Blue Cross of AL,Blue Cross,122.4,,,,,,,Other,94.45,122.4,Based on EAPG RVU's
"C9767 Revasculation, Endovascular, With Intravascular Lithotripsy, With Stent Placement And Atherect",8230073,LOCAL,,,C9767,HCPCS,,,,Outpatient,,,39850,25903,Blue Cross of AL,Blue Cross,16037.41,,,,,,,Other,6417,16417.11,Based on EAPG RVU's
ICD INSERTION WITH EXISTING SINGLE LEAD,8231000,LOCAL,33240,CPT,,,,,,Outpatient,,,51027.88,33168,Blue Cross of AL,Blue Cross,36378.11,,,,,,,Other,12499,36378.11,Based on EAPG RVU's
ICD REMOVAL&REPLACE SINGLE,8267790,LOCAL,33262,CPT,,,,,,Outpatient,,,65510.7,42582,Blue Cross of AL,Blue Cross,36378.11,,,,,,,Other,12499,36378.11,Based on EAPG RVU's
ICD REMOVAL&REPLACE DUAL LEAD,8267778,LOCAL,33263,CPT,,,,,,Outpatient,,,67510.7,43882,Blue Cross of AL,Blue Cross,36378.11,,,,,,,Other,12499,36378.11,Based on EAPG RVU's
ICD REMOVAL&REPLACE MULTIPLE,8267791,LOCAL,33264,CPT,,,,,,Outpatient,,,70510.7,45832,Blue Cross of AL,Blue Cross,36378.11,,,,,,,Other,12499,36378.11,Based on EAPG RVU's
"45300 Proctosigmoidoscopy, rigid; diagnostic, w/ or w/o collection by brushing or washing",7962380,LOCAL,45300,CPT,,,,,,Outpatient,,,198,129,Blue Cross of AL,Blue Cross,1419.32,,,,,,,Other,833.54,1419.32,Based on EAPG RVU's
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,90471,CPT,,,,,,Outpatient,,,216.15,140,Blue Cross of AL,Blue Cross,56.18,,,,,,,Other,42.18,65.07,Based on EAPG RVU's
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,G0010,CPT,,,,,,Outpatient,,,216.15,,Blue Cross of AL,Blue Cross,56.18,,,,,,,Other,42.18,65.07,Based on EAPG RVU's
"25105 ARTHROTOMY, WRIST JOINT WITH SYNOVECTOMY",14130163,LOCAL,25105,CPT,,,,,,Outpatient,,,895,3245,Blue Cross of AL,Blue Cross,2528.75,,,,,,,Other,2528.75,2966.42,Based on EAPG RVU's
PC DOPP ART BIL REST MULTIPLE/SINGLE,8230015,LOCAL,93923,CPT,,,,,26,Outpatient,,,57.19,401,Blue Cross of AL,Blue Cross,244.97,,,,,,,Other,143.05,244.97,Based on EAPG RVU's
PC DOPP ART W/TREADMILL,8230020,LOCAL,93924,CPT,,,,,26,Outpatient,,,241,302,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,143.05,161.71,Based on EAPG RVU's
PC DOPP LEA LIMITED,8230019,LOCAL,93922,CPT,,,,,26,Outpatient,,,150,265,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,117.85,161.71,Based on EAPG RVU's
PC DUP ABD RENAL COMPLETE,8200571,LOCAL,93975,CPT,,,,,26,Outpatient,,,229.11,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
PC DUP ABD RENAL LIMITED,8200581,LOCAL,93976,CPT,,,,,26,Outpatient,,,134.88,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,97.22,245.49,Based on EAPG RVU's
PC DUP AO IVC COMPLETE,8200570,LOCAL,93978,CPT,,,,,26,Outpatient,,,74.95,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
PC DUP AO IVC LIMITED,8200580,LOCAL,93979,CPT,,,,,26,Outpatient,,,50.12,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
PC DUP CAROTID BILATERAL,8200229,LOCAL,93880,CPT,,,,,26,Outpatient,,,76.13,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
PC DUP CAROTID UNILATERAL,8200228,LOCAL,93882,CPT,,,,,26,Outpatient,,,46.65,482,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
PC DUP HEMODIALYSIS ACCESS,8200582,LOCAL,93990,CPT,,,,,26,Outpatient,,,29.64,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
PC DUP LEA BIL,8200577,LOCAL,93925,CPT,,,,,26,Outpatient,,,66.27,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
PC DUP LEA UNI,8200576,LOCAL,93926,CPT,,,,,26,Outpatient,,,45.08,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
PC DUP UPPER ART BIL,8200575,LOCAL,93930,CPT,,,,,26,Outpatient,,,53.18,482,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,161.71,220.99,Based on EAPG RVU's
PC DUP UPPER ART UNI,8200574,LOCAL,93931,CPT,,,,,26,Outpatient,,,35.48,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
PC DUP VENOUS BIL,8200573,LOCAL,93970,CPT,,,,,26,Outpatient,,,87.58,482,Blue Cross of AL,Blue Cross,245.49,,,,,,,Other,220.99,245.49,Based on EAPG RVU's
PC DUP VENOUS UNI,8200572,LOCAL,93971,CPT,,,,,26,Outpatient,,,57.12,310,Blue Cross of AL,Blue Cross,161.71,,,,,,,Other,97.22,161.71,Based on EAPG RVU's
PC US PSEUDOANEURYSM COMPRESSION REPAIR,8200583,LOCAL,76936,CPT,,,,,26,Outpatient,,,285.6,237.6,Blue Cross of AL,Blue Cross,262.79,,,,,,,Other,262.79,284.7,Based on EAPG RVU's
97802 MEDICAL NUTRITIONAL THERAPY PROF CHARGE,13475611,LOCAL,97802,CPT,,,,,,Outpatient,,,70,55,Blue Cross of AL,Blue Cross,287.34,,,,,,,Other,25.2,287.34,Based on EAPG RVU's
97803 MEDICAL NUTRITIONAL RE-ASSESSMENT PROF CHARG,13481228,LOCAL,97803,CPT,,,,,,Outpatient,,,60,48,Blue Cross of AL,Blue Cross,287.34,,,,,,,Other,21.06,287.34,Based on EAPG RVU's
"64640 Destruction by neurolytic agent, other perip",13959658,LOCAL,64640,CPT,,,,,,Outpatient,,,500,927,Blue Cross of AL,Blue Cross,1695.82,,,,,,,Other,813.96,1695.82,Based on EAPG RVU's
10060 PROFEE Drainage of skin abscess,13954453,LOCAL,10060,CPT,,,,,,Outpatient,,,220,420,Blue Cross of AL,Blue Cross,239.03,,,,,,,Other,181.66,863,Based on EAPG RVU's
10061  I&D abscess complicated/multiple Profee,13769279,LOCAL,10061,CPT,,,,,,Outpatient,,,385,420,Blue Cross of AL,Blue Cross,239.03,,,,,,,Other,239.03,863,Based on EAPG RVU's
10120 Incision & Removal Foreign Body Simp PROFEE,14006132,LOCAL,10120,CPT,,,,,,Outpatient,,,285,893,Blue Cross of AL,Blue Cross,239.03,,,,,,,Other,239.03,863,Based on EAPG RVU's
"11042 PROFEE Debride subcutaneous tissue, 1st 20 s",13962336,LOCAL,11042,CPT,,,,,,Outpatient,,,145,836,Blue Cross of AL,Blue Cross,549.61,,,,,,,Other,365.27,863,Based on EAPG RVU's
11043 PROFEE DEB MUSC/FASCIA 20 SQ CM/<,13967660,LOCAL,11043,CPT,,,,,,Outpatient,,,340,836,Blue Cross of AL,Blue Cross,549.61,,,,,,,Other,549.61,863,Based on EAPG RVU's
"11044 Debride bone, 1st 20 sq cm or less Pro Fee",11221020,LOCAL,11044,CPT,,,,,,Outpatient,,,465,2328,Blue Cross of AL,Blue Cross,1466.58,,,,,,,Other,1291,1481.32,Based on EAPG RVU's
"11045 Debride subq tissue, ea addl 20 sq cm Pro Fe",11221021,LOCAL,11045,CPT,,,,,,Outpatient,,,50,836,Blue Cross of AL,Blue Cross,1466.58,,,,,,,Other,20.61,1466.58,Based on EAPG RVU's
11046 PROFEE Debride muscle and/or fascia; ea addl,13954830,LOCAL,11046,CPT,,,,,,Outpatient,,,128,836,Blue Cross of AL,Blue Cross,1466.58,,,,,,,Other,44.01,1466.58,Based on EAPG RVU's
"11047 PROFEE Debridement, sus tissue each add 20 s",13967661,LOCAL,11047,CPT,,,,,,Outpatient,,,195,2092,Blue Cross of AL,Blue Cross,1466.58,,,,,,,Other,78.26,1466.58,Based on EAPG RVU's
11104 Punch Biopsy of Skin; Single Lesion ProFee,8768419,LOCAL,11104,CPT,,,,,,Outpatient,,,243.42,449,Blue Cross of AL,Blue Cross,651.39,,,,,,,Other,365.27,863,Based on EAPG RVU's
11106  Incisional biopsy of skin single lesion Pro,13759967,LOCAL,11106,CPT,,,,,,Outpatient,,,296,800,Blue Cross of AL,Blue Cross,651.39,,,,,,,Other,559.65,1291,Based on EAPG RVU's
"11400 EXCISION, BENIGN LESION INCLUDING MARGINS, E",7929974,LOCAL,11400,CPT,,,,,,Outpatient,,,160,935,Blue Cross of AL,Blue Cross,651.39,,,,,,,Other,643.26,1291,Based on EAPG RVU's
"11406 EXCISION, BENIGN LESION INCLUDING MARGINS, E",7929979,LOCAL,11406,CPT,,,,,,Outpatient,,,470,1620,Blue Cross of AL,Blue Cross,2584.84,,,,,,,Other,1481.32,2584.84,Based on EAPG RVU's
"11604 EXCISION, MALIGNANT LESION INCLUDING MARGINS",7930002,LOCAL,11604,CPT,,,,,,Outpatient,,,410,704,Blue Cross of AL,Blue Cross,1679.75,,,,,,,Other,643.26,1679.75,Based on EAPG RVU's
"11730 PROFEE Avulsion nail plate simple, single",13967650,LOCAL,11730,CPT,,,,,,Outpatient,,,195,228,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,95.93,863,Based on EAPG RVU's
"11750 PROFEE Excision of nail and nail matrix, par",13954836,LOCAL,11750,CPT,,,,,,Outpatient,,,305,1342,Blue Cross of AL,Blue Cross,651.39,,,,,,,Other,365.27,863,Based on EAPG RVU's
15271 PROFEE Application of skin substitute graft,13967652,LOCAL,15271,CPT,,,,,,Outpatient,,,296,1092,Blue Cross of AL,Blue Cross,2862.92,,,,,,,Other,1496,2862.92,Based on EAPG RVU's
15275 PROFEE APPLICATION OF SKIN SUBSTITUTE GRAFT,13954832,LOCAL,15275,CPT,,,,,,Outpatient,,,306,1092,Blue Cross of AL,Blue Cross,2862.92,,,,,,,Other,1496,2862.92,Based on EAPG RVU's
"28810 AMPUTATION, METATARSAL, WITH TOE, SINGLE Pro",7931853,LOCAL,28810,CPT,,,,,,Outpatient,,,820,3245,Blue Cross of AL,Blue Cross,7645.84,,,,,,,Other,2315,7645.84,Based on EAPG RVU's
29445 PROFEE APPLICATION OF RIGID TOTAL CONTACT LE,13962328,LOCAL,29445,CPT,,,,,,Outpatient,,,200,266,Blue Cross of AL,Blue Cross,275.28,,,,,,,Other,242.81,863,Based on EAPG RVU's
31502 Tracheotomy tube change prior to establishme,14397259,LOCAL,31502,CPT,,,,,,Outpatient,,,80,232,Blue Cross of AL,Blue Cross,162.41,,,,,,,Other,162.41,863,Based on EAPG RVU's
"31899 UNLISTED PROCEDURE, TRACHEA, BRONCHI ProFee",7932202,LOCAL,31899,CPT,,,,,,Outpatient,,,91,194,Blue Cross of AL,Blue Cross,2400.33,,,,,,,Other,177.49,2400.33,Based on EAPG RVU's
"58573 LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTO",14831670,LOCAL,58573,CPT,,,,,,Outpatient,,,2172,10411,Blue Cross of AL,Blue Cross,8731.07,,,,,,,Other,5787,9518.56,Based on EAPG RVU's
64454 Genicular Nerve Block Profee,13911832,LOCAL,64454,CPT,,,,,,Outpatient,,,227,244,Blue Cross of AL,Blue Cross,636.45,,,,,,,Other,633.14,1291,Based on EAPG RVU's
64999 XX UNLISTED NERVOUS SYSTEM INJECTION,7939552,LOCAL,64999,CPT,,,,,,Outpatient,,,250,620,Blue Cross of AL,Blue Cross,636.45,,,,,,,Other,269.88,863,Based on EAPG RVU's
93010 EKG INTERPRETATION,7939709,LOCAL,93010,CPT,,,,,,Outpatient,,,65,,Blue Cross of AL,Blue Cross,38.53,,,,,,,Other,10.44333333,38.53,Based on EAPG RVU's
93451 RIGHT HEART CATHERIZATION (OR),8192212,LOCAL,93451,CPT,,,,,26,Outpatient,,,1008,6246,Blue Cross of AL,Blue Cross,3441.53,,,,,,,Other,2940.64,4325,Based on EAPG RVU's
97597 WOUND DEBRIDEMENT ProFee,7935939,LOCAL,97597,CPT,,,,,,Outpatient,,,188.32,395,Blue Cross of AL,Blue Cross,273.27,,,,,,,Other,181.66,863,Based on EAPG RVU's
97598 DEBRID SELCT EA ADD20SQCM ProFee,7935940,LOCAL,97598,CPT,,,,,,Outpatient,,,83,395,Blue Cross of AL,Blue Cross,1466.58,,,,,,,Other,20.42,1466.58,Based on EAPG RVU's
97605 Negative pressure wound therapy less than 50,14327888,LOCAL,97605,CPT,,,,,,Outpatient,,,80,285,Blue Cross of AL,Blue Cross,273.27,,,,,,,Other,181.66,273.27,Based on EAPG RVU's
G0108 DIABETES SERVICE 30 MIN PROF CHARGE,13484119,LOCAL,G0108,CPT,,,,,,Outpatient,,,105,128,Blue Cross of AL,Blue Cross,95.93,,,,,,,Other,52.15,95.93,Based on EAPG RVU's
G0109 DSMT DIABETES GROUP 30 MIN ProFee,7936084,LOCAL,G0109,CPT,,,,,,Outpatient,,,30,18,Blue Cross of AL,Blue Cross,67.18,,,,,,,Other,14.97,67.18,Based on EAPG RVU's
Medical/Surgical Supplies: Prosthetic/Orthotic devices,274,RC,,,,,,,,inpatient,,,,,VIVA,Commercial,,45,Inpatient Carve-outs: Revenue codes 274-279 with billed charges over $500 will be reimbursed at 45% of billed charge,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medical/Surgical Supplies: Pacemaker,275,RC,,,,,,,,inpatient,,,,,VIVA,Commercial,,45,Inpatient Carve-outs: Revenue codes 274-279 with billed charges over $500 will be reimbursed at 45% of billed charge,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medical/Surgical Supplies: Intraocular lens,276,RC,,,,,,,,inpatient,,,,,VIVA,Commercial,,45,Inpatient Carve-outs: Revenue codes 274-279 with billed charges over $500 will be reimbursed at 45% of billed charge,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Oxygen-Take home,277,RC,,,,,,,,inpatient,,,,,VIVA,Commercial,,45,Inpatient Carve-outs: Revenue codes 274-279 with billed charges over $500 will be reimbursed at 45% of billed charge,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medical/Surgical Supplies: Other implants,278,RC,,,,,,,,inpatient,,,,,VIVA,Commercial,,50,Inpatient Carve-outs: Revenue codes 274-279 with billed charges over $500 will be reimbursed at 45% of billed charge,641.7,641.7,641.7,1 through 10,percent of total billed charges,,,
Medical/Surgical Supplies: Other supplies/devices,279,RC,,,,,,,,inpatient,,,,,VIVA,Commercial,,50,Inpatient Carve-outs: Revenue codes 274-279 with billed charges over $500 will be reimbursed at 45% of billed charge,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Emergency Room,450,RC,,,,,,,,Outpatient,,,,,VIVA,Commercial,550,,,,,,,Case Rate,550,550,
Emergency Room: EM/EMTALA,451,RC,,,,,,,,Outpatient,,,,,VIVA,Commercial,550,,,,,,,Case Rate,550,550,
Emergency Room: ER/ Beyond EMTALA,452,RC,,,,,,,,Outpatient,,,,,VIVA,Commercial,550,,,,,,,Case Rate,550,550,
Emergency Room: Urgent care,456,RC,,,,,,,,Outpatient,,,,,VIVA,Commercial,550,,,,,,,Case Rate,550,550,
Emergency Room: Other emergency room,459,RC,,,,,,,,Outpatient,,,,,VIVA,Commercial,550,,,,,,,Case Rate,550,550,
Treatment/Observation Room: Observation room,762,RC,,,,,,,,Outpatient,,,,,VIVA,Commercial,150,,,,,,,Case Rate,150,150,
IMPLANT MEMORY GEL #350-6004BC,4803876,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Protein, Tot & Prot Electrop Interp QSTC",8852423,LOCAL,84165,CPT,,,,,,Outpatient,,,,12.89,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Protein, Total QSTC",8852413,LOCAL,84165,CPT,,,,,,Outpatient,,,,12.89,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DRESSING TELFA ISLAND 4X10,11074306,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.RPR Titer QSTC,6231113,LOCAL,86593,CPT,,,,,,Outpatient,,,,5.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
UA Microscopic,633864,LOCAL,81015,CPT,,,,,,Outpatient,,,,3.66,VIVA,Commercial,,50,,3,3,3,1 through 10,percent of total billed charges,1.68192607,4.02,
Urinalysis Review Manual,8502419,LOCAL,81015,CPT,,,,,,Outpatient,,,,3.66,VIVA,Commercial,,50,,3,3,3,1 through 10,percent of total billed charges,1.68192607,4.02,
Hematocrit QSTC,8852782,LOCAL,85014,CPT,,,,,,Outpatient,,,,2.84,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hemoglobin A2 (Quant) QSTC,8852791,LOCAL,83020,CPT,,,,,,Outpatient,,,,15.44,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hemoglobin QSTC,8852780,LOCAL,85018,CPT,,,,,,Outpatient,,,,2.84,VIVA,Commercial,,50,,34.27,34.27,34.27,1 through 10,percent of total billed charges,8.21,10.94316176,
Red Blood Cell Count QSTC,8852779,LOCAL,85041,CPT,,,,,,Outpatient,,,,3.62,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
87107 Fungal Isolate Identification QST,14813753,LOCAL,87107,CPT,,,,,,Outpatient,,,,12.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
87143 Fungal Isolate Identification QST,14815667,LOCAL,87143,CPT,,,,,,Outpatient,,,,15.02,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
87149 Fungal Isolate Identification QST,14813753,LOCAL,87149,CPT,,,,,,Outpatient,,,,24.06,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glucose Fasting Urine,7974487,LOCAL,81003,CPT,,,,,,Outpatient,,,,2.7,VIVA,Commercial,,50,,9.85,4.08,9.85,1 through 10,percent of total billed charges,3.795286195,4.02,
"Uric Acid, Synovial Fluid QSTC",9607980,LOCAL,84560,CPT,,,,,,Outpatient,,,,6.1,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,19.49,
Alkaline Phosphatase QSTC,8848272,LOCAL,84075,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Isoenzymes QSTC,8848275,LOCAL,84080,CPT,,,,,,Outpatient,,,,17.74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLING ARM MEDIUM,11070727,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,,158,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
acetylcysteine 20% Inhalation Sol [CULL],11208888,LOCAL,J7608,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
albuterol 1.25 mg/3 mL (0.042%) Sol [CULL],11203025,LOCAL,J7613,CPT,,,,,,Outpatient,3,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
albuterol 2.5 mg/3 mL (0.083%) inhalation solution 3 mL [CULL],11203024,LOCAL,J7613,CPT,,,,,,Outpatient,3,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
albuterol 5 mg/mL (0.5%) inhalation solution [CULL],11203026,LOCAL,J7611,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
amiodarone 50 mg/mL intravenous solution 3 mL [CULL],11200004,LOCAL,J0282,CPT,,,,,,Outpatient,3,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
azaTHIOprine 50 mg oral tablet [CULL],11200492,LOCAL,J7500,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BUPivacaine 0.25% preservative-free Sol [CULL],11282035,LOCAL,J0665,CPT,,,,,,Outpatient,10,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BUPivacaine 0.75%-D8.25% preservative-free intrathecal solution 2 mL [CULL],11202136,LOCAL,J0665,CPT,,,,,,Outpatient,2,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
cycloSPORINE modified 25 mg oral capsule [CULL],11210499,LOCAL,J7515,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
dexAMETHasone 10 mg/mL injectable solution 1 mL [CULL],11202292,LOCAL,J1100,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,42.58,3.27,42.58,12,percent of total billed charges,10.48743758,10.48743758,
ipratropium 500 mcg/2.5 mL inhalation solution 2.5 mL [CULL],11203105,LOCAL,J7644,CPT,,,,,,Outpatient,2.5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ketorolac 60 mg/2 mL Sol [CULL],11202716,LOCAL,J1885,CPT,,,,,,Outpatient,2,ML,,,VIVA,Commercial,,50,,4.33,1.39,4.33,17,percent of total billed charges,0.27,0.27,
levalbuterol 0.31 mg/3 mL inhalation solution 3 mL [CULL],11203125,LOCAL,J7614,CPT,,,,,,Outpatient,3,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
levalbuterol 0.63 mg/3 mL inhalation solution 3 mL [CULL],11203127,LOCAL,J7614,CPT,,,,,,Outpatient,3,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
levalbuterol 1.25 mg/3 mL inhalation solution 3 mL [CULL],11203128,LOCAL,J7614,CPT,,,,,,Outpatient,3,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methylPREDNISolone 4 mg oral tablet [CULL],11230944,LOCAL,J7509,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
mitoMYcin 20 mg/40 mL Sol [CULL],11205507,LOCAL,J9280,CPT,,,,,,Outpatient,0.5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ondansetron 2 mg/mL injectable solution 2 mL [CULL],11211057,LOCAL,J2405,CPT,,,,,,Outpatient,2,ML,,,VIVA,Commercial,,50,,26.49,10.9,26.49,27,percent of total billed charges,0.057806268,0.057806268,
phenytoin 50 mg/mL injectable solution 2 mL [CULL],11282560,LOCAL,J1165,CPT,,,,,,Outpatient,2,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
phenytoin 50 mg/mL injectable solution 5 mL [CULL],11212135,LOCAL,J1165,CPT,,,,,,Outpatient,5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
prednisoLONE sodium phosphate 15 mg/5 mL Liq [CULL],11250339,LOCAL,J7510,CPT,,,,,,Outpatient,5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"rabies immune globulin, human 150 intl units/mL intramuscular solution 2 mL [CULL]",11212251,LOCAL,90376,CPT,,,,,,Outpatient,0.007,ML,,347,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tacrolimus 0.5 mg oral capsule [CULL],11205999,LOCAL,J7507,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tobramycin 40 mg/mL injectable solution 2 mL [CULL],11212375,LOCAL,J3260,CPT,,,,,,Outpatient,2,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BUPivacaine 0.25% preservative-free injectable solution 30 mL [CULL],11202111,LOCAL,J0665,CPT,,,,,,Outpatient,30,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Protein, Total, Peritoneal Fluid QSTC",9039313,LOCAL,84157,CPT,,,,,,Outpatient,,,,4.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rheumatoid Factor QSTC,9039252,LOCAL,86431,CPT,,,,,,Outpatient,,,,6.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ketorolac 30 mg/mL injectable solution 1 mL [CULL],11202715,LOCAL,J1885,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,4.33,1.39,4.33,17,percent of total billed charges,0.27,0.27,
RPR (Dx) w/Refl Titer/Confrm Testing QST,8972905,LOCAL,86592,CPT,,,,,,Outpatient,,,,5.12,VIVA,Commercial,,50,,29.61,29.61,29.61,1 through 10,percent of total billed charges,15.29,19.99375,
RPR (Monitor) w/Refl Titer QSTC,8972905,LOCAL,86592,CPT,,,,,,Outpatient,,,,5.12,VIVA,Commercial,,50,,29.61,29.61,29.61,1 through 10,percent of total billed charges,15.29,19.99375,
cefuroxime 750 mg injection [CULL],11201445,LOCAL,J0697,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Creatinine, Random Ur QSTC",9320766,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,40.97514925,
BUPivacaine 0.5% preservative-free injectable solution 10 mL [CULL],11282050,LOCAL,J0665,CPT,,,,,,Outpatient,10,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ciprofloxacin 200 mg/100 mL-D5% intravenous solution 100 mL [CULL],11201485,LOCAL,J0744,CPT,,,,,,Outpatient,100,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
diphenhydrAMINE 50 mg/mL injectable solution 1 mL [CULL],11202342,LOCAL,J1200,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,0.87,0.69,0.87,1 through 10,percent of total billed charges,0.143,0.143,
HYDROmorphone 2 mg/mL Sol [CULL],11202621,LOCAL,J1171,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Source QSTC,8983584,LOCAL,87209,CPT,,,,,,Outpatient,,,,21.58,VIVA,Commercial,,50,,15.41,12.83,15.41,1 through 10,percent of total billed charges,10.57,17.98,
ampicillin 500 mg injection [CULL],11201162,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ampicillin 250 mg injection [CULL],11201150,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
clindamycin 150 mg/mL injectable solution 4 mL [CULL],11202228,LOCAL,J0736,CPT,,,,,,Outpatient,4,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"ANA IFA Scrn w/Rfx Titr & Patt, IFA QSTC",8764654,LOCAL,86038,CPT,,,,,,Outpatient,,,,14.51,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"ANA Scr,IFA w/R Tit/Ptn/MPX Ab Casc QSTC",8764642,LOCAL,86038,CPT,,,,,,Outpatient,,,,14.51,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bacterial Identification, Aerobic QST",13344175,LOCAL,87077,CPT,,,,,,Outpatient,,,,9.7,VIVA,Commercial,,50,,28.15,14.08,28.15,1 through 10,percent of total billed charges,10.57,16.47987421,
T3 Uptake QSTC,9039244,LOCAL,84479,CPT,,,,,,Outpatient,,,,7.76,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COLLAR CERVICAL SOFT MEDIUM,11071045,LOCAL,,,L0120,HCPCS,,,,Outpatient,,,,44,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HYDROmorphone 1 mg/mL Sol,11202620,LOCAL,J1171,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tacrolimus 1 mg oral capsule [CULL],11205998,LOCAL,J7507,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Measles Antibody (IgG) QSTC,8764682,LOCAL,86765,CPT,,,,,,Outpatient,,,,15.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
gentamicin 60 mg/50 mL-NaCl 0.9% intravenous solution 50 mL [CULL],11201825,LOCAL,J1580,CPT,,,,,,Outpatient,50,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLING ARM LARGE,11071011,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,,158,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HYDROmorphone 10 mg/mL Sol [CULL],11202625,LOCAL,J1171,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"hCG, Total, QN Male Only QSTC",8853229,LOCAL,84702,CPT,,,,,,Outpatient,,,,18.06,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Herpes Simplex Virus 2 (IgG), with Reflex to HSV-2 Inhibition QST",14811888,LOCAL,86696,CPT,,,,,,Outpatient,,,,23.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
gentamicin 80 mg/50 mL-NaCl 0.9% intravenous solution 50 mL [CULL],11201824,LOCAL,J1580,CPT,,,,,,Outpatient,50,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
gentamicin 40 mg/mL injectable solution 2 mL [CULL],11282205,LOCAL,J1580,CPT,,,,,,Outpatient,2,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HYDROmorphone 0.5 mg/0.5 mL Sol [CULL],11202622,LOCAL,J1171,CPT,,,,,,Outpatient,0.5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
gentamicin 120 mg/100 mL-NaCl 0.9% intravenous solution 100 mL [CULL],11209100,LOCAL,J1580,CPT,,,,,,Outpatient,100,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
alpha 1-proteinase inhibitor human Sol 10 mg [CULL],11211124,LOCAL,J0256,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chloride, Random Urine without Creatinine QSTC",10011691,LOCAL,82436,CPT,,,,,,Outpatient,,,,6.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Potassium, U24 w/o Creatinine QSTC",13864422,LOCAL,84133,CPT,,,,,,Outpatient,,,,5.68,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,19.32,
Sickle Cell Screen QSTC,10073685,LOCAL,85660,CPT,,,,,,Outpatient,,,,6.61,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
gentamicin 100 mg/100 mL-NaCl 0.9% intravenous solution 100 mL [CULL],11201827,LOCAL,J1580,CPT,,,,,,Outpatient,100,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Creatinine, Random Ur, Microalbumin QSTC",9041589,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,40.97514925,
"Ratio, Microalbumin Random Ur QSTC",9041592,LOCAL,82043,CPT,,,,,,Outpatient,,,,6.94,VIVA,Commercial,,50,,18.49,18.49,18.49,1 through 10,percent of total billed charges,4.02,20.15557971,
Protein Level 24 Hour Urine,633811,LOCAL,84156,CPT,,,,,,Outpatient,,,,4.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Thrombin Clotting Time QSTC,8764547,LOCAL,85670,CPT,,,,,,Outpatient,,,,6.92,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Urea Nitrogen Ur, Rand QSTC",13864416,LOCAL,84540,CPT,,,,,,Outpatient,,,,6.67,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
nalbuphine 10 mg/mL Sol,J2300,CPT,,,,,,,,Outpatient,10,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
cycloSPORINE modified 100 mg oral capsule [CULL],11210500,LOCAL,J7502,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT WRIST FOREARM LEFT LG,11071054,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT WRIST FOREARM LT MED,11071053,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT WRIST FOREARM LT SM,11071052,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT WRIST FOREARM RT LG,11071050,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT WRIST FOREARM RT MED,11071049,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT WRIST FOREARM RT PED,11071047,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT WRIST FOREARM RT SM,11071048,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95852 RANGE OF MOTION-HAND 15 MIN CHARGE,9410221,LOCAL,95852,CPT,,,,,GP,Outpatient,,,,12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT WRIST FOREARM LEFT X L,11074363,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT XLG WRIST FOREARM RIGHT,11074362,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Creatine Kinase Isoenzyme Interp. QSTC,8852390,LOCAL,82550,CPT,,,,,,Outpatient,,,,7.81,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Creatine Kinase Isoenzyme w/ Tot CK QSTC,8764767,LOCAL,82552,CPT,,,,,,Outpatient,,,,16.07,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Creatine Kinase Isoenzymes w/o Ttl QSTC,13864524,LOCAL,82552,CPT,,,,,,Outpatient,,,,16.07,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Creatine Kinase, Total QSTC",8852386,LOCAL,82552,CPT,,,,,,Outpatient,,,,16.07,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rubella Antibody (IgG) QSTC,8853250,LOCAL,86762,CPT,,,,,,Outpatient,,,,17.27,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urine Creatinine,7050475,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,40.97514925,
Urine Protein Level,7412757,LOCAL,84156,CPT,,,,,,Outpatient,,,,4.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
phytonadione 1 mg/0.5 mL injectable solution 0.5 mL [CULL],11212147,LOCAL,J3430,CPT,,,,,,Outpatient,0.5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT WRIST FOREARM LT PED,11070883,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
fosphenytoin 100 mgPE/2 mL Sol [CULL],11205072,LOCAL,Q2009,CPT,,,,,,Outpatient,2,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methylPREDNISolone 40 mg Pow [CULL],11204478,LOCAL,J2919,CPT,,,,,,Outpatient,1,UN,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Almond (F20) IgE QST,14586519,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Alternaria Alternata (M6) IgE QST,14586545,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Brazil Nut (F18) IgE QST,14586553,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Cashew Nut (F202) IgE QST,14586555,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Cat Dander (E1) IgE QST,14586539,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Cladosporium Herbarum (M2) IgE QST,14586543,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Cockroach (I6) IgE QST,14586549,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Codfish (F3) IgE QST,14586521,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Cow's Milk (F2) IgE QST,14586529,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Dermatophagoides Farinae (D2) IgE QST,14586537,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Dermatophagoides Pteronyssinu D1 IgE QST,14586535,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Dog Dander (E5) IgE QST,14586541,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Egg White (F1) IgE QST,14586527,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Hazelnut (F17) IgE QST,14586551,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Immunoglobulin E QST,14586516,LOCAL,82785,CPT,,,,,,Outpatient,,,,19.75,VIVA,Commercial,,50,,31.36,31.36,31.36,1 through 10,percent of total billed charges,17.73,203.9616667,
Macadamia Nut (RF345) IgE QST,14586525,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Mouse Urine Proteins (E72) IgE QST,14586547,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Peanut (F13) IgE QST,14586517,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Shrimp (F24) IgE QST,14586523,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Soybean (F14) IgE QST,14586533,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Walnut (F256) IgE QST,14586557,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Wheat (F4) IgE QST,14586531,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
droNABinol 2.5 mg Cap [CULL],11220183,LOCAL,Q0167,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"HPV mRNA E6/E7, POST-$HYST, VAGINAL W/REFL QST",14782711,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lead Capillary QSTC,14116315,LOCAL,83655,CPT,,,,,,Outpatient,,,,14.53,VIVA,Commercial,,50,,9.57,9.57,9.57,1 through 10,percent of total billed charges,13.99076923,16.07,
"Lead, Blood QSTC",8764839,LOCAL,83655,CPT,,,,,,Outpatient,,,,14.53,VIVA,Commercial,,50,,9.57,9.57,9.57,1 through 10,percent of total billed charges,13.99076923,16.07,
"Lead, Blood QSTC",13864923,LOCAL,83655,CPT,,,,,,Outpatient,,,,14.53,VIVA,Commercial,,50,,9.57,9.57,9.57,1 through 10,percent of total billed charges,13.99076923,16.07,
fluconazole 100 mg/50 mL-NaCl 0.9% intravenous solution 50 mL [CULL],11291246,LOCAL,J1450,CPT,,,,,,Outpatient,50,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Albumin, Peritoneal Fluid QSTC",8972935,LOCAL,82042,CPT,,,,,,Outpatient,,,,9.34,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Albumin, Pleural Fluid QST",12130816,LOCAL,82042,CPT,,,,,,Outpatient,,,,9.34,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Albumin, Pleural Fluid QSTC",12130706,LOCAL,82042,CPT,,,,,,Outpatient,,,,9.34,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Glucose, Peritoneal Fluid QSTC",9039310,LOCAL,82945,CPT,,,,,,Outpatient,,,,4.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiolipin Ab (IgA)QSTC,9215429,LOCAL,86147,CPT,,,,,,Outpatient,,,,30.54,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiolipin Antibody IgG QSTC,10100354,LOCAL,86147,CPT,,,,,,Outpatient,,,,30.54,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiolipin Antibody IgM QSTC,10100355,LOCAL,86147,CPT,,,,,,Outpatient,,,,30.54,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
24hr Urine Creatinine QSTC,10005155,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,40.97514925,
"Creatinine, Random U QSTC",12290061,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,40.97514925,
Interp: QSTC,8851928,LOCAL,84166,CPT,,,,,,Outpatient,,,,21.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interp: QSTC,8851952,LOCAL,84166,CPT,,,,,,Outpatient,,,,21.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Protein, Total, Random Urine QSTC",8851945,LOCAL,84156,CPT,,,,,,Outpatient,,,,4.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SHOE POST OP MALE LARGE,11070723,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,,223,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SHOE POST OP MALE MD,11071019,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SHOE POST OP MALE SMALL,11070721,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,,223,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methotrexate 2.5 mg oral tablet [CULL],11240138,LOCAL,J8610,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
cefTAZidime 1 g injection [CULL],11201385,LOCAL,J0713,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carbon Dioxide Level,7903173,LOCAL,82374,CPT,,,,,,Outpatient,,,,5.86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Creatinine,3454470,LOCAL,82565,CPT,,,,,,Outpatient,,,,6.14,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COLLAR CERVICAL SOFT SMALL,11071044,LOCAL,,,L0120,HCPCS,,,,Outpatient,,,,44,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastric Occult Blood,7974128,LOCAL,82271,CPT,,,,,,Outpatient,,,,6.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin A QSTC,8764567,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin M QSTC,8853219,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"PSA, Free QSTC",8852652,LOCAL,84154,CPT,,,,,,Outpatient,,,,22.07,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COLLAR CERVICAL SOFT LARGE,11071046,LOCAL,,,L0120,HCPCS,,,,Outpatient,,,,44,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
gentamicin 10 mg/mL injectable solution 2 mL [CULL],11201813,LOCAL,J1580,CPT,,,,,,Outpatient,2,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.Manual Differential (CULL),13467987,LOCAL,85007,CPT,,,,,,Outpatient,,,,4.56,VIVA,Commercial,,50,,10.4,4.81,10.4,1 through 10,percent of total billed charges,3.338698061,8.21,
.Manual Differential (CULL_AL),6237143,LOCAL,85007,CPT,,,,,,Outpatient,,,,4.56,VIVA,Commercial,,50,,10.4,4.81,10.4,1 through 10,percent of total billed charges,3.338698061,8.21,
cefuroxime 1.5 g injection [CULL],11201459,LOCAL,J0697,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Albumin, CSF QSTC",13873322,LOCAL,82042,CPT,,,,,,Outpatient,,,,9.34,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"IgG, CSF QSTC",13873321,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amylase, Pleural Fluid QSTC",9039309,LOCAL,82150,CPT,,,,,,Outpatient,,,,7.78,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Calcium, Random Ur QSTC",13864744,LOCAL,82310,CPT,,,,,,Outpatient,,,,6.19,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Creatinine, Random U QSTC",13864745,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,40.97514925,
Fructosamine QSTC,8853273,LOCAL,82985,CPT,,,,,,Outpatient,,,,20.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
butorphanol 1 mg/mL Sol [CULL],11202144,LOCAL,J0595,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Direct LDL QSTC,9039357,LOCAL,83721,CPT,,,,,,Outpatient,,,,12.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hemoglobin A1c QSTC,6213055,LOCAL,83036,CPT,,,,,,Outpatient,,,,11.65,VIVA,Commercial,,50,,36.11,36.11,36.11,1 through 10,percent of total billed charges,7.16,28.59604426,
Varicella-Zoster Virus Ab (IgG) QSTC,8853252,LOCAL,86787,CPT,,,,,,Outpatient,,,,15.46,VIVA,Commercial,,50,,10.8,10.8,10.8,1 through 10,percent of total billed charges,12.88,15.29,
Serum Osmolality QSTC,8972765,LOCAL,83930,CPT,,,,,,Outpatient,,,,7.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
76376 3D RENDER W/O POSTPR CHARGE,9284912,LOCAL,76376,CPT,,,,,,Outpatient,,,,391.88,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
POC Hgb,7160347,LOCAL,83036,CPT,,,,,,Outpatient,,,,11.65,VIVA,Commercial,,50,,36.11,36.11,36.11,1 through 10,percent of total billed charges,7.16,28.59604426,
Creatinine Level 24 Hour Urine,1634894,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,40.97514925,
"Albumin, 24 Hour Urine w/o Creat QSTC",13864523,LOCAL,82043,CPT,,,,,,Outpatient,,,,6.94,VIVA,Commercial,,50,,18.49,18.49,18.49,1 through 10,percent of total billed charges,4.02,20.15557971,
"Folate, RBC QSTS",13899938,LOCAL,82747,CPT,,,,,,Outpatient,,,,21.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatitis C Ab rfx HCV RNA Qnt PCR QSTC,8764583,LOCAL,86803,CPT,,,,,,Outpatient,,,,17.12,VIVA,Commercial,,50,,35,35,35,1 through 10,percent of total billed charges,15.29,32.10014925,
IMMOBILIZER  SHOULDER MEDIUM,11070739,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMMOBILIZER SHOULDER XL,11070165,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"PSA, Total QSTC",8852651,LOCAL,84153,CPT,,,,,,Outpatient,,,,22.07,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"T4, Free QSTC",9291013,LOCAL,84439,CPT,,,,,,Outpatient,,,,10.82,VIVA,Commercial,,50,,30,30,30,1 through 10,percent of total billed charges,18.43,28.58065455,
DRAIN ROUND JP 10FR----OR,11071535,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Heterophile, Mono Screen QSTC",13864506,LOCAL,86308,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"T3, Free QSTC",8972902,LOCAL,84481,CPT,,,,,,Outpatient,,,,20.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMMOBILIZER SHOULDER SMALL,11071014,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COLLECTION: Venous Draw,1779389,LOCAL,36415,CPT,,,,,,Outpatient,,,,10.91,VIVA,Commercial,,50,,6.73,2.35,6.73,53,percent of total billed charges,3.41,6.740753664,
IMMOBILIZER SHOULDER LARGE,11071760,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urine Eosinophil Smear,8690390,LOCAL,85008,CPT,,,,,,Outpatient,,,,4.12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urine Eosinophils,7974116,LOCAL,89051,CPT,,,,,,Outpatient,,,,6.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sodium Level Urine,4185817,LOCAL,84300,CPT,,,,,,Outpatient,,,,6.07,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,9.74,
Almond (F20) IgE QST,13344505,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Almond (f20) IgE QSTC,8764712,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Beef (f27) IgE QSTC,8764717,LOCAL,86003,CPT,86003,HCPCS,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Brazil Nut (F18) IgE QST,13344495,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Brazil Nut (f18) IgE QSTC,8764711,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Cashew Nut (F202) IgE QST,13344499,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Cashew Nut (f202) IgE QSTC,8764689,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Cat Dander (e1) IgE QSTC,6241002,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Catfish (f369) IgE QSTC,8764761,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Chicken Meat (f83) IgE QSTC,8761426,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Clam (f207) IgE QSTC,8764592,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Cocoa (f93) IgE QSTC,8764728,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Coconut (f36) IgE QSTC,8764719,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Cow'S Milk (F2) IgE w/Rflx to Panel QST,12886535,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Cow'S Milk(F2) IgE W/Rfx Panel QSTC,14129187,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Crab (f23) IgE QSTC,6210507,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Crayfish (Rf320) IgE** QSTC,9039458,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
D. Pteronyssinus (d1) IgE QST,6241001,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Dermatophagoides Farinae (d2) IgE QST,10217085,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Dog Dander (e5) IgE QSTC,6241003,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Egg White (f1) IgE QSTC,8764699,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Egg White (F2) IgE w/Rflx to Panel QST,12886536,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Egg Yolk (f75) IgE QSTC,8764725,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Fire Ant (i70) IgE QSTC,8764698,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Gluten (f79) IgE QSTC,9039341,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Hazelnut (F17) IgE QST,13344503,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Hazelnut (f17) IgE QSTC,8764710,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Lobster (f80) IgE QSTC,6210505,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Macadamia Nut (RF345) IgE QST,13344491,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Milk Component Panel QST,10217179,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Oyster (f290) IgE QSTC,6210503,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Peanut (F13) IgE QST,13344507,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Peanut (f13) IgE QSTC,8764708,LOCAL,86003,CPT,86003,HCPCS,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
"Peanut,Tot w/rfx to Peanut Comp Pnl QSTC",8764811,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Pecan Nut (F201) IgE QST,13344493,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Pecan Nut (f201) IgE QSTC,8764727,LOCAL,86003,CPT,86003,HCPCS,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Perch Ocean IgE QSTC,8764760,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Pistachio (F203) IgE QST,13344501,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Pork (f26) IgE QSTC,8764716,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Scallop (f338) IgE QSTC,6210506,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Shrimp (f24) IgE QSTC,6241010,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Soybean (f14) IgE QSTC,8764709,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Strawberry (f44) IgE QSTC,8764722,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Tilapia IgE* QSTC,8972793,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Tomato (f25) IgE QSTC,8764715,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Walnut (F256) IgE QST,13344497,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Walnut (f256) IgE QSTC,8764747,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Wheat (f4) IgE QSTC,6241013,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
95851 ROM MEASUREMENT(EXCLUDE HANDS) CHARGE,9410226,LOCAL,95851,CPT,,,,,GP,Outpatient,,,,15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
digoxin 250 mcg/mL (0.25 mg/mL) injectable solution 2 mL [CULL],11282125,LOCAL,J1160,CPT,,,,,,Outpatient,2,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
sulfamethoxazole-trimethoprim 80 mg-16 mg/mL Sol [CULL],11211277,LOCAL,J2865,CPT,,,,,,Outpatient,5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin G QSTC,8764569,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sjogren's Antibody (SS-A) QSTC,8860711,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sjogren's Antibody (SS-A) QSTC,9039451,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sjogren's Antibody (SS-B) QSTC,8860712,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sjogren's Antibody (SS-B) QSTC,9039452,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methylPREDNISolone 125 mg Pow [CULL],11247586,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
STRAP CLAVACLE LARGE,11070713,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
STRAP CLAVICLE MED 3IN,11098246,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aerobic Bacterium ID/ Susceptibility QST,13344167,LOCAL,87077,CPT,,,,,,Outpatient,,,,9.7,VIVA,Commercial,,50,,28.15,14.08,28.15,1 through 10,percent of total billed charges,10.57,16.47987421,
"Catecholamines, Fractionated, Plasma QSTC",11335672,LOCAL,82384,CPT,,,,,,Outpatient,,,,30.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Clinical Impression QST,10148697,LOCAL,88300,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Comment QST,10148702,LOCAL,88302,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Diagnosis QST,10148701,LOCAL,88304,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Gross Description QST,10148699,LOCAL,88305,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Micro Description QST,10148700,LOCAL,88307,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Procedure QST,10148698,LOCAL,88309,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Childhood Allergy Profile QSTC,8972792,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Expanded Childhood Allergy Profile ADD ON,14019143,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
"Albumin, CSF QSTC",8861454,LOCAL,82042,CPT,,,,,,Outpatient,,,,9.34,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Albumin, Serum QSTC",8861457,LOCAL,82040,CPT,,,,,,Outpatient,,,,5.94,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin G QSTC,8861456,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Maternal Serum AFP QST,8972825,LOCAL,82105,CPT,,,,,,Outpatient,,,,20.12,VIVA,Commercial,,50,,12.94,12.94,12.94,1 through 10,percent of total billed charges,17.73,26.22,
Maternal Serum AFP QSTC,8972825,LOCAL,82105,CPT,,,,,,Outpatient,,,,20.12,VIVA,Commercial,,50,,12.94,12.94,12.94,1 through 10,percent of total billed charges,17.73,26.22,
"G-6-PD, RBC QSTC",8764537,LOCAL,82955,CPT,,,,,,Outpatient,,,,11.64,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ampicillin 1 g injection [CULL],11201129,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOBUTamine 12.5 mg/mL intravenous solution 20 mL [CULL],11201690,LOCAL,J1250,CPT,,,,,,Outpatient,20,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 1 (1) QST,10243602,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 12 (12F) QST,10243608,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 14 (14) QST,10243609,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 17 (17F) QST,10242538,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 19 (19F) QST,10243610,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 2 (2) QST,10242514,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 20 (20) QST,10242544,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 22 (22F) QST,10242547,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 23 (23F) QST,10243611,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 26 (6B) QST,10243612,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 3 (3) QST,10243603,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 34 (10A) QST,10242556,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 4 (4) QST,10243604,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 43 (11A) QST,10242559,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 5 (5) QST,10243605,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 51 (7F) QST,10243613,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 54 (15B) QST,10242565,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 56 (18C) QST,10243614,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 57 (19A) QST,10242571,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 68 (9V) QST,10243615,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 70 (33F) QST,10242577,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 8 (8) QST,10243606,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 9 (9N) QST,10243607,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ciprofloxacin 400 mg/200 mL-5% Sol,11201486,LOCAL,J0744,CPT,,,,,,Outpatient,200,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aldolase QSTC,8764531,LOCAL,82085,CPT,,,,,,Outpatient,,,,11.65,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glucose Fingerstick Clinic POC (RE),4192199,LOCAL,82962,CPT,,,,,,Outpatient,,,,3.94,VIVA,Commercial,,50,,13.47,13.47,13.47,1 through 10,percent of total billed charges,7.16,9.084767596,
".Smooth Muscle Ab, Titer QSTC",13864540,LOCAL,86256,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DNA (ds) Antibody QSTC,8764566,LOCAL,86225,CPT,,,,,,Outpatient,,,,16.49,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatitis B Core Ab (IgM) QSTC,8764681,LOCAL,86705,CPT,,,,,,Outpatient,,,,14.12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mumps Virus Antibody (IgG) QSTC,8764679,LOCAL,86735,CPT,,,,,,Outpatient,,,,15.66,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prolactin QSTC,8972761,LOCAL,84146,CPT,,,,,,Outpatient,,,,23.26,VIVA,Commercial,,50,,137.7,137.7,137.7,1 through 10,percent of total billed charges,18.43,19.38,
Smooth Muscle Ab w/refl Titer QSTC,13864539,LOCAL,83497,CPT,,,,,,Outpatient,,,,15.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Smooth Muscle Ab w/rfx Titer QSTC,13864539,LOCAL,86015,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Treponema pall Ab, Particle Agg QSTC",8972906,LOCAL,86780,CPT,,,,,,Outpatient,,,,15.89,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Protein Level Urine,4186691,LOCAL,84156,CPT,,,,,,Outpatient,,,,4.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lipid Panel w/ Rfx to Direct LDL QSTC,13864433,LOCAL,80061,CPT,,,,,,Outpatient,,,,16.07,VIVA,Commercial,,50,,50.8,25.27,50.8,13,percent of total billed charges,12.14,16.59934459,
cyanocobalamin 1000 mcg/mL injectable solution 1 mL [CULL],11202258,LOCAL,J3420,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0109 DM OP SMT GRP PER 30 MIN CHARGE,8709096,LOCAL,,,G0109,HCPCS,,,,Outpatient,,,,18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ID,8131550,LOCAL,87077,CPT,,,,,,Outpatient,,,,9.7,VIVA,Commercial,,50,,28.15,14.08,28.15,1 through 10,percent of total billed charges,10.57,16.47987421,
ID Add On,13661571,LOCAL,87077,CPT,,,,,,Outpatient,,,,9.7,VIVA,Commercial,,50,,28.15,14.08,28.15,1 through 10,percent of total billed charges,10.57,16.47987421,
Mitochondria M2 Ab (IgG) QSTC,8764575,LOCAL,86381,CPT,,,,,,Outpatient,,,,30.54,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DOPP LOWER EXT ART/ABI,8200227,LOCAL,93922,CPT,,,,,,Outpatient,,,,265,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
clindamycin 300 mg/50 mL-NaCl 0.9% Sol [CULL],11290065,LOCAL,J0737,CPT,,,,,,Outpatient,50,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
butorphanol 2 mg/mL Sol [CULL],11202147,LOCAL,J0595,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Gastrin, Serum QSTC",8764526,LOCAL,82941,CPT,,,,,,Outpatient,,,,21.16,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hep B Core Ab (Total)w/Rfx to IgM QSTC,9039408,LOCAL,86704,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatitis A IgM QSTC,8764600,LOCAL,86709,CPT,,,,,,Outpatient,,,,13.51,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hepatitis B Core Ab, Total QSTC",8764579,LOCAL,86704,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complement Component C3c QSTC,8972768,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complement Component C4c QSTC,8972769,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Insulin QSTC,9039285,LOCAL,83525,CPT,,,,,,Outpatient,,,,13.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Clozapine QSTC,8764629,LOCAL,80159,CPT,,,,,,Outpatient,,,,24.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HSV 1 and 2 IgG Antibodies QSTC,8853241,LOCAL,86695,CPT,,,,,,Outpatient,,,,15.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"HSV 1/2 IgG,Type Specific Ab QST",8389465,LOCAL,86695,CPT,,,,,,Outpatient,,,,15.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97804 Medical Nutrit Group 30Min CHARGE,9323172,LOCAL,97804,CPT,,,,,,Outpatient,,,,20,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Insulin Level Total,3454335,LOCAL,83525,CPT,,,,,,Outpatient,,,,13.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
budesonide 0.25 mg/2 mL inhalation suspension 2 mL [CULL],11205254,LOCAL,J7626,CPT,,,,,,Outpatient,2,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
cefTRIAXone 2 g injection ADDV [CULL],11282070,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,5.8,0.92,5.8,1 through 10,percent of total billed charges,5.161428571,5.161428571,
labetalol 5 mg/mL intravenous solution 20 mL [CULL],11201873,LOCAL,J1920,CPT,,,,,,Outpatient,20,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
triamcinolone acetonide 40 mg/mL injectable suspension 1 mL [CULL],11212390,LOCAL,J3301,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
clindamycin 300 mg/50 mL-D5% intravenous solution 50 mL [CULL],11290065,LOCAL,J0736,CPT,,,,,,Outpatient,50,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
".ANA, Titer and Pattern QSTC",8764643,LOCAL,86039,CPT,,,,,,Outpatient,,,,13.39,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cytomegalovirus Antibody (IgG) QSTC,13972135,LOCAL,86644,CPT,,,,,,Outpatient,,,,17.27,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cytomegalovirus Antibody (IgG) QSTC,8853227,LOCAL,86644,CPT,,,,,,Outpatient,,,,17.27,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C-Reactive Protein,1628890,LOCAL,86140,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,5.95,5.18,5.95,1 through 10,percent of total billed charges,13.29690962,15.29,
Fecal WBC,4123047,LOCAL,87205,CPT,,,,,,Outpatient,,,,5.12,VIVA,Commercial,,50,,20.81,3.54,20.81,1 through 10,percent of total billed charges,10.57,12.26595628,
Stool WBC,10294481,LOCAL,87205,CPT,,,,,,Outpatient,,,,5.12,VIVA,Commercial,,50,,20.81,3.54,20.81,1 through 10,percent of total billed charges,10.57,12.26595628,
"Complement, Total (CH50) QSTC",8764582,LOCAL,86162,CPT,,,,,,Outpatient,,,,24.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DHEA Sulfate QSTC,9696140,LOCAL,82627,CPT,,,,,,Outpatient,,,,26.68,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Haptoglobin QSTC,8764542,LOCAL,83010,CPT,,,,,,Outpatient,,,,15.1,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hepatitis A Ab, Total QSTC",8764599,LOCAL,86708,CPT,,,,,,Outpatient,,,,14.87,VIVA,Commercial,,50,,16.2,16.2,16.2,1 through 10,percent of total billed charges,12.39,15.29,
Jo-1 Antibody QSTC,8764688,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"RNP Antibody, QSTC",10100359,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sm Antibody, QSTC",10100362,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"STRAP, CLAVICLE SMALL-3004-06",6010605,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Albumin, CSF QSTC",13873031,LOCAL,82042,CPT,,,,,,Outpatient,,,,9.34,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Albumin, Serum QSTC",13873034,LOCAL,82040,CPT,,,,,,Outpatient,,,,5.94,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin G QSTC,13873033,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Oligoclonal Bands (IgG),CSF QSTC",13873028,LOCAL,83916,CPT,,,,,,Outpatient,,,,32.87,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin A QSTC,13904383,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tTG IgA Ab QSTC,13904382,LOCAL,86364,CPT,,,,,,Outpatient,,,,13.84,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Delta-Aminolevulinic Acid, Random Urine QSTC",12329984,LOCAL,82135,CPT,,,,,,Outpatient,,,,19.74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilirubin Cord Blood,10237211,LOCAL,82247,CPT,,,,,,Outpatient,,,,6.02,VIVA,Commercial,,50,,16.73,16.73,16.73,1 through 10,percent of total billed charges,5.02,7.16,
Bilirubin Neonatal (Bu/Bc),14541767,LOCAL,82248,CPT,,,,,,Outpatient,,,,6.02,VIVA,Commercial,,50,,50.8,50.8,50.8,1 through 10,percent of total billed charges,7.16,26.6275,
Bilirubin Neonatal 2,8883195,LOCAL,82247,CPT,,,,,,Outpatient,,,,6.02,VIVA,Commercial,,50,,16.73,16.73,16.73,1 through 10,percent of total billed charges,5.02,7.16,
Bilirubin Total,633672,LOCAL,82247,CPT,,,,,,Outpatient,,,,6.02,VIVA,Commercial,,50,,16.73,16.73,16.73,1 through 10,percent of total billed charges,5.02,7.16,
Bilirubin Total,7939102,LOCAL,82247,CPT,,,,,,Outpatient,,,,6.02,VIVA,Commercial,,50,,16.73,16.73,16.73,1 through 10,percent of total billed charges,5.02,7.16,
Bilirubin Total,8443661,LOCAL,82247,CPT,,,,,,Outpatient,,,,6.02,VIVA,Commercial,,50,,16.73,16.73,16.73,1 through 10,percent of total billed charges,5.02,7.16,
Cyclic Citrull Peptide (CCP) Ab IgG QSTC,8764613,LOCAL,86200,CPT,,,,,,Outpatient,,,,15.54,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cholinesterase, Plasma QSTC",13873320,LOCAL,82482,CPT,,,,,,Outpatient,,,,11.77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cholinesterase, RBC QSTC",13873317,LOCAL,82480,CPT,,,,,,Outpatient,,,,9.44,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
STRAP CLAVICLE PED.,11071010,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Calcium, 24 hour Urine QSTC",13864700,LOCAL,82340,CPT,,,,,,Outpatient,,,,7.24,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,22.61833333,
"Citric Acid, 24 Hour Urine QSTC",13864703,LOCAL,82507,CPT,,,,,,Outpatient,,,,33.36,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,17.73,30.625,
"Creatinine, 24 Hour Urine QSTC",13864712,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,40.97514925,
"Magnesium, 24 Hour Urine QSTC",13864709,LOCAL,83735,CPT,,,,,,Outpatient,,,,8.04,VIVA,Commercial,,50,,17.75,5.41,17.75,20,percent of total billed charges,3.657824427,7.16,
"Oxalate, 24 Hour Urine QSTC",13864701,LOCAL,83945,CPT,,,,,,Outpatient,,,,17.34,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,17.73,24.085,
pH Urine QSTC,13864699,LOCAL,83986,CPT,,,,,,Outpatient,,,,4.3,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,18.755,
"Phosphorus, 24 Hour Urine QSTC",13864707,LOCAL,84105,CPT,,,,,,Outpatient,,,,6.94,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,19.835,
"Potassium, 24 Hour Urine QSTC",13864711,LOCAL,84133,CPT,,,,,,Outpatient,,,,5.68,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,19.32,
"Sodium, 24 Hour Urine QSTC",13864704,LOCAL,84300,CPT,,,,,,Outpatient,,,,6.07,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,9.74,
"Sulfate, 24 Hour Urine QSTC",13864705,LOCAL,84392,CPT,,,,,,Outpatient,,,,6.59,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,4.02,19.695,
Uric Acid QSTC,13864716,LOCAL,84560,CPT,,,,,,Outpatient,,,,6.1,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,19.49,
Ammonium Urine QSTC,8997190,LOCAL,82140,CPT,,,,,,Outpatient,,,,17.48,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,17.73,22.62909091,
"Calcium, 24 hour Urine QSTC",8997182,LOCAL,82340,CPT,,,,,,Outpatient,,,,7.24,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,22.61833333,
"Citric Acid, 24 Hour Urine QSTC",8997185,LOCAL,82507,CPT,,,,,,Outpatient,,,,33.36,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,17.73,30.625,
"Creatinine, 24 Hour Urine QSTC",8997192,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,40.97514925,
"Magnesium, 24 Hour Urine QSTC",8997189,LOCAL,83735,CPT,,,,,,Outpatient,,,,8.04,VIVA,Commercial,,50,,17.75,5.41,17.75,20,percent of total billed charges,3.657824427,7.16,
"Oxalate, 24 Hour Urine QSTC",8997183,LOCAL,83945,CPT,,,,,,Outpatient,,,,17.34,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,17.73,24.085,
pH Urine QSTC,8997180,LOCAL,83986,CPT,,,,,,Outpatient,,,,4.3,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,18.755,
"Phosphorus, 24 Hour Urine QSTC",8997188,LOCAL,84105,CPT,,,,,,Outpatient,,,,6.94,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,19.835,
"Potassium, 24 Hour Urine QSTC",8997191,LOCAL,84133,CPT,,,,,,Outpatient,,,,5.68,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,19.32,
"Sodium, 24 Hour Urine QSTC",8997186,LOCAL,84300,CPT,,,,,,Outpatient,,,,6.07,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,9.74,
"Sulfate, 24 Hour Urine QSTC",8997187,LOCAL,84392,CPT,,,,,,Outpatient,,,,6.59,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,4.02,19.695,
"Uric Acid, 24 Hour Urine QSTC",8997184,LOCAL,84560,CPT,,,,,,Outpatient,,,,6.1,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,19.49,
BINDER ABDOMINAL MALE,11070715,LOCAL,,,L0625,HCPCS,,,,Outpatient,,,,86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lipase Level,633776,LOCAL,83690,CPT,,,,,,Outpatient,,,,8.27,VIVA,Commercial,,50,,4.63,2.71,4.63,1 through 10,percent of total billed charges,1.304132029,7.16,
fluconazole 200 mg/100 mL-NaCl 0.9% intravenous solution 100 mL [CULL],11220720,LOCAL,J1450,CPT,,,,,,Outpatient,100,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
vancomycin 500 mg/100 mL intravenous solution 100 mL [CULL],11290008,LOCAL,J3375,CPT,,,,,,Outpatient,100,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ceruloplasmin QSTC,8764535,LOCAL,82390,CPT,,,,,,Outpatient,,,,12.89,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
labetalol 5 mg/mL intravenous solution 4 mL [CULL],11201874,LOCAL,J1920,CPT,,,,,,Outpatient,4,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amikacin Level,9034955,LOCAL,80150,CPT,,,,,,Outpatient,,,,18.1,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"ANA Screen, IFA QSTC",14116751,LOCAL,86038,CPT,,,,,,Outpatient,,,,14.51,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Breath Alcohol,9687753,LOCAL,82075,CPT,,,,,,Outpatient,,,,36,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"CCP, Antibody (IgG) QSTC",14116753,LOCAL,86200,CPT,,,,,,Outpatient,,,,15.54,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"MCV, Antibody QSTC",14116754,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rheumatoid Factor QSTC,14116752,LOCAL,86431,CPT,,,,,,Outpatient,,,,6.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
T4 Total,633845,LOCAL,84436,CPT,,,,,,Outpatient,,,,8.24,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rheumatoid Factor Qualitative,7906954,LOCAL,86430,CPT,,,,,,Outpatient,,,,7.37,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Protein Tot & Protein Electrophore QSTC,8764768,LOCAL,84155,CPT,,,,,,Outpatient,,,,4.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glucose 2 Hour Post Prandial,7973897,LOCAL,82947,CPT,,,,,,Outpatient,,,,4.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lithium Level,2046348,LOCAL,80178,CPT,,,,,,Outpatient,,,,7.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Magnesium Level,633781,LOCAL,83735,CPT,,,,,,Outpatient,,,,8.04,VIVA,Commercial,,50,,17.75,5.41,17.75,20,percent of total billed charges,3.657824427,7.16,
BINDER ABDOMINAL FEMALE,11070714,LOCAL,,,L0625,HCPCS,,,,Outpatient,,,,86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Crystal Analysis QSTC,9658951,LOCAL,89060,CPT,,,,,,Outpatient,,,,8.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glucose 1 Hour,7973889,LOCAL,82951,CPT,,,,,,Outpatient,,,,15.44,VIVA,Commercial,,50,,17.95,17.95,17.95,1 through 10,percent of total billed charges,12.87,17.73,
Glucose 2 Hour,7973890,LOCAL,82952,CPT,,,,,,Outpatient,,,,4.7,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glucose Level,633594,LOCAL,82947,CPT,,,,,,Outpatient,,,,4.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Thyroid Peroxidase Abs QSTC,8861417,LOCAL,86376,CPT,,,,,,Outpatient,,,,17.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Thyroid Peroxidase Antibodies QSTC,8764563,LOCAL,86376,CPT,,,,,,Outpatient,,,,17.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alpha-1-Antitrypsin, Qn QSTC",9039253,LOCAL,82103,CPT,,,,,,Outpatient,,,,16.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alpha-Fetoprotein, Tumor Marker QSTC",8764596,LOCAL,82105,CPT,,,,,,Outpatient,,,,20.12,VIVA,Commercial,,50,,12.94,12.94,12.94,1 through 10,percent of total billed charges,17.73,26.22,
"B2 Microglobulin, Serum QSTC",8764794,LOCAL,82232,CPT,,,,,,Outpatient,,,,19.42,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Decalcification Procedure,8489589,LOCAL,88311,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CA 125 QSTC,8764680,LOCAL,86304,CPT,,,,,,Outpatient,,,,24.97,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CA 19-9 QSTC,8764669,LOCAL,86301,CPT,,,,,,Outpatient,,,,24.97,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CA 27.29 QSTC,8764762,LOCAL,86300,CPT,,,,,,Outpatient,,,,24.97,VIVA,Commercial,,50,,18,18,18,1 through 10,percent of total billed charges,15.29,43.34448276,
Copper QSTC,8764536,LOCAL,82525,CPT,,,,,,Outpatient,,,,14.89,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fungal Identification, Molds QSTC",8873558,LOCAL,87107,CPT,,,,,,Outpatient,,,,12.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Gliadin(Deamidated) Ab,IgA QSTC",9039363,LOCAL,86258,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Gliadin(Deamidated) Ab,IgG QSTC",9039362,LOCAL,86258,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lamotrigine QSTC,8853218,LOCAL,80175,CPT,,,,,,Outpatient,,,,15.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Protein, Total, w/Creat, Random Ur QSTC",9291011,LOCAL,84156,CPT,,,,,,Outpatient,,,,4.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Testosterone, Total, MS QSTC",8848606,LOCAL,84402,CPT,,,,,,Outpatient,,,,30.56,VIVA,Commercial,,50,,17.99,17.99,17.99,1 through 10,percent of total billed charges,18.43,30.485,
SLING PED/INFANT 5'X9,6000156,LOCAL,,,A4565,HCPCS,,,,Outpatient,,,,19,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Copper, 24-Hour Urine QSTC",9390117,LOCAL,82525,CPT,,,,,,Outpatient,,,,14.89,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MALDI ID,X87077,LOCAL,87077,CPT,,,,,,Outpatient,,,,9.7,VIVA,Commercial,,50,,28.15,14.08,28.15,1 through 10,percent of total billed charges,10.57,16.47987421,
cefTAZidime 2 g injection [CULL],11201395,LOCAL,J0713,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"ANA Screen, IFA QST",9110748,LOCAL,86038,CPT,,,,,,Outpatient,,,,14.51,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complement Component C3C QST,12876950,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complement Component C4C QST,12876951,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DNA (DS) Antibody QST,9110747,LOCAL,86225,CPT,,,,,,Outpatient,,,,16.49,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Microalbumin Level Urine,7974117,LOCAL,82043,CPT,,,,,,Outpatient,,,,6.94,VIVA,Commercial,,50,,18.49,18.49,18.49,1 through 10,percent of total billed charges,4.02,20.15557971,
Rheumatoid Factor QST,9110751,LOCAL,86431,CPT,,,,,,Outpatient,,,,6.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ribosomal P Antibody QST,9110754,LOCAL,83516,CPT,,,,,,Outpatient,,,,13.84,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SCL-70 Antibody QST,9110757,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sjogren's Antibody (SS-A) QST,9110760,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sjogren's Antibody (SS-B) QST,9110763,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sm Antibody QST,9110766,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SM/RNP Antibody QST,9110769,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Thyroid Peroxidase Antibodies QST,9110772,LOCAL,86376,CPT,,,,,,Outpatient,,,,17.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EBV EBNA Ab (IgG) Interp QSTC,8849012,LOCAL,86664,CPT,,,,,,Outpatient,,,,18.35,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EBV VCA Ab (IgM) QSTC,8849009,LOCAL,86665,CPT,,,,,,Outpatient,,,,21.77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
".B. henselae Ab(IgG),Titer QSTC",8764830,LOCAL,86611,CPT,,,,,,Outpatient,,,,12.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
".B. henselae Ab(IgM),Titer QSTC",8764831,LOCAL,86611,CPT,,,,,,Outpatient,,,,12.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
".B. quintana Ab(IgG),Titer QSTC",10128892,LOCAL,86611,CPT,,,,,,Outpatient,,,,12.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMMOBLIZER KNEE XX-LARGE,11070340,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,,158,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methocarbamol 100 mg/mL injectable solution 10 mL [CULL],11201939,LOCAL,J2800,CPT,,,,,,Outpatient,10,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
calcium gluconate 100 mg/mL injectable solution 10 mL [CULL],11201252,LOCAL,J0612,CPT,,,,,,Outpatient,10,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLING & SWATHE W/SLEEVE,11071056,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TBG QSTC,8853216,LOCAL,84442,CPT,,,,,,Outpatient,,,,17.74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Culture, Fungus, Skin, Hair, Nails QSTC",8972785,LOCAL,87101,CPT,,,,,,Outpatient,,,,9.25,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostate Specific Antigen Total,7939094,LOCAL,84153,CPT,,,,,,Outpatient,,,,22.07,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prealbumin,3454341,LOCAL,84134,CPT,,,,,,Outpatient,,,,17.51,VIVA,Commercial,,50,,19.99,19.99,19.99,14,percent of total billed charges,4.934545455,17.73,
20560 DRY NEEDLING 1 OR 2 MUSCLES WO INJECTION,9650048,LOCAL,20560,CPT,,,,,,Outpatient,,,,26,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Beef (F27) IgE Class QSTC,14129407,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Glucose Body Fluid,1628896,LOCAL,82945,CPT,,,,,,Outpatient,,,,4.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lamb (F88) IgE Class QSTC,14129413,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Pork (F26) IgE Class QSTC,14129419,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
RESULTS_QSTC,14755730,LOCAL,86008,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pyruvic Acid (Pyruvate),B QSTC",13864526,LOCAL,84210,CPT,,,,,,Outpatient,,,,17.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"VDRL, CSF QSTC",8764738,LOCAL,86592,CPT,,,,,,Outpatient,,,,5.12,VIVA,Commercial,,50,,29.61,29.61,29.61,1 through 10,percent of total billed charges,15.29,19.99375,
Angiotensin Converting Enzyme QSTC,8764564,LOCAL,82164,CPT,,,,,,Outpatient,,,,17.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intrinsic Factor Blocking Antibody QSTC,8764611,LOCAL,86340,CPT,,,,,,Outpatient,,,,18.1,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osmolality Serum,9414322,LOCAL,83930,CPT,,,,,,Outpatient,,,,7.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97018 OT PARAFFIN BATH 1+ AREAS APPLIC CHARGE,9850020,LOCAL,97018,CPT,,,,,GO,Outpatient,,,,27,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97018 OT PARAFFIN BATH CHARGE,9860020,LOCAL,97018,CPT,,,,,GO|CO,Outpatient,,,,27,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Paraffin Bath Assistant Units,7895270,LOCAL,97018,CPT,,,,,CQ,Outpatient,,,,27,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Paraffin Bath Units,1373447,LOCAL,97018,CPT,,,,,GO,Outpatient,,,,27,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Paraffin Bath Charge,7895270,LOCAL,97018,CPT,,,,,GO,Outpatient,,,,27,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Centromere B Antibody QSTC,8764633,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COLLAR LG HARD C,11070731,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,,223,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COLLAR MED.HARD,11071039,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,,223,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COLLAR SM HARD C,11070729,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,,223,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
M. pneumoniae Ab (IgM) QSTC,8764773,LOCAL,86738,CPT,,,,,,Outpatient,,,,15.89,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL Pre-MRI Device Screening,14536295,LOCAL,76014,CPT,,,,,,Outpatient,,,,19.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Safety Screening,14536295,LOCAL,76014,CPT,,,,,,Outpatient,,,,19.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Zinc QSTC,8764557,LOCAL,84630,CPT,,,,,,Outpatient,,,,13.67,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gram Stain (General Lab),8726050,LOCAL,87205,CPT,,,,,,Outpatient,,,,5.12,VIVA,Commercial,,50,,20.81,3.54,20.81,1 through 10,percent of total billed charges,10.57,12.26595628,
Gram Stain Intraoperative,13436049,LOCAL,87205,CPT,,,,,,Outpatient,,,,5.12,VIVA,Commercial,,50,,20.81,3.54,20.81,1 through 10,percent of total billed charges,10.57,12.26595628,
Gram Stain Report,634217,LOCAL,87205,CPT,,,,,,Outpatient,,,,5.12,VIVA,Commercial,,50,,20.81,3.54,20.81,1 through 10,percent of total billed charges,10.57,12.26595628,
"Bile Acids, Fractionated and Total QSTC",13864500,LOCAL,82542,CPT,,,,,,Outpatient,,,,28.91,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Calcium, 24 hr Ur (w/o Creatinine) QSTC",9039238,LOCAL,82340,CPT,,,,,,Outpatient,,,,7.24,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,22.61833333,
Drug Panel (10),13954356,LOCAL,80306,CPT,,,,,,Outpatient,,,,20.57,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Intraoperative Additonal,14048005,LOCAL,88332,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Toxoplasma Antibody (IgG) QSTC,8861628,LOCAL,86777,CPT,,,,,,Outpatient,,,,17.27,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Toxoplasma Antibody (IgM) QSTC,8861629,LOCAL,86778,CPT,,,,,,Outpatient,,,,17.29,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
clindamycin 600 mg/50 mL-NaCl 0.9% Sol [CULL],11290024,LOCAL,J0737,CPT,,,,,,Outpatient,50,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cadmium, Blood, QSTC",13864925,LOCAL,82300,CPT,,,,,,Outpatient,,,,28.37,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vitamin B1 (Thiamine), B QSTC",8972833,LOCAL,84425,CPT,,,,,,Outpatient,,,,25.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Calcium, Ionized QSTC",9039239,LOCAL,82330,CPT,,,,,,Outpatient,,,,16.42,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cortisol, Free, U24 QSTC",8764823,LOCAL,82530,CPT,,,,,,Outpatient,,,,20.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vanillylmandelic Acid, U24 QSTC",8764683,LOCAL,84585,CPT,,,,,,Outpatient,,,,18.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aspergillus fumigatus, IgG Ab QSTC",13864492,LOCAL,86606,CPT,,,,,,Outpatient,,,,18.06,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Blastomyces Ab,Immunodiff QSTC",10100364,LOCAL,86612,CPT,,,,,,Outpatient,,,,15.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cryptococcal Antigen Latex QSTC,8972754,LOCAL,86403,CPT,,,,,,Outpatient,,,,13.85,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"5HIAA, 24-Hour Urine QSTC",8764545,LOCAL,83497,CPT,,,,,,Outpatient,,,,15.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
betamethasone 12 mg/mL injectable suspension 2mL [CULL],11205515,LOCAL,J0702,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O2 Saturation Arterial,12487723,LOCAL,82810,CPT,,,,,,Outpatient,,,,11.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O2 Saturation Venous,12487723,LOCAL,82810,CPT,,,,,,Outpatient,,,,11.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Creatinine Random Ur, QSTC",10127838,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,40.97514925,
"Metanephrine Ur, Total QSTC",10127837,LOCAL,83835,CPT,,,,,,Outpatient,,,,20.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CA 15-3 QSTC,8764684,LOCAL,86300,CPT,,,,,,Outpatient,,,,24.97,VIVA,Commercial,,50,,18,18,18,1 through 10,percent of total billed charges,15.29,43.34448276,
"Electrolytes, Urine",12312936,LOCAL,84166,CPT,,,,,,Outpatient,,,,21.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Occult Blood Stool Screen,7909957,LOCAL,82272,CPT,,,,,,Outpatient,,,,5.08,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Carbamazepine, Total QSTC",9039320,LOCAL,80156,CPT,,,,,,Outpatient,,,,17.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastric Parietal Cell AB QSTC,8764524,LOCAL,83516,CPT,,,,,,Outpatient,,,,13.84,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"ACTH, Plasma QSTC",8764544,LOCAL,82024,CPT,,,,,,Outpatient,,,,46.34,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Beta2-Glycoprotein IgA QSTC,10100357,LOCAL,86146,CPT,,,,,,Outpatient,,,,30.54,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin G Subclass 4 QSTC,10100372,LOCAL,82787,CPT,,,,,,Outpatient,,,,9.62,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testosterone Free & Total MS QSTC,8764632,LOCAL,84403,CPT,,,,,,Outpatient,,,,30.97,VIVA,Commercial,,50,,41.01,41.01,41.01,1 through 10,percent of total billed charges,18.43,52.3775,
Tissue Transglutaminase IgA Ab QSTC,8764753,LOCAL,86364,CPT,,,,,,Outpatient,,,,13.84,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
acetaminophen 10 mg/mL intravenous solution 100 mL [CULL],11200037,LOCAL,J0134,CPT,,,,,,Outpatient,100,ML,,,VIVA,Commercial,,50,,11.52,5.06,11.52,1 through 10,percent of total billed charges,3.159596774,3.159596774,
Scl-70 Antibody QSTC,8853206,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Egg Component Panel QSTC,9039428,LOCAL,86008,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Total Iron Binding Capacity,7909796,LOCAL,83550,CPT,,,,,,Outpatient,,,,10.49,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
amikacin 250 mg/mL injectable solution 2 mL [CULL],11201051,LOCAL,J0278,CPT,,,,,,Outpatient,2,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
cefTRIAXone 250 mg injection [CULL],11202192,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,5.8,0.92,5.8,1 through 10,percent of total billed charges,5.161428571,5.161428571,
clindamycin 600 mg/50 mL-D5% intravenous solution 50 mL [CULL],11290024,LOCAL,J0736,CPT,,,,,,Outpatient,50,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Yeast Culture,7909554,LOCAL,87101,CPT,,,,,,Outpatient,,,,9.25,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
T3 Total,633833,LOCAL,84480,CPT,,,,,,Outpatient,,,,17.02,VIVA,Commercial,,50,,24,24,24,1 through 10,percent of total billed charges,18.43,33.01411765,
97035 OT ULTRASOUND,9850026,LOCAL,97035,CPT,,,,,GO,Outpatient,,,,31,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97035 OT Ultrasound Assistant Units,9860026,LOCAL,97035,CPT,,,,,GO|CO,Outpatient,,,,31,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97035 PT ULTRASOUND,9640026,LOCAL,97035,CPT,,,,,GP,Outpatient,,,,31,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97035 PT Ultrasound Assistant Units,9650026,LOCAL,97035,CPT,,,,,GP|CQ,Outpatient,,,,31,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97035 ULTRASOUND EA 15 MIN CHARGE,9410126,LOCAL,97035,CPT,,,,,GP,Outpatient,,,,31,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Ultrasound Assistant Units,1366376,LOCAL,97035,CPT,,,,,CQ,Outpatient,,,,31,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Ultrasound Charges,1366376,LOCAL,97035,CPT,,,,,GO,Outpatient,,,,31,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Ultrasound Units,1373448,LOCAL,97035,CPT,,,,,GO,Outpatient,,,,31,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Ultrasound Assistant Units,9390428,LOCAL,97035,CPT,,,,,CQ,Outpatient,,,,31,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Charges,1366376,LOCAL,97035,CPT,,,,,GO,Outpatient,,,,31,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Charges,7895933,LOCAL,97035,CPT,,,,,GP,Outpatient,,,,31,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Phenobarbital QSTC,8972760,LOCAL,80184,CPT,,,,,,Outpatient,,,,18.36,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"penicillin G potassium 5,000,000 units injection [CULL]",11211091,LOCAL,J2540,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Semen Analysis Post Vasectomy,3454457,LOCAL,89320,CPT,,,,,,Outpatient,,,,14.77,VIVA,Commercial,,50,,24.48,24.48,24.48,1 through 10,percent of total billed charges,12.31,14.07,
"HIV Ag/Ab, 4th Gen w reflexes QSTC",8764806,LOCAL,87389,CPT,,,,,,Outpatient,,,,28.9,VIVA,Commercial,,50,,24.75,24.75,24.75,1 through 10,percent of total billed charges,10.57,36.55,
"Phenytoin, Free QSTC",8764686,LOCAL,80186,CPT,,,,,,Outpatient,,,,16.51,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"T3, Reverse, LCMSMS QSTC",8764804,LOCAL,84482,CPT,,,,,,Outpatient,,,,18.91,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"82140 Ammonium, 24 HR, U",14789403,LOCAL,82140,CPT,,,,,,Outpatient,,,,17.48,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,17.73,22.62909091,
"82340 Calcium, 24 HR, U",14797185,LOCAL,82340,CPT,,,,,,Outpatient,,,,7.24,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,22.61833333,
"82436 Chloride, 24 HR, U",14797182,LOCAL,82436,CPT,,,,,,Outpatient,,,,6.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"82507 Citrate Excretion, 24 HR, U",14787436,LOCAL,82507,CPT,,,,,,Outpatient,,,,33.36,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,17.73,30.625,
"82570 Creatinine, 24 HR, U",14798767,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,40.97514925,
"83735 Magnesium, 24 HR, U",14789401,LOCAL,83735,CPT,,,,,,Outpatient,,,,8.04,VIVA,Commercial,,50,,17.75,5.41,17.75,20,percent of total billed charges,3.657824427,7.16,
"83945 Oxalate, 24 HR, U",14797186,LOCAL,83945,CPT,,,,,,Outpatient,,,,17.34,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,17.73,24.085,
"84105 Phosphorus, 24 HR, U",14787442,LOCAL,84105,CPT,,,,,,Outpatient,,,,6.94,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,19.835,
"84133 Potassium, 24 HR, U",14797183,LOCAL,84133,CPT,,,,,,Outpatient,,,,5.68,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,19.32,
"84300 Sodium, 24 HR, U",14797184,LOCAL,84300,CPT,,,,,,Outpatient,,,,6.07,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,9.74,
"84540 Urea Nitrogen, 24 HR, U",14789404,LOCAL,84540,CPT,,,,,,Outpatient,,,,6.67,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"84560 Uric Acid, 24 HR, U",14787441,LOCAL,84560,CPT,,,,,,Outpatient,,,,6.1,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,19.49,
BUPivacaine 0.5% preservative-free injectable solution 30 mL [CULL],11282051,LOCAL,J0665,CPT,,,,,,Outpatient,30,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
deferoxamine 500 mg injection [CULL],11214520,LOCAL,J0895,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C-Peptide,12252873,LOCAL,84681,CPT,,,,,,Outpatient,,,,24.97,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
D-Dimer,3454398,LOCAL,85380,CPT,,,,,,Outpatient,,,,12.22,VIVA,Commercial,,50,,9.3,9.3,9.3,1 through 10,percent of total billed charges,5.76079096,8.21,
G0447 BEHAVIORAL COUNSIL OBESITY 15 MIN CHARGE,8635988,LOCAL,,,G0447,HCPCS,,,,Outpatient,,,,33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatitis B S Ab,1628908,LOCAL,86706,CPT,,,,,,Outpatient,,,,12.89,VIVA,Commercial,,50,,25,25,25,1 through 10,percent of total billed charges,15.29,17.794,
Hepatitis B Surface Antibody w/ Interp,9299896,LOCAL,86706,CPT,,,,,,Outpatient,,,,12.89,VIVA,Commercial,,50,,25,25,25,1 through 10,percent of total billed charges,15.29,17.794,
Lactate Dehydrogenase Body Fluid,3454444,LOCAL,83615,CPT,,,,,,Outpatient,,,,7.25,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cytomegalovirus Antibodies (IgG,IgM) QSTC",8972893,LOCAL,86645,CPT,,,,,,Outpatient,,,,20.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cytomegalovirus Antibody (IgM) QSTC,8764581,LOCAL,86645,CPT,,,,,,Outpatient,,,,20.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Micronutrient Vitamin E QSTC,14116320,LOCAL,84446,CPT,,,,,,Outpatient,,,,17.02,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vitamin A (Retinol) QSTC,8764529,LOCAL,84590,CPT,,,,,,Outpatient,,,,13.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ethosuximide QSTC,8764552,LOCAL,80168,CPT,,,,,,Outpatient,,,,19.61,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
77061 MG Diagnostic Tomo Charge: AddOn Left,13960722,LOCAL,G0279,CPT,,,,,LT,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
77061 MG Diagnostic Tomo Charge: AddOn Right,13960723,LOCAL,G0279,CPT,,,,,RT,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
77061 MG Diagnostic Tomo Charge: AddOn Right,13969683,LOCAL,G0279,CPT,,,,,RT,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
77063 MG Tomo Charge: AddOn Left,13621442,LOCAL,77063,CPT,,,,,LT,Outpatient,,,,54.45,VIVA,Commercial,,50,,50.92,50.92,50.92,1 through 10,percent of total billed charges,20.75,74,
77063 MG Tomo Charge: AddOn Right,13621441,LOCAL,77063,CPT,,,,,RT,Outpatient,,,,54.45,VIVA,Commercial,,50,,50.92,50.92,50.92,1 through 10,percent of total billed charges,20.75,74,
PC DOPP ART BIL REST,8200579,LOCAL,93923,CPT,,,,,,Outpatient,,,,401,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
acyclovir 50 mg/mL intravenous solution 10 mL [CULL],11201009,LOCAL,J0133,CPT,,,,,,Outpatient,10,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chloride Level,633621,LOCAL,82435,CPT,,,,,,Outpatient,,,,5.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KOH POCT,10913182,LOCAL,87220,CPT,,,,,,Outpatient,,,,5.12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E-Stim for Wound Other Charge,7895924,LOCAL,G0283,CPT,G0283,HCPCS,,,GP,Outpatient,,,,33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0283 INTERFERENCE CHARGES,9640019,LOCAL,,,G0283,HCPCS,,,GP,Outpatient,,,,33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0283 PT Elect Stim Unattended Assistant Units Charge,9650019,LOCAL,,,G0283,HCPCS,,,GP,Outpatient,,,,33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0283 OT ELEC STIM MEDICARE CHARGE,9860018,LOCAL,,,G0283,HCPCS,,,GO|CO,Outpatient,,,,33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0283 OT ESTIM UNATTENDED CHARGE,9850018,LOCAL,,,G0283,HCPCS,,,GO,Outpatient,,,,33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Unattended E-Stim Assistant Units,7895266,LOCAL,,,G0283,HCPCS,,,CQ,Outpatient,,,,33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OTElectrical Stim (Unattended) - Non-Wound,1373552,LOCAL,,,G0283,HCPCS,,,GO,Outpatient,,,,33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
UA w Micro if Ind,1148022,LOCAL,81003,CPT,,,,,,Outpatient,,,,2.7,VIVA,Commercial,,50,,9.85,4.08,9.85,1 through 10,percent of total billed charges,3.795286195,4.02,
UA w Micro if Ind & Cult if Ind,8088555,LOCAL,81003,CPT,,,,,,Outpatient,,,,2.7,VIVA,Commercial,,50,,9.85,4.08,9.85,1 through 10,percent of total billed charges,3.795286195,4.02,
Urinalysis Macroscopic,633863,LOCAL,81003,CPT,,,,,,Outpatient,,,,2.7,VIVA,Commercial,,50,,9.85,4.08,9.85,1 through 10,percent of total billed charges,3.795286195,4.02,
"T4, Free, Direct Dialysis QSTC",13864535,LOCAL,84439,CPT,,,,,,Outpatient,,,,10.82,VIVA,Commercial,,50,,30,30,30,1 through 10,percent of total billed charges,18.43,28.58065455,
"Immunofixation, Serum QSTC",8764779,LOCAL,86334,CPT,,,,,,Outpatient,,,,26.81,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
77061 MG Diagnostic Tomo Charge: AddOn Left,13960724,LOCAL,G0279,CPT,,,,,LT,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"CtrachomatisRNA, TMA, Urog QSTC",8996973,LOCAL,87491,CPT,,,,,QW,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
"NgonorrhoeaeRNA, TMA, Urog QSTC",8996974,LOCAL,87591,CPT,,,,,QW,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
"Chlamydia Trachomatis RNA, TMA QST",8395007,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",8395010,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
"N. Gonorrhoeae RNA, TMA, Urogenital QSTC",13864518,LOCAL,87591,CPT,,,,,QW,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
Homocysteine QSTC,8764574,LOCAL,83090,CPT,,,,,,Outpatient,,,,21.5,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Mycobact Culture, w Fluorochrome Sm QSTC",9039257,LOCAL,87116,CPT,,,,,,Outpatient,,,,12.96,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Mycobacteria, Cult, w Fluoro Smear QST",9039257,LOCAL,87116,CPT,,,,,,Outpatient,,,,12.96,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ampicillin 2 g injection [CULL],11201144,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOBUTamine 2 mg/mL-D5% intravenous solution 250 mL [CULL],11201692,LOCAL,J1250,CPT,,,,,,Outpatient,250,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
acetylcysteine 20% inhalation solution 4 mL [CULL],11205094,LOCAL,J7608,CPT,,,,,,Outpatient,4,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Angiotensin Converting Enzyme (ACE), CSF QSTC",10170069,LOCAL,82164,CPT,,,,,,Outpatient,,,,17.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Endomysial Ab Screen IgA, Rfx Titer QSTC",8764677,LOCAL,86231,CPT,,,,,,Outpatient,,,,14.51,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hexagonal Phase Confirm. QSTC,9039456,LOCAL,85598,CPT,,,,,,Outpatient,,,,21.58,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
hs-CRP QSTC,8853237,LOCAL,86141,CPT,,,,,,Outpatient,,,,15.54,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lipoprotein (a) QSTC,8853258,LOCAL,83695,CPT,,,,,,Outpatient,,,,17.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Oligoclonal Bands (IgG), CSF QSTC",8764540,LOCAL,83916,CPT,,,,,,Outpatient,,,,32.87,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Plasma Renin Activity, LC/MS/MS QSTC",8764647,LOCAL,84244,CPT,,,,,,Outpatient,,,,26.39,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vitamin D, 1,25-Dihydroxy QSTC",8764639,LOCAL,82652,CPT,,,,,,Outpatient,,,,46.2,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Apolipoprotein Evaluation QSTC,13864521,LOCAL,82172,CPT,,,,,,Outpatient,,,,25.31,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
nitroglycerin 5 mg/mL intravenous solution 10 mL [CULL],11211028,LOCAL,J2305,CPT,,,,,,Outpatient,10,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"C1 Esterase Inhibitor, Protein QSTC",8764554,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
droNABinol 5 mg Cap [CULL],11200011,LOCAL,Q0167,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatitis B Surface Antigen,633752,LOCAL,87340,CPT,,,,,,Outpatient,,,,12.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatitis B Surface Antigen w/ Interp,9517997,LOCAL,87340,CPT,,,,,,Outpatient,,,,12.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HIV 1/2 Antibody Screen (exposure only),9609059,LOCAL,86701,CPT,,,,,,Outpatient,,,,10.67,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMMOBILIZER KNEE LARGE,11071020,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,,158,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMMOBILIZER KNEE XL 79-80028,11070735,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,,158,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Potassium POCT,9616981,LOCAL,84132,CPT,,,,,,Outpatient,,,,5.71,VIVA,Commercial,,50,,30.28,27.5,30.28,1 through 10,percent of total billed charges,7.16,8.697880184,
IMMOBILIZER KNEE MEDIUM,11071084,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,,158,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMMOBILIZER KNEE SMALL,11071082,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,,158,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Additional Testing PTT-LA QSTC,9004754,LOCAL,85730,CPT,,,,,,Outpatient,,,,7.21,VIVA,Commercial,,50,,15.18,15.18,15.18,1 through 10,percent of total billed charges,1.648553055,5.42,
dRVVT Mix Interpretation: QSTC,9004757,LOCAL,85613,CPT,,,,,,Outpatient,,,,11.5,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Valproic Acid Level,3170351,LOCAL,80164,CPT,,,,,,Outpatient,,,,16.25,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.RMSF IgG Titer QSTC,8764766,LOCAL,86757,CPT,,,,,,Outpatient,,,,23.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.RMSF IgM Titer QSTC,8764765,LOCAL,86757,CPT,,,,,,Outpatient,,,,23.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HIV 1 Antibody QSTC,8852095,LOCAL,86701,CPT,,,,,,Outpatient,,,,10.67,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HIV 2 Antibody QSTC,8852096,LOCAL,86702,CPT,,,,,,Outpatient,,,,16.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aldosterone, LC/MS QSTC",8853271,LOCAL,82088,CPT,,,,,,Outpatient,,,,48.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Calcium Level Total,1628887,LOCAL,82310,CPT,,,,,,Outpatient,,,,6.19,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPINEPHrine 1 mg/mL injectable solution 1 mL [CULL],11202413,LOCAL,J0169,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill UA With Microscopic,14634624,LOCAL,81001,CPT,,,,,,Outpatient,,,,3.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DOPP ART BIL EXERCISE,8200578,LOCAL,93924,CPT,,,,,,Outpatient,,,,302,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticulocyte Count,7909814,LOCAL,85044,CPT,,,,,,Outpatient,,,,5.17,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticulocyte Count with Immature Reticulocyte Fraction,3454466,LOCAL,85044,CPT,,,,,,Outpatient,,,,5.17,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
clindamycin 900 mg/50 mL-D5% intravenous solution 50 mL [CULL],11212348,LOCAL,J0736,CPT,,,,,,Outpatient,50,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
milrinone 200 mcg/mL-D5% intravenous solution 100 mL [CULL],11290134,LOCAL,J2260,CPT,,,,,,Outpatient,100,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vitamin B6, Plasma QSTC",8853234,LOCAL,84207,CPT,,,,,,Outpatient,,,,33.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Total Iron Binding Capacity,7050172,LOCAL,84466,CPT,,,,,,Outpatient,,,,15.31,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Total Iron Binding Capacity,10543521,LOCAL,84466,CPT,,,,,,Outpatient,,,,15.31,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Varicella-Zoster Virus Abs(IgG,IgM) QSTC",8853253,LOCAL,86787,CPT,,,,,,Outpatient,,,,15.46,VIVA,Commercial,,50,,10.8,10.8,10.8,1 through 10,percent of total billed charges,12.88,15.29,
protamine 10 mg/mL injectable solution 5 mL [CULL],11211135,LOCAL,J2720,CPT,,,,,,Outpatient,5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin E QSTC,8764571,LOCAL,82785,CPT,,,,,,Outpatient,,,,19.75,VIVA,Commercial,,50,,31.36,31.36,31.36,1 through 10,percent of total billed charges,17.73,203.9616667,
IMMOBILIZER SHOULDER XXXLARGE,4803390,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
orphenadrine 30 mg/mL injectable solution 2 mL [CULL],11212051,LOCAL,J2360,CPT,,,,,,Outpatient,2,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cortisol,3352314,LOCAL,82533,CPT,,,,,,Outpatient,,,,19.56,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cortisol 60 Min,8373789,LOCAL,82533,CPT,,,,,,Outpatient,,,,19.56,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Free T4 Level,3170324,LOCAL,84439,CPT,,,,,,Outpatient,,,,10.82,VIVA,Commercial,,50,,30,30,30,1 through 10,percent of total billed charges,18.43,28.58065455,
Hepatitis A Antibody IgM,1628904,LOCAL,86709,CPT,,,,,,Outpatient,,,,13.51,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HIV 1/2 Antibody and P24 Screen,633757,LOCAL,87389,CPT,,,,,,Outpatient,,,,28.9,VIVA,Commercial,,50,,24.75,24.75,24.75,1 through 10,percent of total billed charges,10.57,36.55,
HIV 1/2 Antibody and P24 Screen,633757,LOCAL,G0475,CPT,,,,,,Outpatient,,,,28.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Protein Body Fluid,1634879,LOCAL,84157,CPT,,,,,,Outpatient,,,,4.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMMOBILIZER SHOULDER XXLARGE 9008-05,4803139,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aspergillus fumigatus QSTC,9966204,LOCAL,86331,CPT,,,,,,Outpatient,,,,14.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
S. viridis QSTC,9966214,LOCAL,86609,CPT,,,,,,Outpatient,,,,15.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
T. candidus QSTC,9966205,LOCAL,86606,CPT,,,,,,Outpatient,,,,18.06,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
adenosine 3 mg/mL intravenous solution 2 mL [CULL],11201015,LOCAL,J0153,CPT,,,,,,Outpatient,2,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Mercury, Blood QSTC",13864924,LOCAL,83825,CPT,,,,,,Outpatient,,,,19.51,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sex Hormone Binding Glob QSTC,8764670,LOCAL,84270,CPT,,,,,,Outpatient,,,,26.08,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Stone Analysis w/ Image QSTC,9777240,LOCAL,82365,CPT,,,,,,Outpatient,,,,15.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97012 APPLICATION OF TRACTION/MECH CHARGE,8133034,LOCAL,97012,CPT,,,,,GP,Outpatient,,,,40,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97012 MECH TRACTION THERAPY Assistant Charge,9860050,LOCAL,97012,CPT,,,,,GO|CO,Outpatient,,,,40,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97012 Mechanical Traction PT,9850050,LOCAL,97012,CPT,,,,,GO,Outpatient,,,,40,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97012 TRACTION - MECHANICAL,9640018,LOCAL,97012,CPT,,,,,GP,Outpatient,,,,40,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mechanical Traction Charge -> Yes,13786833,LOCAL,97012,CPT,,,,,GP,Outpatient,,,,40,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mechanical Traction Provided,8510678,LOCAL,97012,CPT,,,,,GP,Outpatient,,,,40,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Mechanical Trac Therapy Asist Units,7897758,LOCAL,97012,CPT,,,,,CQ,Outpatient,,,,40,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Mechanical Traction Therapy Units,7897758,LOCAL,97012,CPT,,,,,GO,Outpatient,,,,40,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Mechanical Traction Assistant Units,9390392,LOCAL,97012,CPT,,,,,CQ,Outpatient,,,,40,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT TRACTION MECHANICAL,9650018,LOCAL,97012,CPT,,,,,GP|CQ,Outpatient,,,,40,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ethylene Glycol, Blood QSTC",8764539,LOCAL,82693,CPT,,,,,,Outpatient,,,,17.88,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
vancomycin 1 g/200 mL intravenous solution 200 mL [CULL],11291267,LOCAL,J3372,CPT,,,,,,Outpatient,200,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HIV 1/2 Antibody Screen,7939338,LOCAL,86703,CPT,,,,,,Outpatient,,,,16.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alprazolam (Xanax), Serum QSTC",8972830,LOCAL,80299,CPT,,,,,,Outpatient,,,,22.37,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glucose 3 Hour,7973891,LOCAL,82952,CPT,,,,,,Outpatient,,,,4.7,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glucose 4 Hour,7973892,LOCAL,82952,CPT,,,,,,Outpatient,,,,4.7,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glucose 5 Hour,7973894,LOCAL,82952,CPT,,,,,,Outpatient,,,,4.7,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cyclosporine Trough,LCMSMS QSTC",8764656,LOCAL,80158,CPT,,,,,,Outpatient,,,,21.66,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ova&Parasite,Conc&Perm Smear Result QSTC",8873966,LOCAL,87177,CPT,,,,,,Outpatient,,,,10.68,VIVA,Commercial,,50,,10.96,8.9,10.96,1 through 10,percent of total billed charges,8.9,10.57,
97150  Group Therapeutic Procedure,9640074,LOCAL,97150,CPT,,,,,GP,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97150 OT Group Therapy Charge,9850058,LOCAL,97150,CPT,,,,,GO,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97150 OT Group Therapy Modifier Charge,9860058,LOCAL,97150,CPT,,,,,GO|CO,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97150 PT Group Therapy Assistant Units,9650074,LOCAL,97150,CPT,,,,,GP|CQ,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Group Therapy Charge,7895938,LOCAL,97150,CPT,,,,,GP,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Group Therapy Provided,7895280,LOCAL,97150,CPT,,,,,GO,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Group Therapy Assistant Units,7895280,LOCAL,97150,CPT,,,,,CQ,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Group Therapy Assistant Units,7897695,LOCAL,97150,CPT,,,,,CQ,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Group Therapy Rehab Units,7897695,LOCAL,97150,CPT,,,,,GO,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Group Therapy Assistant Units,9390418,LOCAL,97150,CPT,,,,,CQ,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Giardia Antigen, EIA, Stool QSTC",8972764,LOCAL,87329,CPT,,,,,,Outpatient,,,,14.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Methylmalonic Acid QSTC,8853212,LOCAL,83921,CPT,,,,,,Outpatient,,,,25.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nortriptyline QSTC,8853203,LOCAL,80299,CPT,,,,,,Outpatient,,,,22.37,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97034 CONTRAST BATH THERAPY,9860025,LOCAL,97034,CPT,,,,,GO|CO,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97034 CONTRAST BATHS EACH 15 MIN CHARGE,9640025,LOCAL,97034,CPT,,,,,GP,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97034 OT CONTRAST BATH 15 MIN APPL CHARGE,9850025,LOCAL,97034,CPT,,,,,GO,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97034 PT CONTRAST BATH 15 MIN ASST,9650025,LOCAL,97034,CPT,,,,,GP|CQ,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Contrast Bath Assistant Units,7895283,LOCAL,97034,CPT,,,,,CQ,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Contrast Bath Assistant Units,1373567,LOCAL,97034,CPT,,,,,CQ,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Contrast Bath Charges,7895283,LOCAL,97034,CPT,,,,,GO,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Contrast Bath Units,1373567,LOCAL,97034,CPT,,,,,GO,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Attended E-Stim Assistant Units,9390422,LOCAL,97034,CPT,,,,,CQ,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Contrast Bath Charges,7895979,LOCAL,97034,CPT,,,,,GP,Outpatient,,,,41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BRACE ANKLE LG,9400076,LOCAL,,,L1902,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medium Ankle Brace,9400086,LOCAL,,,L1902,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"ANA Screen, IFA QSTC",14127792,LOCAL,86038,CPT,,,,,,Outpatient,,,,14.51,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Beta2-Glycoprotein I (IgA) QSTC,14127808,LOCAL,86146,CPT,,,,,,Outpatient,,,,30.54,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Beta2-Glycoprotein I (IgG) QSTC,14127809,LOCAL,86146,CPT,,,,,,Outpatient,,,,30.54,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Beta2-Glycoprotein I (IgM) QSTC,14127810,LOCAL,86146,CPT,,,,,,Outpatient,,,,30.54,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiolipin Ab (IgA) QSTC,14127805,LOCAL,86147,CPT,,,,,,Outpatient,,,,30.54,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiolipin Ab (IgG) QSTC,14127806,LOCAL,86147,CPT,,,,,,Outpatient,,,,30.54,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiolipin Ab (IgM) QSTC,14127807,LOCAL,86147,CPT,,,,,,Outpatient,,,,30.54,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"CCP, Antibody (IgG) QSTC",14127817,LOCAL,86200,CPT,,,,,,Outpatient,,,,15.54,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Centromere B Antibody QSTC,14127802,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chromatin (Nucleosomal) Ab QSTC,14127794,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complement Component C3c QSTC,14127803,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complement Component C4c QSTC,14127804,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"DNA Ab (DS) Crithidia, IFA QSTC",14127793,LOCAL,86255,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Jo-1 Antibody QSTC,14127801,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"MCV, Antibody QSTC",14127818,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rheumatoid Factor (IgA) QSTC,14127812,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rheumatoid Factor (IgG) QSTC,14127814,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rheumatoid Factor (IgM) QSTC,14127816,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RNP Antibody QSTC,14127797,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Scl-70 Antibody QSTC,14127800,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sjogren's Antibody (SS-A) QSTC,14127798,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sjogren's Antibody (SS-B) QSTC,14127799,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sm Antibody QSTC,14127795,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sm/RNP Antibody QSTC,14127796,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Thyroid Peroxidase Abs QSTC,14127819,LOCAL,86376,CPT,,,,,,Outpatient,,,,17.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Calcitonin QSTC,8764739,LOCAL,82308,CPT,,,,,,Outpatient,,,,32.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"DHEA, Unconjugated QSTC",8853248,LOCAL,82626,CPT,,,,,,Outpatient,,,,30.32,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sjogren's Antibodies (SS-A, SS-B) QSTC",8853207,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Special Stains Group II,8489591,LOCAL,88313,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
17-Hydroxyprogesterone QSTC,8853287,LOCAL,83498,CPT,,,,,,Outpatient,,,,32.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carcinoembryonic Antigen,633697,LOCAL,82378,CPT,,,,,,Outpatient,,,,22.75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatitis B Core Antibody IgM,1628907,LOCAL,86705,CPT,,,,,,Outpatient,,,,14.12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Celiac Disease Comp w/Gliadin Ab IgG QSTC,13864455,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hep B Surface Ag w/Rflx to Confirm. QSTC,9039254,LOCAL,87340,CPT,,,,,,Outpatient,,,,12.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin Panel QSTC,8764543,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Body Fluid Cell Count w/ Diff,6213822,LOCAL,89051,CPT,,,,,,Outpatient,,,,6.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Body Fluid Cell Count with Differential If Indicated,8127214,LOCAL,89051,CPT,,,,,,Outpatient,,,,6.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Body Fluid Differential,4240538,LOCAL,89051,CPT,,,,,,Outpatient,,,,6.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CSF Cell Count with Differential If Indicated,3454318,LOCAL,89051,CPT,,,,,,Outpatient,,,,6.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CSF Differential,3454393,LOCAL,89051,CPT,,,,,,Outpatient,,,,6.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digoxin Level,1628891,LOCAL,80162,CPT,,,,,,Outpatient,,,,15.94,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Potassium Level,633616,LOCAL,84132,CPT,,,,,,Outpatient,,,,5.71,VIVA,Commercial,,50,,30.28,27.5,30.28,1 through 10,percent of total billed charges,7.16,8.697880184,
24hr Urine Creatinine QSTC,10600648,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,40.97514925,
"Aldosterone, 24-Hour Urine QSTC",8995528,LOCAL,82088,CPT,,,,,,Outpatient,,,,48.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aspergillus Ab, Immunodiffusion QSTC",13864516,LOCAL,86606,CPT,,,,,,Outpatient,,,,18.06,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
T3 Free,3170323,LOCAL,84481,CPT,,,,,,Outpatient,,,,20.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ANCA Screen w Reflex to ANCA Titer QSTC,8764789,LOCAL,86036,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Androstenedione QSTC,8764648,LOCAL,82157,CPT,,,,,,Outpatient,,,,35.14,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Antithrombin III Activity QSTC,8764597,LOCAL,85300,CPT,,,,,,Outpatient,,,,14.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Influenza A,7909953,LOCAL,87804,CPT,,,,,,Outpatient,,,,19.86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Influenza B,7909954,LOCAL,87804,CPT,,,,,,Outpatient,,,,19.86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Protein C, Activity QSTC",8764685,LOCAL,85303,CPT,,,,,,Outpatient,,,,16.61,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Protein S Antigen, Free QSTC",9777259,LOCAL,85306,CPT,,,,,,Outpatient,,,,18.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Protein S, Activity QSTC",8764774,LOCAL,85306,CPT,,,,,,Outpatient,,,,18.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Shiga Toxin 1 and 2,7939191,LOCAL,87427,CPT,,,,,,Outpatient,,,,14.38,VIVA,Commercial,,50,,39.62,11.98,39.62,1 through 10,percent of total billed charges,10.57,29.71875,
Shiga Toxin 1 and 2,8875416,LOCAL,87427,CPT,,,,,,Outpatient,,,,14.38,VIVA,Commercial,,50,,39.62,11.98,39.62,1 through 10,percent of total billed charges,10.57,29.71875,
Tissue Transglutaminase IgG Ab QSTC,8764825,LOCAL,86364,CPT,,,,,,Outpatient,,,,13.84,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vitamin B12 QSTC,9291002,LOCAL,82607,CPT,,,,,,Outpatient,,,,18.1,VIVA,Commercial,,50,,92.41,34.37,92.41,1 through 10,percent of total billed charges,18.43,82.43266533,
Glucose CSF,1628897,LOCAL,82945,CPT,,,,,,Outpatient,,,,4.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Protein CSF,1634881,LOCAL,84157,CPT,,,,,,Outpatient,,,,4.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Erythropoietin (EPO) QSTC,8764551,LOCAL,82668,CPT,,,,,,Outpatient,,,,22.55,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT Vapotherm Subsequent CHARGE,8143879,LOCAL,94003,CPT,,,,,,Outpatient,,,,613,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hematocrit,633742,LOCAL,85014,CPT,,,,,,Outpatient,,,,2.84,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hematocrit,1635636,LOCAL,85014,CPT,,,,,,Outpatient,,,,2.84,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hemoglobin,633741,LOCAL,85018,CPT,,,,,,Outpatient,,,,2.84,VIVA,Commercial,,50,,34.27,34.27,34.27,1 through 10,percent of total billed charges,8.21,10.94316176,
Hemoglobin,1635635,LOCAL,85018,CPT,,,,,,Outpatient,,,,2.84,VIVA,Commercial,,50,,34.27,34.27,34.27,1 through 10,percent of total billed charges,8.21,10.94316176,
C1 Esterase Inhibitor QST,13870084,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"C1 Esterase Inhibitor, Functional QSTC",8853251,LOCAL,86161,CPT,,,,,,Outpatient,,,,14.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Antibody Screen Gel 2,8196056,LOCAL,86850,CPT,,,,,,Outpatient,,,,11.72,VIVA,Commercial,,50,,11.06,11.06,11.06,1 through 10,percent of total billed charges,6.29,48.85,
Antibody Screen Tube.,8417431,LOCAL,86850,CPT,,,,,,Outpatient,,,,11.72,VIVA,Commercial,,50,,11.06,11.06,11.06,1 through 10,percent of total billed charges,6.29,48.85,
BB RH (D) TYPE XX,6432042,LOCAL,86901,CPT,,,,,,Outpatient,,,,3.59,VIVA,Commercial,,50,,11.06,11.06,11.06,1 through 10,percent of total billed charges,6.29,35.88,
Acid Fast Stain Report,634214,LOCAL,87206,CPT,,,,,,Outpatient,,,,6.47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Milk Component Panel QSTC,8912186,LOCAL,86008,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF TRXN Pathologist Interp,13479165,LOCAL,86078,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BB REF RH(D) TYPING TRANSFUSION RXN,6433001,LOCAL,86901,CPT,,,,,,Outpatient,,,,3.59,VIVA,Commercial,,50,,11.06,11.06,11.06,1 through 10,percent of total billed charges,6.29,35.88,
BB REF XMATCH (IAT) TRANSFUSION RXN,6433004,LOCAL,86922,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF ABO/Rh (TRXN),13479164,LOCAL,86900,CPT,,,,,,Outpatient,,,,3.59,VIVA,Commercial,,50,,14.89,14.89,14.89,1 through 10,percent of total billed charges,6.29,117.85,
REF Antibody Screen (TRXN),13479162,LOCAL,86850,CPT,,,,,,Outpatient,,,,11.72,VIVA,Commercial,,50,,11.06,11.06,11.06,1 through 10,percent of total billed charges,6.29,48.85,
REF Crossmatch (TRXN),13481255,LOCAL,86920,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF DAT (TRXN),13479163,LOCAL,86880,CPT,,,,,,Outpatient,,,,6.47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Clostridium difficile Quik Chek Complete,10574492,LOCAL,87324,CPT,,,,,,Outpatient,,,,14.38,VIVA,Commercial,,50,,40.87,11.98,40.87,1 through 10,percent of total billed charges,10.57,20.4375,
Hemoglobin (POCT),4192190,LOCAL,85018,CPT,,,,,,Outpatient,,,,2.84,VIVA,Commercial,,50,,34.27,34.27,34.27,1 through 10,percent of total billed charges,8.21,10.94316176,
Hepatitis C Ab,1628911,LOCAL,86803,CPT,,,,,,Outpatient,,,,17.12,VIVA,Commercial,,50,,35,35,35,1 through 10,percent of total billed charges,15.29,32.10014925,
RT Education/Instruction CHARGE,90840011,LOCAL,94664,CPT,,,,,,Outpatient,,,,46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"RT Evaluation, Respiratory CHARGE",90840013,LOCAL,94664,CPT,,,,,,Outpatient,,,,46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tacrolimus 5 mg oral capsule [CULL],11205997,LOCAL,J7507,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Gliadin (Deamidated) Ab (IgG, IgA) QSTC",8764748,LOCAL,86258,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HFO (L3929),10393294,LOCAL,,,L3929,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hemoglobin A1c,1383763,LOCAL,83036,CPT,,,,,,Outpatient,,,,11.65,VIVA,Commercial,,50,,36.11,36.11,36.11,1 through 10,percent of total billed charges,7.16,28.59604426,
"Arsenic, Blood QSTC",13864922,LOCAL,82175,CPT,,,,,,Outpatient,,,,22.76,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97032 ELECTRIC STIM,8478060,LOCAL,97032,CPT,,,,,GN,Outpatient,,,,47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97032 ELECTRIC STIM OT,9630084,LOCAL,97032,CPT,,,,,GN,Outpatient,,,,47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97032 OT E STIM CON - EA 15MIN CHARGE,9856105,LOCAL,97032,CPT,,,,,GO,Outpatient,,,,47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97032 OT Elec Stim Attended Assistant Units,9866105,LOCAL,97032,CPT,,,,,GO|CO,Outpatient,,,,47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97032 PT E STIM CON - EA 15MIN CHARGE,9640023,LOCAL,97032,CPT,,,,,GP,Outpatient,,,,47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97032 PT Elect Stim Attended Assistant Units,9650023,LOCAL,97032,CPT,,,,,GP|CQ,Outpatient,,,,47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Attended E-Stim Charges,1366373,LOCAL,97032,CPT,,,,,GO,Outpatient,,,,47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Attended E-Stim Charges,7895926,LOCAL,97032,CPT,,,,,GP,Outpatient,,,,47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Attended E-Stim Assistant Units,1366373,LOCAL,97032,CPT,,,,,CQ,Outpatient,,,,47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Attended E-Stim Assistant Units,1373442,LOCAL,97032,CPT,,,,,CQ,Outpatient,,,,47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Attended E-Stim Charges,1366373,LOCAL,97032,CPT,,,,,GO,Outpatient,,,,47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Attended E-Stim Units,1373442,LOCAL,97032,CPT,,,,,GO,Outpatient,,,,47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Attended E-Stim Assistant Units,9396343,LOCAL,97032,CPT,,,,,CQ,Outpatient,,,,47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Newborn Hearing Test Type -> Auditory brainstem response,8982858,LOCAL,92700,CPT,,,,,,Outpatient,,,,47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"IGF-1, LC/MS QSTC",8764636,LOCAL,84305,CPT,,,,,,Outpatient,,,,25.51,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chlamydia Trachomatis RNA, TMA QST",10578255,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",10578245,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
Thinprep Review Cytotechnologist: QST,10590230,LOCAL,88175,CPT,,,,,,Outpatient,,,,31.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
pyridoxine 100 mg/mL injectable solution 1 mL [CULL],11212249,LOCAL,J3415,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97803 RE-ASSESSMENT & INTERVENTION CHARGE,8821410,LOCAL,97803,CPT,,,,,,Outpatient,,,,48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amylase Level,631567,LOCAL,82150,CPT,,,,,,Outpatient,,,,7.78,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prothrombin Time,7904947,LOCAL,85610,CPT,,,,,,Outpatient,,,,5.15,VIVA,Commercial,,50,,14.02,14.02,14.02,1 through 10,percent of total billed charges,2.355196507,5.42,
Prothrombin Time and INR,633793,LOCAL,85610,CPT,,,,,,Outpatient,,,,5.15,VIVA,Commercial,,50,,14.02,14.02,14.02,1 through 10,percent of total billed charges,2.355196507,5.42,
Vancomycin Level,1634895,LOCAL,80202,CPT,,,,,,Outpatient,,,,16.25,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vancomycin Level Peak,1634896,LOCAL,80202,CPT,,,,,,Outpatient,,,,16.25,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vancomycin Level Trough,1634897,LOCAL,80202,CPT,,,,,,Outpatient,,,,16.25,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97016 OT VASOPNEUMATIC DEVICE CHARGE,9850019,LOCAL,97016,CPT,,,,,GO,Outpatient,,,,48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97016 PT JOBST COMPRESSION CHARGE,9640020,LOCAL,97016,CPT,,,,,GP,Outpatient,,,,48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97016 PT VASOPNEUMATIC DEVICE CHARGE,9650020,LOCAL,97016,CPT,,,,,GP|CQ,Outpatient,,,,48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Vasopneumatic Device Charge,7895255,LOCAL,97016,CPT,,,,,GO,Outpatient,,,,48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Vasopneumatic Devices Assistant Units,7895255,LOCAL,97016,CPT,,,,,CQ,Outpatient,,,,48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Vasopneumatic Devices Units,1373553,LOCAL,97016,CPT,,,,,GO,Outpatient,,,,48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Vasopneumatic Devices Assistant Units,9390396,LOCAL,97016,CPT,,,,,CQ,Outpatient,,,,48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vasopneumatic Device Charge,7895963,LOCAL,97016,CPT,,,,,GP,Outpatient,,,,48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Beta hCG Quantitative,633665,LOCAL,84702,CPT,,,,,,Outpatient,,,,18.06,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Flu A -Sofia,8267167,LOCAL,87804,CPT,,,,,,Outpatient,,,,19.86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Flu B -Sofia,8267168,LOCAL,87804,CPT,,,,,,Outpatient,,,,19.86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
pH Venous,3454453,LOCAL,82800,CPT,,,,,,Outpatient,,,,13.2,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Protein, Total, 24 Hr Ur QSTC",8851917,LOCAL,84156,CPT,,,,,,Outpatient,,,,4.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SARS-CoV-2 (COVID-19) IgG Ab,9706404,LOCAL,86769,CPT,,,,,,Outpatient,,,,50.56,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Total hCG Quantitative,9299894,LOCAL,84702,CPT,,,,,,Outpatient,,,,18.06,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
pH Pleural Fluid,9631697,LOCAL,83986,CPT,,,,,,Outpatient,,,,4.3,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,18.755,
terbutaline 1 mg/mL injectable solution 1 mL [CULL],11212324,LOCAL,J3105,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Estradiol Lvl,3170319,LOCAL,82670,CPT,,,,,,Outpatient,,,,33.53,VIVA,Commercial,,50,,37.95,37.95,37.95,1 through 10,percent of total billed charges,18.43,51.64,
"Metanephrines, Fraction, LCMSMS,U24 QSTC",8764626,LOCAL,83835,CPT,,,,,,Outpatient,,,,20.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Mycobacteria Stain, Acid Fast, Fluorochrome QST",12126168,LOCAL,87206,CPT,,,,,,Outpatient,,,,6.47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C1 Esterase Inhibitor Protein QST,13870086,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complement Component C4C QST,13870085,LOCAL,86161,CPT,,,,,,Outpatient,,,,14.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Serotonin, Serum QSTC",8853235,LOCAL,84260,CPT,,,,,,Outpatient,,,,37.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.Thyroglobulin QSTC,13864485,LOCAL,84432,CPT,,,,,,Outpatient,,,,19.27,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
dexAMETHasone 4 mg/mL Sol [CULL],11202297,LOCAL,J1100,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,42.58,3.27,42.58,12,percent of total billed charges,10.48743758,10.48743758,
CT PCR,12526323,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
NG PCR,12526324,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
Alkaline Phosphatase,1620878,LOCAL,84075,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0008 MC ADMIN INFLUENZA VIRUS VACCINE CHARGE,7923017,LOCAL,,,G0008,HCPCS,,,,Outpatient,,,,50,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0009 VACCINE ADMINISTRATION PNEUMONIA,12214659,LOCAL,,,G0009,HCPCS,,,,Outpatient,,,,50,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64461 THORACIC PARAVERTEBRAL BLOCK,5661020,LOCAL,64461,CPT,,,,,,Outpatient,,,,50,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cryoglobulin (% Cryocrit), Serum QSTC",8764756,LOCAL,82595,CPT,,,,,,Outpatient,,,,7.76,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Group B Strep Culture,7842541,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,VIVA,Commercial,,50,,101.59,101.59,101.59,1 through 10,percent of total billed charges,10.57,67.60639535,
Partial Thromboplastin Time,633794,LOCAL,85730,CPT,,,,,,Outpatient,,,,7.21,VIVA,Commercial,,50,,15.18,15.18,15.18,1 through 10,percent of total billed charges,1.648553055,5.42,
Partial Thromboplastin Time,7904949,LOCAL,85730,CPT,,,,,,Outpatient,,,,7.21,VIVA,Commercial,,50,,15.18,15.18,15.18,1 through 10,percent of total billed charges,1.648553055,5.42,
Strep Confirmation,8019111,LOCAL,87081,CPT,,,,,,Outpatient,,,,7.96,VIVA,Commercial,,50,,39.78,39.78,39.78,1 through 10,percent of total billed charges,10.57,37.17627685,
99152 MOD SED SAME PHYS/QHP 5/>YRS,8653149,LOCAL,99152,CPT,,,,,,Outpatient,,,,52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
fluconazole 400 mg/200 mL-NaCl 0.9% intravenous solution 200 mL [CULL],11220722,LOCAL,J1450,CPT,,,,,,Outpatient,200,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
20561 DRY NEEDLING 3+ MUSCLES WO INJECTION,9650049,LOCAL,20561,CPT,,,,,,Outpatient,,,,52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GC Culture,633895,LOCAL,87081,CPT,,,,,,Outpatient,,,,7.96,VIVA,Commercial,,50,,39.78,39.78,39.78,1 through 10,percent of total billed charges,10.57,37.17627685,
Lactate Dehydrogenase,633770,LOCAL,83615,CPT,,,,,,Outpatient,,,,7.25,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRSA Screen Culture,8244872,LOCAL,87081,CPT,,,,,,Outpatient,,,,7.96,VIVA,Commercial,,50,,39.78,39.78,39.78,1 through 10,percent of total billed charges,10.57,37.17627685,
Protein Total,633818,LOCAL,84155,CPT,,,,,,Outpatient,,,,4.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bill Only ABID Panel, Selected Cell",8629507,LOCAL,86885,CPT,,,,,,Outpatient,,,,6.86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chromium, Serum QSTC",9701437,LOCAL,82495,CPT,,,,,,Outpatient,,,,24.34,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Levetiracetam QSTC,8764628,LOCAL,80177,CPT,,,,,,Outpatient,,,,15.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chlamydia Trachomatis RNA, TMA QST",10585658,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
HPV mRNA E6/E7 QST,10585657,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neisseria Gonorrhoeae RNA, TMA QST",10585659,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
Thinprep Review Cytotechnologist: QST,10585654,LOCAL,88175,CPT,,,,,,Outpatient,,,,31.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testosterone Level Total,3170320,LOCAL,84403,CPT,,,,,,Outpatient,,,,30.97,VIVA,Commercial,,50,,41.01,41.01,41.01,1 through 10,percent of total billed charges,18.43,52.3775,
methadone 10 mg/mL Injectable Sol 20 mL UD [CULL],11240064,LOCAL,J1230,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malaria/Babesia/Other Blood Parasites QSTC,10707969,LOCAL,87207,CPT,,,,,,Outpatient,,,,7.19,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
H. Pylori CLO,9517164,LOCAL,86677,CPT,,,,,,Outpatient,,,,20.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Phosphorus Level,633803,LOCAL,84100,CPT,,,,,,Outpatient,,,,5.69,VIVA,Commercial,,50,,41.62,41.62,41.62,14,percent of total billed charges,7.16,26.45123596,
"Estrogen, Total, Serum QSTC",8764701,LOCAL,82672,CPT,,,,,,Outpatient,,,,26.04,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PHENobarbital 65 mg/mL Sol [CULL],11211087,LOCAL,J2560,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97129 ST COG/ATTEN/MEM/PROD CHARGE,9600117,LOCAL,97129,CPT,,,,,GN,Outpatient,,,,114,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97130 ST Cognitive skills development each additional 15 minutes,9600118,LOCAL,97130,CPT,,,,,GN,Outpatient,,,,114,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"SLP Cog Ther Intervent, Addl 15Min Units",9399379,LOCAL,97130,CPT,,,,,GN,Outpatient,,,,114,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"SLP Cog Ther Intervent,First 15Min Units",9399375,LOCAL,97129,CPT,,,,,GN,Outpatient,,,,114,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97802 MEDICAL NUTRITIONAL THERAPY CHARGE,13475610,LOCAL,97802,CPT,,,,,,Outpatient,,,,55,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minimum Inhibitory Concentration,294946,LOCAL,87186,CPT,,,,,,Outpatient,,,,10.38,VIVA,Commercial,,50,,85,27.49,85,1 through 10,percent of total billed charges,10.57,35.67132075,
"HPV mRNA E6/E7, POST-$HYSTERECTOMY, VAGINAL QST",14782713,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BB REF LAB RH (D) TYPING,6413256,LOCAL,86901,CPT,,,,,,Outpatient,,,,3.59,VIVA,Commercial,,50,,11.06,11.06,11.06,1 through 10,percent of total billed charges,6.29,35.88,
"Ehrlichia chaffeensis Ab (IgG,IgM) QSTC",8853255,LOCAL,86666,CPT,,,,,,Outpatient,,,,12.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF ABO/Rh,7939266,LOCAL,86900,CPT,,,,,,Outpatient,,,,3.59,VIVA,Commercial,,50,,14.89,14.89,14.89,1 through 10,percent of total billed charges,6.29,117.85,
Uric Acid,633858,LOCAL,84550,CPT,,,,,,Outpatient,,,,5.42,VIVA,Commercial,,50,,15.93,15.93,15.93,1 through 10,percent of total billed charges,7.16,35.17852564,
cefTRIAXone 500 mg injection [CULL],11202193,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,5.8,0.92,5.8,1 through 10,percent of total billed charges,5.161428571,5.161428571,
chloroprocaine 3% preservative-free Sol [CULL],11202203,LOCAL,J2401,CPT,,,,,,Outpatient,20,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chol/HDL C QSTC,14129541,LOCAL,80061,CPT,,,,,,Outpatient,,,,16.07,VIVA,Commercial,,50,,50.8,25.27,50.8,13,percent of total billed charges,12.14,16.59934459,
HDL P QSTC,14129559,LOCAL,83704,CPT,,,,,,Outpatient,,,,41.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HPV mRNA E6/E7 QST,9773934,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HPV mRNA E6/E7 QST,9773934,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HPV mRNA E6/E7 QSTC,9773934,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOBUTamine 1 mg/mL-D5% Sol [CULL],11201073,LOCAL,J1250,CPT,,,,,,Outpatient,250,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Estrone QSTC,8853208,LOCAL,82679,CPT,,,,,,Outpatient,,,,29.94,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
fosphenytoin 500 mgPE/10 mL injectable solution 10 mL [CULL],11205071,LOCAL,Q2009,CPT,,,,,,Outpatient,10,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methacholine varying strength inhalation solution [CULL],11290186,LOCAL,J7674,CPT,,,,,,Outpatient,3,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cyanide QSTC,13864508,LOCAL,82600,CPT,,,,,,Outpatient,,,,23.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
nitroglycerin 200 mcg/mL-D5% intravenous solution 250 mL [CULL],11211024,LOCAL,J2305,CPT,,,,,,Outpatient,250,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Electrolyte Panel,633610,LOCAL,80051,CPT,,,,,,Outpatient,,,,8.41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sodium Level,633611,LOCAL,84295,CPT,,,,,,Outpatient,,,,5.77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
76377 Requiring image post processing on an independent workstation,10740136,LOCAL,76377,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
acetylcysteine 20% inhalation solution 30 mL [CULL],11203022,LOCAL,J7608,CPT,,,,,,Outpatient,30,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Measles Antibody (IgM) QSTC,8853259,LOCAL,86765,CPT,,,,,,Outpatient,,,,15.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Maize/Corn (F8) IgE QSTC,14116318,LOCAL,86001,CPT,,,,,,Outpatient,,,,9.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97022 FLUIDOTHERAPY CHARGES,9646093,LOCAL,97022,CPT,,,,,GP,Outpatient,,,,57,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97022 OT WHIRLPOOL - ASEPTIC,9856111,LOCAL,97022,CPT,,,,,GO,Outpatient,,,,57,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97022 OT WHIRLPOOL 1+ AREAS APPL CHARGE,9866111,LOCAL,97022,CPT,,,,,GO|CO,Outpatient,,,,57,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97022 PT SMALL WHIRLPOOL CHARGE,9656093,LOCAL,97022,CPT,,,,,GP|CQ,Outpatient,,,,57,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97022 WHIRLPOOL CHARGE,9410091,LOCAL,97022,CPT,,,,,GP,Outpatient,,,,57,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Whirlpool Therapy Assitant Units,9401114,LOCAL,97022,CPT,,,,,CQ,Outpatient,,,,57,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Whirlpool Units,9401114,LOCAL,97022,CPT,,,,,GO,Outpatient,,,,57,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Whirlpool, Fluidotherapy Assistant Units",1373554,LOCAL,97022,CPT,,,,,CQ,Outpatient,,,,57,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Whirlpool, Fluidotherapy Units",1373554,LOCAL,97022,CPT,,,,,GO,Outpatient,,,,57,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Whirlpool Full Body Charge,7895951,LOCAL,97022,CPT,,,,,GP,Outpatient,,,,57,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Whirlpool, 1+ Areas 97022",9640021,LOCAL,97022,CPT,,,,,,Outpatient,,,,57,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Factor XI Activity, Clotting QSTC",10358416,LOCAL,85270,CPT,,,,,,Outpatient,,,,21.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99151 MOD SED SAME PHYS/QHP <5 YRS,8653147,LOCAL,99151,CPT,,,,,,Outpatient,,,,58,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Selenium QSTC,8972757,LOCAL,84255,CPT,,,,,,Outpatient,,,,30.64,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Theophylline Level,1634886,LOCAL,80198,CPT,,,,,,Outpatient,,,,16.97,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97552 OT Caregiver Training Group,13649812,LOCAL,97552,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97552 Speech Caregiver Training Group,13767339,LOCAL,97552,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Beta-2-Glycoprotein I Antibodies (IgG, IgM) QSTC",10094523,LOCAL,86146,CPT,,,,,,Outpatient,,,,30.54,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only ABO,7936964,LOCAL,86900,CPT,,,,,,Outpatient,,,,3.59,VIVA,Commercial,,50,,14.89,14.89,14.89,1 through 10,percent of total billed charges,6.29,117.85,
Bill Only Rh,7936965,LOCAL,86901,CPT,,,,,,Outpatient,,,,3.59,VIVA,Commercial,,50,,11.06,11.06,11.06,1 through 10,percent of total billed charges,6.29,35.88,
B-Type Natriuretic Peptide,1383771,LOCAL,83880,CPT,,,,,,Outpatient,,,,47.11,VIVA,Commercial,,50,,45,45,45,1 through 10,percent of total billed charges,13.36379562,46.74,
"GROUP CAREGIVER TRAINING IN STRATEGIES & TECHNIQUES, FACE TO FACE, INITIAL 30 MIN 97552",13788179,LOCAL,97552,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Helicobacter pylori Ag, EIA, Stool QSTC",8873559,LOCAL,87338,CPT,,,,,,Outpatient,,,,17.26,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heparin Induced Plt Ab QSTC,8995550,LOCAL,86022,CPT,,,,,,Outpatient,,,,22.04,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"HPV Genotypes 16,18/45 QST",9773953,LOCAL,87625,CPT,,,,,,Outpatient,,,,48.66,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"HPV GENOTYPES 16,18/45,$POST-HYST, VAGINAL QST",14782712,LOCAL,87625,CPT,,,,,,Outpatient,,,,48.66,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
N-Terminal Pro B-Type Natriuretic Peptide,1503769,LOCAL,83880,CPT,,,,,,Outpatient,,,,47.11,VIVA,Commercial,,50,,45,45,45,1 through 10,percent of total billed charges,13.36379562,46.74,
OT Group Caregiver Training Units,13624357,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Group Caregiver Training Time,14466882,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tacrolimus, Highly Sens, LC/MS/MS QSTC",8764783,LOCAL,80197,CPT,,,,,,Outpatient,,,,16.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Topiramate QSTC,8764585,LOCAL,80201,CPT,,,,,,Outpatient,,,,14.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vitamin D 25 Hydroxy Level,4240407,LOCAL,82306,CPT,,,,,,Outpatient,,,,35.52,VIVA,Commercial,,50,,45,16.74,45,1 through 10,percent of total billed charges,17.73,45.19775253,
NEUROPSYCHOLOGICAL TEST ADMINISTRATION,13472049,LOCAL,96146,CPT,,,,,,Outpatient,,,,59,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Creatinine Urine,1930782,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,40.97514925,
Fibrinogen Level,633728,LOCAL,85384,CPT,,,,,,Outpatient,,,,11.66,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rapid Plasma Reagin,633820,LOCAL,86592,CPT,,,,,,Outpatient,,,,5.12,VIVA,Commercial,,50,,29.61,29.61,29.61,1 through 10,percent of total billed charges,15.29,19.99375,
Rapid Plasma Reagin Qualitative,7948395,LOCAL,86592,CPT,,,,,,Outpatient,,,,5.12,VIVA,Commercial,,50,,29.61,29.61,29.61,1 through 10,percent of total billed charges,15.29,19.99375,
Rapid Plasma Reagin Qualitative w/ Reflex,8166073,LOCAL,86592,CPT,,,,,,Outpatient,,,,5.12,VIVA,Commercial,,50,,29.61,29.61,29.61,1 through 10,percent of total billed charges,15.29,19.99375,
Blood Type ABO/Rh Typing,634326,LOCAL,86900,CPT,,,,,,Outpatient,,,,3.59,VIVA,Commercial,,50,,14.89,14.89,14.89,1 through 10,percent of total billed charges,6.29,117.85,
Cord ABORh,8019069,LOCAL,86900,CPT,,,,,,Outpatient,,,,3.59,VIVA,Commercial,,50,,14.89,14.89,14.89,1 through 10,percent of total billed charges,6.29,117.85,
Neonatal ABORh,8070665,LOCAL,86900,CPT,,,,,,Outpatient,,,,3.59,VIVA,Commercial,,50,,14.89,14.89,14.89,1 through 10,percent of total billed charges,6.29,117.85,
Fetal Screen,634335,LOCAL,85461,CPT,,,,,,Outpatient,,,,11.23,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methylPREDNISolone sodium succinate 500 mg injection [CULL],11201954,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99175 IPECAC EMESIS W/OBSERVATION TechFee,8057714,LOCAL,99175,CPT,,,,,,Outpatient,,,,61,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT Vapotherm Initial CHARGE,8144190,LOCAL,94002,CPT,,,,,,Outpatient,,,,663,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Coccidioides Antibody, CF & ID, S QSTC",8764815,LOCAL,86635,CPT,,,,,,Outpatient,,,,13.76,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chlamydia Trachomatis RNA, TMA QST",9774353,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
DAPTOmycin 350 mg intravenous injection [CULL],11210540,LOCAL,J0878,CPT,,,,,,Outpatient,1,EA,,480,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neisseria Gonorrhoeae RNA, TMA QST",9774354,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
"Trichomonas Vaginalis RNA, Ql, TMA QST",9774358,LOCAL,87661,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Creat Clear,633609,LOCAL,82575,CPT,,,,,,Outpatient,,,,11.35,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Creat Clear (No U24),8477916,LOCAL,82575,CPT,,,,,,Outpatient,,,,11.35,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
doxycycline 100 mg injection [CULL],11201705,LOCAL,J1271,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aspartate aminotransferase,633633,LOCAL,84450,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Blood Urea Nitrogen,633605,LOCAL,84520,CPT,,,,,,Outpatient,,,,4.74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mononucleosis Screen,633785,LOCAL,86308,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Monospot POCT,9038464,LOCAL,86308,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gentamicin Level,3454415,LOCAL,80170,CPT,,,,,,Outpatient,,,,19.66,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gentamicin Level Peak,633736,LOCAL,80170,CPT,,,,,,Outpatient,,,,19.66,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gentamicin Level Trough,633737,LOCAL,80170,CPT,,,,,,Outpatient,,,,19.66,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gamma Glutamyl Transferase,1628895,LOCAL,82977,CPT,,,,,,Outpatient,,,,8.64,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Function Panel,1634883,LOCAL,80069,CPT,,,,,,Outpatient,,,,10.42,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL NM Therapy I131 Cap Per MCI,13644969,LOCAL,,,A9517,HCPCS,,,,Outpatient,,,,64,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96423 CHEMO ARTRL INF EA ADDL HR CHARGE,9404493,LOCAL,96423,CPT,,,,,,Outpatient,,,,64,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
90913 - Bfb training ea addl 15 min.,9442436,LOCAL,90913,CPT,,,,,,Outpatient,,,,64,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Caregiver Agreement on Discipline,7355021,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Caregiver Agreement on Discipline,7355021,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholesterol Total,633705,LOCAL,82465,CPT,,,,,,Outpatient,,,,5.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Progesterone Level,3454459,LOCAL,84144,CPT,,,,,,Outpatient,,,,25.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Triglyceride,633852,LOCAL,84478,CPT,,,,,,Outpatient,,,,6.89,VIVA,Commercial,,50,,49.57,49.57,49.57,14,percent of total billed charges,7.16,52.385,
"Histoplasma Antibody Panel, CF and ID, Serum QSTC",10185600,LOCAL,86698,CPT,,,,,,Outpatient,,,,16.55,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"64420 INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVE, SINGLE ProFee",13959631,LOCAL,64420,CPT,,,,,,Outpatient,,,,693,VIVA,Commercial,,50,,1243.47,486.29,1243.47,1 through 10,percent of total billed charges,633.14,1291,
E3581 Thawed Cryo AHF,7267123,LOCAL,,,P9012,HCPCS,,,,Outpatient,,,,65,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HPV mRNA E6/E7 QST,9775619,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HPV mRNA E6/E7 QST,10585636,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
POC Chem8+ Panel,8920330,LOCAL,80048,CPT,,,,,,Outpatient,,,,10.15,VIVA,Commercial,,50,,40.77,28.31,40.77,1 through 10,percent of total billed charges,12.14,37.17170492,
Thinprep Review Cytotechnologist: QST,9775616,LOCAL,88175,CPT,,,,,,Outpatient,,,,31.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Thinprep Review Cytotechnologist: QST,10585633,LOCAL,88175,CPT,,,,,,Outpatient,,,,31.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97116  SB Pt Gait Train 15 mn,9640030,LOCAL,97116,CPT,,,,,GP,Outpatient,,,,65,VIVA,Commercial,,50,,24.11,16.07,24.11,1 through 10,percent of total billed charges,12.1333871,47.26,
97116 GAIT TRAINING CHARGE,9410151,LOCAL,97116,CPT,,,,,GP,Outpatient,,,,65,VIVA,Commercial,,50,,24.11,16.07,24.11,1 through 10,percent of total billed charges,12.1333871,47.26,
97116 PT Gait Training Assistant Units,9650030,LOCAL,97116,CPT,,,,,GP|CQ,Outpatient,,,,65,VIVA,Commercial,,50,,24.11,16.07,24.11,1 through 10,percent of total billed charges,12.1333871,47.26,
Gait Training Charges,7895941,LOCAL,97116,CPT,,,,,GP,Outpatient,,,,65,VIVA,Commercial,,50,,24.11,16.07,24.11,1 through 10,percent of total billed charges,12.1333871,47.26,
PT Gait Training Assistant Units,9390436,LOCAL,97116,CPT,,,,,CQ,Outpatient,,,,65,VIVA,Commercial,,50,,24.11,16.07,24.11,1 through 10,percent of total billed charges,12.1333871,47.26,
Activated PTT,7938959,LOCAL,85730,CPT,,,,,,Outpatient,,,,7.21,VIVA,Commercial,,50,,15.18,15.18,15.18,1 through 10,percent of total billed charges,1.648553055,5.42,
Bilirubin Direct,4240528,LOCAL,82248,CPT,,,,,,Outpatient,,,,6.02,VIVA,Commercial,,50,,50.8,50.8,50.8,1 through 10,percent of total billed charges,7.16,26.6275,
Bilirubin Direct,7939101,LOCAL,82248,CPT,,,,,,Outpatient,,,,6.02,VIVA,Commercial,,50,,50.8,50.8,50.8,1 through 10,percent of total billed charges,7.16,26.6275,
Bilirubin Direct,8443662,LOCAL,82248,CPT,,,,,,Outpatient,,,,6.02,VIVA,Commercial,,50,,50.8,50.8,50.8,1 through 10,percent of total billed charges,7.16,26.6275,
iSTAT Creatinine POCT,11673045,LOCAL,82565,CPT,,,,,,Outpatient,,,,6.14,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lipid Pnl,633777,LOCAL,80061,CPT,,,,,,Outpatient,,,,16.07,VIVA,Commercial,,50,,50.8,25.27,50.8,13,percent of total billed charges,12.14,16.59934459,
77062 MG Diagnostic Tomo Charge: AddOn Bilateral,13969682,LOCAL,G0279,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
77063 MG Tomo Charge: AddOn Bilateral,13621440,LOCAL,77063,CPT,,,,,,Outpatient,,,,54.45,VIVA,Commercial,,50,,50.92,50.92,50.92,1 through 10,percent of total billed charges,20.75,74,
CULL Mammo Tomo Add On,7867705,LOCAL,77063,CPT,,,,,,Outpatient,,,,54.45,VIVA,Commercial,,50,,50.92,50.92,50.92,1 through 10,percent of total billed charges,20.75,74,
hepatitis B pediatric vaccine 10 mcg/0.5 mL intramuscular suspension 0.5 mL [CULL],11202559,LOCAL,90744,CPT,,,,,,Outpatient,0.5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin G Subclass 1 QSTC,8851875,LOCAL,82787,CPT,,,,,,Outpatient,,,,9.62,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Immunoglobulin G, Serum QSTC",8851879,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"HVA, 24h Urine w/o Creat QSTC",13864511,LOCAL,83150,CPT,,,,,,Outpatient,,,,26.89,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CYSTOGRAM INJ,8210035,LOCAL,51600,CPT,,,,,,Outpatient,,,,246,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Therapeutic Phlebotomy,8118276,LOCAL,99195,CPT,,,,,,Outpatient,,,,67,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Strep A Xpress (GeneXpert),8642789,LOCAL,87651,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,56.06,33.24,56.06,1 through 10,percent of total billed charges,3.7,40.19,
Cerebrospinal Fluid Culture,4122737,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,VIVA,Commercial,,50,,101.59,101.59,101.59,1 through 10,percent of total billed charges,10.57,67.60639535,
pamidronate 3 mg/mL intravenous solution 10 mL [CULL],11211072,LOCAL,J2430,CPT,,,,,,Outpatient,10,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronavirus SARS Ag (Sofia),9803641,LOCAL,87426,CPT,,,,,,Outpatient,,,,42.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COVID-19 Ag,11561110,LOCAL,87426,CPT,,,,,,Outpatient,,,,42.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urine Drug Screen,3454403,LOCAL,80306,CPT,,,,,,Outpatient,,,,20.57,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97533 PT SENSORY INTEGRATIVE TECH 15MIN,9866109,LOCAL,97533,CPT,,,,,GO|CO,Outpatient,,,,68,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97533 SENSORY INTEGATIVE TECHNIQUES EACH 15 MINS,9856109,LOCAL,97533,CPT,,,,,GO,Outpatient,,,,68,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Sensory Integrative Tech Assistant Units,7895276,LOCAL,97533,CPT,,,,,CQ,Outpatient,,,,68,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Sensory Integrative Techniques Units,1373568,LOCAL,97533,CPT,,,,,GO,Outpatient,,,,68,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sensory Stimulation Charge,7895276,LOCAL,97533,CPT,,,,,GO,Outpatient,,,,68,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3908 Clavicle Brace,9800048,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3908 Wrist/forearm Brace,9800047,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chlamydia Trachomatis RNA, TMA QST",14435138,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
HPV mRNA E6/E7 QST,14435137,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neisseria Gonorrhoeae RNA, TMA QST",14435139,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
Thinprep Review Cytotechnologist: QST,14435134,LOCAL,88175,CPT,,,,,,Outpatient,,,,31.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Iron Level,633765,LOCAL,83540,CPT,,,,,,Outpatient,,,,7.76,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Iron Level,7050169,LOCAL,83540,CPT,,,,,,Outpatient,,,,7.76,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Iron Level,10543519,LOCAL,83540,CPT,,,,,,Outpatient,,,,7.76,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vitamin B2 (Riboflavin), P QSTC",8972877,LOCAL,84252,CPT,,,,,,Outpatient,,,,24.29,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3908 Daytimer Wrist Support,9800046,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97537 COMMUNITY/WORK REINTEGRATION,9650036,LOCAL,97537,CPT,,,,,GP|CQ,Outpatient,,,,70,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97537 Community/work reintegration training; each 15 minutes,9860034,LOCAL,97537,CPT,,,,,GO|CO,Outpatient,,,,70,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97537 OT COMM WORK INTEGRATION CHARGE,9850034,LOCAL,97537,CPT,,,,,GO,Outpatient,,,,70,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97537 PT ERGONOMIC TRAINING,9640036,LOCAL,97537,CPT,,,,,GP,Outpatient,,,,70,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Community/Work Reintegration Charges,1366455,LOCAL,97537,CPT,,,,,GO,Outpatient,,,,70,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Community, Work Reintegration Assistant Units",1366455,LOCAL,97537,CPT,,,,,CQ,Outpatient,,,,70,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Community, Work Reintegration Assistant Units",1373453,LOCAL,97537,CPT,,,,,CQ,Outpatient,,,,70,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Community, Work Reintegration Units",1373453,LOCAL,97537,CPT,,,,,GO,Outpatient,,,,70,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Community/Work Reintegration Charges,1366455,LOCAL,97537,CPT,,,,,GO,Outpatient,,,,70,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"PT Community,Work Reintegration Assistant Units",9390450,LOCAL,97537,CPT,,,,,CQ,Outpatient,,,,70,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Community/Work Reintegration Charge,7895991,LOCAL,97537,CPT,,,,,GP,Outpatient,,,,70,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AChR Bind Ab w/rfx MuSK Ab QSTC,13864498,LOCAL,86041,CPT,,,,,,Outpatient,,,,22.08,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alpha-1-Antitrypsin QN QSTC,13873077,LOCAL,82103,CPT,,,,,,Outpatient,,,,16.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carnitine QSTC,8764784,LOCAL,82379,CPT,,,,,,Outpatient,,,,20.24,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EKG Charges - RT -> Routine ECG 12 lead/15 lead tracing only,5367589,LOCAL,93041,CPT,,,,,,Outpatient,,,,71,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97542  SB PT Wheelchair Mgt,9640037,LOCAL,97542,CPT,,,,,GP,Outpatient,,,,71,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97542 OT WHEELCHAIR MANAGE/TRAIN 15MIN,9820201,LOCAL,97542,CPT,,,,,GO,Outpatient,,,,71,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97542 PT WC SEATING EVAL CHARGE,9650037,LOCAL,97542,CPT,,,,,GP|CQ,Outpatient,,,,71,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"97542 Wheelchair management (eg, assessment, fitting, training), each 15 minutes",9860201,LOCAL,97542,CPT,,,,,GO|CO,Outpatient,,,,71,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97542 WHEELCHAIR MANAGEMENT CHARGE,9410201,LOCAL,97542,CPT,,,,,GP,Outpatient,,,,71,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Wheelchair Management Assistant Units,7895273,LOCAL,97542,CPT,,,,,CQ,Outpatient,,,,71,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Wheelchair Management Units,1373570,LOCAL,97542,CPT,,,,,GO,Outpatient,,,,71,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Wheelchair Management Assistant Units,9390452,LOCAL,97542,CPT,,,,,CQ,Outpatient,,,,71,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wheelchair Charge,7895273,LOCAL,97542,CPT,,,,,GO,Outpatient,,,,71,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wheelchair Management Charges,7895931,LOCAL,97542,CPT,,,,,GP,Outpatient,,,,71,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97551 OT Caregiver Training Ea Add'l 15 Mins,13647370,LOCAL,97551,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97551 PT Caregiver Training Ea Add'l 15 Mins,13645598,LOCAL,97551,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97551 ST Caregiver Training Ea  Addl 15 min,14017194,LOCAL,97551,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Facility Eval and Management Level 1 99211,10633491,LOCAL,99211,CPT,,,,,,Outpatient,,,,226,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medical Day Dressing Change,10633491,LOCAL,99211,CPT,,,,,,Outpatient,,,,226,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Caregiver Training, Addl 15 Min Asst",13623455,LOCAL,,,G0542,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Caregiver Training, First 30 Min Asst",13623453,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"SLP Caregiver Training, Addl 15 Min Time",14466886,LOCAL,,,G0542,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
% CD19 (B Cells) QSTC,9416397,LOCAL,86355,CPT,,,,,,Outpatient,,,,45.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
%CD 16+CD56 (NK Cells) QSTC,9416395,LOCAL,86357,CPT,,,,,,Outpatient,,,,45.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
%CD3 Mature T Cells QSTC,9416288,LOCAL,86359,CPT,,,,,,Outpatient,,,,45.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CD4/CD8 Ratio QSTC,8852258,LOCAL,86360,CPT,,,,,,Outpatient,,,,56.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Parvovirus B19 Antibodies(IgG, IgM) QSTC",8764577,LOCAL,86747,CPT,,,,,,Outpatient,,,,18.04,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
chlorproMAZINE 25 mg/mL injectable solution 1 mL [CULL],11202221,LOCAL,J3230,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CBC w/ Manual Differential,633682,LOCAL,85027,CPT,,,,,,Outpatient,,,,7.76,VIVA,Commercial,,50,,55.69,31.75,55.69,13,percent of total billed charges,8.21,27.02937879,
CBC without Differential,3798345,LOCAL,85027,CPT,,,,,,Outpatient,,,,7.76,VIVA,Commercial,,50,,55.69,31.75,55.69,13,percent of total billed charges,8.21,27.02937879,
gentamicin 40 mg/mL injectable solution 20 mL [CULL],11205229,LOCAL,J1580,CPT,,,,,,Outpatient,20,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DNase-B Antibody QSTC,8764548,LOCAL,86215,CPT,,,,,,Outpatient,,,,15.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tissue Transglutaminase Ab(IgG,IgA) QSTC",8972930,LOCAL,86364,CPT,,,,,,Outpatient,,,,13.84,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cord DAT Gel,8416626,LOCAL,86880,CPT,,,,,,Outpatient,,,,6.47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DAT IgG Gel,7906396,LOCAL,86880,CPT,,,,,,Outpatient,,,,6.47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neonatal DAT Gel,13460490,LOCAL,86880,CPT,,,,,,Outpatient,,,,6.47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LA Ven - Sepsis 2Hr,8485386,LOCAL,83605,CPT,,,,,,Outpatient,,,,13.88,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lactic Acid (Venous),3454442,LOCAL,83605,CPT,,,,,,Outpatient,,,,13.88,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lactic Acid (Venous) - Sepsis,8058058,LOCAL,83605,CPT,,,,,,Outpatient,,,,13.88,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Unstable Hemoglobin QSTC,13864449,LOCAL,83068,CPT,,,,,,Outpatient,,,,11.36,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97124 MASSAGE CHARGE,9640031,LOCAL,97124,CPT,,,,,GP,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97124 OT MASSAGE CHARGE,9850029,LOCAL,97124,CPT,,,,,GO,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97124 OT-MASSAGE EA 15 MIN,9860029,LOCAL,97124,CPT,,,,,GO|CO,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97124 PT Massage Assistant Units,9650031,LOCAL,97124,CPT,,,,,GP|CQ,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97140  Manual Therapy 15 min,9850047,LOCAL,97140,CPT,,,,,GO,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97140 MAN THER EA 15 MIN CHARGES,9640047,LOCAL,97140,CPT,,,,,GP,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97140 OT Manual Therapy Assistant Units,9860047,LOCAL,97140,CPT,,,,,GO|CO,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97140 PT Manual Therapy Assistant Units,9650047,LOCAL,97140,CPT,,,,,GP|CQ,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Manual Therapy Charge Units,7895928,LOCAL,97140,CPT,,,,,GP,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Manual Traction Charge,7895279,LOCAL,97140,CPT,,,,,GO,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Massage Charge Units,1041799,LOCAL,97124,CPT,,,,,GO,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Massage Charge Units,7895954,LOCAL,97124,CPT,,,,,GP,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Manual Therapy Assistant Units,1373444,LOCAL,97140,CPT,,,,,CQ,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Manual Therapy Units,1373444,LOCAL,97140,CPT,,,,,GO,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Massage Assistant Units,1041799,LOCAL,97124,CPT,,,,,CQ,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Massage Charge Units,1041799,LOCAL,97124,CPT,,,,,GO,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Massage Rehab Assist Units,7897698,LOCAL,97124,CPT,,,,,CQ,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Massage Rehab Units,7897698,LOCAL,97124,CPT,,,,,GO,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Manual Therapy Assistant Units,9390440,LOCAL,97140,CPT,,,,,CQ,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Massage Assistant Units,9390438,LOCAL,97124,CPT,,,,,CQ,Outpatient,,,,74,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methylergonovine 0.2 mg/mL injectable solution 1 mL [CULL],11202918,LOCAL,J2210,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Thinprep TIS Pap QST,9773891,LOCAL,88175,CPT,,,,,,Outpatient,,,,31.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Thinprep TIS Pap Rfx HPV mRNA E6/E7 QST,9773936,LOCAL,88175,CPT,,,,,,Outpatient,,,,31.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97033 IONTOPHORESIS CHARGE,9410271,LOCAL,97033,CPT,,,,,GP,Outpatient,,,,75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97033 IONTOPHORESIS EA 15 MIN CHARGES,9640077,LOCAL,97033,CPT,,,,,GP,Outpatient,,,,75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97033 OT IONTOPHORESIS,9850073,LOCAL,97033,CPT,,,,,GO,Outpatient,,,,75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97033 OT IONTOPHORESIS 15 MIN APPL CHARGE,9860073,LOCAL,97033,CPT,,,,,GO|CO,Outpatient,,,,75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97033 PT IONTOPHORESIS,9650077,LOCAL,97033,CPT,,,,,GP|CQ,Outpatient,,,,75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Iontophoresis Charges,1366374,LOCAL,97033,CPT,,,,,GO,Outpatient,,,,75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Iontophoresis Charges,7895927,LOCAL,97033,CPT,,,,,GP,Outpatient,,,,75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Iontophoresis Assistant Units,1366374,LOCAL,97033,CPT,,,,,CQ,Outpatient,,,,75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Iontophoresis Assistant Units,1373443,LOCAL,97033,CPT,,,,,CQ,Outpatient,,,,75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Iontophoresis Charges,1366374,LOCAL,97033,CPT,,,,,GO,Outpatient,,,,75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Iontophoresis Units,1373443,LOCAL,97033,CPT,,,,,GO,Outpatient,,,,75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Iontophoresis Assistant Units,9390424,LOCAL,97033,CPT,,,,,CQ,Outpatient,,,,75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergy Panel13 Stinging Insect Grp QSTC,9063178,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Honey Bee (I1) IgE QST,12866524,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Peanut Component Panel QSTC,8764809,LOCAL,86008,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE Chest Physiotherapy -> PEP Therapy Initial,8699752,LOCAL,94668,CPT,,,,,,Outpatient,,,,75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chlamydia Trachomatis RNA, TMA QST",12762527,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
"Mycoplasma Genitalium, rRNA QST",12762530,LOCAL,87563,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neisseria Gonorrhoeae RNA, TMA QST",12762531,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
Trichomonas Vaginalis RNA QST,12762534,LOCAL,87661,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ferritin,1628893,LOCAL,82728,CPT,,,,,,Outpatient,,,,16.36,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97750 - Physical performance test or measurement,9640058,LOCAL,97750,CPT,,,,,GP,Outpatient,,,,77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97750 FCE-FUNCTIONAL CAPACITY EVAL 1 CHARGE,9640050,LOCAL,97750,CPT,,,,,GP,Outpatient,,,,77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97750 OT PERF TEST MEAS 15 MIN CHARGE,9850061,LOCAL,97750,CPT,,,,,GO,Outpatient,,,,77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97750 OT Strapping Shoulder Assistant Units,9860061,LOCAL,97750,CPT,,,,,GO|CO,Outpatient,,,,77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97750 PRE WORK SCREEN CHARGE,9650058,LOCAL,97750,CPT,,,,,GP|CQ,Outpatient,,,,77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97750 PT ISOKINETIC TEST 15 MIN,9640053,LOCAL,97750,CPT,,,,,GP,Outpatient,,,,77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97750 PT ISOKINETIC TEST 15 MIN ASST,9650053,LOCAL,97750,CPT,,,,,GP|CQ,Outpatient,,,,77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97750 PT PHYSICAL PERFORMANCE TEST CHARGE,9650050,LOCAL,97750,CPT,,,,,GP|CQ,Outpatient,,,,77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97761 (PROSTHETIC TRAINING CAWC),9650033,LOCAL,97761,CPT,,,,,GP|CQ,Outpatient,,,,77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97761 PROSTHETIC TRAINING 15 MINS,9640033,LOCAL,97761,CPT,,,,,GP,Outpatient,,,,77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97761 PT PROSTHETIC TRAINING CHARGE,9410181,LOCAL,97761,CPT,,,,,GP,Outpatient,,,,77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Functional Capacity Eval Charge,7895967,LOCAL,97750,CPT,,,,,GP,Outpatient,,,,77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Physical Performance Test Assistant Units,7895284,LOCAL,97750,CPT,,,,,CQ,Outpatient,,,,77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Physical Performance Test Charges,7895284,LOCAL,97750,CPT,,,,,GO,Outpatient,,,,77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Physical Performance Test Units,7897702,LOCAL,97750,CPT,,,,,GO,Outpatient,,,,77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prosthetic Training Charges,7895930,LOCAL,97761,CPT,,,,,GP,Outpatient,,,,77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Physical Performance Assistant Test,9390432,LOCAL,97750,CPT,,,,,CQ,Outpatient,,,,77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Physical Performance Test Charges,7895980,LOCAL,97750,CPT,,,,,GP,Outpatient,,,,77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"PT Prosthetic Management, Train Assistant Units",9390460,LOCAL,97761,CPT,,,,,CQ,Outpatient,,,,77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"29125 Application of short arm splint (forearm to hand); static, right",8584933,LOCAL,29125,CPT,,,,,,Outpatient,,,,129,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chlamydia Trachomatis RNA, TMA QST",14747186,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
Cortisol Baseline,7974014,LOCAL,80400,CPT,,,,,,Outpatient,,,,39.14,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cyt Clinical Info QST,14754292,LOCAL,88104,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cyt Pathologist QST,14754294,LOCAL,88172,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cyt Report Notes QST,14754295,LOCAL,88173,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cyt Report Type QST,14754291,LOCAL,88121,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cyt Screener QST,14754293,LOCAL,87207,CPT,,,,,,Outpatient,,,,7.19,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Mycoplasma Genitalium, rRNA QST",14747189,LOCAL,87563,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neisseria Gonorrhoeae RNA, TMA QST",14747187,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
Tissue 1A Source QST,14754297,LOCAL,88108,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue 1B Source QST,14754303,LOCAL,88108,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue 1C Source QST,14754321,LOCAL,88108,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Clinical Impression QST,14754296,LOCAL,88160,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Comment QST,14754301,LOCAL,88161,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Diagnosis QST,14754300,LOCAL,88162,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Gross Description QST,14754299,LOCAL,88305,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue B Comment QST,14754307,LOCAL,88161,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue B Diagnosis QST,14754306,LOCAL,88162,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue B Gross Description QST,14754305,LOCAL,88305,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue C Clinical Impression QST,14754320,LOCAL,88160,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue C Comment QST,14754325,LOCAL,88161,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue C Diagnosis QST,14754324,LOCAL,88162,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue C Gross Description QST,14754323,LOCAL,88305,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Trichomonas Vaginalis RNA QST,14747188,LOCAL,87661,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
naloxone 1 mg/mL injectable solution 2 mL [CULL],11202975,LOCAL,J2312,CPT,,,,,,Outpatient,2,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
T. candidus QSTC,9010450,LOCAL,86606,CPT,,,,,,Outpatient,,,,18.06,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
T. vulgaris QSTC,9010456,LOCAL,86609,CPT,,,,,,Outpatient,,,,15.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Trichoderma viride IgG QSTC,9010474,LOCAL,86001,CPT,,,,,,Outpatient,,,,9.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3925 Fo pip dip jnt/sprng pre ots,9856100,LOCAL,,,L3925,HCPCS,,,,Outpatient,,,,79,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fecal Lipids, Total QSTC",8972795,LOCAL,82710,CPT,,,,,,Outpatient,,,,20.16,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Oxcarbazepine Metabolite QSTC,8764758,LOCAL,80183,CPT,,,,,,Outpatient,,,,15.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lactated Ringers Injection 1000 mL [CULL],11281275,LOCAL,J7120,CPT,,,,,,Outpatient,1000,ML,,,VIVA,Commercial,,50,,57.64,20.39,57.64,16,percent of total billed charges,0.543820225,0.543820225,
97110  SB OT Thera Exer,9850027,LOCAL,97110,CPT,,,,,GO,Outpatient,,,,79,VIVA,Commercial,,50,,19.64,19.64,19.64,1 through 10,percent of total billed charges,36.59637931,56.44,
97110  SB PT Thera Exer,9650027,LOCAL,97110,CPT,,,,,GP|CQ,Outpatient,,,,79,VIVA,Commercial,,50,,19.64,19.64,19.64,1 through 10,percent of total billed charges,36.59637931,56.44,
97110 EXERCISE 1/MORE AREAS CHARGE,9410136,LOCAL,97110,CPT,,,,,GP,Outpatient,,,,79,VIVA,Commercial,,50,,19.64,19.64,19.64,1 through 10,percent of total billed charges,36.59637931,56.44,
97110 OT Therapeutic Exercise Assistant Units,9860027,LOCAL,97110,CPT,,,,,GO|CO,Outpatient,,,,79,VIVA,Commercial,,50,,19.64,19.64,19.64,1 through 10,percent of total billed charges,36.59637931,56.44,
97110 PT THERAPEUTIC EXERCISE,9640054,LOCAL,97110,CPT,,,,,GP,Outpatient,,,,79,VIVA,Commercial,,50,,19.64,19.64,19.64,1 through 10,percent of total billed charges,36.59637931,56.44,
97110 PT Therapeutic Exercise Assistant Units,9650054,LOCAL,97110,CPT,,,,,GP|CQ,Outpatient,,,,79,VIVA,Commercial,,50,,19.64,19.64,19.64,1 through 10,percent of total billed charges,36.59637931,56.44,
97110 THERAPEUTIC EXER 15 MIN CHARGES,9640027,LOCAL,97110,CPT,,,,,GP,Outpatient,,,,79,VIVA,Commercial,,50,,19.64,19.64,19.64,1 through 10,percent of total billed charges,36.59637931,56.44,
OT Therapeutic Exercise Assistant Units,750901,LOCAL,97110,CPT,,,,,CQ,Outpatient,,,,79,VIVA,Commercial,,50,,19.64,19.64,19.64,1 through 10,percent of total billed charges,36.59637931,56.44,
OT Therapeutic Exercise Charges,750901,LOCAL,97110,CPT,,,,,GO,Outpatient,,,,79,VIVA,Commercial,,50,,19.64,19.64,19.64,1 through 10,percent of total billed charges,36.59637931,56.44,
OT Therapeutic Exercise Rehab Units,7897696,LOCAL,97110,CPT,,,,,GO,Outpatient,,,,79,VIVA,Commercial,,50,,19.64,19.64,19.64,1 through 10,percent of total billed charges,36.59637931,56.44,
PT Therapeutic Exercise Assistant Units,9390430,LOCAL,97110,CPT,,,,,CQ,Outpatient,,,,79,VIVA,Commercial,,50,,19.64,19.64,19.64,1 through 10,percent of total billed charges,36.59637931,56.44,
Therapeutic Exercise Charges,750901,LOCAL,97110,CPT,,,,,GO,Outpatient,,,,79,VIVA,Commercial,,50,,19.64,19.64,19.64,1 through 10,percent of total billed charges,36.59637931,56.44,
Therapeutic Exercise Charges,7895934,LOCAL,97110,CPT,,,,,GP,Outpatient,,,,79,VIVA,Commercial,,50,,19.64,19.64,19.64,1 through 10,percent of total billed charges,36.59637931,56.44,
Creatine Kinase,633712,LOCAL,82550,CPT,,,,,,Outpatient,,,,7.81,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Genital Culture,633894,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,VIVA,Commercial,,50,,101.59,101.59,101.59,1 through 10,percent of total billed charges,10.57,67.60639535,
Respiratory Culture,4123062,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,VIVA,Commercial,,50,,101.59,101.59,101.59,1 through 10,percent of total billed charges,10.57,67.60639535,
Sputum Culture,7909553,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,VIVA,Commercial,,50,,101.59,101.59,101.59,1 through 10,percent of total billed charges,10.57,67.60639535,
Blood Culture,4122800,LOCAL,87040,CPT,,,,,,Outpatient,,,,12.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Blood Unit Culture,7967813,LOCAL,87040,CPT,,,,,,Outpatient,,,,12.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Folate Level,1628894,LOCAL,82746,CPT,,,,,,Outpatient,,,,17.64,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Troponin-I,1634892,LOCAL,84484,CPT,,,,,,Outpatient,,,,14.96,VIVA,Commercial,,50,,23.46,9.83,23.46,1 through 10,percent of total billed charges,0.887987013,17.73,
influenza vaccine (Flucelvax PF) vaccine 2025-2026 [CULL],11292050,LOCAL,90661,CPT,,,,,,Outpatient,0.5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methylPREDNISolone 1 g Pow,11201957,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
29584 PT APPLICATION OF MULTI-LAYER COMPRESSION SYSTEM,9109668,LOCAL,29584,CPT,,,,,GP,Outpatient,,,,81,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT MultiLayer Compress Below Knee Charge,7896004,LOCAL,29584,CPT,,,,,GP,Outpatient,,,,81,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR TMJ Open and Closed Left,9514710,LOCAL,70328,CPT,,,,,LT,Outpatient,,,,66.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR TMJ Open and Closed Right,9514712,LOCAL,70328,CPT,,,,,RT,Outpatient,,,,66.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Kidney Microsomal LKM1 Ab IgG QSTC,8764790,LOCAL,86376,CPT,,,,,,Outpatient,,,,17.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medium Cam Walking Boot,9400074,LOCAL,,,L4387,HCPCS,,,,Outpatient,,,,67,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PTH-Related Protein (PTH-RP) QSTC,8764743,LOCAL,83519,CPT,,,,,,Outpatient,,,,22.08,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF DAT IgG,7939268,LOCAL,86880,CPT,,,,,,Outpatient,,,,6.47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Computer Crossmatch Interp -> Computer XM OK,8142426,LOCAL,86923,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serological Immediate Spin -> Compatible,8014366,LOCAL,86920,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serological Immediate Spin -> Corrected,10125801,LOCAL,86920,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serological Immediate Spin -> Incompatible,9527535,LOCAL,86920,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XM AHG Gel Interp -> Compatible,8013754,LOCAL,86920,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XM AHG Gel Interp -> Incompatible,8013753,LOCAL,86920,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XM AHG Gel Interp -> Least Incompatible,8013752,LOCAL,86920,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XM AHG Tube Interp -> Compatible,8014220,LOCAL,86920,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XM AHG Tube Interp -> Incompatible,8014219,LOCAL,86920,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XM AHG Tube Interp -> Least Incompatible,8014218,LOCAL,86920,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alanine aminotransferase,633632,LOCAL,84460,CPT,,,,,,Outpatient,,,,6.36,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Erythrocyte Sedimentation Rate (ESR),7909828,LOCAL,85652,CPT,,,,,,Outpatient,,,,3.24,VIVA,Commercial,,50,,64.36,2.7,64.36,1 through 10,percent of total billed charges,8.21,43.67975976,
97112 BAL ACT EA 15 MIN CHARGES,9640028,LOCAL,97112,CPT,,,,,GP,Outpatient,,,,83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97112 NEUROMUSCULAR RE-EDUCATION CHARGE,9410141,LOCAL,97112,CPT,,,,,GP,Outpatient,,,,83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97112 OT NEURO MUSCULAR RE ED EA 15 MIN,9850028,LOCAL,97112,CPT,,,,,GO,Outpatient,,,,83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97112 OT Neuromusc Re-education Assistant Units,9860028,LOCAL,97112,CPT,,,,,GO|CO,Outpatient,,,,83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97112 PT Neuromuscular Re-Ed Assistant Units,9650028,LOCAL,97112,CPT,,,,,GP|CQ,Outpatient,,,,83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuromuscular Reeducation Charges,750905,LOCAL,97112,CPT,,,,,GO,Outpatient,,,,83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuromuscular Reeducation Charges,7895932,LOCAL,97112,CPT,,,,,GP,Outpatient,,,,83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Neuromuscular Reeducation Assistant Units,750905,LOCAL,97112,CPT,,,,,CQ,Outpatient,,,,83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Neuromuscular Reeducation Charges,750905,LOCAL,97112,CPT,,,,,GO,Outpatient,,,,83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Neuromuscular Reeducation Rehab Units,7897697,LOCAL,97112,CPT,,,,,GO,Outpatient,,,,83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Neuromuscular Reeducation Assistant Units,9390444,LOCAL,97112,CPT,,,,,CQ,Outpatient,,,,83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Culture Fungus Smear not Hr Skn Bld QST,10217136,LOCAL,87102,CPT,,,,,,Outpatient,,,,10.09,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alcohol Level,1503765,LOCAL,,,G0480,HCPCS,,,,Outpatient,,,,84,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CBC w/ Differential,633683,LOCAL,85025,CPT,,,,,,Outpatient,,,,9.32,VIVA,Commercial,,50,,64.87,10.25,64.87,44,percent of total billed charges,8.21,31.45666667,
Na Citrate Platelet Count,9472554,LOCAL,85049,CPT,,,,,,Outpatient,,,,5.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Platelet Count,2182297,LOCAL,85049,CPT,,,,,,Outpatient,,,,5.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Platelet Count Manual,7974157,LOCAL,85049,CPT,,,,,,Outpatient,,,,5.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
iron dextran 50 mg/mL injectable solution 2 mL [CULL],11205256,LOCAL,J1750,CPT,,,,,,Outpatient,2,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
70030 X-RAY EYE FOR FOREIGN BODY,8658473,LOCAL,70030,CPT,,,,,,Outpatient,,,,72.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Foreign Body Localization Eye,8658473,LOCAL,70030,CPT,,,,,,Outpatient,,,,72.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TSI(Thyroid Stimulating Immunoglob) QSTC,8764795,LOCAL,84445,CPT,,,,,,Outpatient,,,,61.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glucose Fasting GTT,8238854,LOCAL,82951,CPT,,,,,,Outpatient,,,,15.44,VIVA,Commercial,,50,,17.95,17.95,17.95,1 through 10,percent of total billed charges,12.87,17.73,
Small Cam Walking Boot,9400073,LOCAL,,,L4387,HCPCS,,,,Outpatient,,,,67,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3908 Comfort cool thumb/wrist CMC orthosis,9800210,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3908 OT WRIST HAND ORTHOSIS,9800211,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Large Cam Walking Boot,9400070,LOCAL,,,L4387,HCPCS,,,,Outpatient,,,,67,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97535  SB PT Act of Liv 15 m,9640035,LOCAL,97535,CPT,,,,,GP,Outpatient,,,,86,VIVA,Commercial,,50,,42.43,42.43,42.43,1 through 10,percent of total billed charges,14.70452962,47.26,
97535 OT HOME MAKING ACTIVITY CHARGE,9820191,LOCAL,97535,CPT,,,,,GO,Outpatient,,,,86,VIVA,Commercial,,50,,42.43,42.43,42.43,1 through 10,percent of total billed charges,14.70452962,47.26,
97535 OT SELF CARE/HOME MGMT/ADL 15 MIN,9860191,LOCAL,97535,CPT,,,,,GO|CO,Outpatient,,,,86,VIVA,Commercial,,50,,42.43,42.43,42.43,1 through 10,percent of total billed charges,14.70452962,47.26,
97535 PT ADL Training/Self Care Assistant Units,9650035,LOCAL,97535,CPT,,,,,GP|CQ,Outpatient,,,,86,VIVA,Commercial,,50,,42.43,42.43,42.43,1 through 10,percent of total billed charges,14.70452962,47.26,
97535 SELF CARE/HOME MGMT-ADL'S CHARGE,9410191,LOCAL,97535,CPT,,,,,GP,Outpatient,,,,86,VIVA,Commercial,,50,,42.43,42.43,42.43,1 through 10,percent of total billed charges,14.70452962,47.26,
ADL Training Charge,7895959,LOCAL,97535,CPT,,,,,GP,Outpatient,,,,86,VIVA,Commercial,,50,,42.43,42.43,42.43,1 through 10,percent of total billed charges,14.70452962,47.26,
ADL Training Charges,1366372,LOCAL,97535,CPT,,,,,GO,Outpatient,,,,86,VIVA,Commercial,,50,,42.43,42.43,42.43,1 through 10,percent of total billed charges,14.70452962,47.26,
OT ADL Training Charges,1366372,LOCAL,97535,CPT,,,,,GO,Outpatient,,,,86,VIVA,Commercial,,50,,42.43,42.43,42.43,1 through 10,percent of total billed charges,14.70452962,47.26,
"OT Self Care, Home Management Units",1373569,LOCAL,97535,CPT,,,,,GO,Outpatient,,,,86,VIVA,Commercial,,50,,42.43,42.43,42.43,1 through 10,percent of total billed charges,14.70452962,47.26,
"OT Self Care, Home Mgmt Assistant Units",1373569,LOCAL,97535,CPT,,,,,CQ,Outpatient,,,,86,VIVA,Commercial,,50,,42.43,42.43,42.43,1 through 10,percent of total billed charges,14.70452962,47.26,
97530  SB OT Thera Act 15,9850032,LOCAL,97530,CPT,,,,,GO,Outpatient,,,,87,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97530 ACTIVITIES EACH 15 MIN CHARGE,9410270,LOCAL,97530,CPT,,,,,GP,Outpatient,,,,87,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97530 OT Therapeutic Activities Assistant Units,9860032,LOCAL,97530,CPT,,,,,GO|CO,Outpatient,,,,87,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97530 PT MAT\BED ACTIVITIES CHARGE,9640034,LOCAL,97530,CPT,,,,,GP,Outpatient,,,,87,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97530 PT Theraputic Activities Assistant Units,9650034,LOCAL,97530,CPT,,,,,GP|CQ,Outpatient,,,,87,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Therapeutic Activities Assistant Units,750903,LOCAL,97530,CPT,,,,,CQ,Outpatient,,,,87,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Therapeutic Activities Charges,750903,LOCAL,97530,CPT,,,,,GO,Outpatient,,,,87,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Therapeutic Activities Rehab Units,7897699,LOCAL,97530,CPT,,,,,GO,Outpatient,,,,87,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Therapeutic Activity Assistant Units,9390442,LOCAL,97530,CPT,,,,,CQ,Outpatient,,,,87,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Therapeutic Activities Charge,7895929,LOCAL,97530,CPT,,,,,GP,Outpatient,,,,87,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Therapeutic Activities Charges,750903,LOCAL,97530,CPT,,,,,GO,Outpatient,,,,87,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
amiodarone 150 mg/100 mL-D5% intravenous solution 100 mL [CULL],11200044,LOCAL,J0283,CPT,,,,,,Outpatient,100,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BB CROSSMATCH (AHG),6413027,LOCAL,86922,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BB CROSSMATCH (XMG INSTRUMENT),6413070,LOCAL,86922,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urine Culture,4126493,LOCAL,87086,CPT,,,,,,Outpatient,,,,9.68,VIVA,Commercial,,50,,67.32,13.82,67.32,12,percent of total billed charges,10.57,31.43235995,
.dRVVT 1:1 Mix QSTC,6230328,LOCAL,85613,CPT,,,,,,Outpatient,,,,11.5,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glomerular Basement Memb. Ab (IgG) QSTC,8853257,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glutamic Acid Decarboxylase-65 Ab QSTC,8764746,LOCAL,86341,CPT,,,,,,Outpatient,,,,28.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Quad Screen QSTC,8972927,LOCAL,81511,CPT,,,,,,Outpatient,,,,184.2,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ribosomal P Antibody QSTC,8853260,LOCAL,83516,CPT,,,,,,Outpatient,,,,13.84,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Rickettsia RMSF IgG,IgM w rfx Titer QSTC",8764764,LOCAL,86757,CPT,,,,,,Outpatient,,,,23.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tryptase QSTC,8764744,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96523 Port Flush,14892040,LOCAL,96523,CPT,,,,,59,Outpatient,,,,153,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OLANZapine 10 mg VL [CULL],11240752,LOCAL,J2358,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.Endomysial Ab Titer QSTC,8853243,LOCAL,86231,CPT,,,,,,Outpatient,,,,14.51,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endomysial (IgG) Antibody Screen and Titer QSTC,10146198,LOCAL,86231,CPT,,,,,,Outpatient,,,,14.51,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3808 OT SPLINT - DORSAL HAND SPLINT CHARGE,9856068,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,,89,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"L3808 WHFO, RIGID W/O JOINTS CHARGE",9856097,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,,89,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"96361- Hydration, each additional hour",1928298,LOCAL,96361,CPT,,,,,,Outpatient,,,,89,VIVA,Commercial,,50,,52.89,10.24,52.89,1 through 10,percent of total billed charges,42.18,749.76,
96361 IV INFUSION HYDRATION ADDL HR Charge,8049102,LOCAL,96361,CPT,,,,,,Outpatient,,,,89,VIVA,Commercial,,50,,52.89,10.24,52.89,1 through 10,percent of total billed charges,42.18,749.76,
90472 PO IMMUNIZATION ADM EA ADDTL VAC CHARGE,9279753,LOCAL,90472,CPT,,,,,,Outpatient,,,,90,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Phenytoin Lvl Total,7973985,LOCAL,80185,CPT,,,,,,Outpatient,,,,15.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
aztreonam 1 g injection [CULL],11201222,LOCAL,J0457,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Allergy Panel 19, Seafood QSTC",13864480,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Crystal Examination Body Fluid,3454316,LOCAL,89060,CPT,,,,,,Outpatient,,,,8.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Cyto Path Cell Enhance Tech,8489561,LOCAL,88112,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill FNA Eval Interp & Rpt,8489566,LOCAL,88173,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill IHC Antibody Additional,14048006,LOCAL,88341,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Tissue Exam Level 3,14047998,LOCAL,88304,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Tissue Exam Level 4,14036169,LOCAL,88305,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
70250 X-RAY EXAM OF SKULL,8658523,LOCAL,70250,CPT,,,,,,Outpatient,,,,286.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
hepatitis A pediatric vaccine 25 units/0.5 mL intramuscular suspension 0.5 mL [CULL],11202555,LOCAL,90632,CPT,,,,,,Outpatient,0.5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
medroxyPROGESTERone 150 mg/mL intramuscular suspension 1 mL [CULL],11204480,LOCAL,J1050,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"West Nile Ab IgG, CSF QSTC",13872975,LOCAL,86789,CPT,,,,,,Outpatient,,,,17.27,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"West Nile Ab IgG, Serum QSTC",9010233,LOCAL,86789,CPT,,,,,,Outpatient,,,,17.27,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"West Nile Ab IgM, CSF QSTC",13872978,LOCAL,86788,CPT,,,,,,Outpatient,,,,20.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"West Nile Ab IgM, Serum QSTC",9010236,LOCAL,86788,CPT,,,,,,Outpatient,,,,20.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chlamydia Trachomatis RNA, TMA QST",14718353,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
HPV MRNA E6/E7 QSTA,14718356,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Thinprep Review Cytotechnologist: QST,14718368,LOCAL,88175,CPT,,,,,,Outpatient,,,,31.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trichomonas vaginalis, Ql TMA, Pap QST",14718355,LOCAL,87661,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardio IQ(R) Lipoprotein Fraction, Ion Mobility QSTC",9039426,LOCAL,83704,CPT,,,,,,Outpatient,,,,41.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Parathyroid Hormone Intact,3455483,LOCAL,83970,CPT,,,,,,Outpatient,,,,49.54,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Factor VIII Activity, Clotting QSTC",9039263,LOCAL,85240,CPT,,,,,,Outpatient,,,,21.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sirolimus, LC/MS/MS QSTC",8764819,LOCAL,80195,CPT,,,,,,Outpatient,,,,16.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97760 ORTHOTICS FIT/TRAIN EA 15MN CHARGE,9410176,LOCAL,97760,CPT,,,,,GP,Outpatient,,,,94,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97760 ORTHOTICS FITTING & TRAINING CHARGE,9850030,LOCAL,97760,CPT,,,,,GO,Outpatient,,,,94,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97760 OT Orthotic Mgmt/Train Initial Charge Assistant Units,9860030,LOCAL,97760,CPT,,,,,GO|CO,Outpatient,,,,94,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97760 PO ORTHOTIC EVALUATION CHARGE,9640032,LOCAL,97760,CPT,,,,,GP,Outpatient,,,,94,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97760 PO ORTHOTIC FOLLOW UP CHARGE,9650032,LOCAL,97760,CPT,,,,,GP|CQ,Outpatient,,,,94,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orthotic Mgmt and Training Charges,7895275,LOCAL,97760,CPT,,,,,GO,Outpatient,,,,94,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orthotic Mgmt and Training Charges,7895953,LOCAL,97760,CPT,,,,,GP,Outpatient,,,,94,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Orthotic Management, Train Assistant Units",1373573,LOCAL,97760,CPT,,,,,CQ,Outpatient,,,,94,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Orthotic Management, Train Units",1373573,LOCAL,97760,CPT,,,,,GO,Outpatient,,,,94,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"PT Orthotic Management, Train Assistant Units",9390458,LOCAL,97760,CPT,,,,,CQ,Outpatient,,,,94,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Catheter Type:; -> Straight/Intermittent,4610954,LOCAL,51701,CPT,,,,,,Outpatient,,,,94,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EVENT MONITOR RECORDING ONLY,8200120,LOCAL,93270,CPT,,,,,,Outpatient,,,,94,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
desmopressin 4 mcg/mL injectable solution 1 mL [CULL],11201582,LOCAL,J2597,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
% CD3 (Mature T Cells) QSTC,13873423,LOCAL,86359,CPT,,,,,,Outpatient,,,,45.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CD4/CD8 Ratio QSTC,13873439,LOCAL,86360,CPT,,,,,,Outpatient,,,,56.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Beta hCG Qualitative,633663,LOCAL,84703,CPT,,,,,,Outpatient,,,,9.02,VIVA,Commercial,,50,,73.44,73.44,73.44,1 through 10,percent of total billed charges,7.16,7.52,
Serum Pregnancy Qual POCT,10461706,LOCAL,84703,CPT,,,,,,Outpatient,,,,9.02,VIVA,Commercial,,50,,73.44,73.44,73.44,1 through 10,percent of total billed charges,7.16,7.52,
Serum Pregnancy Test Qualitative,7909775,LOCAL,84703,CPT,,,,,,Outpatient,,,,9.02,VIVA,Commercial,,50,,73.44,73.44,73.44,1 through 10,percent of total billed charges,7.16,7.52,
Serum Pregnancy Test Qualitative w/ Reflex,9384303,LOCAL,84703,CPT,,,,,,Outpatient,,,,9.02,VIVA,Commercial,,50,,73.44,73.44,73.44,1 through 10,percent of total billed charges,7.16,7.52,
Urine Pregnancy POCT,8373784,LOCAL,81025,CPT,,,,,,Outpatient,,,,10.33,VIVA,Commercial,,50,,11.6,11.6,11.6,1 through 10,percent of total billed charges,4.02,13.375,
Urine Pregnancy Test Qualitative,7909798,LOCAL,81025,CPT,,,,,,Outpatient,,,,10.33,VIVA,Commercial,,50,,11.6,11.6,11.6,1 through 10,percent of total billed charges,4.02,13.375,
cefTRIAXone 1 g injection [CULL],11201426,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,5.8,0.92,5.8,1 through 10,percent of total billed charges,5.161428571,5.161428571,
"IgA, Serum QSTC",13873298,LOCAL,82787,CPT,,,,,,Outpatient,,,,9.62,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IgA1 QSTC,13873292,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tobramycin Level,1634888,LOCAL,80200,CPT,,,,,,Outpatient,,,,19.36,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Blood Gas Arterial RT,8172944,LOCAL,36600,CPT,,,,,,Outpatient,,,,96,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Blood Gas Draw Type -> Arterial (Puncture),5230102,LOCAL,36600,CPT,,,,,,Outpatient,,,,96,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT Arterial Puncture CHARGE,8143881,LOCAL,36600,CPT,,,,,,Outpatient,,,,96,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"RT CHARGE PFT -> Maximum breathing capacity, Maximal voluntary ventilation (M",5267133,LOCAL,94200,CPT,,,,,,Outpatient,,,,96,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR TMJ Open and Closed Bilateral,1170502,LOCAL,70330,CPT,,,,,,Outpatient,,,,80.85,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diphtheria Antitoxoid QSTC,14129477,LOCAL,86648,CPT,,,,,,Outpatient,,,,18.25,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tetanus Antitoxoid QSTC,14129478,LOCAL,86774,CPT,,,,,,Outpatient,,,,17.76,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatic Function Panel,633744,LOCAL,80076,CPT,,,,,,Outpatient,,,,9.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatic Panel,633744,LOCAL,80076,CPT,,,,,,Outpatient,,,,9.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dihydrotestosterone QSTC,8853275,LOCAL,82642,CPT,,,,,,Outpatient,,,,35.14,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
36430 BLOOD TRANSFUSION CHARGE,9284603,LOCAL,36430,CPT,,,,,,Outpatient,,,,99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BLOOD ADMINISTRATION Charge,5240125,LOCAL,36430,CPT,,,,,,Outpatient,,,,99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92608 ST EX FOR SPEECH DEVICE RX EACH 30 MIN ADDL TIM,9636007,LOCAL,92608,CPT,,,,,GN,Outpatient,,,,99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Speech AAC Eval Addl Half Hour Units,1373854,LOCAL,92608,CPT,,,,,GN,Outpatient,,,,99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Speech Generating Device Eval Additional 30 Min,1373854,LOCAL,92608,CPT,,,,,GN,Outpatient,,,,99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only REF Splitting,13514968,LOCAL,86985,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Quantiferon(R)-TB Gold Plus, 1 Tube QST",9384402,LOCAL,86480,CPT,,,,,,Outpatient,,,,74.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Quantiferon(R)-TB Gold Plus, 1 Tube QSTC",8983765,LOCAL,86480,CPT,,,,,,Outpatient,,,,74.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97113 AQUATIC THERAPY 15 MINS,9650029,LOCAL,97113,CPT,,,,,GP|CQ,Outpatient,,,,100,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97113 AQUATIC THERAPY 15 MINS OT,9860051,LOCAL,97113,CPT,,,,,GO|CO,Outpatient,,,,100,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97113 Occupational Therapy Aquatic charge,9850051,LOCAL,97113,CPT,,,,,GO,Outpatient,,,,100,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97113 OT AQUATIC THERAPY CHARGE,9640029,LOCAL,97113,CPT,,,,,GP,Outpatient,,,,100,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aquatic Charge,7895272,LOCAL,97113,CPT,,,,,GO,Outpatient,,,,100,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aquatic Therapy Charges,7895958,LOCAL,97113,CPT,,,,,GP,Outpatient,,,,100,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Aquatic Exercise Assistant Units,7895272,LOCAL,97113,CPT,,,,,CQ,Outpatient,,,,100,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Aquatic Exercise Assistant Units,7898597,LOCAL,97113,CPT,,,,,CQ,Outpatient,,,,100,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Aquatic Exercise Units,7897709,LOCAL,97113,CPT,,,,,GO,Outpatient,,,,100,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Aquatic Exercise Units,7898597,LOCAL,97113,CPT,,,,,GO,Outpatient,,,,100,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Aquatic Assistant Units,9390434,LOCAL,97113,CPT,,,,,CQ,Outpatient,,,,100,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0237 PULM REHAB EA 15 MIN,10470027,LOCAL,,,G0237,HCPCS,,,59,Outpatient,,,,101,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0239 PULMONARY EXERCISE,10470025,LOCAL,,,G0239,HCPCS,,,,Outpatient,,,,101,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Calcium Oxalate QSTC,8997193,LOCAL,82340,CPT,,,,,,Outpatient,,,,7.24,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,22.61833333,
Sodium Urate QSTC,8997195,LOCAL,84300,CPT,,,,,,Outpatient,,,,6.07,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,9.74,
Uric Acid QSTC,8997197,LOCAL,84560,CPT,,,,,,Outpatient,,,,6.1,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,19.49,
"LD, Pericardial Fluid QSTC",13864442,LOCAL,83615,CPT,,,,,,Outpatient,,,,7.25,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"16000 Initial treatment, first degree burn, when no more than local treatment required",9400038,LOCAL,16000,CPT,,,,,,Outpatient,,,,101,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diphtheria Antitoxoid QST,13824476,LOCAL,86648,CPT,,,,,,Outpatient,,,,18.25,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tetanus Antitoxoid QST,13824477,LOCAL,86774,CPT,,,,,,Outpatient,,,,17.76,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transferrin,633851,LOCAL,84466,CPT,,,,,,Outpatient,,,,15.31,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CANDIDA GLABRATA QST,12439000,LOCAL,87481,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CANDIDA SPECIES QST,12438999,LOCAL,87481,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chlamydia Trachomatis RNA, TMA QST",12439002,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",12439003,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
SURESWAB(R) ADV BV QST,12438998,LOCAL,81513,CPT,,,,,,Outpatient,,,,171.16,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"TRICHOMONAS VAGINALIS (TV), TMA QST",12439001,LOCAL,87661,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CANDIDA GLABRATA QST,12433969,LOCAL,87481,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CANDIDA SPECIES QST,12433968,LOCAL,87481,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"CRYPTOSPORIDIUM ANTIGEN, EIA QSTC",12500635,LOCAL,87328,CPT,,,,,,Outpatient,,,,16.58,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Kappa/LambdaLt Chains,Freew/Ratio,S QSTC",8853285,LOCAL,83521,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Bone Age Studies,1170014,LOCAL,77072,CPT,,,,,,Outpatient,,,,84.98,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BB REF ABO DISCREP (RH),6432002,LOCAL,86901,CPT,,,,,,Outpatient,,,,3.59,VIVA,Commercial,,50,,11.06,11.06,11.06,1 through 10,percent of total billed charges,6.29,35.88,
REF ABO/Rh Discrep,13484121,LOCAL,86900,CPT,,,,,,Outpatient,,,,3.59,VIVA,Commercial,,50,,14.89,14.89,14.89,1 through 10,percent of total billed charges,6.29,117.85,
"Ammonia, Plasma",7974187,LOCAL,82140,CPT,,,,,,Outpatient,,,,17.48,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,17.73,22.62909091,
97164 CIS Prgm PT Re-Evaluation 20 min,9650016,LOCAL,97164,CPT,,,,,GP|CQ,Outpatient,,,,104,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97164 RE-EVALUATION CHARGE,9410061,LOCAL,97164,CPT,,,,,GP,Outpatient,,,,104,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97164 RE-EVALUATION PT CHARGES,9640016,LOCAL,97164,CPT,,,,,GP,Outpatient,,,,104,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT ReEval Time,7896016,LOCAL,97164,CPT,,,,,GP,Outpatient,,,,104,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tobramycin Level Peak,1634889,LOCAL,80200,CPT,,,,,,Outpatient,,,,19.36,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tobramycin Level Trough,1634890,LOCAL,80200,CPT,,,,,,Outpatient,,,,19.36,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11719 TRIM NAIL(S) ANY NUMBER WC CHARGE,8726774,LOCAL,11719,CPT,,,,,,Outpatient,,,,106,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.C-ANCA Titer QSTC,8764786,LOCAL,86037,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.P-ANCA Titer QSTC,6225794,LOCAL,86037,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Methicillin Resistant Staphylococcus aureus,PCR QSTC",9630594,LOCAL,87641,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
phytonadione 10 mg/mL injectable solution 1 mL [CULL],11212150,LOCAL,J3430,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Manual Tumor IM Histochem,14049347,LOCAL,88360,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill SB Consult 1st TB w FS SGL SP,14048002,LOCAL,88331,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill IHC Initial Antibody,14049345,LOCAL,88342,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
29105 - Long Arm Splint,9322359,LOCAL,29105,CPT,,,,,,Outpatient,,,,158,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Toxocara Ab (IgG) QSTC,13864452,LOCAL,86682,CPT,,,,,,Outpatient,,,,15.61,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue Culture,633906,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,VIVA,Commercial,,50,,101.59,101.59,101.59,1 through 10,percent of total billed charges,10.57,67.60639535,
acetaZOLAMIDE 500 mg intravenous injection [CULL],11200001,LOCAL,J1120,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97763 OT Orthotic Mgmt/Train Establish Charge,9650038,LOCAL,97763,CPT,,,,,GP|CQ,Outpatient,,,,110,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97763 OT Orthotic Mgmt/Train Established Assistant Units,9820206,LOCAL,97763,CPT,,,,,GO,Outpatient,,,,110,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97763 OT Orthotic/Prosthetic Mgmt/Training - each 15 min,9860206,LOCAL,97763,CPT,,,,,GO|CO,Outpatient,,,,110,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97763 PT ORTHO/PROST MNG/TRAIN EA 15,9410206,LOCAL,97763,CPT,,,,,GP,Outpatient,,,,110,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97763 PT Orthotic Mgmt/Train Establish Charge,9640038,LOCAL,97763,CPT,,,,,GP,Outpatient,,,,110,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Orthotic Mgmt/Train Est. Assit Units,7965332,LOCAL,97763,CPT,,,,,CQ,Outpatient,,,,110,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Orthotic Mgmt/Train Establish Charge,7965332,LOCAL,97763,CPT,,,,,GO,Outpatient,,,,110,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Orthotic Mgmt/Train Establish Rehab Units,7964942,LOCAL,97763,CPT,,,,,GO,Outpatient,,,,110,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Orthotic Mgmt/Train Establish Charge,7965252,LOCAL,97763,CPT,,,,,GP,Outpatient,,,,110,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"PT Orthotic/Prosthetic Manage,Train Assistant Units",9390462,LOCAL,97763,CPT,,,,,CQ,Outpatient,,,,110,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Total Glutathione QST,14799054,LOCAL,82978,CPT,,,,,,Outpatient,,,,18.54,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
epoetin alfa-epbx 4000 units/mL preservative-free injectable solution 1 mL [CULL],11202396,LOCAL,Q5106,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Heart Calcium Scoring,2424782,LOCAL,75571,CPT,,,,,,Outpatient,,,,90.75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cortisol, LC/MS, Saliva QSTC",8853249,LOCAL,82530,CPT,,,,,,Outpatient,,,,20.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Factor V (Leiden) Mutation Analysis QSTC,8764652,LOCAL,81241,CPT,,,,,,Outpatient,,,,88.04,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lyme Disease Ab (IgM), Blot QSTC",8849718,LOCAL,86617,CPT,,,,,,Outpatient,,,,18.59,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lyme Disease Ab(IgG),Blot QSTC",8849707,LOCAL,86617,CPT,,,,,,Outpatient,,,,18.59,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prothrombin Gene Analysis QSTC,8764653,LOCAL,81240,CPT,,,,,,Outpatient,,,,78.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholesterol HDL,3170344,LOCAL,83718,CPT,,,,,,Outpatient,,,,9.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glucagon QSTC,13864528,LOCAL,82943,CPT,,,,,,Outpatient,,,,17.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
fondaparinux 2.5 mg/0.5 mL subcutaneous solution 0.5 mL [CULL],11260583,LOCAL,J1652,CPT,,,,,,Outpatient,0.5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL MG Wire Loc Needle,13721990,LOCAL,10035,CPT,A4648,HCPCS,,,,Outpatient,,,,114,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
90912 - Bfb training 1st 15 min.,9442435,LOCAL,90912,CPT,,,,,,Outpatient,,,,114,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97129 Cognition Ther Intervent First 15 min,9850048,LOCAL,97129,CPT,,,,,GO,Outpatient,,,,114,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97129 Cognition Ther Intervent First 15 min Assistant Units,9860048,LOCAL,97129,CPT,,,,,GO|CO,Outpatient,,,,114,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97130 Cognition Ther Intervent Addlt 15 min,9850049,LOCAL,97130,CPT,,,,,GO,Outpatient,,,,114,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97130 Cognition Ther Intervent Addlt 15 min Assistant Units,9860049,LOCAL,97130,CPT,,,,,GO|CO,Outpatient,,,,114,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Cog Ther Intervent, Addl 15 Min Asst",9401146,LOCAL,97130,CPT,,,,,CQ,Outpatient,,,,114,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Cog Ther Intervent, Addl 15 Min Units",9401146,LOCAL,97130,CPT,,,,,GO,Outpatient,,,,114,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Cog Ther Intervent, First 15 Min Asst",9401140,LOCAL,97129,CPT,,,,,CQ,Outpatient,,,,114,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Cog Ther Intervent,First 15 Min Units",9401140,LOCAL,97129,CPT,,,,,GO,Outpatient,,,,114,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Pheno Non-Rh EA/Ag,13517193,LOCAL,86905,CPT,,,,,,Outpatient,,,,4.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only REF Thawing,13514966,LOCAL,86927,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ref Hgb S,9527497,LOCAL,85660,CPT,,,,,,Outpatient,,,,6.61,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Basic Metabolic Panel,633628,LOCAL,80048,CPT,,,,,,Outpatient,,,,10.15,VIVA,Commercial,,50,,40.77,28.31,40.77,1 through 10,percent of total billed charges,12.14,37.17170492,
gemcitabine 1 g injection [CULL],11292094,LOCAL,J9201,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE PFT -> Diffusion (DLCO),5267130,LOCAL,94729,CPT,,,,,,Outpatient,,,,115,VIVA,Commercial,,50,,88.21,88.21,88.21,1 through 10,percent of total billed charges,47.24,76.09,
E0773 Thawed FFP CPD,7267127,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,,115,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E1237 Thawed Aph FFP ACDA,7267133,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,,115,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E2701 Thawed Plasma CPD <24h,7267161,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,,115,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E2737 Thawed Plasma CP2D <24h,7267171,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,,115,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4713 Thawed Aph FFP ACDA 1,7267173,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,,115,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4717 Thawed Aph FFP ACDA 2,7267174,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,,115,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4721 Thawed Aph FFP ACDA 3,7267175,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,,115,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
amiodarone 360 mg/200 mL-D5% intravenous solution 200 mL [CULL],11200046,LOCAL,J0283,CPT,,,,,,Outpatient,200,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
protamine 10 mg/mL injectable solution 25 mL [CULL],11211130,LOCAL,J2720,CPT,,,,,,Outpatient,25,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anti-Mullerian Hormone (AMH) Female QSTC,8972886,LOCAL,82166,CPT,,,,,,Outpatient,,,,46.34,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chlamydia Trachomatis RNA, TMA QST",14718336,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
"Chromogranin A, LC/MS/MS QSTC",10319690,LOCAL,86316,CPT,,,,,,Outpatient,,,,24.97,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Estriol, Serum QSTC",9039351,LOCAL,82677,CPT,,,,,,Outpatient,,,,29.02,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
H. pylori Urea Breath Test QSTC,8764622,LOCAL,83013,CPT,,,,,,Outpatient,,,,80.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Metanephrines, Fract Free LCMSMS, P QSTC",8764672,LOCAL,83835,CPT,,,,,,Outpatient,,,,20.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mycophenolic Acid QSTC,9039269,LOCAL,80180,CPT,,,,,,Outpatient,,,,21.66,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neisseria Gonorrhoeae RNA, TMA QST",14718337,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,24.71,24.71,24.71,1 through 10,percent of total billed charges,35.09,40.19,
Thinprep Review Cytotechnologist: QST,14718350,LOCAL,88175,CPT,,,,,,Outpatient,,,,31.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trichomonas vaginalis, Ql TMA, Pap QST",14718338,LOCAL,87661,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Galactose-Alpha-1,3-Galactose IgE QSTC",8764840,LOCAL,86008,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HOLTER MONITOR  24H,8200090,LOCAL,93225,CPT,,,,,,Outpatient,,,,198,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DRAIN TRU-CLOSE 500CC (BUY BY EACH-10/CS,6800045,LOCAL,,,A7048,HCPCS,,,,Outpatient,,,,88,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
FLUORO CENTRAL LINE PLACEMENT,8201221,LOCAL,77001,CPT,,,,,,Outpatient,,,,177.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vitamin B12 Level,633871,LOCAL,82607,CPT,,,,,,Outpatient,,,,18.1,VIVA,Commercial,,50,,92.41,34.37,92.41,1 through 10,percent of total billed charges,18.43,82.43266533,
XR Port Placement,10460170,LOCAL,77001,CPT,,,,,,Outpatient,,,,177.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE Chest Physiotherapy -> PEP Therapy Subsequent,8699751,LOCAL,94667,CPT,,,,,,Outpatient,,,,120,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE Mechanical Oscillation -> Yes,10417130,LOCAL,94667,CPT,,,,,,Outpatient,,,,120,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Streptococcus pneumoniae Ag, Ur QSTC",13864418,LOCAL,87899,CPT,,,,,,Outpatient,,,,19.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"FVIII Act, Clotting QSTC",13873492,LOCAL,85240,CPT,,,,,,Outpatient,,,,21.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"PTT, Activated QSTC",13873491,LOCAL,85730,CPT,,,,,,Outpatient,,,,7.21,VIVA,Commercial,,50,,15.18,15.18,15.18,1 through 10,percent of total billed charges,1.648553055,5.42,
Ristocetin Cofactor QSTC,13873494,LOCAL,85245,CPT,,,,,,Outpatient,,,,27.53,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
von Willebrand Factor Ag QSTC,13873493,LOCAL,85246,CPT,,,,,,Outpatient,,,,27.53,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"vWf Ag, Multimeric QSTC",13873495,LOCAL,85247,CPT,,,,,,Outpatient,,,,27.53,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
benztropine 1 mg/mL injectable solution 2 mL [CULL],11202065,LOCAL,J0515,CPT,,,,,,Outpatient,2,ML,,,VIVA,Commercial,,50,,17.42,17.42,17.42,1 through 10,percent of total billed charges,13.815,13.815,
.T. pallidum Ab QSTC,13864522,LOCAL,86780,CPT,,,,,,Outpatient,,,,15.89,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Syphilis Antibody Cascading Reflex QSTC,8972904,LOCAL,86780,CPT,,,,,,Outpatient,,,,15.89,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3923 HFO W/O JOINTS PRE CST CHARGE,9646078,LOCAL,,,L3923,HCPCS,,,,Outpatient,,,,124,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"MAG-SGPG Ab IgM, EIA QSTC",13864465,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
amphotericin B 50 mg Pow [CULL],J0285,CPT,,,,,,,,Outpatient,50,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"96366 IV INFUSION, MEDICATIONS, ADDITIONAL",7904532,LOCAL,96366,CPT,,,,,,Outpatient,,,,125,VIVA,Commercial,,50,,31,8.18,31,1 through 10,percent of total billed charges,42.18,749.76,
"96366- IV tx, each additional hour",1928300,LOCAL,96366,CPT,,,,,,Outpatient,,,,125,VIVA,Commercial,,50,,31,8.18,31,1 through 10,percent of total billed charges,42.18,749.76,
"96367 IV INFUSION, SEQUENTIAL, NEW OR DIFF",7904533,LOCAL,96367,CPT,,,,,,Outpatient,,,,125,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"96367- IV tx, sequential infusion",1928301,LOCAL,96367,CPT,,,,,,Outpatient,,,,125,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"96374- IV Injection, single/initial",1928305,LOCAL,96374,CPT,,,,,59,Outpatient,,,,125,VIVA,Commercial,,50,,21.23,21.23,21.23,25,percent of total billed charges,64.56,192.63,
96374 IV PUSH MEDS INIT INJ 15 MIN OR LESS,7904536,LOCAL,96374,CPT,,,,,59,Outpatient,,,,125,VIVA,Commercial,,50,,21.23,21.23,21.23,25,percent of total billed charges,64.56,192.63,
"96375- IV Injection, add new drug",1928306,LOCAL,96375,CPT,,,,,59,Outpatient,,,,125,VIVA,Commercial,,50,,44.64,44.64,44.64,29,percent of total billed charges,42.18,64.56,
"96375 IV PUSH INJECTION ADD, NEW OR DIFF",7904537,LOCAL,96375,CPT,,,,,59,Outpatient,,,,125,VIVA,Commercial,,50,,44.64,44.64,44.64,29,percent of total billed charges,42.18,64.56,
INJ IV PUSH THER/PROPH SUBSTANCE INTIAL,8210021,LOCAL,96374,CPT,,,,,59,Outpatient,,,,125,VIVA,Commercial,,50,,21.23,21.23,21.23,25,percent of total billed charges,64.56,192.63,
"Beryllium, Serum/Plasma QSTC",10704808,LOCAL,83018,CPT,,,,,,Outpatient,,,,26.35,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
9581626 EEG AWAKE/DROWSY PRO FEE CHARGES,8795941,LOCAL,95816,CPT,,,,,26,Outpatient,,,,533,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95819 EEG AWAKE AND ASLEEP PRO-FEE CHARGE,13508139,LOCAL,95819,CPT,,,,,26,Outpatient,,,,599,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95822 EEG COMA or SLEEP ONLY PRO,10049176,LOCAL,95822,CPT,,,,,26,Outpatient,,,,499,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vitamin B3 QSTC,8972908,LOCAL,84591,CPT,,,,,,Outpatient,,,,20.47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Thyroid Stimulating Hormone,633844,LOCAL,84443,CPT,,,,,,Outpatient,,,,20.16,VIVA,Commercial,,50,,97.92,54.87,97.92,14,percent of total billed charges,18.43,87.63697303,
TSH with Reflex to FT4,7948309,LOCAL,84439,CPT,,,,,,Outpatient,,,,10.82,VIVA,Commercial,,50,,30,30,30,1 through 10,percent of total billed charges,18.43,28.58065455,
"Mumps Virus Ab IgG, IgM, Diagnostic QSTC",13864479,LOCAL,86735,CPT,,,,,,Outpatient,,,,15.66,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deoxycorticosterone QSTC,13864487,LOCAL,82633,CPT,,,,,,Outpatient,,,,37.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Q Fever Ab IgG IgM w/rfx Titers QSTC,13864460,LOCAL,86638,CPT,,,,,,Outpatient,,,,14.54,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0108 Diabetes Management Treatment 30 Minutes CHARGE,10255367,LOCAL,,,G0108,HCPCS,,,,Outpatient,,,,128,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
94799 Pulm Function Screen Charge,10440012,LOCAL,94799,CPT,,,,,,Outpatient,,,,129,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97168 CIS Prgm OT Re-Evaluation 30 min,9850016,LOCAL,97168,CPT,,,,,GO,Outpatient,,,,131,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97168 RE-EVALUATION CHARGE,9860016,LOCAL,97168,CPT,,,,,GO|CO,Outpatient,,,,131,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT ReEval Units,7895298,LOCAL,97168,CPT,,,,,GO,Outpatient,,,,131,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT ReEvaluation Units,7897819,LOCAL,97168,CPT,,,,,GO,Outpatient,,,,131,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gabapentin QSTC,8764562,LOCAL,80171,CPT,,,,,,Outpatient,,,,26,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TRAb (TSH Receptor Binding Ab) QSTC,8764674,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Coccidioides Ab, CF w/ ID, CSF QSTC",13864531,LOCAL,86635,CPT,,,,,,Outpatient,,,,13.76,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Body Fluid Culture,4122803,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,VIVA,Commercial,,50,,101.59,101.59,101.59,1 through 10,percent of total billed charges,10.57,67.60639535,
Ear Culture,633890,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,VIVA,Commercial,,50,,101.59,101.59,101.59,1 through 10,percent of total billed charges,10.57,67.60639535,
Eye Culture,633892,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,VIVA,Commercial,,50,,101.59,101.59,101.59,1 through 10,percent of total billed charges,10.57,67.60639535,
Medical Device Culture,633898,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,VIVA,Commercial,,50,,101.59,101.59,101.59,1 through 10,percent of total billed charges,10.57,67.60639535,
Nasal Culture,633900,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,VIVA,Commercial,,50,,101.59,101.59,101.59,1 through 10,percent of total billed charges,10.57,67.60639535,
"Porphyrins, Fract, Quant, Random Ur QSTC",13864457,LOCAL,84120,CPT,,,,,,Outpatient,,,,17.65,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Stool Culture,633904,LOCAL,87045,CPT,,,,,,Outpatient,,,,11.33,VIVA,Commercial,,50,,106.22,9.44,106.22,1 through 10,percent of total billed charges,10.57,79.665,
Throat Culture,633905,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,VIVA,Commercial,,50,,101.59,101.59,101.59,1 through 10,percent of total billed charges,10.57,67.60639535,
Wound Culture,633908,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,VIVA,Commercial,,50,,101.59,101.59,101.59,1 through 10,percent of total billed charges,10.57,67.60639535,
Wound Culture Deep,8395521,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,VIVA,Commercial,,50,,101.59,101.59,101.59,1 through 10,percent of total billed charges,10.57,67.60639535,
micafungin 100 mg intravenous injection [CULL],11220353,LOCAL,J2248,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vitamin K QSTC,8972880,LOCAL,84597,CPT,,,,,,Outpatient,,,,16.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PSA Diagnostic,1634882,LOCAL,84153,CPT,,,,,,Outpatient,,,,22.07,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PSA Screening,4123035,LOCAL,,,G0103,HCPCS,,,,Outpatient,,,,134,VIVA,Commercial,,50,,103.43,103.43,103.43,1 through 10,percent of total billed charges,15.29,19.31,
Chromatin (Nucleosomal) Antibody QSTC,10148609,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
94640 UDN SPECIAL MED 2 CHARGE,13515633,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
94640 UDN SPECIAL MED CHARGE,13522003,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE Aerosol Therapy -> Subsequent,5397112,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE EZPAP -> Initial,9429159,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE EZPAP -> Subsequent,9429160,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE MDI -> Initial,12111660,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE MDI -> Subsequent,12111659,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE Suction -> BBG/Nasopharyngeal,6690655,LOCAL,31720,CPT,,,,,,Outpatient,,,,136,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT Continuous Neb Subsequent CHARGE,8144096,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT IPV Subsequent CHARGE,8144062,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sputum Collection Method -> Cough,13657418,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sputum Collection Method -> ET tube,13657417,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sputum Collection Method -> Medication aerosol,8846461,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sputum Collection Method -> Nasal aspirate,13650046,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sputum Collection Method -> Nasal wash,13650044,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3912 HFO FLEXION,9856101,LOCAL,,,L3912,HCPCS,,,,Outpatient,,,,137,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"penicillin G potassium 20,000,000 units injection [CULL]",11211080,LOCAL,J2540,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF Antibody Screen,7939320,LOCAL,86850,CPT,,,,,,Outpatient,,,,11.72,VIVA,Commercial,,50,,11.06,11.06,11.06,1 through 10,percent of total billed charges,6.29,48.85,
US Unlisted Procedure,8733482,LOCAL,76999,CPT,,,,,,Outpatient,,,,113.85,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
%CDT QSTC,13864781,LOCAL,82373,CPT,,,,,,Outpatient,,,,21.67,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transferrin - QSTC,13864778,LOCAL,84466,CPT,,,,,,Outpatient,,,,15.31,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
hyaluronidase 150 units/mL injectable solution 1 mL [CULL],11282257,LOCAL,J3470,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"96372 INJECTIONS (IM, SC) OP",7904535,LOCAL,96372,CPT,,,,,59,Outpatient,,,,139,VIVA,Commercial,,50,,64.23,59.59,64.23,1 through 10,percent of total billed charges,64.56,65.07,
96372- Subq/IM Injection,1928303,LOCAL,96372,CPT,,,,,59,Outpatient,,,,139,VIVA,Commercial,,50,,64.23,59.59,64.23,1 through 10,percent of total billed charges,64.56,65.07,
RT CHARGE PFT -> Lung Volume,9004829,LOCAL,94727,CPT,,,,,,Outpatient,,,,140,VIVA,Commercial,,50,,107.87,107.87,107.87,1 through 10,percent of total billed charges,76.09,143.05,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,90471,CPT,G0010,HCPCS,,,,Outpatient,,,,140,VIVA,Commercial,,50,,133.08,105.33,133.08,1 through 10,percent of total billed charges,42.18,65.07,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,G0010,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CATH LAB US INTRAOPERATIVE,8200550,LOCAL,76998,CPT,,,,,,Outpatient,,,,116.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bladder Scan,649589,LOCAL,51798,CPT,,,,,,Outpatient,,,,59,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOPP LOWER EXT ARTERIAL/ABI,8200450,LOCAL,93922,CPT,,,,,,Outpatient,,,,265,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
69209 REM IMPACT CERUMEN REQ IRRIGAT CHARGE,8020086,LOCAL,69209,CPT,,,,,,Outpatient,,,,143,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97550 CAREGIVER TRAINING 1ST 30 MIN,14015178,LOCAL,97550,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97550 OT Caregiver Training Init 30 Mins,13649811,LOCAL,97550,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97550 ST Caregiver Training 1st 30 min,14013233,LOCAL,97550,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"SLP Caregiver Training, First 30 Min Time",14466884,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only ABSC,7936968,LOCAL,86850,CPT,,,,,,Outpatient,,,,11.72,VIVA,Commercial,,50,,11.06,11.06,11.06,1 through 10,percent of total billed charges,6.29,48.85,
"Platelet Antibody Screen, Serum QSTC",10736090,LOCAL,86022,CPT,,,,,,Outpatient,,,,22.04,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92524 BEHAVIORAL AND QUALITATIVE ANALYSIS OF VOICE AND RESONANCE,9630059,LOCAL,92524,CPT,,,,,GN,Outpatient,,,,144,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Behav/Qual Analysis of Voice and Resonance Charge,7897211,LOCAL,92524,CPT,,,,,GN,Outpatient,,,,144,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Analysis of Voice & Resonance Units,7897212,LOCAL,92524,CPT,,,,,GN,Outpatient,,,,144,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92597 EVAL FOR USE AND/OR FITTING OF VOICE PROSTHETIC TO SUPPLEMENT ORAL SPEECH,9630068,LOCAL,92597,CPT,,,,,GN,Outpatient,,,,146,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Eval for Use/Fitting of Voice Prosthetic Dvc Chg,1373846,LOCAL,92597,CPT,,,,,GN,Outpatient,,,,146,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"SLP Use,Fit Speech Prosthetic Eval Units",1373846,LOCAL,92597,CPT,,,,,GN,Outpatient,,,,146,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64418- Suprascapular nerve block,10452404,LOCAL,64418,CPT,,,,,,Outpatient,,,,693,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
75809 SHUNTOGRAM PREV PLCMNT INDWELLING NONVASC SHUNT,13650394,LOCAL,75809,CPT,,,,,,Outpatient,,,,87.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hantavirus Antibody IgG,IgM QSTC",13864534,LOCAL,86790,CPT,,,,,,Outpatient,,,,15.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Histoplasma Quantitative Antigen, EIA QSTC",9752803,LOCAL,87385,CPT,,,,,,Outpatient,,,,15.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Potassium w/o Creatinine, Random Ur QSTC",9039260,LOCAL,84133,CPT,,,,,,Outpatient,,,,5.68,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,19.32,
Soluble Transferrin Receptor QSTC,9777250,LOCAL,84238,CPT,,,,,,Outpatient,,,,43.88,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Shunt Series,13650394,LOCAL,75809,CPT,,,,,,Outpatient,,,,87.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dengue Fever Ab (IgG) QSTC,13873177,LOCAL,86790,CPT,,,,,,Outpatient,,,,15.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dengue Fever Ab (IgM) QSTC,13873183,LOCAL,86790,CPT,,,,,,Outpatient,,,,15.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Mycoplasma pneumoniae Ab (IgG, IgM) QSTC",8972832,LOCAL,86738,CPT,,,,,,Outpatient,,,,15.89,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF DAT Polyspecific,7939270,LOCAL,86880,CPT,,,,,,Outpatient,,,,6.47,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
voriconazole 200 mg intravenous injection [CULL],11211371,LOCAL,J3465,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92610  Bedside Swallowing Eval,9630082,LOCAL,92610,CPT,,,,,GN,Outpatient,,,,151,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Eval of Oral and Pharyngeal Swallowing Fx Chg  nd Pharyngeal Swallowing Fx Chg,7896918,LOCAL,92610,CPT,,,,,GN,Outpatient,,,,151,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Eval of Oral and Pharyngeal Swallowing Fx Chg  nd Pharyngeal Swallowing Fx Chg -> Yes,7896918,LOCAL,92610,CPT,,,,,GN,Outpatient,,,,151,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Pharyngeal Swallow Eval Units,1373843,LOCAL,92610,CPT,,,,,GN,Outpatient,,,,151,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Caregiver / patient demonstrates understanding of substance abuse, triggers, treatment",4517330,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Caregiver / patient demonstrates understanding of substance abuse, triggers, treatment",4517330,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT CAREGIVER TRAINING INT 30 MIN,4517330,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96523 FLUSH VAD CHARGE,8213318,LOCAL,96523,CPT,,,,,,Outpatient,,,,153,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Follicle Stimulating Hormone Level,3170314,LOCAL,83001,CPT,,,,,,Outpatient,,,,22.3,VIVA,Commercial,,50,,119.34,119.34,119.34,1 through 10,percent of total billed charges,18.43,98.80384615,
Antibody ID,634330,LOCAL,86870,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BB THAW FFP,6413062,LOCAL,86931,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill IHC Multiplex Antibody,14048007,LOCAL,88344,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bill Only Antigen Type, Patient",8872565,LOCAL,86905,CPT,,,,,,Outpatient,,,,4.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bill Only Antigen Type, Product",8872566,LOCAL,86902,CPT,,,,,,Outpatient,,,,7.62,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Tissue Exam Level 5,14049344,LOCAL,88307,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11732 AVULSION OF EACH ADDITIONAL NAIL PLATE,13029593,LOCAL,11732,CPT,,,,,,Outpatient,,,,156,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93463 Pharmacologic Agent Administration,8230065,LOCAL,93463,CPT,,,,,,Outpatient,,,,156,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
36591 COLLECT BLOOD FROM IMPL VEN DEVICE CHARGE,10451346,LOCAL,36591,CPT,,,,,,Outpatient,,,,157,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Central Line Activity. -> Blood drawn,12856467,LOCAL,36592,CPT,,,,,,Outpatient,,,,157,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anaerobic Culture,4122782,LOCAL,87075,CPT,,,,,,Outpatient,,,,11.36,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only ABID Panel,7936969,LOCAL,86870,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US OB Greater Than 14 Weeks,1169850,LOCAL,76805,CPT,,,,,,Outpatient,,,,130.35,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US OB Greater Than 14 Weeks,1169851,LOCAL,76805,CPT,,,,,,Outpatient,,,,130.35,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
FLUOROSCOPY <1 HOUR,8210790,LOCAL,76000,CPT,,,,,,Outpatient,,,,380.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.Hep C Viral RNA Quant RealTime PCR QSTC,8764584,LOCAL,87522,CPT,,,,,,Outpatient,,,,51.41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HCV RNA Quan Progress to Genotyping QSTC,9039270,LOCAL,87522,CPT,,,,,,Outpatient,,,,51.41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hepatitis C, RNA, Quantitative, PCR QSTC",8764755,LOCAL,87522,CPT,,,,,,Outpatient,,,,51.41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"HSV Type 1&2 DNA, Qual RT PCR QSTC",8873562,LOCAL,87529,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pancreatic Elastase-1 QSTC,8764835,LOCAL,82653,CPT,,,,,,Outpatient,,,,27.56,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF PLT Screening,13475613,LOCAL,86022,CPT,,,,,,Outpatient,,,,22.04,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE Aerosol Therapy -> Initial,12502774,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT Continuous Neb Initial CHARGE,8144200,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT IPV Initial CHARGE,8144187,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96415 CHEMO IV INFUSION EA ADDL HR INF CHARGE,9665726,LOCAL,96415,CPT,,,,,,Outpatient,,,,161,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
aztreonam 2 g injection [CULL],11201229,LOCAL,J0457,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Clobazam and Metabolite, Serum/Plasma QSTC",8764736,LOCAL,80299,CPT,,,,,,Outpatient,,,,22.37,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95977 - device analysis and complex programming,14685299,LOCAL,95977,CPT,,,,,,Outpatient,,,,92,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hep Acute Pnl,633756,LOCAL,80074,CPT,,,,,,Outpatient,,,,57.16,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hep Acute Pnl Post Exposure,9517262,LOCAL,80074,CPT,,,,,,Outpatient,,,,57.16,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COLLAR HARD PED 8 -11,6000015,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,,223,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Albumin Level,1620877,LOCAL,82040,CPT,,,,,,Outpatient,,,,5.94,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Luteinizing Hormone,4240834,LOCAL,83002,CPT,,,,,,Outpatient,,,,22.22,VIVA,Commercial,,50,,125.46,125.46,125.46,1 through 10,percent of total billed charges,18.43,18.52,
Rufinamide QSTC,13864436,LOCAL,80210,CPT,,,,,,Outpatient,,,,32.53,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hand 2 Views Left,1170215,LOCAL,73120,CPT,,,,,LT,Outpatient,,,,135.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hand 2 Views Right,1170217,LOCAL,73120,CPT,,,,,RT,Outpatient,,,,135.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Lower Extremity Infant 2 Views Bilat,8455866,LOCAL,73592,CPT,,,,,,Outpatient,,,,136.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Lower Extremity Infant 2 Views Left,8455869,LOCAL,73592,CPT,,,,,LT,Outpatient,,,,136.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Lower Extremity Infant 2 Views Right,8455872,LOCAL,73592,CPT,,,,,RT,Outpatient,,,,136.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
hepatitis B adult vaccine 20 mcg/mL intramuscular suspension 1 mL [CULL],11202558,LOCAL,90746,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Chest 1 View,8132832,LOCAL,71045,CPT,,,,,,Outpatient,,,,136.13,VIVA,Commercial,,50,,48.44,40.73,48.44,1 through 10,percent of total billed charges,80.5,83.69,
XR Elbow 1 View Left,13554981,LOCAL,73070,CPT,,,,,52|LT,Outpatient,,,,136.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Elbow 1 View Right,13554984,LOCAL,73070,CPT,,,,,52|RT,Outpatient,,,,136.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
69210 REM IMPACT CERUMEN REQ INSTRU CHARGE,8020194,LOCAL,69210,CPT,,,,,,Outpatient,,,,166,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Computer Search EA/Ag,13517192,LOCAL,86902,CPT,,,,,,Outpatient,,,,7.62,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Fresh Unit (<5 Days Old),13517198,LOCAL,86999,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Pelvic Ltd,8206967,LOCAL,76857,CPT,,,,,,Outpatient,,,,137.78,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE PFT -> Spirometry,5274349,LOCAL,94010,CPT,,,,,,Outpatient,,,,168,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97161  SB PT Eval Low Comp,9640014,LOCAL,97161,CPT,,,,,GP,Outpatient,,,,170,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97161 EVAL - LOW COMPLEXITY CHARGE,9410054,LOCAL,97161,CPT,,,,,GP,Outpatient,,,,170,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97161 PHYSICAL THERAPY EVALUATION CHARGE,9650014,LOCAL,97161,CPT,,,,,GP|CQ,Outpatient,,,,170,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Low Complex Units,7896010,LOCAL,97161,CPT,,,,,GP,Outpatient,,,,170,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lactoferrin, QL, Stool QSTC",9039266,LOCAL,83630,CPT,,,,,,Outpatient,,,,23.64,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"92521 EVALUATION OF SPEECH FLUENCY (STUTTERING, CLUTTERING)",9630056,LOCAL,92521,CPT,,,,,GN,Outpatient,,,,172,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Speech Fluency Eval Units,7897205,LOCAL,92521,CPT,,,,,GN,Outpatient,,,,172,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Speech Fluency Eval Charge,7897205,LOCAL,92521,CPT,,,,,GN,Outpatient,,,,172,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methylPREDNISolone 1 g preservative-free Pow,11287452,LOCAL,J2919,CPT,,,,,,Outpatient,1,UN,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92526  Treatment of Swallow,9630083,LOCAL,92526,CPT,,,,,GN,Outpatient,,,,172,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
dihydroergotamine 1 mg/mL injectable solution 1 mL [CULL],11202330,LOCAL,J1110,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Swallow Dysfunction Oral Feed Units,1373842,LOCAL,92526,CPT,,,,,GN,Outpatient,,,,172,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Treatment of Swallowing Dysfunction Charge,7896917,LOCAL,92526,CPT,,,,,GN,Outpatient,,,,172,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Treatment of Swallowing Dysfunction Charge -> Yes,7896917,LOCAL,92526,CPT,,,,,GN,Outpatient,,,,172,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RNA Polymerase III Antibody QSTC,10067478,LOCAL,83516,CPT,,,,,,Outpatient,,,,13.84,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Sinuses Paranasal < 3 Views,1170432,LOCAL,70210,CPT,,,,,,Outpatient,,,,142.73,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Pelvis 1 or 2 Views,1170351,LOCAL,72170,CPT,,,,,,Outpatient,,,,142.73,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Zonisamide QSTC,8764609,LOCAL,80203,CPT,,,,,,Outpatient,,,,15.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Iodine, U24 QSTC",13864440,LOCAL,82542,CPT,,,,,,Outpatient,,,,28.91,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.Atypical P-ANCA Titer QSTC,8764788,LOCAL,86037,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acylcarnitine, Plasma QSTC",9215425,LOCAL,82017,CPT,,,,,,Outpatient,,,,20.24,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C. difficile Toxin B Qual PCR QSTC,13864437,LOCAL,87493,CPT,,,,,,Outpatient,,,,44.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cytomegalovirus DNA, QN, Real-T PCR QSTC",8764608,LOCAL,87497,CPT,,,,,,Outpatient,,,,51.41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Kappa/Lambda Lght Chn, Free w Rat U QSTC",9039383,LOCAL,83883,CPT,,,,,,Outpatient,,,,16.32,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Kappa/Lambda Light Chains, Tot Ur QSTC",9039383,LOCAL,83883,CPT,,,,,,Outpatient,,,,16.32,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Mycoplasma Genitalium,R-T PCR QST",9773947,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reference Lab Crossmatch -> Compatible,8185614,LOCAL,86920,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reference Lab Crossmatch -> Incompatible,8185613,LOCAL,86920,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reference Lab Crossmatch -> Least Incompatible,8185612,LOCAL,86920,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
von Willebrand Factor Ag QSTC,8764731,LOCAL,85246,CPT,,,,,,Outpatient,,,,27.53,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99281 Emergency Department Visit. Level 1,2644297,LOCAL,99281,CPT,,,,,25,Outpatient,,,,177,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Finger(s) 1 View Left,13554987,LOCAL,73140,CPT,,,,,52|LT,Outpatient,,,,146.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Finger(s) 1 View Right,13554990,LOCAL,73140,CPT,,,,,52|RT,Outpatient,,,,146.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Electrocardiogram 12 Lead.,9696149,LOCAL,93005,CPT,,,,,,Outpatient,,,,178,VIVA,Commercial,,50,,53.46,15.85,53.46,32,percent of total billed charges,38.53,54.31,
93242 Holter 3 to 7 Days Recording,90820010,LOCAL,93242,CPT,,,,,,Outpatient,,,,179,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prolactin Level,3170316,LOCAL,84146,CPT,,,,,,Outpatient,,,,23.26,VIVA,Commercial,,50,,137.7,137.7,137.7,1 through 10,percent of total billed charges,18.43,19.38,
XR Elbow 2 Views Left,1170121,LOCAL,73070,CPT,,,,,LT,Outpatient,,,,136.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Elbow 2 Views Right,1170123,LOCAL,73070,CPT,,,,,RT,Outpatient,,,,136.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.TR Interpretation,1173781,LOCAL,86078,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BB REF LAB PHYSICIAN INTERP,6413086,LOCAL,86077,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Crossmatch IS,8419033,LOCAL,86920,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
hepatitis B immune globulin intramuscular solution 0.5 mL [CULL],11202561,LOCAL,J1571,CPT,,,,,,Outpatient,0.5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine 1 View Specify Level,8058789,LOCAL,72020,CPT,,,,,,Outpatient,,,,150.98,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Knee 1 View Standing AP Bilateral,1170291,LOCAL,73565,CPT,,,,,,Outpatient,,,,151.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Iodine QSTC,13864439,LOCAL,82542,CPT,,,,,,Outpatient,,,,28.91,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Neck Soft Tissue,1170331,LOCAL,70360,CPT,,,,,,Outpatient,,,,152.63,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97162  SB PT Eval Mod Comp,9640015,LOCAL,97162,CPT,,,,,GP,Outpatient,,,,187,VIVA,Commercial,,50,,46.12,46.12,46.12,1 through 10,percent of total billed charges,42.68861429,349.89,
97162 EVAL - MODERATE COMPLEXITY CHARGE,9410055,LOCAL,97162,CPT,,,,,GP,Outpatient,,,,187,VIVA,Commercial,,50,,46.12,46.12,46.12,1 through 10,percent of total billed charges,42.68861429,349.89,
97162 PT EVAL MOD COMPLEX CHARGES,9650015,LOCAL,97162,CPT,,,,,GP|CQ,Outpatient,,,,187,VIVA,Commercial,,50,,46.12,46.12,46.12,1 through 10,percent of total billed charges,42.68861429,349.89,
PT Moderate Complex Units,7896012,LOCAL,97162,CPT,,,,,GP,Outpatient,,,,187,VIVA,Commercial,,50,,46.12,46.12,46.12,1 through 10,percent of total billed charges,42.68861429,349.89,
Soluble Liver Antigen (SLA) Autoantibody QSTC,10148492,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Shoulder 1 View Left,1170409,LOCAL,73020,CPT,,,,,LT,Outpatient,,,,155.1,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Shoulder 1 View Right,1170411,LOCAL,73020,CPT,,,,,RT,Outpatient,,,,155.1,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR AC Joints Bilateral,1169922,LOCAL,73050,CPT,,,,,,Outpatient,,,,155.1,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Calcaneus Limited Left,13554972,LOCAL,73650,CPT,,,,,52|LT,Outpatient,,,,174.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Calcaneus Limited Right,13554975,LOCAL,73650,CPT,,,,,52|RT,Outpatient,,,,174.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BD Bone Density DEXA Vert Fracture Assmt,8206345,LOCAL,77086,CPT,,,,,,Outpatient,,,,155.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Foreign Body Localization Child 1 Vw,1170207,LOCAL,76010,CPT,,,,,,Outpatient,,,,155.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
cefTRIAXone 2 g injection [CULL],11202189,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,5.8,5.8,5.8,1 through 10,percent of total billed charges,5.161428571,5.161428571,
"Cytomegalovirus DNA, QL R-T PCR QSTC",9777223,LOCAL,87496,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Factor IX Activity,Clotting [352X]  QSTC",12534660,LOCAL,85250,CPT,,,,,,Outpatient,,,,22.85,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"HIV-1 RNA, QN, Real-Time PCR QSTC",8764763,LOCAL,87536,CPT,,,,,,Outpatient,,,,102.12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Chest Decubitus,1170049,LOCAL,71046,CPT,,,,,,Outpatient,,,,212.85,VIVA,Commercial,,50,,387.38,83.41,387.38,1 through 10,percent of total billed charges,80.5,83.69,
"Factor VIII Inhibitor, EIA QSTC",13873092,LOCAL,85335,CPT,,,,,,Outpatient,,,,15.44,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"FVIII Act, Clotting QSTC",13873093,LOCAL,85240,CPT,,,,,,Outpatient,,,,21.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Upper Extremity Infant 2 Views Left,8455878,LOCAL,73092,CPT,,,,,LT,Outpatient,,,,159.23,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Upper Extremity Infant 2 Views Right,8455881,LOCAL,73092,CPT,,,,,RT,Outpatient,,,,159.23,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ref Rh Phenotyping,9527485,LOCAL,86906,CPT,,,,,,Outpatient,,,,9.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92611 ST VIDEOFLUOR SWALLOW CHARGE,9630067,LOCAL,92611,CPT,,,,,GN,Outpatient,,,,193,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fluoroscopic Evaluation of Swallow Function Charge,7896919,LOCAL,92611,CPT,,,,,GN,Outpatient,,,,193,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Fluoroscopic Evaluation Units,1373839,LOCAL,92611,CPT,,,,,GN,Outpatient,,,,193,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97165 EVAL -  LOW COMPLEXITY CHARGE,9850014,LOCAL,97165,CPT,,,,,GO,Outpatient,,,,194,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97165 OT Evaluation Low Complexity 30 min,9860014,LOCAL,97165,CPT,,,,,GO|CO,Outpatient,,,,194,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Evaluation Low Complexity Units,7897807,LOCAL,97165,CPT,,,,,GO,Outpatient,,,,194,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Low Complex Units,7895291,LOCAL,97165,CPT,,,,,GO,Outpatient,,,,194,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aspergillus Antigen, EIA, Serum QSTC",9777227,LOCAL,87305,CPT,,,,,,Outpatient,,,,14.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
29581 PT Lower Extremity Application of Strapping,9640079,LOCAL,29581,CPT,,,,,GP,Outpatient,,,,195,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Lymphedema Wrap below Knee Charge,7895901,LOCAL,29581,CPT,,,,,GP,Outpatient,,,,195,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lacosamide QSTC,8764635,LOCAL,80235,CPT,,,,,,Outpatient,,,,32.53,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tetanus/diphth/pertussis (Tdap) adult/adol 5 units-2 units-15.5 mcg/0.5 mL intramuscular suspension 0.5 mL [CULL],11202346,LOCAL,90714,CPT,,,,,,Outpatient,0.5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Toe(s) 2 PLUS Views Right,1170522,LOCAL,73660,CPT,,,,,RT,Outpatient,,,,161.7,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Toe(s) 2+ Views Left,1170520,LOCAL,73660,CPT,,,,,LT,Outpatient,,,,161.7,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
influenza vaccine (Fluzone HD) vaccine 2025-2026 [CULL],11292055,LOCAL,90662,CPT,,,,,,Outpatient,0.5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Large Humeral Fracture Brace,9400080,LOCAL,,,L3982,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medium Humeral Fracture Brace,9400079,LOCAL,,,L3982,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CV Holter Monitor Recording up to 48 Hrs,8230053,LOCAL,93225,CPT,,,,,,Outpatient,,,,198,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Holter Monitor 48 Hr,8230053,LOCAL,93225,CPT,,,,,,Outpatient,,,,198,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Rh Phenotyping,7936966,LOCAL,86906,CPT,,,,,,Outpatient,,,,9.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COV19/Flu/RSV (GeneXpert Plus),10791321,LOCAL,87637,CPT,,,,,,Outpatient,,,,171.16,VIVA,Commercial,,50,,196,142.63,196,1 through 10,percent of total billed charges,40.19,69.4761107,
US OB Less Than 14 Weeks,8206952,LOCAL,76801,CPT,,,,,,Outpatient,,,,165,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chlamydia/Chlamydophila Ab 2 IgM QSTC,13864537,LOCAL,86632,CPT,,,,,,Outpatient,,,,15.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPINEPHrine 8 mg/250 mL-NaCl 0.9% Sol [CULL],11200040,LOCAL,J0165,CPT,,,,,,Outpatient,250,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Comprehensive Metabolic Panel,633709,LOCAL,80053,CPT,,,,,,Outpatient,,,,12.67,VIVA,Commercial,,50,,153.61,24.26,153.61,42,percent of total billed charges,12.14,82.75523053,
XR Ankle 1 View Left,13554963,LOCAL,73600,CPT,,,,,52|LT,Outpatient,,,,165,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Ankle 1 View Right,13554966,LOCAL,73600,CPT,,,,,52|RT,Outpatient,,,,165,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Foot 2 Views Left,1170185,LOCAL,73620,CPT,,,,,LT,Outpatient,,,,165.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Foot 2 Views Right,1170187,LOCAL,73620,CPT,,,,,RT,Outpatient,,,,165.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bill Only ABID Panel, Enzyme (Ab)",13517190,LOCAL,86870,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bill Only ABID Panel, Enzyme (Ezym)",13517194,LOCAL,86971,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Insulin Autoantibody QSTC,8764818,LOCAL,86337,CPT,,,,,,Outpatient,,,,25.69,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Finger(s) 2 Plus Views Left,1170151,LOCAL,73140,CPT,,,,,LT,Outpatient,,,,146.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Finger(s) 2 Plus Views Right,1170153,LOCAL,73140,CPT,,,,,RT,Outpatient,,,,146.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97163  SB PT Eval High Comp,9640017,LOCAL,97163,CPT,,,,,GP,Outpatient,,,,203,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97163 EVAL - HIGH COMPLEXITY CHARGE,9410062,LOCAL,97163,CPT,,,,,GP,Outpatient,,,,203,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97163 IND EDUCATION EVAL CHARGE,9650017,LOCAL,97163,CPT,,,,,GP|CQ,Outpatient,,,,203,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT High Complex Units,7896014,LOCAL,97163,CPT,,,,,GP,Outpatient,,,,203,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Factor II Activity QSTC,8972859,LOCAL,85210,CPT,,,,,,Outpatient,,,,15.58,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Implant Screening Lt w/ Tomo.,8146654,LOCAL,77067,CPT,,,,,LT,Outpatient,,,,363,VIVA,Commercial,,50,,338.22,338.22,338.22,1 through 10,percent of total billed charges,74,79.68,
MG Mammo Implant Screening Rt w/ Tomo.,8146657,LOCAL,77067,CPT,,,,,RT,Outpatient,,,,363,VIVA,Commercial,,50,,338.22,338.22,338.22,1 through 10,percent of total billed charges,74,79.68,
MG Mammo Screening Left w/ Tomo.,8146660,LOCAL,77067,CPT,,,,,LT,Outpatient,,,,363,VIVA,Commercial,,50,,338.22,338.22,338.22,1 through 10,percent of total billed charges,74,79.68,
MG Mammo Screening Right w/ Tomo.,8146663,LOCAL,77067,CPT,,,,,RT,Outpatient,,,,363,VIVA,Commercial,,50,,338.22,338.22,338.22,1 through 10,percent of total billed charges,74,79.68,
92609 ST USE OF SPEECH DEVICE SERVICES,9636008,LOCAL,92609,CPT,,,,,GN,Outpatient,,,,204,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Speech-Gen Dev Prog and Mod,7896913,LOCAL,92609,CPT,,,,,GN,Outpatient,,,,204,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Speech-Gen Dev Prog and Mod Time,1373849,LOCAL,92609,CPT,,,,,GN,Outpatient,,,,204,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Tx Generating Device Units,1373849,LOCAL,92609,CPT,,,,,GN,Outpatient,,,,204,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Factor V Activity, Clotting QSTC",9777239,LOCAL,85220,CPT,,,,,,Outpatient,,,,21.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatitis B Virus DNA Qnt RT PCR QSTC,8764549,LOCAL,87517,CPT,,,,,,Outpatient,,,,51.41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inhibin A QSTC,8972775,LOCAL,86336,CPT,,,,,,Outpatient,,,,18.71,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Viral Respiratory, Rapid Culture with Reflex QST",12126195,LOCAL,87140,CPT,,,,,,Outpatient,,,,6.68,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Porphyrins, Total QSTC",13864419,LOCAL,82542,CPT,,,,,,Outpatient,,,,28.91,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"73040 Radiologic examination, shoulder, arthrography: AddOn",14917589,LOCAL,73040,CPT,,,,,,Outpatient,,,,777.98,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Forearm 1 View Left,13554993,LOCAL,73090,CPT,,,,,52|LT,Outpatient,,,,170.78,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Forearm 1 View Right,13554996,LOCAL,73090,CPT,,,,,52|RT,Outpatient,,,,170.78,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Ankle 2 Views Left,1169936,LOCAL,73600,CPT,,,,,LT,Outpatient,,,,165,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Ankle 2 Views Right,1169938,LOCAL,73600,CPT,,,,,RT,Outpatient,,,,165,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tobramycin 1.2 g injection [CULL],11211303,LOCAL,J3260,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complement Component C1q QSTC,8972752,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97166  SB OT Eval Mod Comp,9860015,LOCAL,97166,CPT,,,,,GO|CO,Outpatient,,,,210,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97166 EVAL -  MODERATE COMPLEXITY CHARGE,9850015,LOCAL,97166,CPT,,,,,GO,Outpatient,,,,210,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Evaluation Moderate Complexity Units,7897808,LOCAL,97166,CPT,,,,,GO,Outpatient,,,,210,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Moderate Complex Units,7895293,LOCAL,97166,CPT,,,,,GO,Outpatient,,,,210,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Calcaneus Left,1170032,LOCAL,73650,CPT,,,,,LT,Outpatient,,,,174.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Calcaneus Right,1170034,LOCAL,73650,CPT,,,,,RT,Outpatient,,,,174.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
94618 PULM STRESS TEST - 6 MIN WALK CHARGE,10470023,LOCAL,94618,CPT,,,,,59,Outpatient,,,,212,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
94618 PULMONARY STRESS TEST CHARGE,10470022,LOCAL,94618,CPT,,,,,,Outpatient,,,,212,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hips 2 Views w/AP Pelvis Bilat,7520609,LOCAL,73521,CPT,,,,,,Outpatient,,,,175.73,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neutrophil Funct, Oxidative Burst QSTC",13864519,LOCAL,82657,CPT,,,,,,Outpatient,,,,26.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Clavicle Limited Left,13554978,LOCAL,73000,CPT,,,,,52|LT,Outpatient,,,,198.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Clavicle Limited Right,13575896,LOCAL,73000,CPT,,,,,52|RT,Outpatient,,,,198.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR CV Line Injection,10153535,LOCAL,77001,CPT,,,,,,Outpatient,,,,177.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Portogram,8602535,LOCAL,36598,CPT,,,,,,Outpatient,,,,587,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neuron Specific Enolase, CSF QSTC",13864472,LOCAL,86316,CPT,,,,,,Outpatient,,,,24.97,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Sternum 2+ Views,1170496,LOCAL,71120,CPT,,,,,,Outpatient,,,,179.85,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Borrelia species DNA, QL RT PCR QSTC",13864432,LOCAL,87801,CPT,,,,,,Outpatient,,,,84.24,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Calprotectin, Stool QSTC",8764641,LOCAL,83993,CPT,,,,,,Outpatient,,,,23.56,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Factor VII Activity, Clotting QSTC",12530023,LOCAL,85230,CPT,,,,,,Outpatient,,,,21.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Rheumatoid Factor (IgA, IgG, IgM) QSTC",9743436,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SURESWAB(R) ADV BV QST,12432150,LOCAL,81513,CPT,,,,,,Outpatient,,,,171.16,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Estrogens, Fractionated, LC/MS QSTC",8972883,LOCAL,82671,CPT,,,,,,Outpatient,,,,38.76,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"86617-Lyme Disease Abs (IgG, IgM) IBL CSF QSTC",14825580,LOCAL,86617,CPT,,,,,,Outpatient,,,,18.59,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"BK Virus DNA, Quant, RT PCR QSTC",8853280,LOCAL,87799,CPT,,,,,,Outpatient,,,,51.41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lyme Disease Ab Rfx Blot IgG, IgM QSTC",8764732,LOCAL,86618,CPT,,,,,,Outpatient,,,,20.44,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lyme Disease Abs (IgG, IgM) IBL CSF QSTC",14114578,LOCAL,86617,CPT,,,,,,Outpatient,,,,18.59,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lyme Disease Antibodies (IgG, IgM), Immunoblot, CSF QST",6232109,LOCAL,86617,CPT,,,,,,Outpatient,,,,18.59,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
sodium thiosulfate 25% intravenous solution 50 mL [CULL],11260081,LOCAL,J0208,CPT,,,,,,Outpatient,50,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chlamydia/Chlamydophila Ab 1 IgG QSTC,13864536,LOCAL,86631,CPT,,,,,,Outpatient,,,,14.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"TRICHOMONAS VAGINALIS (TV), TMA QST",12432301,LOCAL,87661,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CANDIDA GLABRATA QST,12432300,LOCAL,87481,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CANDIDA SPECIES QST,12432293,LOCAL,87481,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CANDIDA SPECIES QST,12432299,LOCAL,87481,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SURESWAB(R) ADV BV QST,12432298,LOCAL,81513,CPT,,,,,,Outpatient,,,,171.16,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"EBV DNA, QN PCR QSTC",8764620,LOCAL,87799,CPT,,,,,,Outpatient,,,,51.41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Wrist 2 Views Left,1170606,LOCAL,73100,CPT,,,,,LT,Outpatient,,,,184.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Wrist 2 Views Right,1170608,LOCAL,73100,CPT,,,,,RT,Outpatient,,,,184.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF LAB IAT CROSSMATCH,13797753,LOCAL,86922,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Forearm 2 Views Left,1170197,LOCAL,73090,CPT,,,,,LT,Outpatient,,,,170.78,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Forearm 2 Views Right,1170199,LOCAL,73090,CPT,,,,,RT,Outpatient,,,,170.78,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97167 EVAL -  HIGH COMPLEXITY CHARGE,9850017,LOCAL,97167,CPT,,,,,GO,Outpatient,,,,226,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97167 IND EDUCATION EVAL CHARGE,9860017,LOCAL,97167,CPT,,,,,GO|CO,Outpatient,,,,226,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Evaluation High Complexity Units,7897809,LOCAL,97167,CPT,,,,,GO,Outpatient,,,,226,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT High Complex Units,7895295,LOCAL,97167,CPT,,,,,GO,Outpatient,,,,226,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99211 LEVEL I VISIT CHARGE,9319019,LOCAL,99211,CPT,,,,,,Outpatient,,,,226,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99211 Office Visit Established Pt. Level 1,10168485,LOCAL,99211,CPT,,,,,,Outpatient,,,,226,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Scapula Left,1170401,LOCAL,73010,CPT,,,,,LT,Outpatient,,,,187.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Scapula Right,1170403,LOCAL,73010,CPT,,,,,RT,Outpatient,,,,187.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mycobacterium Slow Grower MIC QST,13864520,LOCAL,87186,CPT,,,,,,Outpatient,,,,10.38,VIVA,Commercial,,50,,85,27.49,85,1 through 10,percent of total billed charges,10.57,35.67132075,
Mycobacterium Slow Grower MIC QSTC,13864520,LOCAL,87186,CPT,,,,,,Outpatient,,,,10.38,VIVA,Commercial,,50,,85,27.49,85,1 through 10,percent of total billed charges,10.57,35.67132075,
CPAP Charge -> Subsequent,8365858,LOCAL,94660,CPT,,,,,,Outpatient,,,,279,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
17110 CRYOSURGERY REMOVAL OF LESIONS CHARGE,9038957,LOCAL,17110,CPT,,,,,,Outpatient,,,,228,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
94625 PHY/QHP OP PULM RHB W/O MNTR,10470028,LOCAL,94625,CPT,,,,,,Outpatient,,,,407,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11730 AVULSION OF NAIL PLATE SINGLE,8715870,LOCAL,11730,CPT,,,,,,Outpatient,,,,228,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
94618 PULMONARY STRESS TEST 6 MINUTE WALK,10440014,LOCAL,94618,CPT,,,,,,Outpatient,,,,212,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
linezolid 2 mg/mL-D5% intravenous solution 300 mL [CULL],11201931,LOCAL,J2020,CPT,,,,,,Outpatient,300,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE PFT -> Bedside Spirometry,8860673,LOCAL,94060,CPT,,,,,,Outpatient,,,,230,VIVA,Commercial,,50,,250.82,250.82,250.82,1 through 10,percent of total billed charges,149.57,284.7,
RT CHARGE PFT -> Spirometry before & after,5267139,LOCAL,94060,CPT,,,,,,Outpatient,,,,230,VIVA,Commercial,,50,,250.82,250.82,250.82,1 through 10,percent of total billed charges,149.57,284.7,
Alpha Subunit QSTC,9849271,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Thoracic 2 Views,1170484,LOCAL,72070,CPT,,,,,,Outpatient,,,,192.23,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
micafungin 50 mg intravenous injection [CULL],11220352,LOCAL,J2248,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acetylcholine Recept. Modulating Ab QSTC,13864533,LOCAL,86043,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adenovirus DNA Qual RT PCR QSTC,10100374,LOCAL,87798,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"B.pertussis/para DNA,Ql Rl-Time PCR QSTC",8873570,LOCAL,87798,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bartonella Sp Ab IgG,IgM w/rf Titer QSTC",9777261,LOCAL,86611,CPT,,,,,,Outpatient,,,,12.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Copeptin QSTC,9039409,LOCAL,86255,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatitis C Viral RNA Genotype LiPA QSTC,8764578,LOCAL,87902,CPT,,,,,,Outpatient,,,,308.94,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Histamine QSTC,13864456,LOCAL,83088,CPT,,,,,,Outpatient,,,,35.44,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HSV 1 QST,9775428,LOCAL,87529,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HSV 2 QST,9775429,LOCAL,87529,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mycobacterium Avium Complex MIC QST,13344174,LOCAL,87186,CPT,,,,,,Outpatient,,,,10.38,VIVA,Commercial,,50,,85,27.49,85,1 through 10,percent of total billed charges,10.57,35.67132075,
methylPREDNISolone sodium succinate 2 g injection [CULL],11201958,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Mandible Less Than 4 Views,1170303,LOCAL,70100,CPT,,,,,,Outpatient,,,,194.7,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Babesia microti Ab (IgG) QSTC,13872991,LOCAL,86753,CPT,,,,,,Outpatient,,,,14.87,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ehrlichia chaffeensis Ab IgG QSTC,13872999,LOCAL,86753,CPT,,,,,,Outpatient,,,,14.87,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lyme Ab Screen QSTC,13872998,LOCAL,86618,CPT,,,,,,Outpatient,,,,20.44,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Clavicle Left,1170075,LOCAL,73000,CPT,,,,,LT,Outpatient,,,,198.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Clavicle Right,1170077,LOCAL,73000,CPT,,,,,RT,Outpatient,,,,198.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Humerus Limited Left,13554999,LOCAL,73060,CPT,,,,,52|LT,Outpatient,,,,223.58,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Humerus Limited Right,13555002,LOCAL,73060,CPT,,,,,52|RT,Outpatient,,,,223.58,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reptilase Clotting Time QSTC,13864513,LOCAL,85635,CPT,,,,,,Outpatient,,,,11.82,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Tibia/Fibula Left,1170516,LOCAL,73590,CPT,,,,,LT,Outpatient,,,,200.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Tibia/Fibula Right,1170518,LOCAL,73590,CPT,,,,,RT,Outpatient,,,,200.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
27095 INJ PROC FOR HIP ARTHROGRAPHY W/ ANESTH,5661071,LOCAL,27095,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"64454 - Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imagin",12897048,LOCAL,64454,CPT,,,,,,Outpatient,,,,244,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"64454 Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging",9520502,LOCAL,64454,CPT,,,,,,Outpatient,,,,244,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
caspofungin 50 mg intravenous injection [CULL],11201273,LOCAL,J0637,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bill Only Adsorption (Pheno, Rest, Wrm)",13517195,LOCAL,86978,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bill Only Rare Unit, Outside Search",13517199,LOCAL,86999,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tuberculin purified protein derivative 5 tuberculin units/0.1 mL intradermal solution 1 mL [CULL],11200764,LOCAL,86580,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"SureSwab(R) Trich. Vag. RNA,QL TMA QSTC",8853247,LOCAL,87661,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trichomonas Vaginalis RNA, Ql, TMA QST",8853247,LOCAL,87661,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Femur 1 View Left,7520564,LOCAL,73551,CPT,,,,,LT,Outpatient,,,,205.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Femur 1 View Right,7520567,LOCAL,73551,CPT,,,,,RT,Outpatient,,,,205.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hereditary Hemochroma DNA Mut Analy QSTC,8764601,LOCAL,81256,CPT,,,,,,Outpatient,,,,78.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Absorption,7967780,LOCAL,86978,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Food and Tree Nut Allergy Panel QSTC,14884175,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
99282 - Level 2,2644298,LOCAL,99282,CPT,,,,,25,Outpatient,,,,256,VIVA,Commercial,,50,,272.3,150.59,272.3,1 through 10,percent of total billed charges,144.78,144.78,
BRACE COOL X-ACT DON-JOY (USE),4852073,LOCAL,,,L1833,HCPCS,,,,Outpatient,,,,994,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93797 Cardiac Rehab without ECG monitoring,10411210,LOCAL,93797,CPT,,,,,,Outpatient,,,,256,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93798 Cardiac Rehab Phase II,10411000,LOCAL,93798,CPT,,,,,,Outpatient,,,,256,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUP ARTERIAL & VENOUS MAPPING UNI,8200502,LOCAL,93986,CPT,,,,,,Outpatient,,,,257,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Vein Mapping Lower Extremity Left,12175098,LOCAL,93986,CPT,,,,,LT,Outpatient,,,,257,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Vein Mapping Lower Extremity Right,12175101,LOCAL,93986,CPT,,,,,RT,Outpatient,,,,257,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Vein Mapping Upper Extremity Left,12175107,LOCAL,93986,CPT,,,,,LT,Outpatient,,,,257,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Vein Mapping Upper Extremity Right,12175110,LOCAL,93986,CPT,,,,,RT,Outpatient,,,,257,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
caspofungin 70 mg intravenous injection [CULL],11201274,LOCAL,J0637,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
71046 XR Chest 2 Views: AddOn,13632841,LOCAL,71046,CPT,,,,,,Outpatient,,,,212.85,VIVA,Commercial,,50,,387.38,83.41,387.38,1 through 10,percent of total billed charges,80.5,83.69,
XR Chest 2 Views,689607,LOCAL,71046,CPT,,,,,,Outpatient,,,,212.85,VIVA,Commercial,,50,,387.38,83.41,387.38,1 through 10,percent of total billed charges,80.5,83.69,
Heparin Anti-Xa QSTC,8972922,LOCAL,85520,CPT,,,,,,Outpatient,,,,15.71,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Abdomen KUB 1 View,1169926,LOCAL,74018,CPT,,,,,,Outpatient,,,,215.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Knee 1 or 2 Views Left,1170263,LOCAL,73560,CPT,,,,,LT,Outpatient,,,,215.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Knee 1 or 2 Views Right,1170265,LOCAL,73560,CPT,,,,,RT,Outpatient,,,,215.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
21- Hydroxylase Antibody QSTC,9708927,LOCAL,83516,CPT,,,,,,Outpatient,,,,13.84,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"96360 - Hydration, first hour",1928297,LOCAL,96360,CPT,,,,,,Outpatient,,,,262,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"96360 IV HYDRATION, INITIAL 31-90 MINS",7904529,LOCAL,96360,CPT,,,,,,Outpatient,,,,262,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inhibin B QSTC,6210082,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rituxan Sensitivity (CD20) QSTC,13864421,LOCAL,86356,CPT,,,,,,Outpatient,,,,32.14,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hip 1 View Left,1170225,LOCAL,73501,CPT,,,,,LT,Outpatient,,,,218.63,VIVA,Commercial,,50,,67.19,67.19,67.19,1 through 10,percent of total billed charges,80.5,83.69,
XR Hip 1 View Right,1170227,LOCAL,73501,CPT,,,,,RT,Outpatient,,,,218.63,VIVA,Commercial,,50,,67.19,67.19,67.19,1 through 10,percent of total billed charges,80.5,83.69,
A. phagocytophilum Ab IgG IgM QSTC,13864527,LOCAL,86666,CPT,,,,,,Outpatient,,,,12.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Bone Length Studies Scanograms,1170016,LOCAL,77073,CPT,,,,,,Outpatient,,,,218.63,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOP ABI-ANKLE BRACHIAL INDEX,8230017,LOCAL,93922,CPT,,,,,,Outpatient,,,,265,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US ABI,8206802,LOCAL,93922,CPT,,,,,,Outpatient,,,,265,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Segmental Pressures LE 1-2 Lvls Bilat,1169757,LOCAL,93922,CPT,,,,,,Outpatient,,,,265,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Sacrum/Coccyx 2+ Views,1170391,LOCAL,72220,CPT,,,,,,Outpatient,,,,219.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Sniff Test,8602547,LOCAL,71046,CPT,,,,,,Outpatient,,,,212.85,VIVA,Commercial,,50,,387.38,83.41,387.38,1 through 10,percent of total billed charges,80.5,83.69,
XR Sternoclavicular Joint(s),1170494,LOCAL,71130,CPT,,,,,,Outpatient,,,,220.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Antigen Type Group 1,13517191,LOCAL,86902,CPT,,,,,,Outpatient,,,,7.62,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Proinsulin QSTC,8972777,LOCAL,84206,CPT,,,,,,Outpatient,,,,32.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Elbow Complete 3+ Views Left,1170127,LOCAL,73080,CPT,,,,,LT,Outpatient,,,,221.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Elbow Complete 3+ Views Right,1170129,LOCAL,73080,CPT,,,,,RT,Outpatient,,,,221.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOPP ART EXT BIL MULTIPLE,8200300,LOCAL,93923,CPT,,,,,,Outpatient,,,,401,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOPP ART EXT BIL W/EXERCISE,8200310,LOCAL,93924,CPT,,,,,,Outpatient,,,,302,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Shoulder Complete 2 Plus Views Left,1170415,LOCAL,73030,CPT,,,,,LT,Outpatient,,,,222.75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Shoulder Complete 2 Plus Views Right,1170417,LOCAL,73030,CPT,,,,,RT,Outpatient,,,,222.75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Femur 2 Views Left,7520570,LOCAL,73552,CPT,,,,,LT,Outpatient,,,,223.58,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Femur 2 Views Right,7520573,LOCAL,73552,CPT,,,,,RT,Outpatient,,,,223.58,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Humerus Left,1170245,LOCAL,73060,CPT,,,,,LT,Outpatient,,,,223.58,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Humerus Right,1170247,LOCAL,73060,CPT,,,,,RT,Outpatient,,,,223.58,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hip 1 View w/ AP Pelvis Left,7520576,LOCAL,73501,CPT,,,,,LT,Outpatient,,,,218.63,VIVA,Commercial,,50,,67.19,67.19,67.19,1 through 10,percent of total billed charges,80.5,83.69,
XR Hip 1 View w/ AP Pelvis Right,7520579,LOCAL,73501,CPT,,,,,RT,Outpatient,,,,218.63,VIVA,Commercial,,50,,67.19,67.19,67.19,1 through 10,percent of total billed charges,80.5,83.69,
15272 APP SKN SUB GRFT TAL 100 SQ CM ADDT FAC CHARGE,12831013,LOCAL,15272,CPT,,,,,,Outpatient,,,,273,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"epoetin alfa-epbx 10,000 units/mL preservative-free injectable solution 1 mL [CULL]",11202387,LOCAL,Q5105,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11055 BENIGN LESION PARING/CUTTING, SINGLE",13043366,LOCAL,11055,CPT,,,,,,Outpatient,,,,278,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Enterovirus RNA, QL Real-Time PCR QSTC",8873564,LOCAL,87498,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL US Echo Dop w/ Spectr Ltd,13734793,LOCAL,93321,CPT,,,,,,Outpatient,,,,278,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ECHO DOP W/SPECTR LTD,8200175,LOCAL,93321,CPT,,,,,,Outpatient,,,,278,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CPAP Charge -> Initial,8365859,LOCAL,94660,CPT,,,,,,Outpatient,,,,279,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"S. pneumoniae Ab (IgG), MAID QSTC",13864418,LOCAL,87899,CPT,,,,,,Outpatient,,,,19.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Foot Complete 3 Plus Views Left,1170191,LOCAL,73630,CPT,,,,,LT,Outpatient,,,,231,VIVA,Commercial,,50,,286.24,230.37,286.24,1 through 10,percent of total billed charges,80.5,83.69,
XR Foot Complete 3 plus Views Right,1170193,LOCAL,73630,CPT,,,,,RT,Outpatient,,,,231,VIVA,Commercial,,50,,286.24,230.37,286.24,1 through 10,percent of total billed charges,80.5,83.69,
ER US VASCULAR ACCESS GUIDANCE,8200565,LOCAL,76937,CPT,,,,,,Outpatient,,,,231.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US VASCULAR ACCESS GUIDANCE,8200560,LOCAL,76937,CPT,,,,,,Outpatient,,,,231.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E0181 RBC CPD 500 LR,7266548,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E0226 RBC CPDA1 500 LR,7266556,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E0366 RBC CP2D AS3 500,7266579,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E0382 RBC CP2D AS3 500 LR,7266659,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E0424 RBC CPD AS5 500 LR,7266667,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4531 Aph RBC ACDA AS1 LR,7266601,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4532 Aph RBC ACDA AS1 LR 1,7266602,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4533 Aph RBC ACDA AS1 LR 2,7266603,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4543 Aph RBC ACDA AS3 LR,7266613,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4544 Aph RBC ACDA AS3 LR 1,7266614,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4545 Aph RBC ACDA AS3 LR 2,7266615,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E5157 RBC CPD AS1 LR LV,8069011,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hip 2-3 Views Left,7520582,LOCAL,73502,CPT,,,,,LT,Outpatient,,,,232.65,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hip 2-3 Views Right,7520585,LOCAL,73502,CPT,,,,,RT,Outpatient,,,,232.65,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
fondaparinux 7.5 mg/0.6 mL subcutaneous solution 0.6 mL [CULL],11260585,LOCAL,J1652,CPT,,,,,,Outpatient,0.6,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Ankle Complete 3 Plus Views Left,1169942,LOCAL,73610,CPT,,,,,LT,Outpatient,,,,233.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Ankle Complete 3 Plus Views Right,1169944,LOCAL,73610,CPT,,,,,RT,Outpatient,,,,233.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hand Complete 3 Plus Views Right,1170223,LOCAL,73130,CPT,,,,,RT,Outpatient,,,,235.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hand Complete 3 Views Left,1170221,LOCAL,73130,CPT,,,,,LT,Outpatient,,,,235.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E0336 RBC CPD AS1 500 LR,7266574,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11056 BENIGN LESION PARING(2-4),13029575,LOCAL,11056,CPT,,,,,,Outpatient,,,,285,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11103 TANGENTIAL BIOP EA ADDT CHARGE,9322081,LOCAL,11103,CPT,,,,,,Outpatient,,,,285,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11721 DEBRIDE NAIL 6 OR MORE WC CHARGE,8726776,LOCAL,11721,CPT,,,,,,Outpatient,,,,285,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97602 DEBRIDE MAGGOT THERAPY NON-EXC,11633062,LOCAL,97602,CPT,,,,,,Outpatient,,,,285,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97605 Wound VAC <=50 sq cm,10015643,LOCAL,97605,CPT,,,,,,Outpatient,,,,285,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Sacroiliac Joints 3+ Views,1170387,LOCAL,72202,CPT,,,,,,Outpatient,,,,235.95,VIVA,Commercial,,50,,220.13,220.13,220.13,1 through 10,percent of total billed charges,83.69,97.22,
BD Bone Density DEXA Axial w/Frac Assess,5017920,LOCAL,77085,CPT,,,,,,Outpatient,,,,237.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US PSEUDOANEURYSM COMPRESSION,8200520,LOCAL,76936,CPT,,,,,,Outpatient,,,,237.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Pseudoaneurysm Compression Repair,7936316,LOCAL,76936,CPT,,,,,,Outpatient,,,,237.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Sinuses Paranasal Complete,1170434,LOCAL,70220,CPT,,,,,,Outpatient,,,,238.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92523 SPEECH SOUND LANGUAGE COMPREHENS CHARGE,9630058,LOCAL,92523,CPT,,,,,GN,Outpatient,,,,290,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Analysis of Voice & Resonance Minutes,7897211,LOCAL,92523,CPT,,,,,GN,Outpatient,,,,290,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Sound Prod w/ Lang Comp Eval Units,7897209,LOCAL,92523,CPT,,,,,GN,Outpatient,,,,290,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Speech Sound Prod w/ Language Charge,7896929,LOCAL,92523,CPT,,,,,GN,Outpatient,,,,290,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hip 2-3 Views w/AP Pelvis Left,7520588,LOCAL,73502,CPT,,,,,LT,Outpatient,,,,232.65,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hip 2-3 Views w/AP Pelvis Right,7520591,LOCAL,73502,CPT,,,,,RT,Outpatient,,,,232.65,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3931 Forearm based radial nerve orthosis,9646083,LOCAL,,,L3931,HCPCS,,,GP,Outpatient,,,,291,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3931 OT WRIST HAND FINGER ORTHOSIS,9856104,LOCAL,,,L3931,HCPCS,,,,Outpatient,,,,291,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3931 Wrst/thmb Spic Spnt,9800062,LOCAL,,,L3931,HCPCS,,,,Outpatient,,,,291,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Breast Limited Left.,8068444,LOCAL,76642,CPT,,,,,LT,Outpatient,,,,240.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Breast Limited Right.,8068447,LOCAL,76642,CPT,,,,,RT,Outpatient,,,,240.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
pneumococcal 23-polyvalent vaccine injectable solution 0.5 mL [CULL],11212160,LOCAL,90732,CPT,,,,,,Outpatient,0.5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adalimumab Level for IBD QSTC,13864453,LOCAL,80145,CPT,,,,,,Outpatient,,,,46.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amino Acid Analysis, Plasma QSTC",9039235,LOCAL,82139,CPT,,,,,,Outpatient,,,,20.24,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"BK Virus DNA, Quant, RT PCR, Ur QSTC",8764640,LOCAL,87799,CPT,,,,,,Outpatient,,,,51.41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL CV Nurse MRI Monitoring,14671862,LOCAL,76018,CPT,,,,,,Outpatient,,,,75.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Histamine Release Chronic Urticaria QSTC,8764646,LOCAL,86343,CPT,,,,,,Outpatient,,,,14.95,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infliximab Anti-drug Antibody for IBD QSTC,12552286,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infliximab Level for IBD QSTC,13864454,LOCAL,80230,CPT,,,,,,Outpatient,,,,46.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Interleukin-6 (IL-6), Serum QSTC",9708918,LOCAL,83529,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SJMC 76018 MR Safety Implant Electronics Preparation,14671862,LOCAL,76018,CPT,,,,,,Outpatient,,,,75.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"VZV DNA, QL RT PCR QSTC",9777241,LOCAL,87798,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"99202 LEVEL II INITIAL VISIT, FAC CHARGE",12832515,LOCAL,99202,CPT,,,,,,Outpatient,,,,294,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99202 Office Visit New Pt. Level 2,10168481,LOCAL,99202,CPT,,,,,,Outpatient,,,,294,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99212 LEVEL II VISIT CHARGE,9319021,LOCAL,99212,CPT,,,,,,Outpatient,,,,294,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99212 Office Visit Established Pt. Level 2,10168486,LOCAL,99212,CPT,,,,,,Outpatient,,,,294,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
12001 SIMPLE REPAIR OF WOUND TRUNK,13029607,LOCAL,12001,CPT,,,,,,Outpatient,,,,295,VIVA,Commercial,,50,,307.52,282.41,307.52,1 through 10,percent of total billed charges,181.66,863,
FIRST HOUR DIRECT OBSERVATION CHARGE,8566355,LOCAL,,,G0379,HCPCS,,,25,Outpatient,,,,297,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CHOLANGIO W EXIST CATH S&I,8210339,LOCAL,47531,CPT,,,,,,Outpatient,,,,298,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
esmolol 10 mg/mL-sterile water Sol 250 mL [CULL],11201727,LOCAL,J1806,CPT,,,,,,Outpatient,250,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pregabalin QSTC,8853245,LOCAL,80299,CPT,,,,,,Outpatient,,,,22.37,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
29580 Application of a Paste Boot (Bilateral),12642335,LOCAL,29580,CPT,,,,,,Outpatient,,,,301,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
29580 PT UNNA BOOT APPL,9410275,LOCAL,29580,CPT,,,,,GP,Outpatient,,,,301,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US EXT NONVASC COMPLETE,8230013,LOCAL,76881,CPT,,,,,,Outpatient,,,,248.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US EXT NONVASC LIMITED ANATOMIC SPEC,8230014,LOCAL,76882,CPT,,,,,,Outpatient,,,,248.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Elution,7967778,LOCAL,86860,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Pelvis Complete 3+ Views,1170353,LOCAL,72190,CPT,,,,,,Outpatient,,,,248.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOP ART - LEA W/ TREADMILL,8230021,LOCAL,93924,CPT,,,,,,Outpatient,,,,302,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Lower Ext Doppler w/ Stress Test,1169765,LOCAL,93924,CPT,,,,,,Outpatient,,,,302,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Osseous Survey Infant,1170020,LOCAL,77076,CPT,,,,,,Outpatient,,,,249.98,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Facial Bones < 3 Views,1170139,LOCAL,70140,CPT,,,,,,Outpatient,,,,253.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Orbits Limited,13555005,LOCAL,70140,CPT,,,,,,Outpatient,,,,253.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Hips Infant Limited/Static,8206871,LOCAL,76886,CPT,,,,,,Outpatient,,,,253.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Spinal Canal,1169879,LOCAL,76800,CPT,,,,,,Outpatient,,,,253.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Rare Donor Fee,13517197,LOCAL,86999,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96373- Intra-Arterial Injection,1928304,LOCAL,96373,CPT,,,,,59,Outpatient,,,,308,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96373 S-INJ NON CHEMO IA CHARGE,8049127,LOCAL,96373,CPT,,,,,59,Outpatient,,,,308,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOP VENOUS LOWER EXT UNILATERAL,8200430,LOCAL,93971,CPT,,,,,,Outpatient,,,,310,VIVA,Commercial,,50,,238.16,238.16,238.16,1 through 10,percent of total billed charges,97.22,161.71,
DOP VENOUS UPPER EXT UNI OR LTD,8200431,LOCAL,93971,CPT,,,,,,Outpatient,,,,310,VIVA,Commercial,,50,,238.16,238.16,238.16,1 through 10,percent of total billed charges,97.22,161.71,
DUP AO IVC ILIAC LIMITED,8200531,LOCAL,93979,CPT,,,,,,Outpatient,,,,310,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Aorta IVC Iliac Duplex Limited,1169579,LOCAL,93979,CPT,,,,,,Outpatient,,,,310,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Lower Ext Venous Duplex Left,1169771,LOCAL,93971,CPT,,,,,LT,Outpatient,,,,310,VIVA,Commercial,,50,,238.16,238.16,238.16,1 through 10,percent of total billed charges,97.22,161.71,
US Lower Ext Venous Duplex Right,1169773,LOCAL,93971,CPT,,,,,RT,Outpatient,,,,310,VIVA,Commercial,,50,,238.16,238.16,238.16,1 through 10,percent of total billed charges,97.22,161.71,
US Upper Ext Venous Duplex Left,1169903,LOCAL,93971,CPT,,,,,LT,Outpatient,,,,310,VIVA,Commercial,,50,,238.16,238.16,238.16,1 through 10,percent of total billed charges,97.22,161.71,
US Upper Ext Venous Duplex Right,1169905,LOCAL,93971,CPT,,,,,RT,Outpatient,,,,310,VIVA,Commercial,,50,,238.16,238.16,238.16,1 through 10,percent of total billed charges,97.22,161.71,
DUP AV FISTULA OR DIALYSIS GRAFT,8200500,LOCAL,93990,CPT,,,,,,Outpatient,,,,310,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUPLEX ARTERAL UPPER EXT UNI OR LTD,8200490,LOCAL,93931,CPT,,,,,,Outpatient,,,,310,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUPLEX ARTERIAL LOWER EXT UNI OR LTD,8200470,LOCAL,93926,CPT,,,,,,Outpatient,,,,310,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Hemodialysis Duplex Access Lt,8206865,LOCAL,93990,CPT,,,,,,Outpatient,,,,310,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Hemodialysis Duplex Access Rt,8206868,LOCAL,93990,CPT,,,,,RT,Outpatient,,,,310,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Lower Ext Arterial Duplex Left,1169761,LOCAL,93926,CPT,,,,,LT,Outpatient,,,,310,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Lower Ext Arterial Duplex Right,1169763,LOCAL,93926,CPT,,,,,RT,Outpatient,,,,310,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Upper Ext Arterial Duplex Left,1169897,LOCAL,93931,CPT,,,,,LT,Outpatient,,,,310,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Upper Ext Arterial Duplex Right,1169899,LOCAL,93931,CPT,,,,,RT,Outpatient,,,,310,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DAPTOmycin 500 mg intravenous injection [CULL],11210536,LOCAL,J0878,CPT,,,,,,Outpatient,1,EA,,480,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL MG Needle/Wire Loc Breast,13720943,LOCAL,19281,CPT,,,,,,Outpatient,,,,313,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Guided Needle Loc Left,8206592,LOCAL,19281,CPT,,,,,LT,Outpatient,,,,313,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Guided Needle Loc Right,8206595,LOCAL,19281,CPT,,,,,RT,Outpatient,,,,313,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Tissue Exam Level 6,14048000,LOCAL,88309,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IA-2 Antibody QSTC,9039410,LOCAL,86341,CPT,,,,,,Outpatient,,,,28.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Low LSO,9400072,LOCAL,,,L0642,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96422 CHEMO ARTERIAL INFUS UP TO 1HR CHARGE,9404492,LOCAL,96422,CPT,,,,,,Outpatient,,,,318,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3933 OT FINGER ORTHOSIS,9856060,LOCAL,,,L3933,HCPCS,,,,Outpatient,,,,318,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Reticulocyte Separation,8629513,LOCAL,86972,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11105 Punch Biopsy of Skin, Ea Separate/Additional CRRH_GA",13243078,LOCAL,11105,CPT,,,,,,Outpatient,,,,319,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
A. phagocytophilum/E chaffeensis Ab QSTC,13864420,LOCAL,86666,CPT,,,,,,Outpatient,,,,12.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Cervical 2 or 3 Views,1170452,LOCAL,72040,CPT,,,,,,Outpatient,,,,266.48,VIVA,Commercial,,50,,248.34,116.65,248.34,1 through 10,percent of total billed charges,80.5,83.69,
96125 ST-COGNITIVE TEST PER 1HR,9630086,LOCAL,96125,CPT,,,,,GN,Outpatient,,,,323,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Cognitive Test Units,7897180,LOCAL,96125,CPT,,,,,GN,Outpatient,,,,323,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Standardized Cognitive Eval Charge,7897180,LOCAL,96125,CPT,,,,,GN,Outpatient,,,,323,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"45300 PROCTOSIGMOIDOSCOPY, RIGID, DIAGNOSTIC, W OR W/O COLLECTION BY BRUSHING OR WASHING",8934255,LOCAL,45300,CPT,,,,,,Outpatient,,,,129,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BD Bone Density DEXA Axial Skeleton,1167839,LOCAL,77080,CPT,,,,,,Outpatient,,,,267.3,VIVA,Commercial,,50,,249.55,249.55,249.55,1 through 10,percent of total billed charges,97.22,116.02,
OASIS MATRIX WOUND 3X3.5,13962593,LOCAL,,,Q4102,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0463 CR REHAB ASSESSMENT CHARGE,10470016,LOCAL,,,G0463,HCPCS,,,,Outpatient,,,,326,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0463 HOSPITAL OP CLINIC VISIT W PROC MCR ONLY,13436347,LOCAL,,,G0463,HCPCS,,,25,Outpatient,,,,326,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0463 HOSPITAL OUTPATIENT VISIT CHARGE,10470015,LOCAL,,,G0463,HCPCS,,,25,Outpatient,,,,326,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0463 OUTPATIENT CLINIC VISIT,13043743,LOCAL,,,G0463,HCPCS,,,25,Outpatient,,,,326,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IVUS ADDL VESSEL,8230049,LOCAL,92979,CPT,,,,,,Outpatient,,,,329,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Susceptibility Aerobic Bacteria,MIC QSTC",9039459,LOCAL,87186,CPT,,,,,,Outpatient,,,,10.38,VIVA,Commercial,,50,,85,27.49,85,1 through 10,percent of total billed charges,10.57,35.67132075,
"Susceptibility, Aerobic Bacterium QST",8389539,LOCAL,87186,CPT,,,,,,Outpatient,,,,10.38,VIVA,Commercial,,50,,85,27.49,85,1 through 10,percent of total billed charges,10.57,35.67132075,
Administration of Blood (Bridge),8019084,LOCAL,36430,CPT,,,,,,Outpatient,,,,99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TRANSFUSE Fresh Frozen Plasma (Bridge),8482691,LOCAL,36430,CPT,,,,,,Outpatient,,,,99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TRANSFUSE Platelet Product (Bridge),8482692,LOCAL,36430,CPT,,,,,,Outpatient,,,,99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TRANSFUSE Red Blood Cells Leukoreduced (Bridge),8482690,LOCAL,36430,CPT,,,,,,Outpatient,,,,99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Nasal Bones 3+ Views,1170329,LOCAL,70160,CPT,,,,,,Outpatient,,,,273.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bill Only RBC Pretreatment, Chemicals",8629511,LOCAL,86970,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bill Only RBC Pretreatment, Enyzme",8629512,LOCAL,86971,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Injection Ankle Left,1169950,LOCAL,20605,CPT,,,,,LT,Outpatient,,,,336,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Injection Ankle Right,1169952,LOCAL,20605,CPT,,,,,RT,Outpatient,,,,336,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Injection Elbow Right,1169958,LOCAL,20605,CPT,,,,,RT,Outpatient,,,,336,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Injection Wrist Left,1169996,LOCAL,20605,CPT,,,,,LT,Outpatient,,,,336,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Injection Wrist Right,1169998,LOCAL,20605,CPT,,,,,RT,Outpatient,,,,336,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT ALLODERM 1/2,13962573,LOCAL,,,Q4116,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ECHO DOP COLOR FLOW MAPPING,8200220,LOCAL,93325,CPT,,,,,,Outpatient,,,,336,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Lumbosacral 2 or 3 Views,1170470,LOCAL,72100,CPT,,,,,,Outpatient,,,,278.85,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"G0399 HOME SLEEP STUDY, CHARGE",8303751,LOCAL,,,G0399,HCPCS,,,,Outpatient,,,,340,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11057 BENIGN LESION PARING(4+),13029576,LOCAL,11057,CPT,,,,,,Outpatient,,,,340,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
16030 Dressing/Debridement Large More than one ext or >10% total body,9400041,LOCAL,16030,CPT,,,,,,Outpatient,,,,863,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15276 APPL-HC SKSB GRT F/N/H/G-AD 25CM CHARGE,9709030,LOCAL,15276,CPT,,,,,,Outpatient,,,,342,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Knee 3 Views Left,1170269,LOCAL,73562,CPT,,,,,LT,Outpatient,,,,282.98,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Knee 3 Views Right,1170271,LOCAL,73562,CPT,,,,,RT,Outpatient,,,,282.98,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Barium Swallow,9756897,LOCAL,74220,CPT,,,,,,Outpatient,,,,282.98,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Swallowing Function w/ Speech,1170500,LOCAL,74230,CPT,,,,,,Outpatient,,,,282.98,VIVA,Commercial,,50,,263.89,263.89,263.89,1 through 10,percent of total billed charges,162.76,176.48,
RT CHARGE PFT -> Bronchoprovocation,5267129,LOCAL,94070,CPT,,,,,,Outpatient,,,,345,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ertapenem Sodium 1 gram intravenous injection [CULL],11201820,LOCAL,J1335,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Mandible Complete 4+ Views,1170301,LOCAL,70110,CPT,,,,,,Outpatient,,,,286.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Facial Bones 3+ Views,1170141,LOCAL,70150,CPT,,,,,,Outpatient,,,,286.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Skull < 4 Views,1170436,LOCAL,70250,CPT,,,,,,Outpatient,,,,286.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hips 3-4 Views Bilat,7520612,LOCAL,73522,CPT,,,,,,Outpatient,,,,286.28,VIVA,Commercial,,50,,267.1,267.1,267.1,1 through 10,percent of total billed charges,83.69,97.22,
XR Hips 3-4 Views w/AP Pelvis Bilat,7520615,LOCAL,73522,CPT,,,,,,Outpatient,,,,286.28,VIVA,Commercial,,50,,267.1,267.1,267.1,1 through 10,percent of total billed charges,83.69,97.22,
93799 INPATIENT TEACH CARDIAC REHAB CHARGE,8230066,LOCAL,93799,CPT,,,,,,Outpatient,,,,348,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Wrist Complete 3 Plus Views Right,1170614,LOCAL,73110,CPT,,,,,RT,Outpatient,,,,288.75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Wrist Complete 3+ Views Left,1170612,LOCAL,73110,CPT,,,,,LT,Outpatient,,,,288.75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"COVID-19, Respiratory Panel 2.1(Biofire)",9624028,LOCAL,0202U,CPT,,,,,,Outpatient,,,,500.14,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Antigen Type Group 2,10312940,LOCAL,86902,CPT,,,,,,Outpatient,,,,7.62,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Abdomen 2 Views,8132826,LOCAL,74019,CPT,,,,,,Outpatient,,,,292.88,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3807 Tko Splint,9646038,LOCAL,,,L3807,HCPCS,,,,Outpatient,,,,357,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96132 NEUROPSYCH TESTING EVAL; FIRST HOUR CHARGE,9496220,LOCAL,96132,CPT,,,,,,Outpatient,,,,357,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Cervical 4 or 5 Views,1170454,LOCAL,72050,CPT,,,,,,Outpatient,,,,296.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
albumin human 25% intravenous solution 100 mL [CULL],11281015,LOCAL,P9047,CPT,,,,,,Outpatient,100,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0277 HBO Full Body 30 Min Interval,10015694,LOCAL,,,G0277,HCPCS,,,,Outpatient,,,,360,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Knee Complete 4 Plus Views Left,1170287,LOCAL,73564,CPT,,,,,LT,Outpatient,,,,297,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Knee Complete 4 Plus Views Right,1170289,LOCAL,73564,CPT,,,,,RT,Outpatient,,,,297,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"penicillin G benzathine 600,000 units/mL intramuscular suspension 1 mL [CULL]",11202082,LOCAL,J0561,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ADAMTS13 Activity w/Rfx Inhibitor QSTC,9777262,LOCAL,85397,CPT,,,,,,Outpatient,,,,37.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chromosome Analysis, Blood QSTC",8848485,LOCAL,88262,CPT,,,,,,Outpatient,,,,150.59,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Clinical Indication: QSTC,8848484,LOCAL,88230,CPT,,,,,,Outpatient,,,,139.79,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kleihauer-Betke Stain QSTC,9956031,LOCAL,85460,CPT,,,,,,Outpatient,,,,9.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respirat. Allergy Profile Region VI QSTC,9039268,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,VIVA,Commercial,,50,,150.35,150.35,150.35,1 through 10,percent of total billed charges,5.22,15.29,
Respirat. Allergy Profile Region VI QSTC,9041102,LOCAL,82785,CPT,,,,,,Outpatient,,,,19.75,VIVA,Commercial,,50,,31.36,31.36,31.36,1 through 10,percent of total billed charges,17.73,203.9616667,
Respiratory Allergy Panel Region VI with Reflexes QSTC,14884176,LOCAL,82785,CPT,,,,,,Outpatient,,,,19.75,VIVA,Commercial,,50,,31.36,31.36,31.36,1 through 10,percent of total billed charges,17.73,203.9616667,
XR Spine Thoracic 3 Views,1170486,LOCAL,72072,CPT,,,,,,Outpatient,,,,304.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Ribs 2 Views Left,1170371,LOCAL,71100,CPT,,,,,LT,Outpatient,,,,304.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Ribs 2 Views Right,1170373,LOCAL,71100,CPT,,,,,RT,Outpatient,,,,304.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Breast ABUS Left,8746657,LOCAL,76641,CPT,,,,,LT,Outpatient,,,,306.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Breast ABUS Left.,8567804,LOCAL,76641,CPT,,,,,LT,Outpatient,,,,306.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Breast ABUS Right.,8567807,LOCAL,76641,CPT,,,,,RT,Outpatient,,,,306.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Breast Complete Left.,8068438,LOCAL,76641,CPT,,,,,LT,Outpatient,,,,306.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Breast Complete Right.,8068441,LOCAL,76641,CPT,,,,,RT,Outpatient,,,,306.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Electrocardiogram 12 Lead,2322786,LOCAL,93005,CPT,,,,,,Outpatient,,,,178,VIVA,Commercial,,50,,53.46,15.85,53.46,32,percent of total billed charges,38.53,54.31,
99283 - Level 3,2644299,LOCAL,99283,CPT,,,,,25,Outpatient,,,,376,VIVA,Commercial,,50,,308.95,93.45,308.95,22,percent of total billed charges,253.15,253.15,
pneumococcal 21-valent conjugate vaccine (cvx 327) - Sus [CULL],11200021,LOCAL,90684,CPT,,,,,,Outpatient,0.5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
29581 APPL MULTLAY COMPRS LWR LEG,9739188,LOCAL,29581,CPT,,,,,,Outpatient,,,,195,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Ribs 3 Views Bilateral,1170375,LOCAL,71110,CPT,,,,,,Outpatient,,,,311.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Thoracic 4+ Views,1170488,LOCAL,72074,CPT,,,,,,Outpatient,,,,311.85,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Sinus Tract SI,2425614,LOCAL,76080,CPT,,,,,,Outpatient,,,,312.68,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Rare Unit,8196052,LOCAL,86999,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Oviduct chromotubation 58350,9093091,LOCAL,58350,CPT,,,,,,Outpatient,,,,4936,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ER ECHOCARDIOGRAM 2D LIMITED,8200203,LOCAL,93308,CPT,,,,,,Outpatient,,,,564,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TRANSPAC REUSABLE CABLE 42661-03,8200204,LOCAL,93308,CPT,,,,,,Outpatient,,,,564,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64445 NERV BLOCK SCIATIC,5661029,LOCAL,64445,CPT,,,,,,Outpatient,,,,382,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"FISH, Chromosome Specific 1 Pr QSTC",13864683,LOCAL,88271,CPT,,,,,,Outpatient,,,,25.7,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Specimen Source: FISH Chrom Pr x1 QSTC,13864676,LOCAL,88273,CPT,,,,,,Outpatient,,,,41.77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
rifAMPin 600 mg intravenous injection [CULL],11211144,LOCAL,J2804,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF Antibody ID,7032173,LOCAL,86870,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Head Newborn,8206862,LOCAL,76506,CPT,,,,,,Outpatient,,,,316.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Very Long Chain Fatty Acids QSTC,8764801,LOCAL,82726,CPT,,,,,,Outpatient,,,,23.7,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Fetal Biophysical Profile w/ Non-Str,1169687,LOCAL,76818,CPT,,,,,,Outpatient,,,,316.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99203  New Patient-Detailed,12642291,LOCAL,99203,CPT,,,,,,Outpatient,,,,387,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99203 Office Visit New Pt. Level 3,10168482,LOCAL,99203,CPT,,,,,,Outpatient,,,,387,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99203 Office Visit New Pt. Level 3,10168482,LOCAL,99203,CPT,,,,,,Outpatient,,,,387,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99213 Established patient visit- level 3,7947777,LOCAL,99213,CPT,,,,,,Outpatient,,,,387,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99213 Established patient visit- level 3,7947777,LOCAL,99213,CPT,,,,,,Outpatient,,,,387,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99213 LEVEL III VISIT CHARGE,9319022,LOCAL,99213,CPT,,,,,,Outpatient,,,,387,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99213 Office Visit Established Pt. Level 3,10168487,LOCAL,99213,CPT,,,,,,Outpatient,,,,387,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LENS #SA60AT,4832535,LOCAL,,,V2632,HCPCS,,,,Outpatient,,,,392,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Creatinine, Random, Ur QSTC",13873086,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,40.97514925,
"N-Methylhistamine, Random, Ur QSTC",13873083,LOCAL,82542,CPT,,,,,,Outpatient,,,,28.91,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Ribs w/ PA Chest Bilateral,1170377,LOCAL,71111,CPT,,,,,,Outpatient,,,,322.58,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
36010 INTRO CATH SUP/INF VENA CAVA,8266890,LOCAL,36010,CPT,,,,,,Outpatient,,,,393,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INTRO CATH VENA CAVA,8267101,LOCAL,36010,CPT,,,,,,Outpatient,,,,393,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Antenatal Testing Type -> Contraction stress test,10446024,LOCAL,59020,CPT,,,,,,Outpatient,,,,94,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97597 ACTIVE WOUND CARE MANAGEMENT FIRST 20 CM,13048047,LOCAL,97597,CPT,,,,,59,Outpatient,,,,395,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97597 DEBRIDE SCISSOR/SCAPEL 20SQ CM,9410251,LOCAL,97597,CPT,,,,,GP,Outpatient,,,,395,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97597 DEBRIDEMENT,9866113,LOCAL,97597,CPT,,,,,GO|CO,Outpatient,,,,395,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97597 OT SELECT DEBRIDE ME CHARGE,9856113,LOCAL,97597,CPT,,,,,GO,Outpatient,,,,395,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97598 Debrid Open wound > 20 sq cm charge,12511973,LOCAL,97598,CPT,,,,,,Outpatient,,,,395,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Removal Devitalized Tissue < 20 cm Units,7897756,LOCAL,97597,CPT,,,,,GO,Outpatient,,,,395,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Removal Tissue <20 Assist Units,7897756,LOCAL,97597,CPT,,,,,CQ,Outpatient,,,,395,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Selective Debridement Charge,7895252,LOCAL,97597,CPT,,,,,GO,Outpatient,,,,395,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Selective Debridement Charge,7895942,LOCAL,97597,CPT,,,,,GP,Outpatient,,,,395,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Selective Debridement Charge -> Yes, total wound surface area, first 20 sq cm or less",8968080,LOCAL,97597,CPT,,,,,GP,Outpatient,,,,395,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Cystogram Limited,13703435,LOCAL,74430,CPT,,,,,52,Outpatient,,,,554.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Chest,1169635,LOCAL,76604,CPT,,,,,,Outpatient,,,,328.35,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Ribs w/ PA Chest Left,1170379,LOCAL,71101,CPT,,,,,LT,Outpatient,,,,330,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Ribs w/ PA Chest Right,1170381,LOCAL,71101,CPT,,,,,RT,Outpatient,,,,330,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Strep Pneumoniae Ab IgG 23 Serotypes QST,10217037,LOCAL,86581,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Strep pneumoniae IgG Abs, 23 Serotypes QST",14006318,LOCAL,86581,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUP ARTERIAL & VENOUS MAPPING BIL,8200501,LOCAL,93985,CPT,,,,,,Outpatient,,,,401,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Vein Mapping Lower Extremity Bilat,12175095,LOCAL,93985,CPT,,,,,,Outpatient,,,,401,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Vein Mapping Upper Extremity Bilat,12175104,LOCAL,93985,CPT,,,,,,Outpatient,,,,401,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Vessel Mapping for Hemo Access Bilat,10216429,LOCAL,93985,CPT,,,,,,Outpatient,,,,401,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOP ART-LEA WITH ABI SEG PRESSURES,8230018,LOCAL,93923,CPT,,,,,,Outpatient,,,,401,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOP ART-UEA W/ PRESSURES UPPER,8230064,LOCAL,93923,CPT,,,,,,Outpatient,,,,401,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Segmental Pressures LE 3+ Lvls Bilat,1169755,LOCAL,93923,CPT,,,,,,Outpatient,,,,401,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Segmental Pressures UE 3+ Lvls Bilat,9759154,LOCAL,93923,CPT,,,,,,Outpatient,,,,401,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3913 Hand finger orthosis (HFO) without joints may include soft interface straps custom fabricated,9856095,LOCAL,,,L3913,HCPCS,,,,Outpatient,,,,403,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3913 HFO W/O JOINTS CF CHARGE,9856102,LOCAL,,,L3913,HCPCS,,,,Outpatient,,,,403,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Diagnostic Left w/ Tomo.,8058649,LOCAL,77065,CPT,,,,,LT,Outpatient,,,,334.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Diagnostic Right w/ Tomo.,8058652,LOCAL,77065,CPT,,,,,RT,Outpatient,,,,334.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Digital Diagnostic Left.,7918560,LOCAL,77065,CPT,,,,,LT,Outpatient,,,,334.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Digital Diagnostic Right.,7918563,LOCAL,77065,CPT,,,,,RT,Outpatient,,,,334.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Implant Diag Left w/ Tomo.,8058658,LOCAL,77065,CPT,,,,,LT,Outpatient,,,,334.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Implant Diag Right w/ Tomo.,8058661,LOCAL,77065,CPT,,,,,RT,Outpatient,,,,334.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Implant Digital Diag Left.,8058667,LOCAL,77065,CPT,,,,,LT,Outpatient,,,,334.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Implant Digital Diag Right.,8058670,LOCAL,77065,CPT,,,,,RT,Outpatient,,,,334.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Osseous Survey Limited,1170022,LOCAL,77074,CPT,,,,,,Outpatient,,,,335.78,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
94625 OUTPATIENT PULMONARY REHAB W/O CONTINIOUS MONITORING,10470029,LOCAL,94625,CPT,,,,,,Outpatient,,,,407,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Newborn Screen,8165282,LOCAL,84035,CPT,,,,,,Outpatient,,,,4.78,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Phenylketonuria, Blood SO",9565050,LOCAL,84030,CPT,,,,,,Outpatient,,,,6.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Susceptibility, Yeast, Comp. Panel QSTC",6250013,LOCAL,87186,CPT,,,,,,Outpatient,,,,10.38,VIVA,Commercial,,50,,85,27.49,85,1 through 10,percent of total billed charges,10.57,35.67132075,
US OB Limited,1169856,LOCAL,76815,CPT,,,,,,Outpatient,,,,339.08,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"L3702 Elbow orthosis, without joints, may include soft interface, straps, custom fabricated",9646073,LOCAL,,,L3702,HCPCS,,,,Outpatient,,,,412,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3702 ELBOW SPLINT,9856096,LOCAL,,,L3702,HCPCS,,,,Outpatient,,,,412,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL US Echo Dop w/ Spectral Complete,13736513,LOCAL,93320,CPT,,,,,,Outpatient,,,,414,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ECHO DOP W/SPECTRAL COMPLETE,8200180,LOCAL,93320,CPT,,,,,,Outpatient,,,,414,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"epoetin alfa 10,000 units/mL preservative-free Sol 1 mL [CULL]",11202387,LOCAL,J0885,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
74248 XR Small Bowel Follow Thru: AddOn,13626886,LOCAL,74248,CPT,,,,,,Outpatient,,,,341.55,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL XR Small Bowel Follow Thru,13626886,LOCAL,74248,CPT,,,,,,Outpatient,,,,341.55,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64486 TAP BLOCK UNILATERAL BY INJECTION(S),5661023,LOCAL,64486,CPT,,,,,,Outpatient,,,,415,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INTRO CATH RT HEART PA,8267102,LOCAL,36013,CPT,,,,,,Outpatient,,,,415,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
alteplase 2 mg injection [CULL],11201047,LOCAL,J2997,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Supersaturation, U24 SO",13938669,LOCAL,83945,CPT,,,,,,Outpatient,,,,17.34,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,17.73,24.085,
10060 DRAINAGE OF SKIN ABSCESS CHARGE,9704026,LOCAL,10060,CPT,,,,,,Outpatient,,,,420,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
10061 I & D COMPLEX,13048116,LOCAL,10061,CPT,,,,,,Outpatient,,,,420,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Prostate Biopsy,14048008,LOCAL,,,G0416,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Thoracolumbar 2 Views,1170490,LOCAL,72080,CPT,,,,,,Outpatient,,,,349.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
High LSO,9400071,LOCAL,,,L0648,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11102 Tangential Biopsy of Skin, 1 lesion",9620037,LOCAL,11102,CPT,,,,,,Outpatient,,,,427,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
16020 BURN DEBRIDEMENT/DRESSING INITIAL OR SUB,13043448,LOCAL,16020,CPT,,,,,,Outpatient,,,,427,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
16020 Chemical Canterizaiton,9400039,LOCAL,16020,CPT,,,,,,Outpatient,,,,427,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
17250 CAUTERY OF WOUND (ELECTRICAL),13033473,LOCAL,17250,CPT,,,,,,Outpatient,,,,427,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97606 Wound VAC >50 sq cm HBO,10015644,LOCAL,97606,CPT,,,,,,Outpatient,,,,427,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF ABO Discrep (ABSC),13481254,LOCAL,86850,CPT,,,,,,Outpatient,,,,11.72,VIVA,Commercial,,50,,11.06,11.06,11.06,1 through 10,percent of total billed charges,6.29,48.85,
TELEMETRY DAILY CHARGE,9341351,LOCAL,93229,CPT,,,,,,Outpatient,,,,311,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
13133 >  Each additional 5 cm or less (List separately in addition to primary procedure),12788295,LOCAL,13133,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"13133-Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; e",14746903,LOCAL,13133,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
82570 QST,14798876,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,17,17,17,1 through 10,percent of total billed charges,7.16,40.97514925,
"Leukotriene E4, Random, Urine QST",14798876,LOCAL,82542,CPT,,,,,,Outpatient,,,,28.91,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Antigen Type Group 3,10312933,LOCAL,86902,CPT,,,,,,Outpatient,,,,7.62,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"JC Polyoma Virus DNA, Qual PCR CSF QSTC",10170129,LOCAL,87798,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Skull Complete,1170438,LOCAL,70260,CPT,,,,,,Outpatient,,,,360.53,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only REF Washing,13514969,LOCAL,86999,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US AAA Screening,8058767,LOCAL,76706,CPT,,,,,,Outpatient,,,,362.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Abdomen Limited,1169569,LOCAL,76705,CPT,,,,,,Outpatient,,,,362.18,VIVA,Commercial,,50,,51.78,51.78,51.78,1 through 10,percent of total billed charges,97.22,161.71,
US Renal,7936319,LOCAL,76770,CPT,,,,,,Outpatient,,,,362.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Retroperitoneal Complete,1169867,LOCAL,76770,CPT,,,,,,Outpatient,,,,362.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Digital Screening Bilateral.,7918566,LOCAL,77067,CPT,,,,,,Outpatient,,,,363,VIVA,Commercial,,50,,338.22,338.22,338.22,1 through 10,percent of total billed charges,74,79.68,
MG Mammo Digital Screening Left.,7949062,LOCAL,77067,CPT,,,,,52|LT,Outpatient,,,,363,VIVA,Commercial,,50,,338.22,338.22,338.22,1 through 10,percent of total billed charges,74,79.68,
MG Mammo Digital Screening Right.,7949065,LOCAL,77067,CPT,,,,,52|RT,Outpatient,,,,363,VIVA,Commercial,,50,,338.22,338.22,338.22,1 through 10,percent of total billed charges,74,79.68,
MG Mammo Implant Digital Screening Bil.,8058673,LOCAL,77067,CPT,,,,,,Outpatient,,,,363,VIVA,Commercial,,50,,338.22,338.22,338.22,1 through 10,percent of total billed charges,74,79.68,
MG Mammo Implant Screening Bil w/ Tomo.,8058682,LOCAL,77067,CPT,,,,,,Outpatient,,,,363,VIVA,Commercial,,50,,338.22,338.22,338.22,1 through 10,percent of total billed charges,74,79.68,
MG Mammo Screening Bilateral w/ Tomo.,8058685,LOCAL,77067,CPT,,,,,,Outpatient,,,,363,VIVA,Commercial,,50,,338.22,338.22,338.22,1 through 10,percent of total billed charges,74,79.68,
64450 INJECTION PERIPHERAL NERVE OR BRANCH,5661030,LOCAL,64450,CPT,,,,,,Outpatient,,,,1613,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
57105 - BIOPSY VAGINAL MUCOSA EXTENSIVE,14749499,LOCAL,57105,CPT,,,,,,Outpatient,,,,3180,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
adenosine 3 mg/mL intravenous solution 30 mL [CULL],11201017,LOCAL,J0153,CPT,,,,,,Outpatient,30,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Immunoglobulins Panel, CSF QSTC",13864507,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LENS PRELOADED #PCB00,4851541,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LENS PRELOADED DCB00,4855985,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Fetal Biophysical Profile w/o N-Str,1169689,LOCAL,76819,CPT,,,,,,Outpatient,,,,369.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"FISH, Prenatal Scr Interp QSTC",13864670,LOCAL,88274,CPT,,,,,,Outpatient,,,,50.86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"FISH, Prenatal Screen QSTC",13864673,LOCAL,88271,CPT,,,,,,Outpatient,,,,25.7,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
zoledronic acid 4 mg/100 mL intravenous solution 100 mL [CULL],11211397,LOCAL,J3489,CPT,,,,,,Outpatient,100,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11104 Punch Biopsy,10017193,LOCAL,11104,CPT,,,,,,Outpatient,,,,449,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Abdomen Series Chest 1 View,1169932,LOCAL,74022,CPT,,,,,,Outpatient,,,,53.63,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Osseous Survey Complete,1170018,LOCAL,77075,CPT,,,,,,Outpatient,,,,372.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Cervical 6+ Views,1170461,LOCAL,72052,CPT,,,,,,Outpatient,,,,376.2,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"96365 IV INFUSION, MEDS, INITIAL 16-90 MINS",7904531,LOCAL,96365,CPT,,,,,,Outpatient,,,,457,VIVA,Commercial,,50,,206.31,112.86,206.31,13,percent of total billed charges,192.63,442.94,
"96365- IV tx, first hour",1928299,LOCAL,96365,CPT,,,,,,Outpatient,,,,457,VIVA,Commercial,,50,,206.31,112.86,206.31,13,percent of total billed charges,192.63,442.94,
US Aorta,7936256,LOCAL,76775,CPT,,,,,,Outpatient,,,,377.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Retroperitoneal Limited,1169869,LOCAL,76775,CPT,,,,,,Outpatient,,,,377.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
F/U EMBOLIZATION/INFUSION,8210730,LOCAL,75898,CPT,,,,,,Outpatient,,,,379.5,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Extremity Nonvascular Limited Left,2425338,LOCAL,76882,CPT,,,,,LT,Outpatient,,,,248.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Extremity Nonvascular Limited Right,2425341,LOCAL,76882,CPT,,,,,RT,Outpatient,,,,248.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Head/Neck Soft Tissue,1169729,LOCAL,76536,CPT,,,,,,Outpatient,,,,380.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
76000 XR Fluoroscopy Under 1 Hour: AddOn,13658083,LOCAL,76000,CPT,,,,,,Outpatient,,,,380.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64495 - INJ PARAVERT F JNT L/S 3 LEV,5661079,LOCAL,64495,CPT,,,,,,Outpatient,,,,462,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INTRO CAROTID VERTEBRAL ARTERY,8267188,LOCAL,36100,CPT,,,,,,Outpatient,,,,462,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Urography Retrograde,10454609,LOCAL,74420,CPT,,,,,,Outpatient,,,,383.63,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97607 Disp NP Wound Tx <=50 Sq Cm.,10017200,LOCAL,97607,CPT,,,,,,Outpatient,,,,466,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
".Thyroglobulin, LC/MS/MS QSTC",13864486,LOCAL,84432,CPT,,,,,,Outpatient,,,,19.27,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93017 CARDIAC STRESS TEST CHARGE,7938407,LOCAL,93017,CPT,,,,,,Outpatient,,,,469,VIVA,Commercial,,50,,134.15,134.15,134.15,1 through 10,percent of total billed charges,244.97,284.7,
CARDIAC STRESS W/TRACING,8200041,LOCAL,93017,CPT,,,,,,Outpatient,,,,469,VIVA,Commercial,,50,,134.15,134.15,134.15,1 through 10,percent of total billed charges,244.97,284.7,
NM Stress Test Trace,2426005,LOCAL,93017,CPT,,,,,,Outpatient,,,,469,VIVA,Commercial,,50,,134.15,134.15,134.15,1 through 10,percent of total billed charges,244.97,284.7,
64405 Occipital Nerve Block Unilateral,5661077,LOCAL,64405,CPT,,,,,,Outpatient,,,,879,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI 3D Reconstruction w/o Workstation,8108472,LOCAL,76376,CPT,,,,,,Outpatient,,,,391.88,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only REF Thawing & Washing RBC,13514967,LOCAL,86931,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3808 Forearm based orthosis w/o dynamic,9856093,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,,89,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT CARPAL TUNNEL SPLINTS,9646074,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,,89,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF HLA ABSC,13484120,LOCAL,86829,CPT,,,,,,Outpatient,,,,77.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF HPA-1 Typing,13481256,LOCAL,81105,CPT,,,,,,Outpatient,,,,146.66,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93571 Cor Flow Wire 1st Measure,8230055,LOCAL,93571,CPT,,,,,,Outpatient,,,,477,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LENS #ACU0T0,4853561,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LENS #SN60WF,4891100,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrocentesis Asp/Inj Intmed Jt Lt,14807134,LOCAL,20605,CPT,,,,,LT,Outpatient,,,,336,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrocentesis Asp/Inj Intmed Jt Rt,14807137,LOCAL,20605,CPT,,,,,RT,Outpatient,,,,336,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrocentesis Asp/Inj Major Jt Bilat,14807140,LOCAL,20610,CPT,,,,,50,Outpatient,,,,650,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrocentesis Asp/Inj Major Jt Lt,14807143,LOCAL,20610,CPT,,,,,LT,Outpatient,,,,650,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrocentesis Asp/Inj Major Jt Rt,14807146,LOCAL,20610,CPT,,,,,RT,Outpatient,,,,650,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrocentesis Asp/Inj Small Jt Lt,14807149,LOCAL,20600,CPT,,,,,LT,Outpatient,,,,295,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrocentesis Asp/Inj Small Jt Rt,14807152,LOCAL,20600,CPT,,,,,RT,Outpatient,,,,295,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Colon Barium Enema,9427624,LOCAL,74270,CPT,,,,,,Outpatient,,,,396.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOP VENOUS LOWER EXT BILATERAL,8200420,LOCAL,93970,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOP VENOUS UPPER EXT BIL,8200421,LOCAL,93970,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUP AO IVC ILIAC COMPLETE,8200530,LOCAL,93978,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUP CAROTID BILATERAL,8200370,LOCAL,93880,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUP CAROTID UNI,8200380,LOCAL,93882,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUP HEPATOPORTAL INFLOW/OUTFLOW COMP,8200434,LOCAL,93975,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUP MESENTERIC/CELIAC ARTERY IN/OUT COMP,8200433,LOCAL,93975,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUP RENAL ARTERIES INFLOW/OUTFLOW COMP,8200432,LOCAL,93975,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUPLEX ARTERIAL LOWER EXT BIL,8200460,LOCAL,93925,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUPLEX ARTERIAL UPPER EXT BIL,8200480,LOCAL,93930,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Abdomen Vascular Limited,8206811,LOCAL,93975,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Aorta IVC Iliac Duplex Complete,1169577,LOCAL,93978,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Art/Vein Abd/Pelvis/Scrotal Complete,1169581,LOCAL,93975,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Carotid Duplex Bilateral,1169631,LOCAL,93880,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Carotid Duplex Left,8814383,LOCAL,93882,CPT,,,,,LT,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Carotid Duplex Right,8814386,LOCAL,93882,CPT,,,,,RT,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Lower Ext Arterial Duplex Bilateral,1169759,LOCAL,93925,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Lower Ext Venous Duplex Bilateral,1169769,LOCAL,93970,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Renal Artery Duplex Bilateral,4246822,LOCAL,93975,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Upper Ext Arterial Duplex Bilateral,1169895,LOCAL,93930,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Upper Ext Venous Duplex Bilateral,1169901,LOCAL,93970,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUP RENAL ARTERIES UNI,8200585,LOCAL,93976,CPT,,,,,,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Renal Artery Duplex Left,4246828,LOCAL,93976,CPT,,,,,LT,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Renal Artery Duplex Right,4246843,LOCAL,93976,CPT,,,,,RT,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acetylcholine Receptor Binding Ab QSTC,8853232,LOCAL,86041,CPT,,,,,,Outpatient,,,,22.08,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Small Bowel Series,12908279,LOCAL,74250,CPT,,,,,,Outpatient,,,,401.78,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chlamydophila pneumoniae QSTC,9727429,LOCAL,87486,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Human RSV A QSTC,9727398,LOCAL,87633,CPT,,,,,,Outpatient,,,,500.14,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mycoplasma pneumoniae QSTC,9727431,LOCAL,87581,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF Antibody Titer,7943112,LOCAL,86886,CPT,,,,,,Outpatient,,,,6.22,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64494 - INJ PARAVERT F JNT L/S 2 LEV,5661036,LOCAL,64494,CPT,,,,,,Outpatient,,,,495,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF HLA PLT ABSC,13479160,LOCAL,86829,CPT,,,,,,Outpatient,,,,77.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF PLT ABSC,13484122,LOCAL,86022,CPT,,,,,,Outpatient,,,,22.04,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95822 EEG COMA OR SLEEP ONLY CHARGE,8687098,LOCAL,95822,CPT,,,,,,Outpatient,,,,499,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EEG EXTENDED 41-60 MINUTES CHARGE,13515636,LOCAL,95812,CPT,,,,,,Outpatient,,,,499,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Diagnostic Bilateral w/ Tomo.,8058646,LOCAL,77066,CPT,,,,,,Outpatient,,,,413.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Digital Diagnostic Bilat.,7918557,LOCAL,77066,CPT,,,,,,Outpatient,,,,413.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Implant Diag Bilateral w/ Tomo.,8058655,LOCAL,77066,CPT,,,,,,Outpatient,,,,413.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Implant Diag Bilateral w/ Tomo.,8058655,LOCAL,G0279,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Implant Digital Diag Bilateral.,8058664,LOCAL,77066,CPT,,,,,,Outpatient,,,,413.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pen G Benz/Proc (Bicillin CR) [CULL],11202075,LOCAL,J0558,CPT,,,,,,Outpatient,2,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97608 Disp NP Wound Tx >50 Sq Cm.,10017187,LOCAL,97608,CPT,,,,,,Outpatient,,,,505,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Antigen Type Group 4,10312939,LOCAL,86902,CPT,,,,,,Outpatient,,,,7.62,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64491 INJ PARAVER CERV/THOR 2ND LEVEL,5661064,LOCAL,64491,CPT,,,,,,Outpatient,,,,509,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64492 FACET CERV/THOR 3RD ADDTL LEVEL CHARGE,5661080,LOCAL,64492,CPT,,,,,,Outpatient,,,,509,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"FISH, Locus Specific X2 100 QSTC",13864693,LOCAL,88271,CPT,,,,,,Outpatient,,,,25.7,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - DISK 14MM 2,13962583,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Liver Fibrosis, Fibro-ActiTest Pnl QSTC",8764813,LOCAL,81596,CPT,,,,,,Outpatient,,,,86.63,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Specimen Source: FISH Locus Pr x2 QSTC,13864687,LOCAL,88275,CPT,,,,,,Outpatient,,,,61.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ICD DFT TESTING,8231015,LOCAL,93641,CPT,,,,,,Outpatient,,,,512,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99204 New patient-level 4 specialty clinic,13538609,LOCAL,,,G0463,HCPCS,,,,Outpatient,,,,326,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99204 Office Visit New Pt. Level 4,10168483,LOCAL,99204,CPT,,,,,,Outpatient,,,,513,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99204 Office Visit New Pt. Level 4,10168483,LOCAL,99204,CPT,,,,,,Outpatient,,,,513,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99214 LEVEL IV VISIT CHARGE,9319023,LOCAL,99214,CPT,,,,,,Outpatient,,,,513,VIVA,Commercial,,50,,419.25,91.59,419.25,1 through 10,percent of total billed charges,80.51,80.51,
99214 Office Visit Established Pt. Level 4,10168488,LOCAL,99214,CPT,,,,,,Outpatient,,,,513,VIVA,Commercial,,50,,419.25,91.59,419.25,1 through 10,percent of total billed charges,80.51,80.51,
New Patient Level 4,13436278,LOCAL,99204,CPT,,,,,25,Outpatient,,,,513,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
New Patient Level 4,13436278,LOCAL,G0463,CPT,,,,,25,Outpatient,,,,326,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
36593 DECLOT IMPLANT DEVICE/CATHETER CHARGE,8700839,LOCAL,36593,CPT,,,,,,Outpatient,,,,517,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64590  Insertion or replacement of peripheral or gastric neurostimulator pulse generator,8529396,LOCAL,64590,CPT,,,,,,Outpatient,,,,519,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Transvaginal Non-OB,1169889,LOCAL,76830,CPT,,,,,,Outpatient,,,,428.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
JAK2 V617F Mutation Analysis QSTC,9039438,LOCAL,81270,CPT,,,,,,Outpatient,,,,109.99,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TPMT Genotype QSTC,10168397,LOCAL,81335,CPT,,,,,,Outpatient,,,,209.77,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LENS CLAREON CCA0T0,4802028,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LENS CLAREON CNA0T0,4890000,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95816 EEG AWAKE AND DROWSY CHARGE,8303772,LOCAL,95816,CPT,,,,,,Outpatient,,,,533,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ADD'L ART 2ND/3RD ABD,8267115,LOCAL,36248,CPT,,,,,,Outpatient,,,,533,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Lumbosacral 4 Plus Views,1170476,LOCAL,72110,CPT,,,,,,Outpatient,,,,441.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"GAD65, IA-2 and Insulin Autoantibody QSTC",14105691,LOCAL,86337,CPT,,,,,,Outpatient,,,,25.69,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"GAD65, IA-2 and Insulin Autoantibody QSTC.",14621959,LOCAL,86337,CPT,,,,,,Outpatient,,,,25.69,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LENS #DIB00,4803761,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92978 Cath IVUS First Vessel,8230048,LOCAL,92978,CPT,,,,,,Outpatient,,,,538,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Rho D Immune Globulin, Human, full dose, 300 micrograms, INJ",90620010,LOCAL,J2790,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Knee SI Left,2425410,LOCAL,73580,CPT,,,,,LT,Outpatient,,,,447.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Knee SI Right,2425413,LOCAL,73580,CPT,,,,,RT,Outpatient,,,,447.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abeta 40 - QST,13874686,LOCAL,82233,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abeta 42 - QST,13874685,LOCAL,82234,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PASSY-MUIR PMV2001- 703-2001,8800100,LOCAL,,,L8501,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"epoetin alfa-epbx 20,000 units/mL injectable solution 1 mL [CULL]",11202388,LOCAL,Q5106,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
36005 Venogram Injection,8212037,LOCAL,36005,CPT,,,,,,Outpatient,,,,551,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
levothyroxine 40 mcg (0.04 mg)/mL intravenous solution 5 mL [CULL],11202740,LOCAL,J0650,CPT,,,,,,Outpatient,5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Upper GI w/ Air Contrast,1170566,LOCAL,74246,CPT,,,,,,Outpatient,,,,492.53,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Upper GI w/ Air w/ Small Bowel,1170570,LOCAL,74246,CPT,,,,,,Outpatient,,,,492.53,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPINEPHrine 1 mg/mL injectable solution 30 mL [CULL],11202381,LOCAL,J0165,CPT,,,,,,Outpatient,30,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Scrotum (Contents),8206982,LOCAL,76870,CPT,,,,,,Outpatient,,,,463.65,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US OB Transvaginal,1169861,LOCAL,76817,CPT,,,,,,Outpatient,,,,464.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93308 LMTD STUDENT ECHOCARDIOGRAM CHARGE,6011002,LOCAL,93308,CPT,,,,,,Outpatient,,,,564,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ECHO 2D LTD,8200150,LOCAL,93308,CPT,,,,,,Outpatient,,,,564,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Echo 2D Limited,8071400,LOCAL,93308,CPT,,,,,,Outpatient,,,,564,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumonia Panel (Biofire),9594219,LOCAL,87633,CPT,,,,,,Outpatient,,,,500.14,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tbo-filgrastim 300 mcg/0.5 mL subcutaneous solution 0.5 mL [CULL],11202449,LOCAL,J1447,CPT,,,,,,Outpatient,0.5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Colon Barium Enema w/ Air Contrast,9427627,LOCAL,74280,CPT,,,,,,Outpatient,,,,467.78,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CARDIAC THROMBOLYTICS IV,8267127,LOCAL,92977,CPT,,,,,,Outpatient,,,,568,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Thyroid Imaging,2426008,LOCAL,78013,CPT,A9512,HCPCS,,,,Outpatient,,,,471.08,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92612 - ENDOSCOPY SWALLOW TST (FEES),9636010,LOCAL,92612,CPT,,,,,GN,Outpatient,,,,575,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92612 Fiber Endo Eval Swallow Video Charge,9410192,LOCAL,92612,CPT,,,,,GN,Outpatient,,,,575,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Fiberoptic Swallow Eval Units,1373844,LOCAL,92612,CPT,,,,,GN,Outpatient,,,,575,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Speech Fiberoptic Swallow Eval Charge,1373844,LOCAL,92612,CPT,,,,,GN,Outpatient,,,,575,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99284 - Level 4,2644300,LOCAL,99284,CPT,,,,,25,Outpatient,,,,576,VIVA,Commercial,,50,,406.54,406.54,406.54,41,percent of total billed charges,389.31,389.31,
3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase (HMGCR) Antibody (IgG) QSTC,13864471,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hips 5+ Views Bilat,7520618,LOCAL,73523,CPT,,,,,,Outpatient,,,,477.68,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hips 5+ Views w/AP Pelvis Bilat,7520621,LOCAL,73523,CPT,,,,,,Outpatient,,,,477.68,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Barium Swallow w/ Upper GI + KUB,8912828,LOCAL,74240,CPT,,,,,,Outpatient,,,,477.68,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Upper GI,1170562,LOCAL,74240,CPT,,,,,,Outpatient,,,,477.68,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Upper GI w/ Small Bowel,1170574,LOCAL,74240,CPT,,,,,,Outpatient,,,,477.68,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ceftaroline 600 mg intravenous injection [CULL],11201425,LOCAL,J0712,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"ANNA3 Ab, IFA, CSF QSTC",13873554,LOCAL,86255,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"GAD65 Ab, IFA, CSF QSTC",13873575,LOCAL,86341,CPT,,,,,,Outpatient,,,,28.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TPMT Activity QSTC,8764663,LOCAL,84433,CPT,,,,,,Outpatient,,,,26.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CATH PL 1ST ORDER VENOUS,8267186,LOCAL,36011,CPT,,,,,,Outpatient,,,,590,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VENOGRAM INJ BILATERAL,8267755,LOCAL,36005,CPT,,,,,,Outpatient,,,,551,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Barium Swallow w/ Upper GI w/ Air,13554969,LOCAL,74246,CPT,,,,,,Outpatient,,,,492.53,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95819 EEG AWAKE & ASLEEP CHARGE,8704890,LOCAL,95819,CPT,,,,,,Outpatient,,,,599,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Biopsy Abdomen/Retroperitoneal Mass,8565247,LOCAL,76942,CPT,,,,,,Outpatient,,,,497.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Biopsy Liver,1169599,LOCAL,76942,CPT,,,,,,Outpatient,,,,497.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Breast Needle Loc Left,7936259,LOCAL,19285,CPT,,,,,LT,Outpatient,,,,603,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Breast Needle Loc Right,7936262,LOCAL,19285,CPT,,,,,RT,Outpatient,,,,603,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US NEEDLE PLACEMENT CVS,8200510,LOCAL,76942,CPT,,,,,,Outpatient,,,,497.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Cholangiogram T-Tube Check,8207012,LOCAL,47531,CPT,,,,,,Outpatient,,,,298,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - DISK 16MM 2,13962585,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Elbow SI Left,2425398,LOCAL,73085,CPT,,,,,LT,Outpatient,,,,500.78,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Elbow SI Right,2425401,LOCAL,73085,CPT,,,,,RT,Outpatient,,,,500.78,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bartonella DNA, Qual, RT PCR QSTC",13864512,LOCAL,87471,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BiPAP Charge -> Subsequent,2678299,LOCAL,94003,CPT,,,,,,Outpatient,,,,613,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Lung Perfusion Imaging,1169328,LOCAL,78580,CPT,A9540,HCPCS,,,,Outpatient,,,,508.2,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64999 PERI-INFILTRATION HARDWARE,5661083,LOCAL,64999,CPT,,,,,,Outpatient,,,,620,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3806 OT WRIST HAND FINGER ORTHOSIS,9856094,LOCAL,,,L3806,HCPCS,,,,Outpatient,,,,628,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"penicillin G benzathine 1,200,000 units/2 mL intramuscular suspension 2 mL [CULL]",11202076,LOCAL,J0561,CPT,,,,,,Outpatient,2,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ADD'L ART 2ND/3RD THORAC,8267111,LOCAL,36218,CPT,,,,,,Outpatient,,,,631,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CATH PLACE SEG SUBSEG PA,8267104,LOCAL,36015,CPT,,,,,,Outpatient,,,,637,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Abdomen Complete,1169567,LOCAL,76700,CPT,,,,,,Outpatient,,,,528,VIVA,Commercial,,50,,492.23,492.23,492.23,1 through 10,percent of total billed charges,97.22,245.49,
BiPAP Charge -> Initial,2678300,LOCAL,94002,CPT,,,,,,Outpatient,,,,663,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BiPAP/CPAP Mode -> NIMV,2678300,LOCAL,94002,CPT,,,,,,Outpatient,,,,663,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ECHOCARDIOGRAM 2D W/STRESS,8200440,LOCAL,93350,CPT,,,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
16025 DRESS AN/OR DEBMT BURN INI MED CHARGE,8020080,LOCAL,16025,CPT,,,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Heart/Coronary Arteries,9515210,LOCAL,75574,CPT,,,,,,Outpatient,,,,532.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
20610 INJECT MAJOR JOINT,5661087,LOCAL,20610,CPT,,,,,,Outpatient,,,,650,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methylene blue 5 mg/mL intravenous solution 10 mL [CULL],11202913,LOCAL,Q9968,CPT,,,,,,Outpatient,10,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OASIS MATRIX WOUND 3 X 7 CM,13962592,LOCAL,,,Q4102,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Parathyroid Imaging w/ Spect Inj/Scan,2425984,LOCAL,78071,CPT,A9500,HCPCS,,,,Outpatient,,,,331.65,VIVA,Commercial,,50,,53.77,53.77,53.77,1 through 10,percent of total billed charges,367.38,560.96,
XR Arthrogram Hip SI Left,2425404,LOCAL,73525,CPT,,,,,LT,Outpatient,,,,538.73,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Hip SI Right,2425407,LOCAL,73525,CPT,,,,,RT,Outpatient,,,,538.73,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INTRO EXTREMITY ARTERY,8267105,LOCAL,36140,CPT,,,,,,Outpatient,,,,664,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PERC CHANGE TUBE OR DRAINAGE CATH S&I,8210742,LOCAL,75984,CPT,,,,,,Outpatient,,,,551.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Drainage Perc Cath Replace,9343679,LOCAL,75984,CPT,,,,,,Outpatient,,,,551.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11107 INCAL BX SKN EA SEP/ADDL CHARGE,9704096,LOCAL,11107,CPT,,,,,,Outpatient,,,,670,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CYSTOGRAM S&I,8211185,LOCAL,74430,CPT,,,,,,Outpatient,,,,554.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Cystogram,4126362,LOCAL,74430,CPT,,,,,,Outpatient,,,,554.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Lw Int Arth/Asp/Inj Left,3148332,LOCAL,20606,CPT,,,,,LT,Outpatient,,,,673,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Lw Int Arth/Asp/Inj Right,3148335,LOCAL,20606,CPT,,,,,RT,Outpatient,,,,673,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Lw Maj Arth/Asp/Inj Left,3148338,LOCAL,20611,CPT,,,,,LT,Outpatient,,,,673,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Lw Maj Arth/Asp/Inj Right,3148341,LOCAL,20611,CPT,,,,,RT,Outpatient,,,,673,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Lw Sm Arth/Asp/Inj Left,6130396,LOCAL,20604,CPT,,,,,LT,Outpatient,,,,673,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Lw Sm Arth/Asp/Inj Right,6130399,LOCAL,20604,CPT,,,,,RT,Outpatient,,,,673,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Up Int Arth/Asp/Inj Left,2425353,LOCAL,20606,CPT,,,,,LT,Outpatient,,,,673,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Up Int Arth/Asp/Inj Right,2425356,LOCAL,20606,CPT,,,,,RT,Outpatient,,,,673,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Up Maj Arth/Asp/Inj Left,2425359,LOCAL,20611,CPT,,,,,LT,Outpatient,,,,673,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Up Maj Arth/Asp/Inj Right,2425362,LOCAL,20611,CPT,,,,,RT,Outpatient,,,,673,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Up Sm Arth/Asp/Inj Left,6130402,LOCAL,20604,CPT,,,,,LT,Outpatient,,,,673,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Up Sm Arth/Asp/Inj Right,6130405,LOCAL,20604,CPT,,,,,RT,Outpatient,,,,673,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GASTRO-JEJUNOSTOMY TUBE REPLACEMENT,8200254,LOCAL,49452,CPT,,,,,,Outpatient,,,,676,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chikungunya Virus RNA, Qual RT PCR QSTC",13864475,LOCAL,87798,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ARTERIAL LINE PLACEMENT,8210320,LOCAL,36620,CPT,,,,,,Outpatient,,,,684,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Hepatobiliary Imaging,2425957,LOCAL,78226,CPT,,,,,,Outpatient,,,,567.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DART FIRE EDGE SCREW,4810328,LOCAL,,,C1716,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NEPHROSTOGRAM S&I,8212039,LOCAL,74425,CPT,,,,,,Outpatient,,,,575.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
glucagon 1 mg injection [CULL],11282210,LOCAL,J1610,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99205 LEVEL V INITIAL VISIT FAC CHARGE,12832503,LOCAL,99205,CPT,,,,,,Outpatient,,,,701,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99205 New patient-level 5 specialty clinic,13538610,LOCAL,,,G0463,HCPCS,,,,Outpatient,,,,326,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99205 Office Visit New Pt. Level 5,10168484,LOCAL,99205,CPT,,,,,,Outpatient,,,,701,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99205 Office Visit New Pt. Level 5,10168484,LOCAL,99205,CPT,,,,,,Outpatient,,,,701,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99215 LEVEL V VISIT CHARGE,9322144,LOCAL,99215,CPT,,,,,,Outpatient,,,,701,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99215 Office Visit Established Pt. Level 5,10168489,LOCAL,99215,CPT,,,,,,Outpatient,,,,701,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Leptospira DNA, Qual RT PCR QSTC",13864445,LOCAL,87798,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fungal Sequencing, ITS Region QSTC",13864438,LOCAL,87153,CPT,,,,,,Outpatient,,,,138.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cortisol, Free, LC/MS, Serum QSTC",8972878,LOCAL,82530,CPT,,,,,,Outpatient,,,,20.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
acetylcysteine 20% intravenous solution 30 mL [CULL],11200013,LOCAL,J0132,CPT,,,,,,Outpatient,30,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pneumocystis jirovecii,Qual Real-Time PCR QSTC",9215420,LOCAL,87798,CPT,,,,,,Outpatient,,,,42.11,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CATH PL 2ND ORDER VENOUS,8267187,LOCAL,36012,CPT,,,,,,Outpatient,,,,730,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Gastrointestinal Blood Loss Imaging,1169242,LOCAL,78278,CPT,A9512,HCPCS,,,,Outpatient,,,,603.08,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bird Fancier's Precipitin Panel I QSTC,13864443,LOCAL,86331,CPT,,,,,,Outpatient,,,,14.38,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99285 - Level 5,2644301,LOCAL,99285,CPT,,,,,25,Outpatient,,,,738,VIVA,Commercial,,50,,218.95,218.95,218.95,23,percent of total billed charges,560.53,560.53,
chlorothiazide 0.5 g intravenous injection [CULL],11240810,LOCAL,J1205,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Breast ABUS Bilateral.,13939856,LOCAL,76641,CPT,,,,,50,Outpatient,,,,306.9,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR ERCP Biliary,8649296,LOCAL,74328,CPT,,,,,,Outpatient,,,,612.98,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR ERCP Pancreatic,8649299,LOCAL,74329,CPT,,,,,,Outpatient,,,,612.98,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
amphotericin B liposomal 50 mg intravenous injection [CULL],11202015,LOCAL,J0289,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GUIDED PERC DRAIN W CATH S&I,8210333,LOCAL,75989,CPT,,,,,,Outpatient,,,,618.75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Pelvic Comp,8206964,LOCAL,76856,CPT,,,,,,Outpatient,,,,622.05,VIVA,Commercial,,50,,579.73,579.73,579.73,1 through 10,percent of total billed charges,97.22,245.49,
29445 APPL RIGID LEG CAST,9739196,LOCAL,29445,CPT,,,,,,Outpatient,,,,266,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Hyperthyroid Therapy,8567789,LOCAL,79005,CPT,A9517,HCPCS,,,,Outpatient,,,,622.88,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Scoliosis 1 View,7520627,LOCAL,72081,CPT,,,,,,Outpatient,,,,627.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Wrist SI Left,2425422,LOCAL,73115,CPT,,,,,LT,Outpatient,,,,631.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Wrist SI Right,2425425,LOCAL,73115,CPT,,,,,RT,Outpatient,,,,631.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E3077 Aph Plt ACDA LR,7266775,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E3087 Aph Plt ACDA LR 1,7266780,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E3088 Aph Plt ACDA LR 2,7266781,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E3089 Aph Plt ACDA LR 3,7266782,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4643 Aph Plt ACDA LR <3E11,7266909,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E5030 Aph Plt ACDA LR BM,8058823,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E5032 Aph Plt ACDA LR BM 2,8029134,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E5033 Aph Plt ACDA LR BM 3,8058812,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E5036 Aph Plt ACDA LR Irr BM 2,8029108,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E5075 Aph Plt ACDA LR <3E11 BM,8058809,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E9232 Aph Plt ACDA LR BT6,10074919,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E5031  Aph Plt ACDA LR BM 1,8029138,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64480 CERVICAL THORACIC TRANSFORAMINAL EACH AD,5661052,LOCAL,64480,CPT,,,,,,Outpatient,,,,776,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95824 EEG CEREBRAL DEATH EVALUATION ONLY CHARGE,9646722,LOCAL,95824,CPT,,,,,,Outpatient,,,,776,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BREAST SIZER SMOOTH ROUND HIGH 565CC,4850931,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE 505HP,4840154,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"RT CHARGE Ventilator Restart, Ongoing -> Yes",12109384,LOCAL,94003,CPT,,,,,,Outpatient,,,,613,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - 1.75 X 1.75CM,13962575,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Prostaglandin D2 (Pg D2), Urine QST",12667576,LOCAL,84150,CPT,,,,,,Outpatient,,,,50.12,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15274 App Skin Sub Graft (TWSA>100cm2) t/s/l ; add 100 cm 2,12642329,LOCAL,15274,CPT,,,,,,Outpatient,,,,800,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15278 APPL-HC SKSB GRT F/N/H/G-KD A100 CHARGE,9709036,LOCAL,15278,CPT,,,,,,Outpatient,,,,800,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11106 INCAL BX SKN SINGLE LES CHARGE,9704095,LOCAL,11106,CPT,,,,,,Outpatient,,,,800,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aquaporin-4 (AQP4) (NMO-IgG) Antibody with Reflex to Titer, Serum QSTC",10041610,LOCAL,86052,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"JC Polyoma Virus DNA, Qnt PCR, Serum QSTC",10274092,LOCAL,87799,CPT,,,,,,Outpatient,,,,51.41,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"NMO Spectrum Eval (AQP4 w/Rflx toMOG), Serum QSTC",10274088,LOCAL,86052,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"64520 Injection Lumbar or Thoracic, Paravertebral Sympathetic",5661043,LOCAL,64520,CPT,,,,,,Outpatient,,,,806,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96413 CHEMO IV INFUSION 1ST HR INF CHARGE,9665725,LOCAL,96413,CPT,,,,,,Outpatient,,,,809,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF Genetic RBC Phenotyping,13481257,LOCAL,81403,CPT,,,,,,Outpatient,,,,222.24,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Liver/Spleen Imaging Injection/Scan,1169286,LOCAL,78215,CPT,A9541,HCPCS,,,,Outpatient,,,,669.08,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"CBFB/MYH11 inv(16), Quant RT PCR QSTC",13864502,LOCAL,81401,CPT,,,,,,Outpatient,,,,164.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF PLT Crossmatch,13481259,LOCAL,86022,CPT,,,,,,Outpatient,,,,22.04,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
epoetin alfa 20000 units/mL Sol 1 mL [CULL],11202388,LOCAL,J0885,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admark Phospho Tau/Ttl Ab42 Comments QST,13877904,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admark Phospho Tau/Ttl Ab42 Interp QST,13877902,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admark Phospho Tau/Ttl Ab42 Methods QST,13877905,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
62320 Cervical/Thoracic Epidural without Fluor,5661014,LOCAL,62320,CPT,,,,,,Outpatient,,,,835,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11042 DEB SQ TISSUE-1ST 20SQCM/< CHARGE,9704056,LOCAL,11042,CPT,,,,,,Outpatient,,,,836,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11043 DEB MUS/FASCIA-1ST 20SQCM/< CHARGE,9704059,LOCAL,11043,CPT,,,,,,Outpatient,,,,836,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11045 Debrid bone 1st 20 sq cm charge,12510099,LOCAL,11045,CPT,,,,,,Outpatient,,,,836,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11045 Debrid Sub Tissue > 20 sq cm charge,12511974,LOCAL,11045,CPT,,,,,,Outpatient,,,,836,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11046 DEB MUS/FASCIA-EA ADDL 20SQCM CHARGE,9704068,LOCAL,11046,CPT,,,,,,Outpatient,,,,836,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Urethrocystography Retrograde,1170578,LOCAL,74450,CPT,,,,,,Outpatient,,,,697.95,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MTB Complex Rifampin Resist PCR Sput QSTC,8873578,LOCAL,87801,CPT,,,,,,Outpatient,,,,84.24,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US OB Greater Than 14 Weeks Single,8583651,LOCAL,76805,CPT,,,,,,Outpatient,,,,130.35,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Parathyroid Imaging Injection/Scan,1169316,LOCAL,78070,CPT,A9500,HCPCS,,,,Outpatient,,,,710.33,VIVA,Commercial,,50,,53.77,53.77,53.77,1 through 10,percent of total billed charges,367.38,1409.71,
NM Bone Marrow Imaging Whole Body,1169186,LOCAL,78104,CPT,A9541,HCPCS,,,,Outpatient,,,,711.98,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
16030 DRESS AN/OR DEBMT BURN INI LG CHARGE,8020081,LOCAL,16030,CPT,,,,,,Outpatient,,,,863,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93660 STRESS TILT TABLE CHARGE,8200435,LOCAL,93660,CPT,,,,,,Outpatient,,,,870,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
JEJUNOSTOMY PERC,8200251,LOCAL,49441,CPT,,,,,,Outpatient,,,,870,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial 16S rDNA Sequencing QSTC,8873571,LOCAL,87153,CPT,,,,,,Outpatient,,,,138.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64620 DESTR INTERCOSTAL NERVE,5661066,LOCAL,64620,CPT,,,,,,Outpatient,,,,874,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64634 DESTR FACET CRV/THR EA ADL LVL,5661058,LOCAL,64634,CPT,,,,,,Outpatient,,,,874,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15002 SITE PREP -100 SQCM(TAL),12625535,LOCAL,15002,CPT,,,,,,Outpatient,,,,877,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64405 OCCIPITAL - BILATERAL CHARGE,5661078,LOCAL,64405,CPT,,,,,,Outpatient,,,,879,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
conjugated estrogens 25 mg injection [CULL],11201516,LOCAL,J1410,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
10120 Incision & removal of Foreign Body Simple,9620024,LOCAL,10120,CPT,,,,,,Outpatient,,,,893,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
62321 CERVICAL THORACIC EPIDURAL,5661016,LOCAL,62321,CPT,,,,,,Outpatient,,,,894,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64520 LUMBAR OR THORACIC Sympathetic Charge,5661033,LOCAL,64520,CPT,,,,,,Outpatient,,,,806,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64490 INJ PARAVER CERV/THOR 1ST LEVEL,5661063,LOCAL,64490,CPT,,,,,,Outpatient,,,,895,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INTRO CATH AORTA,8267107,LOCAL,36200,CPT,,,,,,Outpatient,,,,897,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tbo-filgrastim 480 mcg/0.8 mL subcutaneous solution 0.8 mL [CULL],11202451,LOCAL,J1447,CPT,,,,,,Outpatient,0.8,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64479 CERVICAL THORACIC TRANSFORAMINAL EPIDRL,5661051,LOCAL,64479,CPT,,,,,,Outpatient,,,,909,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BUPivacaine liposome 1.3% (13.3 mg/mL) injectable suspension 20 mL [CULL],11202119,LOCAL,J0666,CPT,,,,,,Outpatient,20,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
62323 LUMBAR OR CAUDAL EPIDURAL,5661015,LOCAL,62323,CPT,,,,,,Outpatient,,,,915,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PERC ASPIRATION DISC,8230054,LOCAL,62267,CPT,,,,,,Outpatient,,,,916,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPIFIX SKIN SUBSTITUTE 14MM,13962560,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64510 NERV BLK STELLATE GANGLION,5661032,LOCAL,64510,CPT,,,,,,Outpatient,,,,922,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when per",9520503,LOCAL,64624,CPT,,,,,,Outpatient,,,,926,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64640 DESTR OTH PERIPHERAL NERVE/BRCH,5661065,LOCAL,64640,CPT,,,,,,Outpatient,,,,927,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
62290 INJ DISKOGRAPH LUMBAR EA LVL,5661062,LOCAL,62290,CPT,,,,,,Outpatient,,,,931,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11400 EXC BENIGN LES-T/A/L 0.5CM OR < CHARGE FACILITY,9704107,LOCAL,11400,CPT,,,,,,Outpatient,,,,935,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PLACE ART 2ND ABD & BELOW,8267113,LOCAL,36246,CPT,,,,,,Outpatient,,,,937,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Kidney Imaging Single w/ Pharm,1169262,LOCAL,78708,CPT,A9562,HCPCS,,,,Outpatient,,,,775.5,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"92950 Cardiopulmonary resuscitation (eg, in cardiac arrest)",7968980,LOCAL,92950,CPT,,,,,,Outpatient,,,,941,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92950 Cardiopulmonary Resuscitation Cath Lab,8212013,LOCAL,92950,CPT,,,,,,Outpatient,,,,941,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92950 CARDIOPULMONARY RESUSCITATION CHARGE,8207219,LOCAL,92950,CPT,,,,,,Outpatient,,,,941,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE Ventilator Initiate -> Yes,12109383,LOCAL,94002,CPT,,,,,,Outpatient,,,,663,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Inflammation Loc Limited,1226092,LOCAL,78800,CPT,,,,,,Outpatient,,,,783.75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Inflammation Loc Limited - Ceretec,1169144,LOCAL,78800,CPT,A9521,HCPCS,,,,Outpatient,,,,783.75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11402 EXC BENIGN LES-T/A/L 1.1-2.0 CM CHARGE,9704151,LOCAL,11402,CPT,,,,,,Outpatient,,,,963,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
62273 BLOOD PATCH,5661017,LOCAL,62273,CPT,,,,,,Outpatient,,,,971,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"13131-Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1",14749500,LOCAL,13131,CPT,,,,,,Outpatient,,,,400,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Fingers w/ Contrast Left,9343664,LOCAL,73219,CPT,,,,,LT,Outpatient,,,,813.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Fingers w/ Contrast Right,9343667,LOCAL,73219,CPT,,,,,RT,Outpatient,,,,813.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Forearm w/ Contrast Left,8206725,LOCAL,73219,CPT,,,,,LT,Outpatient,,,,813.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Forearm w/ Contrast Right,8206727,LOCAL,73219,CPT,,,,,RT,Outpatient,,,,813.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hand w/ Contrast Left,1168924,LOCAL,73219,CPT,,,,,LT,Outpatient,,,,813.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hand w/ Contrast Right,1168926,LOCAL,73219,CPT,,,,,RT,Outpatient,,,,813.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Humerus w/ Contrast Left,8206756,LOCAL,73219,CPT,,,,,LT,Outpatient,,,,813.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Humerus w/ Contrast Right,8206758,LOCAL,73219,CPT,,,,,RT,Outpatient,,,,813.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Scapula w/ Contrast Left,12912778,LOCAL,73219,CPT,,,,,LT,Outpatient,,,,813.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Scapula w/ Contrast Right,12912781,LOCAL,73219,CPT,,,,,RT,Outpatient,,,,813.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Intestine Imaging Meckels,1169254,LOCAL,78290,CPT,A9512,HCPCS,,,,Outpatient,,,,823.35,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Scoliosis 2-3 Views,7520630,LOCAL,72082,CPT,,,,,,Outpatient,,,,827.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR ERCP Biliary and Pancreatic,8207021,LOCAL,74330,CPT,,,,,,Outpatient,,,,827.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR IVP,1170251,LOCAL,74400,CPT,,,,,,Outpatient,,,,831.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64493 - INJ PARAVERT F JNT L/S 1 LEV,5661035,LOCAL,64493,CPT,,,,,,Outpatient,,,,1016,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0260 INJ SACRO JNT ARTHR ANEST/STER,8132863,LOCAL,G0260,CPT,,,,,,Outpatient,,,,1017,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Bone Imaging Limited Injection,1169176,LOCAL,78300,CPT,,,,,,Outpatient,,,,839.85,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"62272 SPINAL PUNC, THERAP",5661019,LOCAL,62272,CPT,,,,,,Outpatient,,,,693,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64425 NERV BLK ILIOINGUINAL,5661024,LOCAL,64425,CPT,,,,,,Outpatient,,,,1032,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64483 TRANS INJ LUMB/SACR-UNILATERAL CHARGE,5661053,LOCAL,64483,CPT,,,,,,Outpatient,,,,1812,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64484 TRANS INJ LUMB/SACR EA ADD UIL CHARGE,5661054,LOCAL,64484,CPT,,,,,,Outpatient,,,,1812,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ECHO COMPLETE W/ DOPPLER,8200137,LOCAL,93306,CPT,,,,,,Outpatient,,,,1036,VIVA,Commercial,,50,,796.6,491.57,796.6,1 through 10,percent of total billed charges,501.29,678.38,
ECHOCARDIOGRAM 2D COMPLETE,8200140,LOCAL,93307,CPT,,,,,,Outpatient,,,,1036,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Echo Doppler Complete,7936277,LOCAL,93306,CPT,,,,,,Outpatient,,,,1036,VIVA,Commercial,,50,,796.6,491.57,796.6,1 through 10,percent of total billed charges,501.29,678.38,
XR Spine Scoliosis 4-5 Views,7520624,LOCAL,72083,CPT,,,,,,Outpatient,,,,856.35,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
phentolamine 5 mg injection [CULL],11211090,LOCAL,J2760,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TLSO,9400067,LOCAL,,,L0648,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64636 DESTR FACET LUM/SAC EA ADL LVL,5661056,LOCAL,64636,CPT,,,,,,Outpatient,,,,1049,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"12020 SIMP CLOSURE, SUPERF WOUND CHARGE",9303466,LOCAL,12020,CPT,,,,,,Outpatient,,,,1050,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"rabies vaccine, human diploid cell 2.5 intl units intramuscular injection [CULL]",11212261,LOCAL,90675,CPT,,,,,,Outpatient,1,EA,,328,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BAL Fluid Count with Differential,12449847,LOCAL,0202U,CPT,,,,,,Outpatient,,,,500.14,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Scoliosis 6+ Views,7520633,LOCAL,72084,CPT,,,,,,Outpatient,,,,886.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Non-Cardiac Vascular Flow Imaging,1169314,LOCAL,78445,CPT,,,,,,Outpatient,,,,886.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
63650 IMPLANT NEURSTIM ELEC EPIDURAL,10283945,LOCAL,63650,CPT,,,,,,Outpatient,,,,6563,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
63650 IMPLANT NEURSTIM ELEC EPIDURAL,8132877,LOCAL,63650,CPT,,,,,,Outpatient,,,,6563,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
63650-IMPLANT NEURSTIM ELEC EPIDURAL,8132877,LOCAL,63650,CPT,,,,,,Outpatient,,,,6563,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"rabies vaccine, human diploid cell 2.5 intl units Pow [CULL]",11212261,LOCAL,90675,CPT,,,,,,Outpatient,1,EA,,328,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Nephrostogram,8115644,LOCAL,50430,CPT,,,,,,Outpatient,,,,1389,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Nephrostogram Existing Access,10454588,LOCAL,50431,CPT,,,,,,Outpatient,,,,1389,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
36568 INTRO CATH VENA CAVA PICC CHARGE,13709100,LOCAL,36568,CPT,,,,,,Outpatient,,,,1091,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REPOSITION CVL UNDER FLUORO,8210300,LOCAL,36597,CPT,,,,,,Outpatient,,,,1091,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
omadacycline 100 mg injection [CULL],11290183,LOCAL,J0121,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15271 APP SKN SUB GRFT T/A/L 100 SQ CM FAC CHARGE,12831012,LOCAL,15271,CPT,,,,,,Outpatient,,,,1092,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"15275 App Skin Sub Graft (TWSA<100cm2) f/a/h-ft/aig; 1""25 sp cm",12641291,LOCAL,15275,CPT,,,,,,Outpatient,,,,1092,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Zika Virus RNA, Qual TMA QSTC",13864496,LOCAL,87662,CPT,,,,,,Outpatient,,,,61.57,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CATH LAB STRESS ECHO,8200161,LOCAL,93351,CPT,,,,,,Outpatient,,,,1104,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Stress Echo,7936322,LOCAL,93351,CPT,,,,,,Outpatient,,,,1104,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64581 Incision for implantation of neurostimulator electrode array; sacral nerve,8603595,LOCAL,64581,CPT,,,,,,Outpatient,,,,1108,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CASPR2 Ab QSTC,13864490,LOCAL,86255,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT 625CC 350-1695,4802349,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"KIT D816, Mutation Analysis  QSTC",13864489,LOCAL,81273,CPT,,,,,,Outpatient,,,,149.84,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ganglioside Ab Panel 6 QSTC,13864481,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64418 - suprascapular nerve block,10452404,LOCAL,64418,CPT,,,,,,Outpatient,,,,693,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64420 NERV BLK INTERCSTL NERV SNGL,5661025,LOCAL,64420,CPT,,,,,,Outpatient,,,,693,VIVA,Commercial,,50,,1243.47,486.29,1243.47,1 through 10,percent of total billed charges,633.14,1291,
64454 Genicular block,13776911,LOCAL,64454,CPT,,,,,,Outpatient,,,,244,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64461 THORACIC PARAVERTEBRAL BLOCK,13786726,LOCAL,64461,CPT,,,,,,Outpatient,,,,50,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Injection Blood Patch Epidural,7633812,LOCAL,62273,CPT,,,,,,Outpatient,,,,971,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LGI1 Ab QSTC,13864491,LOCAL,86255,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PULM ANGIO DURING CORONARIES,8230012,LOCAL,93568,CPT,,,,,,Outpatient,,,,1134,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92960 ELEC CARDIOVERSION/DEFIBRILATION OP Tech Fee,7969852,LOCAL,92960,CPT,,,,,,Outpatient,,,,1144,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Perc Cor Stent-Drug Eluding LD,4221012,LOCAL,92960,CPT,,,,,,Outpatient,,,,1144,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
10030 FLUID DRAIN SOFT TIS PERC GUID,8266849,LOCAL,10030,CPT,,,,,,Outpatient,,,,704,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Thyroid Uptake Single/Multi,2426011,LOCAL,78014,CPT,,,,,,Outpatient,,,,952.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Thyroid w/ Uptake Single,12109219,LOCAL,78014,CPT,A9516,HCPCS,,,,Outpatient,,,,952.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NUSHIELD 1.6CM DISC,13962586,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Surgical Specimen,9437784,LOCAL,76098,CPT,,,,,,Outpatient,,,,953.7,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GASTROSTOMY TUBE REPLACEMENT,8200253,LOCAL,49450,CPT,,,,,,Outpatient,,,,1166,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
JEJUNOSTOMY REPLACEMENT PERC,8200252,LOCAL,49451,CPT,,,,,,Outpatient,,,,1166,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Critical Care Ill/Injured Patient Init 30-74 Min 99291,2389455,LOCAL,99291,CPT,,,,,25,Outpatient,,,,1181,VIVA,Commercial,,50,,374,374,374,1 through 10,percent of total billed charges,770.36,770.36,
"13132 -Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet;",14751269,LOCAL,13132,CPT,,,,,,Outpatient,,,,612,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Myocardial Planar Single Study,2425978,LOCAL,78481,CPT,A9500,HCPCS,,,,Outpatient,,,,982.58,VIVA,Commercial,,50,,53.77,53.77,53.77,1 through 10,percent of total billed charges,492.12,560.96,
MRI Breast w/o Contrast Left.,9386272,LOCAL,77046,CPT,,,,,LT,Outpatient,,,,983.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Breast w/o Contrast Right.,9386275,LOCAL,77046,CPT,,,,,RT,Outpatient,,,,983.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL US OB Greater Than 14 Wks Add'l Gest,13579115,LOCAL,76810,CPT,,,,,,Outpatient,,,,990.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US OB Greater Than 14 Weeks Multi,8108499,LOCAL,76810,CPT,,,,,,Outpatient,,,,990.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Tumor Loc Limited,1169410,LOCAL,78800,CPT,,,,,,Outpatient,,,,783.75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Tumor Loc Multiple Areas,1169412,LOCAL,78801,CPT,,,,,,Outpatient,,,,2895.75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PARACENTESIS ABDOMINAL WITH IMAGING,8267134,LOCAL,49083,CPT,,,,,,Outpatient,,,,1208,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Cardiac MUGA,1169208,LOCAL,78472,CPT,A9512,HCPCS,,,,Outpatient,,,,998.25,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Meningitis Panel (BioFire),7909558,LOCAL,87483,CPT,,,,,,Outpatient,,,,500.14,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PLACE ART 1ST ABD & BELOW,8267112,LOCAL,36245,CPT,,,,,,Outpatient,,,,1224,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GRAFIX PRIME 16MM,13962570,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,,3671,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PLACE ART 1ST THORAC/BRAC,8267108,LOCAL,36215,CPT,,,,,,Outpatient,,,,1246,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PLACE ART 2ND THORAC/BRAC,8267109,LOCAL,36216,CPT,,,,,,Outpatient,,,,1246,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PLACE ART 3RD THORAC/BRAC,8267110,LOCAL,36217,CPT,,,,,,Outpatient,,,,1246,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Lung Vent/Perf Imaging,2425966,LOCAL,78582,CPT,A9540,HCPCS,,,,Outpatient,,,,1029.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PLACE ART 3RD ABD & BELOW,8267114,LOCAL,36247,CPT,,,,,,Outpatient,,,,1253,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Lymphoscintigraphy Injection/Scan,1169292,LOCAL,78195,CPT,,,,,,Outpatient,,,,1034.55,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alpha-Globin Gene Deletion/Dupl. QSTC,13864435,LOCAL,81269,CPT,,,,,,Outpatient,,,,242.88,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Kidney Imaging Single w/o Pharm,1169264,LOCAL,78707,CPT,A9562,HCPCS,,,,Outpatient,,,,1051.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF HLA Antibody ID,13479161,LOCAL,86830,CPT,,,,,,Outpatient,,,,114.62,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PERICARDIOCENTESIS INITIAL,8230050,LOCAL,33016,CPT,,,,,,Outpatient,,,,1278,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REMOVAL BILIARY DRAIN CATH,8200538,LOCAL,47537,CPT,,,,,,Outpatient,,,,1278,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Apolipoprotein E Isoform, CSF QST",12677744,LOCAL,82542,CPT,,,,,,Outpatient,,,,28.91,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - DISK 14MM,13962582,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL Selective Add'l Vessel S&I,13635231,LOCAL,75774,CPT,,,,,,Outpatient,,,,1059.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SELECTIVE ADD'L VESSEL S&I,8210640,LOCAL,75774,CPT,,,,,,Outpatient,,,,1059.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CATH PLACE LT RT PA,8267103,LOCAL,36014,CPT,,,,,,Outpatient,,,,1291,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
remdesivir 100 mg Injection [CULL],11201128,LOCAL,J0248,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ECHO LIMITED WITH CONTRAST,8200178,LOCAL,,,C8924,HCPCS,,,,Outpatient,,,,1315,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Echo 2D Limited w/ Contrast,7936274,LOCAL,93308,CPT,C8924,HCPCS,,,,Outpatient,,,,564,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
".MOG Ab, CBA, Serum QSTC",10274091,LOCAL,86362,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Myelin Oligodendrocyte Glycoprotein w/Rfx Titer, Serum QSTC",12613098,LOCAL,86362,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PURAPLY AM COMMERCIAL 1.6CM DISC,13962603,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,,3861,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
36589 - Removal of tunneled central venous catheter,12431092,LOCAL,36589,CPT,,,,,,Outpatient,,,,1316,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
37253 Invasc US Each Addl Vessel,8230057,LOCAL,37253,CPT,,,,,,Outpatient,,,,1323,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"64449 N BLOCK INJ, LUMBAR PLEXUS",8882246,LOCAL,64449,CPT,,,,,,Outpatient,,,,890,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"CRMP5/CV2 Ab, LB QSTC",13873513,LOCAL,84182,CPT,,,,,,Outpatient,,,,35.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"GAD65 Ab, LB QSTC",13873519,LOCAL,86341,CPT,,,,,,Outpatient,,,,28.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tocilizumab 20 mg/mL Sol 4 mL [CULL],11260558,LOCAL,J3262,CPT,,,,,,Outpatient,4,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92953 TRANSCUTANEOUS PACING TechFee,8057710,LOCAL,92953,CPT,,,,,,Outpatient,,,,1339,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92953-Temp transcutaneous pacing Charge,8212036,LOCAL,92953,CPT,,,,,,Outpatient,,,,1339,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXTERNAL PACER,4221033,LOCAL,92953,CPT,,,,,,Outpatient,,,,1339,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Testicular Imaging w/ Vasc Flow,8733473,LOCAL,78761,CPT,A9512,HCPCS,,,,Outpatient,,,,1106.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11750 EXCISION NAIL MATRIX PERMANENT CHARGE,9303447,LOCAL,11750,CPT,,,,,,Outpatient,,,,1342,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
33967 Insertion Intra-aortic Percutaneous Device Charge,8211150,LOCAL,33967,CPT,,,,,,Outpatient,,,,1367,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - 3 X 3.5CM,13962577,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ibutilide 0.1 mg/mL intravenous solution 10 mL [CULL],11201842,LOCAL,J1742,CPT,,,,,,Outpatient,10,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Hepatobiliary Imaging w/ Drug,2425957,LOCAL,78226,CPT,A9537,HCPCS,,,,Outpatient,,,,567.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Hepatobiliary Imaging w/ EF,12894248,LOCAL,78227,CPT,A9537,HCPCS,,,,Outpatient,,,,1145.1,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VENOGRAM BILATERAL EXT S&I,8211110,LOCAL,75822,CPT,,,,,,Outpatient,,,,1157.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Venogram Extremity Bilateral,13085158,LOCAL,75822,CPT,,,,,,Outpatient,,,,1157.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NUSHIELD 1.6CM DISC,10510071,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64633 DESTR FACET CERV/THOR SNG LVL,5661057,LOCAL,64633,CPT,,,,,,Outpatient,,,,1416,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64635 DESTR FACET LUM/SAC SINGLE LVL,5661055,LOCAL,64635,CPT,,,,,,Outpatient,,,,1416,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93567 Inj Supra Aortography,8230011,LOCAL,93567,CPT,,,,,,Outpatient,,,,1422,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Gastric Emptying Study,1169236,LOCAL,78264,CPT,,,,,,Outpatient,,,,1176.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Bone Spect,1169188,LOCAL,78803,CPT,,,,,,Outpatient,,,,1181.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
APPLY SKIN SUB 1ST 255Q CM LEG UP TO 100,13531303,LOCAL,15271,CPT,,,,,25,Outpatient,,,,1092,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Ankle w/o Contrast Left,1167903,LOCAL,73700,CPT,,,,,LT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Ankle w/o Contrast Right,1167905,LOCAL,73700,CPT,,,,,RT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Clavicle w/o Contrast Left,12885310,LOCAL,73200,CPT,,,,,LT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Clavicle w/o Contrast Right,12885313,LOCAL,73200,CPT,,,,,RT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Elbow w/o Contrast Left,1168002,LOCAL,73200,CPT,,,,,LT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Elbow w/o Contrast Right,1168004,LOCAL,73200,CPT,,,,,RT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Femur w/o Contrast Left,8202922,LOCAL,73700,CPT,,,,,LT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Femur w/o Contrast Right,8202924,LOCAL,73700,CPT,,,,,RT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Foot w/o Contrast Left,1168040,LOCAL,73700,CPT,,,,,LT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Foot w/o Contrast Right,1168042,LOCAL,73700,CPT,,,,,RT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Forearm w/o Contrast Left,8202950,LOCAL,73200,CPT,,,,,LT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Forearm w/o Contrast Right,8202952,LOCAL,73200,CPT,,,,,RT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Hand w/o Contrast Left,1168086,LOCAL,73200,CPT,,,,,LT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Hand w/o Contrast Right,1168088,LOCAL,73200,CPT,,,,,RT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Hip w/o Contrast Left,1168116,LOCAL,73700,CPT,,,,,LT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Hip w/o Contrast Right,1168118,LOCAL,73700,CPT,,,,,RT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Humerus w/o Contrast Left,8202997,LOCAL,73200,CPT,,,,,LT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Humerus w/o Contrast Right,8202999,LOCAL,73200,CPT,,,,,RT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Knee w/o Contrast Left,1168158,LOCAL,73700,CPT,,,,,LT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Knee w/o Contrast Right,1168160,LOCAL,73700,CPT,,,,,RT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Shoulder w/o Contrast Left,1168220,LOCAL,73200,CPT,,,,,LT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Shoulder w/o Contrast Right,1168222,LOCAL,73200,CPT,,,,,RT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Tibia/Fibula w/o Contrast Left,8203045,LOCAL,73700,CPT,,,,,LT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Tibia/Fibula w/o Contrast Right,8203047,LOCAL,73700,CPT,,,,,RT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Wrist w/o Contrast Left,1168341,LOCAL,73200,CPT,,,,,LT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Wrist w/o Contrast Right,1168343,LOCAL,73200,CPT,,,,,RT,Outpatient,,,,1191.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Abdomen Aorta + Iliofemoral,1167851,LOCAL,75635,CPT,,,,,,Outpatient,,,,1202.85,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
37252 Invasc US Initial Vessel,8230056,LOCAL,37252,CPT,,,,,,Outpatient,,,,1464,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15277 App Skin Sub Graft(TWSA>100cm2 f/a/h-ft diag add 100 cm2,12635466,LOCAL,15277,CPT,,,,,,Outpatient,,,,1471,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93312 TEE 2D MM COMPLETE WO CHARGE,8200160,LOCAL,93312,CPT,,,,,,Outpatient,,,,1482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Echo Transesophageal,7936283,LOCAL,93312,CPT,,,,,,Outpatient,,,,1482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0278-CL ILIAC/FEM ANGIO FOR CLOSURE Charge,8212025,LOCAL,,,G0278,HCPCS,,,,Outpatient,,,,1496,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Gastric Emptying w/ SB,10110882,LOCAL,78265,CPT,,,,,,Outpatient,,,,1234.2,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
onabotulinumtoxinA 100 units injection [CULL],11212323,LOCAL,J0585,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Brachial Plexus w/o Contrast Lt,8784911,LOCAL,73221,CPT,,,,,LT,Outpatient,,,,1242.45,VIVA,Commercial,,50,,1838.13,1292.09,1838.13,1 through 10,percent of total billed charges,220.99,372.26,
MRI Brachial Plexus w/o Contrast Rt,8784914,LOCAL,73221,CPT,,,,,RT,Outpatient,,,,1242.45,VIVA,Commercial,,50,,1838.13,1292.09,1838.13,1 through 10,percent of total billed charges,220.99,372.26,
MRI Clavicle w/o Contrast Left,9647312,LOCAL,71550,CPT,,,,,LT,Outpatient,,,,1765.5,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Clavicle w/o Contrast Right,9647315,LOCAL,71550,CPT,,,,,RT,Outpatient,,,,1765.5,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Fingers w/o Contrast Left,8513078,LOCAL,73218,CPT,,,,,LT,Outpatient,,,,1242.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Fingers w/o Contrast Right,8513081,LOCAL,73218,CPT,,,,,RT,Outpatient,,,,1242.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Forearm w/o Contrast Lt,8058719,LOCAL,73218,CPT,,,,,LT,Outpatient,,,,1242.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Forearm w/o Contrast Rt,8058722,LOCAL,73218,CPT,,,,,RT,Outpatient,,,,1242.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hand w/o Contrast Left,1168930,LOCAL,73218,CPT,,,,,LT,Outpatient,,,,1242.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hand w/o Contrast Right,1168932,LOCAL,73218,CPT,,,,,RT,Outpatient,,,,1242.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Humerus w/o Contrast Left,8203080,LOCAL,73218,CPT,,,,,LT,Outpatient,,,,1242.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Humerus w/o Contrast Right,8203082,LOCAL,73218,CPT,,,,,RT,Outpatient,,,,1242.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Scapula w/o Contrast Left,9647339,LOCAL,73218,CPT,,,,,LT,Outpatient,,,,1242.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Scapula w/o Contrast Right,9647342,LOCAL,73218,CPT,,,,,RT,Outpatient,,,,1242.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Neck w/o Contrast,1168683,LOCAL,70547,CPT,,,,,,Outpatient,,,,1242.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - DISK 16MM,13962584,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Pelvis w/o Contrast,1168691,LOCAL,72198,CPT,,,,,,Outpatient,,,,1767.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Pelvis w/o Contrast,1168691,LOCAL,C8919,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Myelogram Cervical Spine,1170319,LOCAL,62302,CPT,,,,,,Outpatient,,,,1527,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Myelogram Thoracic Spine,1170327,LOCAL,62303,CPT,,,,,,Outpatient,,,,1527,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Spine Thoracic w/o Contrast,1169066,LOCAL,72146,CPT,,,,,,Outpatient,,,,1268.03,VIVA,Commercial,,50,,1182.66,1182.66,1182.66,1 through 10,percent of total billed charges,220.99,372.26,
ILR REMOVAL,8267777,LOCAL,33286,CPT,,,,,,Outpatient,,,,1548,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Spine Lumbar w/o Contrast,1168246,LOCAL,72131,CPT,,,,,,Outpatient,,,,1286.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Bone Three Phase Study Injection/Scan,1169190,LOCAL,78315,CPT,,,,,,Outpatient,,,,1301.85,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
36002 Pseudoanrsm Repair W Thrombin Us Gud,8212049,LOCAL,36002,CPT,,,,,,Outpatient,,,,1579,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AV FISTULAGRAM S&I,8210332,LOCAL,36901,CPT,,,,,,Outpatient,,,,1588,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"CRMP5/CV2 Ab, LB, CSF QSTC",13873605,LOCAL,84182,CPT,,,,,,Outpatient,,,,35.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"GAD65 Ab, LB, CSF QSTC",13873611,LOCAL,86341,CPT,,,,,,Outpatient,,,,28.28,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INTERNAL MAMMARY S&I,8210631,LOCAL,75756,CPT,,,,,,Outpatient,,,,1316.7,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PULMONARY NONSELECTIVE S&I,8210620,LOCAL,75746,CPT,,,,,,Outpatient,,,,1316.7,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Pelvis,1167881,LOCAL,72191,CPT,,,,,,Outpatient,,,,1317.53,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Thoracentesis w/ CT Guidance,2424869,LOCAL,77012,CPT,,,,,,Outpatient,,,,1318.35,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - 1.75 X 1.75 CM,13962574,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Neck Soft Tissue w/o Contrast,1168234,LOCAL,70490,CPT,,,,,,Outpatient,,,,1329.08,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64450 INJECTION ANESTHETIC AGENT PERIPHERAL NE,13437921,LOCAL,64450,CPT,,,,,,Outpatient,,,,1613,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tetanus immune globulin 250 units/mL intramuscular solution 1 mL [CULL],11212346,LOCAL,J1670,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Ankle w/ Contrast Left,1167897,LOCAL,73701,CPT,,,,,LT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Ankle w/ Contrast Right,1167899,LOCAL,73701,CPT,,,,,RT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Clavicle w/ Contrast Left,12885304,LOCAL,73201,CPT,,,,,LT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Clavicle w/ Contrast Right,12885307,LOCAL,73201,CPT,,,,,RT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Elbow w/ Contrast Left,1167996,LOCAL,73201,CPT,,,,,LT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Elbow w/ Contrast Right,1167998,LOCAL,73201,CPT,,,,,RT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Femur w/ Contrast Left,8202918,LOCAL,73701,CPT,,,,,LT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Femur w/ Contrast Right,8202920,LOCAL,73701,CPT,,,,,RT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Foot w/ Contrast Left,1168034,LOCAL,73701,CPT,,,,,LT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Foot w/ Contrast Right,1168036,LOCAL,73701,CPT,,,,,RT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Forearm w/ Contrast Left,8202943,LOCAL,73201,CPT,,,,,LT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Forearm w/ Contrast Right,8202945,LOCAL,73201,CPT,,,,,RT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Hand w/ Contrast Left,1168080,LOCAL,73201,CPT,,,,,LT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Hand w/ Contrast Right,1168082,LOCAL,73201,CPT,,,,,RT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Hip w/ Contrast Left,1168110,LOCAL,73701,CPT,,,,,LT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Hip w/ Contrast Right,1168112,LOCAL,73701,CPT,,,,,RT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Humerus w/ Contrast Left,8202990,LOCAL,73201,CPT,,,,,LT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Humerus w/ Contrast Right,8202992,LOCAL,73201,CPT,,,,,RT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Knee w/ Contrast Left,1168152,LOCAL,73701,CPT,,,,,LT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Knee w/ Contrast Right,1168154,LOCAL,73701,CPT,,,,,RT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Shoulder w/ Contrast Left,1168214,LOCAL,73201,CPT,,,,,LT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Shoulder w/ Contrast Right,1168216,LOCAL,73201,CPT,,,,,RT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Tibia/Fibula w/ Contrast Left,8203041,LOCAL,73701,CPT,,,,,LT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Tibia/Fibula w/ Contrast Right,8203043,LOCAL,73701,CPT,,,,,RT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Wrist w/ Contrast Left,1168335,LOCAL,73201,CPT,,,,,LT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Wrist w/ Contrast Right,1168337,LOCAL,73201,CPT,,,,,RT,Outpatient,,,,1338.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64454 - Injection of anesthetic agent into genicular nerve branches including imaging guidance.,14144343,LOCAL,64454,CPT,,,,,,Outpatient,,,,244,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"64624 Destruction by neurolytic agent, genicular nerve branches",9487180,LOCAL,64624,CPT,,,,,,Outpatient,,,,926,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64421 NERVE BLOCK INTERCOSTAL MULTIPLE NERVES,5661026,LOCAL,64421,CPT,,,,,,Outpatient,,,,890,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15273 ACELLULAR DERM REPL LTH 100 SQ CM,8716218,LOCAL,15273,CPT,,,,,,Outpatient,,,,1631,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PRIMATRIX 3X3,13962595,LOCAL,,,Q4110,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
dimethyl sulfoxide 50% irrigation solution 50 mL [CULL],11205390,LOCAL,J1212,CPT,,,,,,Outpatient,50,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INJ PERC CHOL W EXIS CATH,8210336,LOCAL,47531,CPT,,,,,,Outpatient,,,,298,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Elbow w/o Contrast Left,1168848,LOCAL,73221,CPT,,,,,LT,Outpatient,,,,1242.45,VIVA,Commercial,,50,,1838.13,1292.09,1838.13,1 through 10,percent of total billed charges,220.99,372.26,
MRI Elbow w/o Contrast Right,1168850,LOCAL,73221,CPT,,,,,RT,Outpatient,,,,1242.45,VIVA,Commercial,,50,,1838.13,1292.09,1838.13,1 through 10,percent of total billed charges,220.99,372.26,
MRI Shoulder w/o Contrast Left,1169044,LOCAL,73221,CPT,,,,,LT,Outpatient,,,,1242.45,VIVA,Commercial,,50,,1838.13,1292.09,1838.13,1 through 10,percent of total billed charges,220.99,372.26,
MRI Shoulder w/o Contrast Right,1169046,LOCAL,73221,CPT,,,,,RT,Outpatient,,,,1242.45,VIVA,Commercial,,50,,1838.13,1292.09,1838.13,1 through 10,percent of total billed charges,220.99,372.26,
MRI Wrist w/o Contrast Left,1169140,LOCAL,73221,CPT,,,,,LT,Outpatient,,,,1242.45,VIVA,Commercial,,50,,1838.13,1292.09,1838.13,1 through 10,percent of total billed charges,220.99,372.26,
MRI Wrist w/o Contrast Right,1169142,LOCAL,73221,CPT,,,,,RT,Outpatient,,,,1242.45,VIVA,Commercial,,50,,1838.13,1292.09,1838.13,1 through 10,percent of total billed charges,220.99,372.26,
ASPIRATION / INJECTION OF RENAL PELVIS,8210655,LOCAL,50390,CPT,,,,,,Outpatient,,,,1682,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Femur w/o Contrast Lt,8058707,LOCAL,73718,CPT,,,,,LT,Outpatient,,,,1389.3,VIVA,Commercial,,50,,1743.28,1295.52,1743.28,1 through 10,percent of total billed charges,220.99,372.26,
MRI Femur w/o Contrast Rt,8058710,LOCAL,73718,CPT,,,,,RT,Outpatient,,,,1389.3,VIVA,Commercial,,50,,1743.28,1295.52,1743.28,1 through 10,percent of total billed charges,220.99,372.26,
MRI Foot w/o Contrast Left,1168890,LOCAL,73718,CPT,,,,,LT,Outpatient,,,,1389.3,VIVA,Commercial,,50,,1743.28,1295.52,1743.28,1 through 10,percent of total billed charges,220.99,372.26,
MRI Foot w/o Contrast Right,1168892,LOCAL,73718,CPT,,,,,RT,Outpatient,,,,1389.3,VIVA,Commercial,,50,,1743.28,1295.52,1743.28,1 through 10,percent of total billed charges,220.99,372.26,
MRI Tibia/Fibula w/o Contrast Left,8206789,LOCAL,73718,CPT,,,,,LT,Outpatient,,,,1389.3,VIVA,Commercial,,50,,1743.28,1295.52,1743.28,1 through 10,percent of total billed charges,220.99,372.26,
MRI Tibia/Fibula w/o Contrast Right,8206791,LOCAL,73718,CPT,,,,,RT,Outpatient,,,,1389.3,VIVA,Commercial,,50,,1743.28,1295.52,1743.28,1 through 10,percent of total billed charges,220.99,372.26,
MRA Neck w/ Contrast,1168681,LOCAL,70548,CPT,,,,,,Outpatient,,,,1389.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOEXCEL SKIN SUBSTITUTE 18MM,13962552,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LENS TORIC #SA6AT4,4853560,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LENS TORIC ABSORBING SA6AT5,4853594,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IR Venogram Cava Superior1,8071895,LOCAL,75827,CPT,,,,,,Outpatient,,,,1392.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SUPERIOR VENA CAVA S&I,8210670,LOCAL,75827,CPT,,,,,,Outpatient,,,,1392.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VENOGRAM UNILATERAL EXT S&I,8211100,LOCAL,75820,CPT,,,,,,Outpatient,,,,1392.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Venogram Extremity Left,8115647,LOCAL,75820,CPT,,,,,LT,Outpatient,,,,1392.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Venogram Extremity Right,8115650,LOCAL,75820,CPT,,,,,RT,Outpatient,,,,1392.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Procedure Performed. -> Paracentesis,9739222,LOCAL,49082,CPT,,,,,,Outpatient,,,,1691,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Pelvis w/ Contrast,1168689,LOCAL,72198,CPT,,,,,,Outpatient,,,,1767.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Pelvis w/ Contrast,1168689,LOCAL,C8918,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Bone Imaging Whole Body Injection,1169180,LOCAL,78306,CPT,,,,,,Outpatient,,,,1407.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Lower Extremity Bilateral,8058637,LOCAL,73706,CPT,,,,,,Outpatient,,,,1414.88,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Lower Extremity Left,1167875,LOCAL,73706,CPT,,,,,LT,Outpatient,,,,1414.88,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Lower Extremity Right,1167877,LOCAL,73706,CPT,,,,,RT,Outpatient,,,,1414.88,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Spine Thoracic w/ Contrast,1169064,LOCAL,72147,CPT,,,,,,Outpatient,,,,1414.88,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOEXCEL PLUS 17MM,13962547,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C8925 TEE COMPLETE 2D WWO CHARGE,8200184,LOCAL,,,C8925,HCPCS,,,,Outpatient,,,,1718,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ECHO COMPLETE WITH DOP/CONTRAST,8200176,LOCAL,,,C8929,HCPCS,,,,Outpatient,,,,1718,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Echo Doppler Complete w/ Contrast,13780988,LOCAL,93306,CPT,C8929,HCPCS,,,,Outpatient,,,,1036,VIVA,Commercial,,50,,796.6,491.57,796.6,1 through 10,percent of total billed charges,678.38,722.32,
95805 MAINTENANCE OF WAKEFULNESS CHARGE,9569825,LOCAL,95805,CPT,,,,,,Outpatient,,,,1724,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95805 MSLT CHARGES,8795717,LOCAL,95805,CPT,,,,,,Outpatient,,,,1724,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95805 MSLT/MWT CHARGES,9442365,LOCAL,95805,CPT,,,,,,Outpatient,,,,1724,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
".MOG Ab, Titer QSTC",13864468,LOCAL,86362,CPT,,,,,,Outpatient,,,,14.46,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PURAPLY AM 2X2 COMMERCIAL 4SQ CM,13962597,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,,3861,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Spine Lumbar w/ Contrast,1168244,LOCAL,72132,CPT,,,,,,Outpatient,,,,1433.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Brain/Head w/o Contrast,1168653,LOCAL,70544,CPT,,,,,,Outpatient,,,,1442.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Lower Extremity w/ + w/o Cnt Left,1168663,LOCAL,73725,CPT,,,,,LT,Outpatient,,,,1442.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Lower Extremity w/ + w/o Cnt Right,1168665,LOCAL,73725,CPT,,,,,RT,Outpatient,,,,1442.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRV Head w/o Contrast,8450965,LOCAL,70544,CPT,,,,,,Outpatient,,,,1442.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Clavicle w/ + w/o Contrast Left,12885298,LOCAL,73202,CPT,,,,,LT,Outpatient,,,,1445.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Clavicle w/ + w/o Contrast Right,12885301,LOCAL,73202,CPT,,,,,RT,Outpatient,,,,1445.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Elbow w/ + w/o Contrast Left,8202901,LOCAL,73202,CPT,,,,,LT,Outpatient,,,,1445.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Elbow w/ + w/o Contrast Right,8202903,LOCAL,73202,CPT,,,,,RT,Outpatient,,,,1445.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Forearm w/ + w/o Contrast Left,8202936,LOCAL,73202,CPT,,,,,LT,Outpatient,,,,1445.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Forearm w/ + w/o Contrast Right,8202938,LOCAL,73202,CPT,,,,,RT,Outpatient,,,,1445.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Hand w/ + w/o Contrast Left,8202957,LOCAL,73202,CPT,,,,,LT,Outpatient,,,,1445.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Hand w/ + w/o Contrast Right,8202959,LOCAL,73202,CPT,,,,,RT,Outpatient,,,,1445.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Humerus w/ + w/o Contrast Left,8202983,LOCAL,73202,CPT,,,,,LT,Outpatient,,,,1445.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Humerus w/ + w/o Contrast Right,8202985,LOCAL,73202,CPT,,,,,RT,Outpatient,,,,1445.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Shoulder w/ + w/o Contrast Left,8203023,LOCAL,73202,CPT,,,,,LT,Outpatient,,,,1445.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Shoulder w/ + w/o Contrast Right,8203025,LOCAL,73202,CPT,,,,,RT,Outpatient,,,,1445.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Wrist w/ + w/o Contrast Left,8203057,LOCAL,73202,CPT,,,,,LT,Outpatient,,,,1445.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Wrist w/ + w/o Contrast Right,8203059,LOCAL,73202,CPT,,,,,RT,Outpatient,,,,1445.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Spine Thoracic w/o Contrast,1168252,LOCAL,72128,CPT,,,,,,Outpatient,,,,1450.35,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Spine Cervical w/o Contrast,1168240,LOCAL,72125,CPT,,,,,,Outpatient,,,,1454.48,VIVA,Commercial,,50,,135.31,115,135.31,1 through 10,percent of total billed charges,97.22,170.53,
CT Abdomen w/ Oral Contrast Only,8206354,LOCAL,74150,CPT,,,,,,Outpatient,,,,1459.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Abdomen w/o Contrast,1167849,LOCAL,74150,CPT,,,,,,Outpatient,,,,1459.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Pelvis w/ Oral Contrast Only,8206452,LOCAL,72192,CPT,,,,,,Outpatient,,,,1459.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Pelvis w/o Contrast,1168198,LOCAL,72192,CPT,,,,,,Outpatient,,,,1459.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Ankle w/o Contrast Left,1168750,LOCAL,73721,CPT,,,,,LT,Outpatient,,,,1466.03,VIVA,Commercial,,50,,1366.62,1366.62,1366.62,1 through 10,percent of total billed charges,220.99,372.26,
MRI Ankle w/o Contrast Right,1168752,LOCAL,73721,CPT,,,,,RT,Outpatient,,,,1466.03,VIVA,Commercial,,50,,1366.62,1366.62,1366.62,1 through 10,percent of total billed charges,220.99,372.26,
MRI Hip w/o Contrast Left,1168948,LOCAL,73721,CPT,,,,,LT,Outpatient,,,,1466.03,VIVA,Commercial,,50,,1366.62,1366.62,1366.62,1 through 10,percent of total billed charges,220.99,372.26,
MRI Hip w/o Contrast Right,1168950,LOCAL,73721,CPT,,,,,RT,Outpatient,,,,1466.03,VIVA,Commercial,,50,,1366.62,1366.62,1366.62,1 through 10,percent of total billed charges,220.99,372.26,
MRI Knee w/o Contrast Left,1168984,LOCAL,73721,CPT,,,,,LT,Outpatient,,,,1466.03,VIVA,Commercial,,50,,1366.62,1366.62,1366.62,1 through 10,percent of total billed charges,220.99,372.26,
MRI Knee w/o Contrast Right,1168986,LOCAL,73721,CPT,,,,,RT,Outpatient,,,,1466.03,VIVA,Commercial,,50,,1366.62,1366.62,1366.62,1 through 10,percent of total billed charges,220.99,372.26,
CT Neck Soft Tissue w/ Contrast,1168232,LOCAL,70491,CPT,,,,,,Outpatient,,,,1475.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Abdomen w/o Contrast,1168639,LOCAL,74185,CPT,,,,,,Outpatient,,,,2017.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64483 TRANS INJ LUMB/SACR-BILATERAL CHARGE,5661040,LOCAL,64483,CPT,,,,,,Outpatient,,,,1812,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64484 TRANS INJ LUMB/SACR EA ADD BIL CHARGE,5661049,LOCAL,64484,CPT,,,,,,Outpatient,,,,1812,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Chest w/o Contrast,1168647,LOCAL,71555,CPT,,,,,,Outpatient,,,,1645.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Chest w/o Contrast,1168647,LOCAL,C8910,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Abdomen w/o Contrast,1168734,LOCAL,74181,CPT,,,,,,Outpatient,,,,1503.98,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI MRCP w/o Contrast,8203102,LOCAL,74181,CPT,,,,,,Outpatient,,,,1503.98,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Spine Cervical w/o Contrast,1169054,LOCAL,72141,CPT,,,,,,Outpatient,,,,1503.98,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Spine Lumbar w/o Contrast,1169060,LOCAL,72148,CPT,,,,,,Outpatient,,,,1503.98,VIVA,Commercial,,50,,1402.16,1402.16,1402.16,1 through 10,percent of total billed charges,220.99,372.26,
CT Brain/Head Stroke Alert,8202967,LOCAL,70450,CPT,,,,,,Outpatient,,,,1510.58,VIVA,Commercial,,50,,2611.42,119.43,2611.42,22,percent of total billed charges,97.22,461.98,
CT Brain/Head w/o Contrast,1168094,LOCAL,70450,CPT,,,,,,Outpatient,,,,1510.58,VIVA,Commercial,,50,,2611.42,119.43,2611.42,22,percent of total billed charges,97.22,461.98,
PLACE CENTRAL VENOUS LINE,8210290,LOCAL,36556,CPT,,,,,,Outpatient,,,,1853,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Brachial Plexus w/ Contrast Lt,10558521,LOCAL,73222,CPT,,,,,LT,Outpatient,,,,1532.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Brachial Plexus w/ Contrast Rt,10558524,LOCAL,73222,CPT,,,,,RT,Outpatient,,,,1532.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Clavicle w/ Contrast Left,12912772,LOCAL,71551,CPT,,,,,LT,Outpatient,,,,1532.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Clavicle w/ Contrast Right,12912775,LOCAL,71551,CPT,,,,,RT,Outpatient,,,,1532.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Elbow w/ Contrast Left,1168842,LOCAL,73222,CPT,,,,,LT,Outpatient,,,,1532.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Elbow w/ Contrast Right,1168844,LOCAL,73222,CPT,,,,,RT,Outpatient,,,,1532.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Shoulder w/ Contrast Left,1169038,LOCAL,73222,CPT,,,,,LT,Outpatient,,,,1532.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Shoulder w/ Contrast Right,1169040,LOCAL,73222,CPT,,,,,RT,Outpatient,,,,1532.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Wrist w/ Contrast Left,1169134,LOCAL,73222,CPT,,,,,LT,Outpatient,,,,1532.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Wrist w/ Contrast Right,1169136,LOCAL,73222,CPT,,,,,RT,Outpatient,,,,1532.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOEXCEL SKIN SUBSTITUTE 1.5CM X 1.5CM,13962551,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Femur w/ Contrast Left,8206704,LOCAL,73719,CPT,,,,,LT,Outpatient,,,,1536.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Femur w/ Contrast Right,8206706,LOCAL,73719,CPT,,,,,RT,Outpatient,,,,1536.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Foot w/ Contrast Left,1168884,LOCAL,73719,CPT,,,,,LT,Outpatient,,,,1536.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Foot w/ Contrast Right,1168886,LOCAL,73719,CPT,,,,,RT,Outpatient,,,,1536.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Tibia/Fibula w/ Contrast Left,8206783,LOCAL,73719,CPT,,,,,LT,Outpatient,,,,1536.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Tibia/Fibula w/ Contrast Right,8206785,LOCAL,73719,CPT,,,,,RT,Outpatient,,,,1536.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Chest,1167863,LOCAL,71275,CPT,,,,,,Outpatient,,,,1539.45,VIVA,Commercial,,50,,1585.44,169.29,1585.44,1 through 10,percent of total billed charges,162.76,565.59,
20220 BIOPSY BONE TROC/NDL SUPERFICL CHARGE,9709066,LOCAL,20220,CPT,,,,,,Outpatient,,,,1868,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Orbit Sella etc. or IAC w/o Cont,8362458,LOCAL,70480,CPT,,,,,,Outpatient,,,,1541.1,VIVA,Commercial,,50,,1437.03,1437.03,1437.03,1 through 10,percent of total billed charges,97.22,170.53,
Antenatal Testing Type -> Non-Stress test,9848446,LOCAL,59025,CPT,,,,,,Outpatient,,,,1876,VIVA,Commercial,,50,,161.84,161.83,161.84,1 through 10,percent of total billed charges,183.92,863,
Non Stress Test Charge,9919812,LOCAL,59025,CPT,,,,,,Outpatient,,,,1876,VIVA,Commercial,,50,,161.84,161.83,161.84,1 through 10,percent of total billed charges,183.92,863,
Abeta 40 QST,13873829,LOCAL,82542,CPT,,,,,,Outpatient,,,,28.91,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abeta 42/40 Ratio QST,13873830,LOCAL,82172,CPT,,,,,,Outpatient,,,,25.31,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Pelvis w/o Contrast,1169028,LOCAL,72195,CPT,,,,,,Outpatient,,,,1586.48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Lower Extremity w/o Contrast Left,1168675,LOCAL,73725,CPT,,,,,LT,Outpatient,,,,1442.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Lower Extremity w/o Contrast Right,1168677,LOCAL,73725,CPT,,,,,RT,Outpatient,,,,1442.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Abdomen,1167853,LOCAL,74175,CPT,,,,,,Outpatient,,,,1590.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI TMJ,1169068,LOCAL,70336,CPT,,,,,,Outpatient,,,,1594.73,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Spine Thoracic w/ Contrast,1168250,LOCAL,72129,CPT,,,,,,Outpatient,,,,1597.2,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Spine Cervical w/ Contrast,1168238,LOCAL,72126,CPT,,,,,,Outpatient,,,,1601.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Cisternography Injection,1169226,LOCAL,78630,CPT,A9548,HCPCS,,,,Outpatient,,,,1601.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Brain/Head,1167871,LOCAL,70496,CPT,,,,,,Outpatient,,,,1603.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Upper Extremity Bilateral,8058640,LOCAL,73206,CPT,,,,,,Outpatient,,,,1603.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Upper Extremity Left,1167885,LOCAL,73206,CPT,,,,,LT,Outpatient,,,,1603.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Upper Extremity Right,1167887,LOCAL,73206,CPT,,,,,RT,Outpatient,,,,1603.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Abdomen w/ Contrast,1167847,LOCAL,74160,CPT,,,,,,Outpatient,,,,1605.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Abdomen w/ Contrast + Oral,13452972,LOCAL,74160,CPT,,,,,,Outpatient,,,,1605.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Pelvis w/ Contrast,1168196,LOCAL,72193,CPT,,,,,,Outpatient,,,,1605.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Pelvis w/ Contrast + Oral,13554960,LOCAL,72193,CPT,,,,,,Outpatient,,,,1605.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Ankle w/ Contrast Left,1168744,LOCAL,73722,CPT,,,,,LT,Outpatient,,,,1612.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Ankle w/ Contrast Right,1168746,LOCAL,73722,CPT,,,,,RT,Outpatient,,,,1612.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hip w/ Contrast Left,1168942,LOCAL,73722,CPT,,,,,LT,Outpatient,,,,1612.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hip w/ Contrast Right,1168944,LOCAL,73722,CPT,,,,,RT,Outpatient,,,,1612.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Knee w/ Contrast Left,1168978,LOCAL,73722,CPT,,,,,LT,Outpatient,,,,1612.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Knee w/ Contrast Right,1168980,LOCAL,73722,CPT,,,,,RT,Outpatient,,,,1612.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST 360CC,4850676,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Neck,1167879,LOCAL,70498,CPT,,,,,,Outpatient,,,,1630.2,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Chest High Resolution,8658939,LOCAL,71250,CPT,,,,,,Outpatient,,,,1635.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Chest High Resolution w/o Contrast,8658939,LOCAL,71250,CPT,,,,,,Outpatient,,,,1635.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Chest w/o Contrast,8071395,LOCAL,71250,CPT,,,,,,Outpatient,,,,1635.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Low Dose Lung Screening,8090304,LOCAL,71271,CPT,,,,,,Outpatient,,,,1635.15,VIVA,Commercial,,50,,1524.53,1524.53,1524.53,1 through 10,percent of total billed charges,97.22,170.53,
MRA Abdomen w/ Contrast,1168637,LOCAL,74185,CPT,,,,,,Outpatient,,,,2017.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Chest w/ Contrast,1168645,LOCAL,71555,CPT,,,,,,Outpatient,,,,1645.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Chest w/ Contrast,1168645,LOCAL,C8909,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Abdomen w/ Contrast,1168732,LOCAL,74182,CPT,,,,,,Outpatient,,,,1650.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Spine Cervical w/ Contrast,1169052,LOCAL,72142,CPT,,,,,,Outpatient,,,,1650.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Spine Lumbar w/ Contrast,1169058,LOCAL,72149,CPT,,,,,,Outpatient,,,,1650.83,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Brain/Head w/ Contrast,1168092,LOCAL,70460,CPT,,,,,,Outpatient,,,,1657.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
immune globulin intravenous and subcutaneous 10% injectable solution 50 mL [CULL],11205108,LOCAL,J1561,CPT,,,,,,Outpatient,50,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Maxillofacial w/o Contrast,1168186,LOCAL,70486,CPT,,,,,,Outpatient,,,,1678.88,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Central Line Access Type. -> Peripherally inserted central catheter (PICC),9344166,LOCAL,36569,CPT,,,,,,Outpatient,,,,2042,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Orbit Sella etc. or IAC w/ Cont,8362455,LOCAL,70481,CPT,,,,,,Outpatient,,,,1687.95,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Tumor Loc Whole Body 2+ Days,1169416,LOCAL,78804,CPT,,,,,,Outpatient,,,,1689.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Tumor Loc Whole Body 2+ Days Gallium,1169418,LOCAL,78804,CPT,A9556,HCPCS,,,,Outpatient,,,,1689.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Ankle w/ + w/o Contrast Left,8202894,LOCAL,73702,CPT,,,,,LT,Outpatient,,,,1704.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Ankle w/ + w/o Contrast Right,8202896,LOCAL,73702,CPT,,,,,RT,Outpatient,,,,1704.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Femur w/ + w/o Contrast Left,8202914,LOCAL,73702,CPT,,,,,LT,Outpatient,,,,1704.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Femur w/ + w/o Contrast Right,8202916,LOCAL,73702,CPT,,,,,RT,Outpatient,,,,1704.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Foot w/ + w/o Contrast Left,8202926,LOCAL,73702,CPT,,,,,LT,Outpatient,,,,1704.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Foot w/ + w/o Contrast Right,8202928,LOCAL,73702,CPT,,,,,RT,Outpatient,,,,1704.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Hip w/ + w/o Contrast Left,8202973,LOCAL,73702,CPT,,,,,LT,Outpatient,,,,1704.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Hip w/ + w/o Contrast Right,8202975,LOCAL,73702,CPT,,,,,RT,Outpatient,,,,1704.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Knee w/ + w/o Contrast Left,8203007,LOCAL,73702,CPT,,,,,LT,Outpatient,,,,1704.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Knee w/ + w/o Contrast Right,8203009,LOCAL,73702,CPT,,,,,RT,Outpatient,,,,1704.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Tibia/Fibula w/ + w/o Contrast Left,8203037,LOCAL,73702,CPT,,,,,LT,Outpatient,,,,1704.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Tibia/Fibula w/ + w/o Contrast Right,8203039,LOCAL,73702,CPT,,,,,RT,Outpatient,,,,1704.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CHOLECYSTOSTOMY DRAIN PLACEMENT,8267773,LOCAL,47490,CPT,,,,,,Outpatient,,,,2080,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11047  Debridement Sub-Q, bone each add l 20sq cm",10013082,LOCAL,11047,CPT,,,,,,Outpatient,,,,2092,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11047 Debrid bone > 20 sq cm charge,12508109,LOCAL,11047,CPT,,,,,,Outpatient,,,,2092,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Guided Perc Drain/Placement,7936217,LOCAL,75989,CPT,,,,,,Outpatient,,,,618.75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Drainage Perc Cath Placement,8058781,LOCAL,75989,CPT,,,,,,Outpatient,,,,618.75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LENS DIU450,4852298,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Neck w/ + w/o Contrast,1168679,LOCAL,70549,CPT,,,,,,Outpatient,,,,1756.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Brachial Plexus w/ + w/o Contrast Lt,8784905,LOCAL,73223,CPT,,,,,LT,Outpatient,,,,1756.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Brachial Plexus w/ + w/o Contrast Rt,8784908,LOCAL,73223,CPT,,,,,RT,Outpatient,,,,1756.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Clavicle w/ + w/o Contrast Left,9647306,LOCAL,71552,CPT,,,,,LT,Outpatient,,,,2131.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Clavicle w/ + w/o Contrast Right,9647309,LOCAL,71552,CPT,,,,,RT,Outpatient,,,,2131.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Fingers w/ + w/o Contrast Left,8513072,LOCAL,73220,CPT,,,,,LT,Outpatient,,,,1756.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Fingers w/ + w/o Contrast Right,8513075,LOCAL,73220,CPT,,,,,RT,Outpatient,,,,1756.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Forearm w/ + w/o Contrast Lt,8058713,LOCAL,73220,CPT,,,,,LT,Outpatient,,,,1756.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Forearm w/ + w/o Contrast Rt,8058716,LOCAL,73220,CPT,,,,,RT,Outpatient,,,,1756.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hand w/ + w/o Contrast Left,1168918,LOCAL,73220,CPT,,,,,LT,Outpatient,,,,1756.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hand w/ + w/o Contrast Right,1168920,LOCAL,73220,CPT,,,,,RT,Outpatient,,,,1756.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Humerus w/ + w/o Contrast Left,8203076,LOCAL,73220,CPT,,,,,LT,Outpatient,,,,1756.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Humerus w/ + w/o Contrast Right,8203078,LOCAL,73220,CPT,,,,,RT,Outpatient,,,,1756.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Scapula w/ + w/o Contrast Left,9647333,LOCAL,73220,CPT,,,,,LT,Outpatient,,,,1756.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Scapula w/ + w/o Contrast Right,9647336,LOCAL,73220,CPT,,,,,RT,Outpatient,,,,1756.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Myelogram 2 or More Regions,10386814,LOCAL,62305,CPT,,,,,,Outpatient,,,,2134,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Chest w/o Contrast,1168824,LOCAL,71550,CPT,,,,,,Outpatient,,,,1765.5,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Pelvis w/ + w/o Contrast,1168687,LOCAL,72198,CPT,,,,,,Outpatient,,,,1767.15,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Pelvis w/ + w/o Contrast,1168687,LOCAL,C8920,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Chest w/ Contrast,8071392,LOCAL,71260,CPT,,,,,,Outpatient,,,,1782,VIVA,Commercial,,50,,1661.26,1661.26,1661.26,1 through 10,percent of total billed charges,162.76,162.76,
US Echo Transesophag w/ Cont,13770878,LOCAL,93312,CPT,C8925,HCPCS,,,,Outpatient,,,,1482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PERC PLEURAL INSERTION/DRAINAGE AND S&I,8230068,LOCAL,32557,CPT,,,,,,Outpatient,,,,2166,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GRAFIX PRIME 1.5 X 2CM,13962569,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,,3671,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPIFIX SKIN SUBSTITUTE 18MM,13962561,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Spine Lumbar w/ + w/o Contrast,1168242,LOCAL,72133,CPT,,,,,,Outpatient,,,,1799.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPIFIX SKIN SUBSTITUTE 18MM,10510009,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Poliovirus 1, 3 Ab, Neutralization QSTC",13864497,LOCAL,86382,CPT,,,,,,Outpatient,,,,20.29,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Lower Extremity w/ Contrast Left,90720012,LOCAL,73725,CPT,,,,,LT,Outpatient,,,,1442.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Lower Extremity w/ Contrast Right,90720013,LOCAL,73725,CPT,,,,,RT,Outpatient,,,,1442.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Upper Extremity w/ Contrast Left,90720010,LOCAL,73225,CPT,,,,,LT,Outpatient,,,,2038.58,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Upper Extremity w/ Contrast Right,90720011,LOCAL,73225,CPT,,,,,RT,Outpatient,,,,2038.58,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Face Neck Orbit w/o Contrast,1168856,LOCAL,70540,CPT,,,,,,Outpatient,,,,1814.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Maxillofacial w/ Contrast,1168184,LOCAL,70487,CPT,,,,,,Outpatient,,,,1825.73,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - 3 X 3.5 CM,13962576,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TRANSCATH EMBOLIZATION S&I,8267120,LOCAL,75894,CPT,,,,,,Outpatient,,,,1838.93,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Neck Soft Tissue w/ + w/o Contrast,1168230,LOCAL,70492,CPT,,,,,,Outpatient,,,,1843.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Parathyroid 4-Phase Study,13554957,LOCAL,70492,CPT,,,,,,Outpatient,,,,1843.05,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Brain + IAC w/o Contrast,9427804,LOCAL,70551,CPT,,,,,,Outpatient,,,,1848,VIVA,Commercial,,50,,3246.61,229.87,3246.61,1 through 10,percent of total billed charges,220.99,372.26,
MRI Brain w/o Contrast,1168800,LOCAL,70551,CPT,,,,,,Outpatient,,,,1848,VIVA,Commercial,,50,,3246.61,229.87,3246.61,1 through 10,percent of total billed charges,220.99,372.26,
MRI Pituitary w/o Contrast,8203111,LOCAL,70551,CPT,,,,,,Outpatient,,,,1848,VIVA,Commercial,,50,,3246.61,229.87,3246.61,1 through 10,percent of total billed charges,220.99,372.26,
DISKOGRAM LUMBAR S & I,8299004,LOCAL,72295,CPT,,,,,,Outpatient,,,,1851.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Tumor Loc Spect,1169408,LOCAL,78803,CPT,,,,,,Outpatient,,,,1181.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Tumor Loc Whole Body 1 Day,1169414,LOCAL,78802,CPT,,,,,,Outpatient,,,,2870.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NUSHIELD 2X3CM,13962587,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
28090 EXCISION GANGLION CYST FOOT,13436341,LOCAL,28090,CPT,,,,,,Outpatient,,,,2296,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ICD REMOVAL SC/DC LEAD TV EXTRACT,8231010,LOCAL,33244,CPT,,,,,,Outpatient,,,,2302,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Elbow w/ + w/o Contrast Left,1168836,LOCAL,73223,CPT,,,,,LT,Outpatient,,,,1756.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Elbow w/ + w/o Contrast Right,1168838,LOCAL,73223,CPT,,,,,RT,Outpatient,,,,1756.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Shoulder w/ + w/o Contrast Left,1169032,LOCAL,73223,CPT,,,,,LT,Outpatient,,,,1756.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Shoulder w/ + w/o Contrast Right,1169034,LOCAL,73223,CPT,,,,,RT,Outpatient,,,,1756.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Wrist w/ + w/o Contrast Left,1169128,LOCAL,73223,CPT,,,,,LT,Outpatient,,,,1756.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Wrist w/ + w/o Contrast Right,1169130,LOCAL,73223,CPT,,,,,RT,Outpatient,,,,1756.43,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Femur w/ + w/o Contrast Lt,8058701,LOCAL,73720,CPT,,,,,LT,Outpatient,,,,1902.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Femur w/ + w/o Contrast Rt,8058704,LOCAL,73720,CPT,,,,,RT,Outpatient,,,,1902.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Foot w/ + w/o Contrast Left,1168878,LOCAL,73720,CPT,,,,,LT,Outpatient,,,,1902.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Foot w/ + w/o Contrast Right,1168880,LOCAL,73720,CPT,,,,,RT,Outpatient,,,,1902.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Tibia/Fibula w/ + w/o Contrast Left,8206777,LOCAL,73720,CPT,,,,,LT,Outpatient,,,,1902.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Tibia/Fibula w/ + w/o Contrast Right,8206779,LOCAL,73720,CPT,,,,,RT,Outpatient,,,,1902.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THERASKIN 1.75 X 1.75,13962605,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,,2431,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3900 WHFO DYNAMIC,9856098,LOCAL,,,L3900,HCPCS,,,,Outpatient,,,,2327,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"L3900 Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger",9856099,LOCAL,,,L3900,HCPCS,,,,Outpatient,,,,2327,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11044 DEBRID BONE FIRST 20SQ CM OR < CHARGE,8019965,LOCAL,11044,CPT,,,,,,Outpatient,,,,2328,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Face Neck Orbit w/ Contrast,1168854,LOCAL,70542,CPT,,,,,,Outpatient,,,,1948.65,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
bivalirudin 250 mg intravenous injection [CULL],11220339,LOCAL,J0583,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Pelvis w/ + w/o Contrast,1169024,LOCAL,72197,CPT,,,,,,Outpatient,,,,1953.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Prostate w/ + w/o Contrast,4126347,LOCAL,72197,CPT,,,,,,Outpatient,,,,1953.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Spine Thoracic w/ + w/o Contrast,1168248,LOCAL,72130,CPT,,,,,,Outpatient,,,,1963.5,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Breast w/o Contrast Bilateral.,8784923,LOCAL,77047,CPT,,,,,,Outpatient,,,,1966.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Spine Cervical w/ + w/o Contrast,1168236,LOCAL,72127,CPT,,,,,,Outpatient,,,,1967.63,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Abdomen w/ + w/o Contrast,1167845,LOCAL,74170,CPT,,,,,,Outpatient,,,,1972.58,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Pelvis w/ + w/o Contrast,1168194,LOCAL,72194,CPT,,,,,,Outpatient,,,,1972.58,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
28190 Appy Rigid Leg Cast (Professional Charge only if Provider Applies),12642333,LOCAL,28190,CPT,,,,,,Outpatient,,,,2392,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Ankle w/ + w/o Contrast Left,1168738,LOCAL,73723,CPT,,,,,LT,Outpatient,,,,1979.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Ankle w/ + w/o Contrast Right,1168740,LOCAL,73723,CPT,,,,,RT,Outpatient,,,,1979.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hip w/ + w/o Contrast Left,1168936,LOCAL,73723,CPT,,,,,LT,Outpatient,,,,1979.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hip w/ + w/o Contrast Right,1168938,LOCAL,73723,CPT,,,,,RT,Outpatient,,,,1979.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Knee w/ + w/o Contrast Left,1168972,LOCAL,73723,CPT,,,,,LT,Outpatient,,,,1979.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Knee w/ + w/o Contrast Right,1168974,LOCAL,73723,CPT,,,,,RT,Outpatient,,,,1979.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-2004BC,4802098,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-3004 300cc,4801298,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-3504bc,4801299,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-4754BC,4852770,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-5504BC,4803723,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-6501BC,4805039,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST 445ML,4855517,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST GEL 700CC,4850683,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST MEMORY GEL 510CC,4853454,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT MEMORY GEL 225CC,4830332,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Brain/Head w/ + w/o Contrast,1168649,LOCAL,70546,CPT,,,,,,Outpatient,,,,1979.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Brain + IAC w/ Contrast,9427801,LOCAL,70552,CPT,,,,,,Outpatient,,,,1994.85,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Brain w/ Contrast,1168798,LOCAL,70552,CPT,,,,,,Outpatient,,,,1994.85,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THERASKIN 2.5 X 2.5 CM,13962606,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,,2431,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Abdomen w/ + w/o Contrast,1168635,LOCAL,74185,CPT,,,,,,Outpatient,,,,2017.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Abdomen w/ + w/o Contrast,1168730,LOCAL,74183,CPT,,,,,,Outpatient,,,,2017.13,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Brain/Head w/ + w/o Contrast,1168090,LOCAL,70470,CPT,,,,,,Outpatient,,,,2023.73,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
10140 DRAINAGE OF HEMATOMA,8715913,LOCAL,10140,CPT,,,,,,Outpatient,,,,2454,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Upper Extremity w/ + w/o Cnt Left,1168704,LOCAL,73225,CPT,,,,,LT,Outpatient,,,,2038.58,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Upper Extremity w/ + w/o Cnt Left,1168704,LOCAL,C8936,CPT,,,,,LT,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Upper Extremity w/ + w/o Cnt Right,1168707,LOCAL,73225,CPT,,,,,RT,Outpatient,,,,2038.58,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Upper Extremity w/ + w/o Cnt Right,1168707,LOCAL,C8936,CPT,,,,,RT,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Orbit Sella etc. or IAC w/ + w/o Cont,8362452,LOCAL,70482,CPT,,,,,,Outpatient,,,,2054.25,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-2504 250CC,4801300,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-3501BC,4803006,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST 565CC,4851020,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Abdomen and Pelvis w/ Oral Contrast,8206351,LOCAL,74176,CPT,,,,,,Outpatient,,,,2074.88,VIVA,Commercial,,50,,226.41,226.41,226.41,1 through 10,percent of total billed charges,220.99,461.98,
CT Abdomen and Pelvis w/o Contrast,2424650,LOCAL,74176,CPT,,,,,,Outpatient,,,,2074.88,VIVA,Commercial,,50,,226.41,226.41,226.41,1 through 10,percent of total billed charges,220.99,461.98,
AMNIOEXCEL SKIN SUBSTITUTE 2CM X 3CM,13962553,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11404 EXCISION BENIGN LESION 3.1 CM TO 4.0 CM CHARGE,8726719,LOCAL,11404,CPT,,,,,,Outpatient,,,,2544,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OASIS ULTRA THIN DRESSING 7 X 10 CM,13962594,LOCAL,,,Q4124,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - 3 X 7CM,13962579,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Chest w/ + w/o Contrast,1168820,LOCAL,71552,CPT,,,,,,Outpatient,,,,2131.8,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-3754BC,4804163,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Chest High Resolution w/ + w/o Contrast,8658939,LOCAL,71270,CPT,,,,,,Outpatient,,,,2148.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Chest w/ + w/o Contrast,8071389,LOCAL,71270,CPT,,,,,,Outpatient,,,,2148.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Breast w/ + w/o Contrast Left.,8784917,LOCAL,77048,CPT,,,,,LT,Outpatient,,,,2161.5,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Breast w/ + w/o Contrast Left.,8784917,LOCAL,C8905,CPT,,,,,LT,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Breast w/ + w/o Contrast Right.,8784920,LOCAL,77048,CPT,,,,,RT,Outpatient,,,,2161.5,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Breast w/ + w/o Contrast Right.,8784920,LOCAL,C8905,CPT,,,,,RT,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PACEMAKER POCKET,8210140,LOCAL,33222,CPT,,,,,,Outpatient,,,,2620,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PURAPLY AM 2X4 COMMERCIAL 8SQ CM,13962598,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,,3861,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOEXCEL PLUS 2CMX2CM,13962548,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Face Neck Orbit w/ + w/o Contrast,1168852,LOCAL,70543,CPT,,,,,,Outpatient,,,,2181.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Maxillofacial w/ + w/o Contrast,1168182,LOCAL,70488,CPT,,,,,,Outpatient,,,,2192.03,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"64625 Radiofrequency ablation, nerves innervating the SI joint",5661090,LOCAL,64625,CPT,,,,,,Outpatient,,,,2665,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Abdomen and Pelvis w/ Contrast,2424647,LOCAL,74177,CPT,,,,,,Outpatient,,,,2221.73,VIVA,Commercial,,50,,327.21,215.42,327.21,14,percent of total billed charges,326.51,461.98,
CT Abdomen and Pelvis w/ Contrast + Oral,13452969,LOCAL,74177,CPT,,,,,,Outpatient,,,,2221.73,VIVA,Commercial,,50,,327.21,215.42,327.21,14,percent of total billed charges,326.51,461.98,
95808 SLEEP STAGING CHARGE,13485403,LOCAL,95808,CPT,,,,,,Outpatient,,,,2701,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PRIMATRIX 4X4 MESH,13962596,LOCAL,,,Q4110,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THERASKIN 2.5 X 5.1 CM,13962607,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,,2431,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Beta Amyloid 42/40 Ratio, CSF QST",13873765,LOCAL,82542,CPT,,,,,,Outpatient,,,,28.91,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INSERTION OF INTRAPERITONEAL CATHETER,8267131,LOCAL,49418,CPT,,,,,,Outpatient,,,,2723,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Insert Tun IP Cath Perc,10460131,LOCAL,49418,CPT,,,,,,Outpatient,,,,2723,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOEXCEL SKIN SUBSTITUTE 3.5CM X 3.5CM,13962554,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NUSHIELD 2X3CM,10510072,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NUSHIELD 2X4CM,13962588,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Breast w/ + w/o Contrast Bilateral.,8145272,LOCAL,77049,CPT,,,,,,Outpatient,,,,2333.1,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IR Nephro Plcmt New Access W Cath,8267190,LOCAL,50432,CPT,,,,,,Outpatient,,,,2829,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NEPHROSTOGRAM CATHETER PLACEMENT S&I,8267190,LOCAL,50432,CPT,,,,,,Outpatient,,,,2829,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXCHANGE NEPHROSTOMY TUBE,8212021,LOCAL,50435,CPT,,,,,,Outpatient,,,,2833,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ACTIGRAFT PRO-RD2301,10510000,LOCAL,,,G0460,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Brain + IAC w/ + w/o Contrast,9427798,LOCAL,70553,CPT,,,,,,Outpatient,,,,2361.15,VIVA,Commercial,,50,,4203.72,339.61,4203.72,1 through 10,percent of total billed charges,326.51,652.35,
MRI Brain w/ + w/o Contrast,1168796,LOCAL,70553,CPT,,,,,,Outpatient,,,,2361.15,VIVA,Commercial,,50,,4203.72,339.61,4203.72,1 through 10,percent of total billed charges,326.51,652.35,
MRI Pituitary w/ + w/o Contrast,8058740,LOCAL,70553,CPT,,,,,,Outpatient,,,,2361.15,VIVA,Commercial,,50,,4203.72,339.61,4203.72,1 through 10,percent of total billed charges,326.51,652.35,
AMNIOEXCEL SKIN SUBSTITUTE 4CM X 4CM,13962555,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PULMONARY UNILATERAL S&I,8210600,LOCAL,75741,CPT,,,,,,Outpatient,,,,2404.88,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VENOUS SAMPLING WO/W ANGIO,8210720,LOCAL,75893,CPT,,,,,,Outpatient,,,,2404.88,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VISCERAL S&I,8210570,LOCAL,75726,CPT,,,,,,Outpatient,,,,2404.88,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Abdomen and Pelvis,2424686,LOCAL,74174,CPT,,,,,,Outpatient,,,,2433.75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THERASKIN 2.5 X 2.5 CM,10510018,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,,2431,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-4004BC,4803833,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-4504BC,4841089,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT MEMORY GEL 300CC,4852825,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GRAFIX PRIME 2 X 3CM,13962571,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,,3671,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PTA URETERAL STRICTURE WITH IMAGING,8267792,LOCAL,50706,CPT,,,,,,Outpatient,,,,3086,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Spine Cervical w/ + w/o Contrast,1169050,LOCAL,72156,CPT,,,,,,Outpatient,,,,2545.95,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPIFIX SKIN SUBSTITUTE 2 X 2 CM,13962562,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Abdomen and Pelvis w/ + w/o Contrast,2424644,LOCAL,74178,CPT,,,,,,Outpatient,,,,2588.03,VIVA,Commercial,,50,,3519.91,2413.27,3519.91,1 through 10,percent of total billed charges,326.51,461.98,
CT Urogram,8203051,LOCAL,74178,CPT,,,,,,Outpatient,,,,2588.03,VIVA,Commercial,,50,,3519.91,2413.27,3519.91,1 through 10,percent of total billed charges,326.51,461.98,
EPIFIX SKIN SUBSTITUTE 2 X 2 CM,10510011,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Inflammation Loc Spect,1169158,LOCAL,78803,CPT,,,,,,Outpatient,,,,1181.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
antivenin (Crotalidae equine) polyvalent intravenous injection [CULL],11250856,LOCAL,J0841,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THERASKIN 2.5 X 5.1 CM,10510019,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,,2431,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tocilizumab 20 mg/mL Sol 10 mL [CULL],11260565,LOCAL,J3262,CPT,,,,,,Outpatient,10,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Spine Thoracic w/ + w/o Contrast,1169062,LOCAL,72157,CPT,,,,,,Outpatient,,,,2736.53,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CATH LAB INSERTION OF PLEURAL CATHETER,8230067,LOCAL,32550,CPT,,,,,,Outpatient,,,,3336,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95782 PEDI POLYSOMNOGRAPHY (<6YO) CHARGE,9303178,LOCAL,95782,CPT,,,,,,Outpatient,,,,3342,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95810 POLYSOMNOGRAPHY CHARGE.,8303749,LOCAL,95810,CPT,,,,,,Outpatient,,,,3342,VIVA,Commercial,,50,,5091.48,959.68,5091.48,1 through 10,percent of total billed charges,930.16,1113.98,
NUSHIELD 2X4CM,10510073,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Cardiac Amyloid PYP Spect,9955566,LOCAL,78803,CPT,A9538,HCPCS,,,,Outpatient,,,,1181.4,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Spine Lumbar w/ + w/o Contrast,1169056,LOCAL,72158,CPT,,,,,,Outpatient,,,,2842.95,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95783 POLYSOM <6 YRS SLP W/CPAP CHARGE,10732463,LOCAL,95783,CPT,,,,,,Outpatient,,,,3477,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95811 POLYSOMMOGRAPHY w/ CPAP CHARGE,8303770,LOCAL,95811,CPT,,,,,,Outpatient,,,,3477,VIVA,Commercial,,50,,5274.1,959.68,5274.1,15,percent of total billed charges,930.16,930.16,
NM Inflammation Loc Whole Body - Ceretec,1169152,LOCAL,78802,CPT,A9521,HCPCS,,,,Outpatient,,,,2870.18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPIFIX SKIN SUBSTITUTE 2 X 3 CM,13962563,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Inflammation Loc Limited - Indium,1169148,LOCAL,78801,CPT,,,,,,Outpatient,,,,2895.75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Inflammation Loc Multi,12113627,LOCAL,78801,CPT,,,,,,Outpatient,,,,2895.75,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOEXCEL PLUS 3X3,13962549,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THROMBECTOMY VENOUS ADDL,8210394,LOCAL,37188,CPT,,,,,,Outpatient,,,,3523,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - 3 X 7,13962578,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THERASKIN 5.1 X 7.6 CM,13962608,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,,2431,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NEW ACCESS NEPHROSTOMY TUBE,8200537,LOCAL,50433,CPT,,,,,,Outpatient,,,,3545,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PTA RENAL ARTERY (ADD'L),8210240,LOCAL,37247,CPT,,,,,,Outpatient,,,,3567,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-6504BC 650CC,4801608,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-8004BC,4803074,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST 700CC #350-7004BC MENTOR,4803075,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST SILICONE 500CC,4805180,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT SILICONE 750CC,4851569,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PURAPLY AM 3.76 CM X 4.76 CM,13962601,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,,3861,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
27603 DRAIN LOWER LEG LESION,13043453,LOCAL,27603,CPT,,,,,LT,Outpatient,,,,3592,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Myocardial Planar Rest and Stress,2425972,LOCAL,78454,CPT,A9500,HCPCS,,,,Outpatient,,,,2999.7,VIVA,Commercial,,50,,53.77,53.77,53.77,1 through 10,percent of total billed charges,1193.55,1409.71,
EPIFIX SKIN SUBSTITUTE 3.5 X 3.5 CM,13962565,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GRAFIX PRIME 2 X 3CM,10510014,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,,3671,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GRAFIX PL 3.0 X 4.0CM,13962568,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,,3671,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVISION REPLACE GENERATOR  BLADDER,8268108,LOCAL,64595,CPT,,,,,,Outpatient,,,,3699,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVISION REPLACE LEAD BLADDER STIMULATOR,8268107,LOCAL,64585,CPT,,,,,,Outpatient,,,,3699,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOEXCEL PLUS 2CMX2CM,10510060,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INTRO AV SHUNT W S&I,8267106,LOCAL,36902,CPT,,,,,,Outpatient,,,,11107,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
APLIGRAF-COM,13962557,LOCAL,,,Q4101,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPIFIX SKIN SUBSTITUTE 4 X 4.5 CM,13962566,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPIFIX SKIN SUBSTITUTE 4 X 4.5CM,13962567,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15120 SKN SPLT A-GRFT FAC/NCK/HF/G 100 SQ CM/1% BA,10006441,LOCAL,15120,CPT,,,,,,Outpatient,,,,3735,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REPOSITION IVC FILTER,8267129,LOCAL,37192,CPT,,,,,,Outpatient,,,,3751,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPICORD 2CM X 3CM,13962558,LOCAL,,,Q4187,HCPCS,,,,Outpatient,,,,3788,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VENOUS PTA EACH ADD'L,8267100,LOCAL,37249,CPT,,,,,,Outpatient,,,,3820,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PURAPLY AM 3 CM X 4 CM,13962599,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,,3861,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PURAPLY AM 3 X 4CM FEN FINISHED PROD,13962600,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,,3861,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Central Line Access Type. -> Tunneled,13449753,LOCAL,36810,CPT,,,,,,Outpatient,,,,3874,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NUSHIELD 3X4CM,13962589,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NUSHIELD 4X4CM,13962590,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
prothrombin complex - Pow [CULL],11220535,LOCAL,J7168,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AFFINITY 1.5 CM X 1.5 CM,10500119,LOCAL,,,Q4159,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPIFIX SKIN SUBSTITUTE 2 X 4 CM,13962564,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
33215 Reposition Pacing Defibrillator Lead,8212027,LOCAL,33215,CPT,,,,,,Outpatient,,,,3968,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ICD REMOVAL ONLY,8231005,LOCAL,33241,CPT,,,,,,Outpatient,,,,3968,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXTREMITY UNILATERAL S&I,8210530,LOCAL,75710,CPT,,,,,,Outpatient,,,,3288.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Angio Extremity in OR SI Left,2425383,LOCAL,75710,CPT,,,,,LT,Outpatient,,,,3288.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Angio Extremity in OR SI Right,2425386,LOCAL,75710,CPT,,,,,RT,Outpatient,,,,3288.45,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
immune globulin intravenous and subcutaneous 10% injectable solution 100 mL [CULL],11205089,LOCAL,J1561,CPT,,,,,,Outpatient,100,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TRANSCATH THER.ART.INF.(FINAL DAY),8210027,LOCAL,37214,CPT,,,,,,Outpatient,,,,4104,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BULKAMID URETHRAL BULKING SYSTEM,4830058,LOCAL,,,L8603,HCPCS,,,,Outpatient,,,,3364,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE 750-900ML,4854109,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE DERMASPAN 600-720CC,4805041,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE LPP-FH13S,4832956,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE LPP-FH14S,4803623,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93503 INSERTION OF SWAN GANZ CHARGE,8210870,LOCAL,93503,CPT,,,,,,Outpatient,,,,4157,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PA CATHETER SV02,4221129,LOCAL,93503,CPT,,,,,,Outpatient,,,,4157,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GENERATOR REMOVAL ONLY,8210160,LOCAL,33233,CPT,,,,,,Outpatient,,,,4190,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
fomepizole 1 g/mL intravenous solution 1.5 mL [CULL],11290124,LOCAL,J1451,CPT,,,,,,Outpatient,1.5,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Myocardial SPECT Drug Stress Multi,8567792,LOCAL,78452,CPT,,,,,,Outpatient,,,,3625.05,VIVA,Commercial,,50,,2318.51,1257.03,2318.51,1 through 10,percent of total billed charges,1193.55,1409.71,
NM Myocardial SPECT Rest and Stress,2425975,LOCAL,78452,CPT,,,,,,Outpatient,,,,3625.05,VIVA,Commercial,,50,,2318.51,1257.03,2318.51,1 through 10,percent of total billed charges,1193.55,1409.71,
dalbavancin 500 mg Pow [CULL],11287452,LOCAL,J0875,CPT,,,,,,Outpatient,1,UN,,4440,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST SHPB-235,4852442,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST SHPB-585,4851979,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST SHPB-635,4805161,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GRAFIX PL 3.0 X 4.0CM,10510066,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,,3671,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PERC URETERAL STENT REMOVAL & REPLACE,8210741,LOCAL,50382,CPT,,,,,,Outpatient,,,,4500,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL NM TC99M Ceretec Per Dose,13644947,LOCAL,,,A9521,HCPCS,,,,Outpatient,,,,4544,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPICORD 2CM X 3CM,10510051,LOCAL,,,Q4187,HCPCS,,,,Outpatient,,,,3788,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST 775,4850675,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"BRCAvantage(R), Comprehensive QSTC",9039435,LOCAL,81162,CPT,,,,,,Outpatient,,,,2189.86,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PURAPLY AM 3 X 4CM FEN FINISHED PROD,10510076,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,,3861,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NUSHIELD 4X4CM,10510075,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THROMBECTOMY ARTERIAL SECONDARY PERC,8210390,LOCAL,37186,CPT,,,,,,Outpatient,,,,4799,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"15100 AUTO-SPLIT THICK T/A/L, 1ST 100 SQCM CHARGE",12816476,LOCAL,15100,CPT,,,,,,Outpatient,,,,4802,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AFFINITY 1.5CM X 1.5CM,10500119,LOCAL,,,Q4159,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THROMBECTOMY VENOUS PRIMARY,8210393,LOCAL,37187,CPT,,,,,,Outpatient,,,,4926,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GRAFT STRAVIX 2 X 4,13962572,LOCAL,,,Q4132,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPIFIX SKIN SUBSTITUTE 4 X 4.5 CM,10510064,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXCHANGE OF BILIARY DRAIN CATH,8267769,LOCAL,47536,CPT,,,,,,Outpatient,,,,5124,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PLACEMENT BILIARY DRAIN CATH INT/EXT,8201219,LOCAL,47534,CPT,,,,,,Outpatient,,,,5124,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
36253 Insertion Of Cath Renal Arterial 2Nd Unilateral,8212045,LOCAL,36253,CPT,,,,,,Outpatient,,,,5233,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CERVICOCEREBRAL S&I,8201615,LOCAL,36221,CPT,,,,,,Outpatient,,,,5233,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COMMON CAROTID UNI S&I,8201600,LOCAL,36223,CPT,,,,,,Outpatient,,,,5233,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXTERNAL CAROTID UNI S&I,8201610,LOCAL,36222,CPT,,,,,,Outpatient,,,,5233,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INFERIOR VENA CAVA S&I,8210660,LOCAL,75825,CPT,,,,,,Outpatient,,,,4317.23,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IR Angio Pulmonary Bilateral,7949335,LOCAL,75743,CPT,,,,,,Outpatient,,,,4317.23,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PULMONARY BILATERAL S&I,8210610,LOCAL,75743,CPT,,,,,,Outpatient,,,,4317.23,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RENAL UNILATERAL PLACEMENT & SI,8210550,LOCAL,36251,CPT,,,,,,Outpatient,,,,5233,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VERTEBRAL SUBCLAVIAN OR INNOMINATE,8201625,LOCAL,36225,CPT,,,,,,Outpatient,,,,5233,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Venogram Cava Inferior,10386826,LOCAL,75825,CPT,,,,,,Outpatient,,,,4317.23,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
25040 FOREIGN BODY REMOVAL FOREARM LEFT,13416875,LOCAL,25040,CPT,,,,,LT,Outpatient,,,,5250,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
FOREIGN BODY RETRIEVAL,8201630,LOCAL,37197,CPT,,,,,,Outpatient,,,,5252,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
FOREIGN BODY RETRIEVAL S&I,8201635,LOCAL,37197,CPT,,,,,,Outpatient,,,,5252,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REMOVAL IVC FILTER,8267130,LOCAL,37193,CPT,,,,,,Outpatient,,,,5252,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL NM Indium WBC Per 0.5 MCI,13644939,LOCAL,,,A9547,HCPCS,,,,Outpatient,,,,5266,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL NM Kinevac Per 5 MCG Vial,13644941,LOCAL,,,A9547,HCPCS,,,,Outpatient,,,,5266,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PERC INTRO CATH/STENT URETERAL PREEXIST,8200532,LOCAL,50693,CPT,,,,,,Outpatient,,,,5280,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PERC INTRO URETERAL NEW ACCESS W CATH,8200534,LOCAL,50695,CPT,,,,,,Outpatient,,,,5280,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PERC INTRO URETERAL NEW ACCESS WO CATH,8200533,LOCAL,50694,CPT,,,,,,Outpatient,,,,5280,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VERTEBROPLASTY ADDL THOR/LUMB,8267765,LOCAL,22512,CPT,,,,,,Outpatient,,,,5438,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VERTEBROPLASTY LUMBAR,8211170,LOCAL,22511,CPT,,,,,,Outpatient,,,,5438,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VERTEBROPLASTY THORACIC,8211160,LOCAL,22510,CPT,,,,,,Outpatient,,,,5438,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RENAL BILATERAL PLACEMENT & SI,8210560,LOCAL,36252,CPT,,,,,,Outpatient,,,,5550,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93452 Left Heart Cath,8230003,LOCAL,93452,CPT,,,,,,Outpatient,,,,5706,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TEMP SACRAL ELECTRODE WITH IMAGING,8268102,LOCAL,64561,CPT,,,,,,Outpatient,,,,5785,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
27372 FOREIGN BODY REMOVAL KNEE,13435628,LOCAL,27372,CPT,,,,,,Outpatient,,,,5815,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST ARTOURA 455CC SMOOTH,4853890,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
75630-IR Aortogram Abdominal + Iliofemoral1,8071871,LOCAL,75630,CPT,,,,,,Outpatient,,,,4835.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AORTO ABD+ILIOFEMORAL SERIAL,8210430,LOCAL,75630,CPT,,,,,,Outpatient,,,,4835.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AORTOGRAM THORACIC S&I,8210410,LOCAL,75605,CPT,,,,,,Outpatient,,,,4835.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXTREMITY BILATERAL S&I,8210540,LOCAL,75716,CPT,,,,,,Outpatient,,,,4835.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IR Aortogram Thoracic w/ Serialography,7949377,LOCAL,75605,CPT,,,,,,Outpatient,,,,4835.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Angio Extremity in OR SI Bilat,9343676,LOCAL,75716,CPT,,,,,,Outpatient,,,,4835.33,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
20240 BIOPSY BONE EXCISIONAL SUPERFI CHARGE,8020082,LOCAL,20240,CPT,,,,,,Outpatient,,,,5961,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
20240-BIOPSY BONE EXCISIONAL SUPERFI CHARGE,8020082,LOCAL,20240,CPT,,,,,,Outpatient,,,,5961,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE ALLOX2,4850383,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE ALLOX2-15SE,4800802,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE ALLOX2-FH13E,4800497,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE ALLOX2-FH14E,4840653,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TISSUE EXPANDER ALLOX2-FH15E,4810961,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMINOFIX 7CM X 6CM,13962545,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOEXCEL PLUS  3 X 4CM,13962546,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"93451 Catheterization, Right Heart",8230000,LOCAL,93451,CPT,,,,,,Outpatient,,,,6246,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93453 Combined Left and Right Heart Cath,8230006,LOCAL,93453,CPT,,,,,,Outpatient,,,,6246,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOFIX 4X6CM,13962556,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THROMBECTOMY ARTERIAL ADDL,8210392,LOCAL,37185,CPT,,,,,,Outpatient,,,,6339,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93454 HT Left Heart Cath WO LV,8210890,LOCAL,93454,CPT,,,,,,Outpatient,,,,6392,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92973 PTC Thromebectomy Add On,8200030,LOCAL,92973,CPT,,,,,,Outpatient,,,,6395,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NUSHIELD 6CM X 6CM,13962591,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TRANSCATH THER ART INFUSION FOR THROM,8210026,LOCAL,37211,CPT,,,,,,Outpatient,,,,6591,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CATH LAB IVC FILTER PLACEMENT,8210330,LOCAL,37191,CPT,,,,,,Outpatient,,,,6618,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INSERTION IVC FILTER,8267128,LOCAL,37191,CPT,,,,,,Outpatient,,,,6618,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PERC PLACE IVC FILTER S&I,8210740,LOCAL,37191,CPT,,,,,,Outpatient,,,,6618,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
leuprolide 45 mg/6 months Pow [CULL],11299002,LOCAL,J9217,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL NM Indium DTPA Per 0.5 MCI,13644937,LOCAL,,,A9548,HCPCS,,,,Outpatient,,,,6781,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - 7 X 10CM,13962581,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THROMBECTOMY ARTERIAL PRIMARY,8210391,LOCAL,37184,CPT,,,,,,Outpatient,,,,7024,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AORTOGRAM ABDOMEN S&I,8210420,LOCAL,75625,CPT,,,,,,Outpatient,,,,5844.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IR Aortogram Abdominal w/ Serialography1,8071874,LOCAL,75625,CPT,,,,,,Outpatient,,,,5844.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Aorta Abdomen Catheter in OR SI,2425389,LOCAL,75625,CPT,,,,,,Outpatient,,,,5844.3,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PURAPLY AM 5 CM X 5 CM,13962602,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,,3861,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER BREAST TISSUE ARTOURA 375CC,4853226,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE ARTOURA SDC100UH,4803722,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDERS TISSUE 475CC SDC-130H,4852707,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TRANSCATH STENT CERV CAROTID WITH DEVICE,8210025,LOCAL,37215,CPT,,,,,,Outpatient,,,,7459,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VERTEBRAL CERVICAL/CRANIAL S&I,8201620,LOCAL,36226,CPT,,,,,,Outpatient,,,,7488,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LEAD REPLACEMENT DUAL,8210110,LOCAL,33217,CPT,,,,,,Outpatient,,,,7768,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LEAD REPLACEMENT SGL,8210100,LOCAL,33216,CPT,,,,,,Outpatient,,,,7768,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
calcitonin 200 intl units/mL Sol [CULL],J0630,CPT,,,,,,,,Outpatient,200,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93455 HT Left Cath W Cor Inj WO LV,8230002,LOCAL,93455,CPT,,,,,,Outpatient,,,,7817,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
immune globulin intravenous and subcutaneous 10% injectable solution 200 mL [CULL],11205107,LOCAL,J1561,CPT,,,,,,Outpatient,200,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ALLOGRAFT DERMAPURE 7X10CM,4810278,LOCAL,Q4152,CPT,Q4152,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93458 HT Cath Left W LV and Cor Angio,8230004,LOCAL,93458,CPT,,,,,,Outpatient,,,,8133,VIVA,Commercial,,50,,6194.5,6194.5,6194.5,1 through 10,percent of total billed charges,2940.64,4325,
93460 HT Cath L or R W LV and Cor Angio,8230007,LOCAL,93460,CPT,,,,,,Outpatient,,,,8133,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
33210 INSERTION TEMP PACEMAKER SINGLE CHAMBER CHARGE,13707085,LOCAL,33210,CPT,,,,,,Outpatient,,,,8153,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TEMP PACEMAKER SGL CHAMBER,8210050,LOCAL,33210,CPT,,,,,,Outpatient,,,,8153,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92920 PTCA 1st Vessel,8201256,LOCAL,92920,CPT,,,,,,Outpatient,,,,8298,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PTA RENAL ARTERY (INITIAL),8267124,LOCAL,37246,CPT,,,,,,Outpatient,,,,17592,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ANGIO CPLX 1,8230034,LOCAL,37224,CPT,,,,,,Outpatient,,,,8298,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS IVT ANGIO CPLX1,8230030,LOCAL,37220,CPT,,,,,,Outpatient,,,,8298,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS TPVT ANGIO SF 1ST,8230022,LOCAL,37228,CPT,,,,,,Outpatient,,,,8298,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THERASKIN 7.6 X 15.2 CM,13962609,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,,2431,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93459 HT Cath Left W LV and Cor Grf Angio,8230005,LOCAL,93459,CPT,,,,,,Outpatient,,,,8765,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93461 HT Cath L or R W LV Cor Grf Angio,8230008,LOCAL,93461,CPT,,,,,,Outpatient,,,,8765,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
riTUXimab pvvr 10 mg/mL Sol 50 mL [CULL],11211085,LOCAL,Q5119,CPT,,,,,,Outpatient,50,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"C1 esterase inhibitor, human 500 intl units intravenous kit [CULL]",11201256,LOCAL,J0597,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOEXCEL PLUS 4X5CM,13962550,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ATHERECTOMY ABD AORTA,8230043,LOCAL,0236T,CPT,,,,,,Outpatient,,,,9388,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ATHERECTOMY BRACHIOCEPHALIC & BRANCHES,8230044,LOCAL,0237T,CPT,,,,,,Outpatient,,,,9388,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ATHERECTOMY ILIAC EACH,8230045,LOCAL,0238T,CPT,,,,,,Outpatient,,,,12175,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ATHERECTOMY RENAL,8230041,LOCAL,0234T,CPT,,,,,,Outpatient,,,,9388,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ATHERECTOMY VISCERAL,8230042,LOCAL,0235T,CPT,,,,,,Outpatient,,,,9388,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPICORD 3 X 5,13962559,LOCAL,,,Q4187,HCPCS,,,,Outpatient,,,,3788,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INTERNAL CAROTID UNI S&I,8201636,LOCAL,36224,CPT,,,,,,Outpatient,,,,9628,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
37239 STENT ANGIO VEIN EA ADDL CHARGE,8230063,LOCAL,37239,CPT,,,,,,Outpatient,,,,10194,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ARTERY STENT ADD'L (NONCORONARY),8230061,LOCAL,37237,CPT,,,,,,Outpatient,,,,10194,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93456 Right Heart Catheterization With Angiography,8230009,LOCAL,93456,CPT,,,,,,Outpatient,,,,10413,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
33285 Implant Pt Activated Cardiac Event Recorder,8267776,LOCAL,33285,CPT,,,,,,Outpatient,,,,10419,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92928 Trnscath Plcmnt Metal Single,8201254,LOCAL,92928,CPT,,,,,,Outpatient,,,,10803,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL Octreotide,14874647,LOCAL,,,A9572,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
alteplase 50 mg intravenous injection [CULL],11201048,LOCAL,J2997,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93457 Right or Left Heart Cath with No LV Gram Charge,8230010,LOCAL,93457,CPT,,,,,,Outpatient,,,,11044,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AV FISTULAGRAM WITH ANGIOPLASTY,8210331,LOCAL,36902,CPT,,,,,,Outpatient,,,,11107,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"C9764 Revasculation, Endovascular, With Intravascular Lithotripsy, Includes Angioplasty",8230070,LOCAL,,,C9764,HCPCS,,,,Outpatient,,,,11270,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
digoxin immune FAB 40 mg intravenous injection [CULL],11201675,LOCAL,J1162,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - 7 X 10,13962580,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GENERATOR ONLY SGL CHAMBER INSERTION,8210070,LOCAL,33212,CPT,,,,,,Outpatient,,,,11691,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PACEMAKER REMOVAL SINGLE,8210171,LOCAL,33227,CPT,,,,,,Outpatient,,,,11691,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
immune globulin intravenous and subcutaneous 10% injectable solution 300 mL [CULL],11205109,LOCAL,J1561,CPT,,,,,,Outpatient,300,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
0238T Iliac Athrectomy with or without PTA,8230069,LOCAL,0238T,CPT,,,,,,Outpatient,,,,12175,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INSERTION NEUROSTIMULATOR GENERATOR,8268101,LOCAL,64590,CPT,,,,,,Outpatient,,,,519,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GENERATOR REMOVAL AND REPLACEMENT DUAL,8210172,LOCAL,33228,CPT,,,,,,Outpatient,,,,13640,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C9604 Revasc thru Bypass Single Vessel w DES (M'care),8201640,LOCAL,,,C9604,HCPCS,,,,Outpatient,,,,13725,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C9607 Revasc CTO Single Vessel w DES (M'care),8201642,LOCAL,,,C9607,HCPCS,,,,Outpatient,,,,13725,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PERQ BM STENT ADD ON  RAMUS,8201252,LOCAL,,,C9600,HCPCS,,,,Outpatient,,,,13725,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TIB/PER REVASC W/ATHER ADD ON  LT,8210020,LOCAL,33206,CPT,,,,,,Outpatient,,,,13997,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C9772 Revasc Lithotrip Tibi/Peroneal Artery (Shockwave IVL),8230074,LOCAL,,,C9772,HCPCS,,,,Outpatient,,,,14403,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PTA VENOUS PERC W S&I,8267099,LOCAL,37248,CPT,,,,,,Outpatient,,,,14476,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VENTRICULAR PACEMAKER IMPLANT INS OR REP,8210030,LOCAL,33207,CPT,,,,,,Outpatient,,,,14551,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ATHRC CPLX 1,8230035,LOCAL,37225,CPT,,,,,,Outpatient,,,,15305,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ST CPLX 1ST,8230036,LOCAL,37226,CPT,,,,,,Outpatient,,,,15305,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS IVT ST CPLX 1ST,8230031,LOCAL,37221,CPT,,,,,,Outpatient,,,,15305,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS TPVT ATHRC CPLX 1,8230023,LOCAL,37229,CPT,,,,,,Outpatient,,,,15305,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VASC EMBOLIZE OCCLUDE ARTERY,8210362,LOCAL,37242,CPT,,,,,,Outpatient,,,,15482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VASC EMBOLIZE OCCLUDE BLEED,8210364,LOCAL,37244,CPT,,,,,,Outpatient,,,,15482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VASC EMBOLIZE OCCLUDE ORGAN,8210363,LOCAL,37243,CPT,,,,,,Outpatient,,,,15482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VASC EMBOLIZE OCCLUDE VENOUS,8210361,LOCAL,37241,CPT,,,,,,Outpatient,,,,15482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
37238 STENT ANGIO VEIN INITIAL CHARGE,8230062,LOCAL,37238,CPT,,,,,,Outpatient,,,,15809,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
37236 Stent Angioplasty Artery Int,8230060,LOCAL,37236,CPT,,,,,,Outpatient,,,,15968,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SACRAL NERVE (TRANSFORAMINAL PLACEMENT),8268100,LOCAL,64581,CPT,,,,,,Outpatient,,,,1108,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SHOULDER SYSTEMHEAD DWF041,4811086,LOCAL,,,L3975,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PTA BRACHIOCEPHALIC TRUNK W S&I,8210280,LOCAL,37246,CPT,,,,,,Outpatient,,,,17592,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
A V PACEMAKER IMPLANT INS OR REPLACE,8210040,LOCAL,33208,CPT,,,,,,Outpatient,,,,18010,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
UPGRADE SGL DUAL LEAD/CHAMBER,8210090,LOCAL,33214,CPT,,,,,,Outpatient,,,,18010,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C9773 Revasc Lithotrip-Stent Tib/Peroneal Atr (Shockwave IVL),8230075,LOCAL,,,C9773,HCPCS,,,,Outpatient,,,,18430,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C9774 Revasc Lithotr-Ather Tib/Peroneal Atr (Shockwave IVL),8230076,LOCAL,,,C9774,HCPCS,,,,Outpatient,,,,18430,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C9775 Revasc Lithotr-Stent-Ather-Peroneal Atr (Shockwave IVL),8230077,LOCAL,,,C9775,HCPCS,,,,Outpatient,,,,18430,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"C9765 Revasculation, Endovascular, With Intravascular Lithotripsy, With Stent Placement Includes Ang",8230071,LOCAL,,,C9765,HCPCS,,,,Outpatient,,,,19321,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"C9766 Revasculation, Endovascular, With Intravascular Lithotripsy, Includes Atherectomy",8230072,LOCAL,,,C9766,HCPCS,,,,Outpatient,,,,19321,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tenecteplase 50 mg intravenous injection [CULL],11211269,LOCAL,J3101,CPT,,,,,,Outpatient,1,EA,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PTA STENT TIBPERONEAL INITIAL,8230024,LOCAL,37230,CPT,,,,,,Outpatient,,,,21279,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ST ATHRC CPX 1,8230037,LOCAL,37227,CPT,,,,,,Outpatient,,,,21505,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
alteplase 100 mg intravenous injection [CULL],11201042,LOCAL,J2997,CPT,,,,,,Outpatient,1,ML,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SIMPLIDERM ACELLULAR DERMAL,13962604,LOCAL,,,Q4116,HCPCS,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"C9767 Revasculation, Endovascular, With Intravascular Lithotripsy, With Stent Placement And Atherect",8230073,LOCAL,,,C9767,HCPCS,,,,Outpatient,,,,25903,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANTABLE STIM 2-LEAD EBI 10-1335M,4802519,LOCAL,,,E0749,HCPCS,,,,Outpatient,,,,22885,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PTA ARTHRECTOMY STENT TIBPERONEAL INITIA,8230025,LOCAL,37231,CPT,,,,,,Outpatient,,,,32867,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ICD INSERTION WITH EXISTING SINGLE LEAD,8231000,LOCAL,33240,CPT,,,,,,Outpatient,,,,33168,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ICD REMOVAL&REPLACE SINGLE,8267790,LOCAL,33262,CPT,,,,,,Outpatient,,,,42582,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ICD REMOVAL&REPLACE DUAL LEAD,8267778,LOCAL,33263,CPT,,,,,,Outpatient,,,,43882,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ICD REMOVAL&REPLACE MULTIPLE,8267791,LOCAL,33264,CPT,,,,,,Outpatient,,,,45832,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"45300 Proctosigmoidoscopy, rigid; diagnostic, w/ or w/o collection by brushing or washing",7962380,LOCAL,45300,CPT,,,,,,Outpatient,,,,129,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,90471,CPT,,,,,,Outpatient,,,,140,VIVA,Commercial,,50,,133.08,105.33,133.08,1 through 10,percent of total billed charges,42.18,65.07,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,G0010,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"25105 ARTHROTOMY, WRIST JOINT WITH SYNOVECTOMY",14130163,LOCAL,25105,CPT,,,,,,Outpatient,,,,3245,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DOPP ART BIL REST MULTIPLE/SINGLE,8230015,LOCAL,93923,CPT,,,,,26,Outpatient,,,,401,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DOPP ART W/TREADMILL,8230020,LOCAL,93924,CPT,,,,,26,Outpatient,,,,302,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DOPP LEA LIMITED,8230019,LOCAL,93922,CPT,,,,,26,Outpatient,,,,265,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP ABD RENAL COMPLETE,8200571,LOCAL,93975,CPT,,,,,26,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP ABD RENAL LIMITED,8200581,LOCAL,93976,CPT,,,,,26,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP AO IVC COMPLETE,8200570,LOCAL,93978,CPT,,,,,26,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP AO IVC LIMITED,8200580,LOCAL,93979,CPT,,,,,26,Outpatient,,,,310,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP CAROTID BILATERAL,8200229,LOCAL,93880,CPT,,,,,26,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP CAROTID UNILATERAL,8200228,LOCAL,93882,CPT,,,,,26,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP HEMODIALYSIS ACCESS,8200582,LOCAL,93990,CPT,,,,,26,Outpatient,,,,310,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP LEA BIL,8200577,LOCAL,93925,CPT,,,,,26,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP LEA UNI,8200576,LOCAL,93926,CPT,,,,,26,Outpatient,,,,310,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP UPPER ART BIL,8200575,LOCAL,93930,CPT,,,,,26,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP UPPER ART UNI,8200574,LOCAL,93931,CPT,,,,,26,Outpatient,,,,310,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP VENOUS BIL,8200573,LOCAL,93970,CPT,,,,,26,Outpatient,,,,482,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP VENOUS UNI,8200572,LOCAL,93971,CPT,,,,,26,Outpatient,,,,310,VIVA,Commercial,,50,,238.16,238.16,238.16,1 through 10,percent of total billed charges,97.22,161.71,
PC US PSEUDOANEURYSM COMPRESSION REPAIR,8200583,LOCAL,76936,CPT,,,,,26,Outpatient,,,,237.6,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97802 MEDICAL NUTRITIONAL THERAPY PROF CHARGE,13475611,LOCAL,97802,CPT,,,,,,Outpatient,,,,55,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97803 MEDICAL NUTRITIONAL RE-ASSESSMENT PROF CHARG,13481228,LOCAL,97803,CPT,,,,,,Outpatient,,,,48,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"64640 Destruction by neurolytic agent, other perip",13959658,LOCAL,64640,CPT,,,,,,Outpatient,,,,927,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
10060 PROFEE Drainage of skin abscess,13954453,LOCAL,10060,CPT,,,,,,Outpatient,,,,420,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
10061  I&D abscess complicated/multiple Profee,13769279,LOCAL,10061,CPT,,,,,,Outpatient,,,,420,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
10120 Incision & Removal Foreign Body Simp PROFEE,14006132,LOCAL,10120,CPT,,,,,,Outpatient,,,,893,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11042 PROFEE Debride subcutaneous tissue, 1st 20 s",13962336,LOCAL,11042,CPT,,,,,,Outpatient,,,,836,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11043 PROFEE DEB MUSC/FASCIA 20 SQ CM/<,13967660,LOCAL,11043,CPT,,,,,,Outpatient,,,,836,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11044 Debride bone, 1st 20 sq cm or less Pro Fee",11221020,LOCAL,11044,CPT,,,,,,Outpatient,,,,2328,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11045 Debride subq tissue, ea addl 20 sq cm Pro Fe",11221021,LOCAL,11045,CPT,,,,,,Outpatient,,,,836,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11046 PROFEE Debride muscle and/or fascia; ea addl,13954830,LOCAL,11046,CPT,,,,,,Outpatient,,,,836,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11047 PROFEE Debridement, sus tissue each add 20 s",13967661,LOCAL,11047,CPT,,,,,,Outpatient,,,,2092,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11104 Punch Biopsy of Skin; Single Lesion ProFee,8768419,LOCAL,11104,CPT,,,,,,Outpatient,,,,449,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11106  Incisional biopsy of skin single lesion Pro,13759967,LOCAL,11106,CPT,,,,,,Outpatient,,,,800,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11400 EXCISION, BENIGN LESION INCLUDING MARGINS, E",7929974,LOCAL,11400,CPT,,,,,,Outpatient,,,,935,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11406 EXCISION, BENIGN LESION INCLUDING MARGINS, E",7929979,LOCAL,11406,CPT,,,,,,Outpatient,,,,1620,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11604 EXCISION, MALIGNANT LESION INCLUDING MARGINS",7930002,LOCAL,11604,CPT,,,,,,Outpatient,,,,704,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11730 PROFEE Avulsion nail plate simple, single",13967650,LOCAL,11730,CPT,,,,,,Outpatient,,,,228,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11750 PROFEE Excision of nail and nail matrix, par",13954836,LOCAL,11750,CPT,,,,,,Outpatient,,,,1342,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15271 PROFEE Application of skin substitute graft,13967652,LOCAL,15271,CPT,,,,,,Outpatient,,,,1092,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15275 PROFEE APPLICATION OF SKIN SUBSTITUTE GRAFT,13954832,LOCAL,15275,CPT,,,,,,Outpatient,,,,1092,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"28810 AMPUTATION, METATARSAL, WITH TOE, SINGLE Pro",7931853,LOCAL,28810,CPT,,,,,,Outpatient,,,,3245,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
29445 PROFEE APPLICATION OF RIGID TOTAL CONTACT LE,13962328,LOCAL,29445,CPT,,,,,,Outpatient,,,,266,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
31502 Tracheotomy tube change prior to establishme,14397259,LOCAL,31502,CPT,,,,,,Outpatient,,,,232,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"31899 UNLISTED PROCEDURE, TRACHEA, BRONCHI ProFee",7932202,LOCAL,31899,CPT,,,,,,Outpatient,,,,194,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"58573 LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTO",14831670,LOCAL,58573,CPT,,,,,,Outpatient,,,,10411,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64454 Genicular Nerve Block Profee,13911832,LOCAL,64454,CPT,,,,,,Outpatient,,,,244,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64999 XX UNLISTED NERVOUS SYSTEM INJECTION,7939552,LOCAL,64999,CPT,,,,,,Outpatient,,,,620,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93010 EKG INTERPRETATION,7939709,LOCAL,93010,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93451 RIGHT HEART CATHERIZATION (OR),8192212,LOCAL,93451,CPT,,,,,26,Outpatient,,,,6246,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97597 WOUND DEBRIDEMENT ProFee,7935939,LOCAL,97597,CPT,,,,,,Outpatient,,,,395,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97598 DEBRID SELCT EA ADD20SQCM ProFee,7935940,LOCAL,97598,CPT,,,,,,Outpatient,,,,395,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97605 Negative pressure wound therapy less than 50,14327888,LOCAL,97605,CPT,,,,,,Outpatient,,,,285,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99183 HBO PER SESSION ProFee,7935966,LOCAL,99183,CPT,,,,,,Outpatient,,,,,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99202 LEVEL 2 VISIT NEW PT ProFee,7935970,LOCAL,99202,CPT,,,,,,Outpatient,,,,294,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99203 LEVEL 3 VISIT NEW PT ProFee,7935971,LOCAL,99203,CPT,,,,,,Outpatient,,,,387,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99204 LEVEL 4 NEW PT PROF CHARGE,8700762,LOCAL,99204,CPT,,,,,,Outpatient,,,,513,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99205 PROFEE OFFICE VISIT LEV 5 NEW PT,13962366,LOCAL,99205,CPT,,,,,,Outpatient,,,,701,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99211 LEVEL 1 EST PT PROF CHARGE,8700763,LOCAL,99211,CPT,,,,,,Outpatient,,,,226,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99212 LEVEL 2 EST PT PROF CHARGE,8700764,LOCAL,99212,CPT,,,,,,Outpatient,,,,294,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99213 LEVEL 3 EST PT PROF CHARGE,8700765,LOCAL,99213,CPT,,,,,,Outpatient,,,,387,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99214 LEVEL 4 EST PT PROF CHARGE,8700766,LOCAL,99214,CPT,,,,,,Outpatient,,,,513,VIVA,Commercial,,50,,419.25,91.59,419.25,1 through 10,percent of total billed charges,80.51,80.51,
99215 LEVEL 5 EST PT PROF CHARGE,8700767,LOCAL,99215,CPT,,,,,,Outpatient,,,,701,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0108 DIABETES SERVICE 30 MIN PROF CHARGE,13484119,LOCAL,G0108,CPT,,,,,,Outpatient,,,,128,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0109 DSMT DIABETES GROUP 30 MIN ProFee,7936084,LOCAL,G0109,CPT,,,,,,Outpatient,,,,18,VIVA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT MEMORY GEL #350-6004BC,4803876,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Protein, Tot & Prot Electrop Interp QSTC",8852423,LOCAL,84165,CPT,,,,,,Outpatient,,,,12.89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Protein, Total QSTC",8852413,LOCAL,84165,CPT,,,,,,Outpatient,,,,12.89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DRESSING TELFA ISLAND 4X10,11074306,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.RPR Titer QSTC,6231113,LOCAL,86593,CPT,,,,,,Outpatient,,,,5.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
UA Microscopic,633864,LOCAL,81015,CPT,,,,,,Outpatient,,,,3.66,CIGNA,Commercial,,50,,1.87,1.87,5.71,39,percent of total billed charges,1.68192607,4.02,
Urinalysis Review Manual,8502419,LOCAL,81015,CPT,,,,,,Outpatient,,,,3.66,CIGNA,Commercial,,50,,1.87,1.87,5.71,39,percent of total billed charges,1.68192607,4.02,
Hematocrit QSTC,8852782,LOCAL,85014,CPT,,,,,,Outpatient,,,,2.84,CIGNA,Commercial,,50,,2.28,2.28,2.28,1 through 10,percent of total billed charges,8.21,12.62068493,
Hemoglobin A2 (Quant) QSTC,8852791,LOCAL,83020,CPT,,,,,,Outpatient,,,,15.44,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hemoglobin QSTC,8852780,LOCAL,85018,CPT,,,,,,Outpatient,,,,2.84,CIGNA,Commercial,,50,,2.28,2.28,2.28,1 through 10,percent of total billed charges,8.21,10.94316176,
Red Blood Cell Count QSTC,8852779,LOCAL,85041,CPT,,,,,,Outpatient,,,,3.62,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
87107 Fungal Isolate Identification QST,14813753,LOCAL,87107,CPT,,,,,,Outpatient,,,,12.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
87143 Fungal Isolate Identification QST,14815667,LOCAL,87143,CPT,,,,,,Outpatient,,,,15.02,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
87149 Fungal Isolate Identification QST,14813753,LOCAL,87149,CPT,,,,,,Outpatient,,,,24.06,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glucose Fasting Urine,7974487,LOCAL,81003,CPT,,,,,,Outpatient,,,,2.7,CIGNA,Commercial,,50,,16.1,16.1,16.1,1 through 10,percent of total billed charges,3.795286195,4.02,
"Uric Acid, Synovial Fluid QSTC",9607980,LOCAL,84560,CPT,,,,,,Outpatient,,,,6.1,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alkaline Phosphatase QSTC,8848272,LOCAL,84075,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Isoenzymes QSTC,8848275,LOCAL,84080,CPT,,,,,,Outpatient,,,,17.74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLING ARM MEDIUM,11070727,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,,158,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
acetylcysteine 20% Inhalation Sol [CULL],11208888,LOCAL,J7608,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
albuterol 1.25 mg/3 mL (0.042%) Sol [CULL],11203025,LOCAL,J7613,CPT,,,,,,Outpatient,3,ML,,,CIGNA,Commercial,,50,,5.53,4.06,7,1 through 10,percent of total billed charges,4.66,4.66,
albuterol 2.5 mg/3 mL (0.083%) inhalation solution 3 mL [CULL],11203024,LOCAL,J7613,CPT,,,,,,Outpatient,3,ML,,,CIGNA,Commercial,,50,,5.53,4.06,7,1 through 10,percent of total billed charges,4.66,4.66,
albuterol 5 mg/mL (0.5%) inhalation solution [CULL],11203026,LOCAL,J7611,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
amiodarone 50 mg/mL intravenous solution 3 mL [CULL],11200004,LOCAL,J0282,CPT,,,,,,Outpatient,3,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
azaTHIOprine 50 mg oral tablet [CULL],11200492,LOCAL,J7500,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BUPivacaine 0.25% preservative-free Sol [CULL],11282035,LOCAL,J0665,CPT,,,,,,Outpatient,10,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BUPivacaine 0.75%-D8.25% preservative-free intrathecal solution 2 mL [CULL],11202136,LOCAL,J0665,CPT,,,,,,Outpatient,2,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
cycloSPORINE modified 25 mg oral capsule [CULL],11210499,LOCAL,J7515,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
dexAMETHasone 10 mg/mL injectable solution 1 mL [CULL],11202292,LOCAL,J1100,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,48.05,2.5,153.96,49,percent of total billed charges,10.48743758,10.48743758,
ipratropium 500 mcg/2.5 mL inhalation solution 2.5 mL [CULL],11203105,LOCAL,J7644,CPT,,,,,,Outpatient,2.5,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ketorolac 60 mg/2 mL Sol [CULL],11202716,LOCAL,J1885,CPT,,,,,,Outpatient,2,ML,,,CIGNA,Commercial,,50,,23.09,3.12,71.7,60,percent of total billed charges,0.27,0.27,
levalbuterol 0.31 mg/3 mL inhalation solution 3 mL [CULL],11203125,LOCAL,J7614,CPT,,,,,,Outpatient,3,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
levalbuterol 0.63 mg/3 mL inhalation solution 3 mL [CULL],11203127,LOCAL,J7614,CPT,,,,,,Outpatient,3,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
levalbuterol 1.25 mg/3 mL inhalation solution 3 mL [CULL],11203128,LOCAL,J7614,CPT,,,,,,Outpatient,3,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methylPREDNISolone 4 mg oral tablet [CULL],11230944,LOCAL,J7509,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
mitoMYcin 20 mg/40 mL Sol [CULL],11205507,LOCAL,J9280,CPT,,,,,,Outpatient,0.5,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ondansetron 2 mg/mL injectable solution 2 mL [CULL],11211057,LOCAL,J2405,CPT,,,,,,Outpatient,2,ML,,,CIGNA,Commercial,,50,,45.71,9.38,137.36,115,percent of total billed charges,0.057806268,0.057806268,
phenytoin 50 mg/mL injectable solution 2 mL [CULL],11282560,LOCAL,J1165,CPT,,,,,,Outpatient,2,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
phenytoin 50 mg/mL injectable solution 5 mL [CULL],11212135,LOCAL,J1165,CPT,,,,,,Outpatient,5,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
prednisoLONE sodium phosphate 15 mg/5 mL Liq [CULL],11250339,LOCAL,J7510,CPT,,,,,,Outpatient,5,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"rabies immune globulin, human 150 intl units/mL intramuscular solution 2 mL [CULL]",11212251,LOCAL,90376,CPT,,,,,,Outpatient,0.007,ML,,347,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tacrolimus 0.5 mg oral capsule [CULL],11205999,LOCAL,J7507,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tobramycin 40 mg/mL injectable solution 2 mL [CULL],11212375,LOCAL,J3260,CPT,,,,,,Outpatient,2,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BUPivacaine 0.25% preservative-free injectable solution 30 mL [CULL],11202111,LOCAL,J0665,CPT,,,,,,Outpatient,30,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Protein, Total, Peritoneal Fluid QSTC",9039313,LOCAL,84157,CPT,,,,,,Outpatient,,,,4.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rheumatoid Factor QSTC,9039252,LOCAL,86431,CPT,,,,,,Outpatient,,,,6.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ketorolac 30 mg/mL injectable solution 1 mL [CULL],11202715,LOCAL,J1885,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,23.09,3.12,71.7,60,percent of total billed charges,0.27,0.27,
RPR (Dx) w/Refl Titer/Confrm Testing QST,8972905,LOCAL,86592,CPT,,,,,,Outpatient,,,,5.12,CIGNA,Commercial,,50,,28.77,2.53,28.77,1 through 10,percent of total billed charges,15.29,19.99375,
RPR (Monitor) w/Refl Titer QSTC,8972905,LOCAL,86592,CPT,,,,,,Outpatient,,,,5.12,CIGNA,Commercial,,50,,28.77,2.53,28.77,1 through 10,percent of total billed charges,15.29,19.99375,
cefuroxime 750 mg injection [CULL],11201445,LOCAL,J0697,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Creatinine, Random Ur QSTC",9320766,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,28.64,5.07,45.51,1 through 10,percent of total billed charges,7.16,40.97514925,
BUPivacaine 0.5% preservative-free injectable solution 10 mL [CULL],11282050,LOCAL,J0665,CPT,,,,,,Outpatient,10,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ciprofloxacin 200 mg/100 mL-D5% intravenous solution 100 mL [CULL],11201485,LOCAL,J0744,CPT,,,,,,Outpatient,100,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
diphenhydrAMINE 50 mg/mL injectable solution 1 mL [CULL],11202342,LOCAL,J1200,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,3.74,2.96,11.25,11,percent of total billed charges,0.143,0.143,
HYDROmorphone 2 mg/mL Sol [CULL],11202621,LOCAL,J1171,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,3.12,8.215,13.31,17,percent of total billed charges,1.836603774,1.836603774,
Source QSTC,8983584,LOCAL,87209,CPT,,,,,,Outpatient,,,,21.58,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ampicillin 500 mg injection [CULL],11201162,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ampicillin 250 mg injection [CULL],11201150,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
clindamycin 150 mg/mL injectable solution 4 mL [CULL],11202228,LOCAL,J0736,CPT,,,,,,Outpatient,4,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"ANA IFA Scrn w/Rfx Titr & Patt, IFA QSTC",8764654,LOCAL,86038,CPT,,,,,,Outpatient,,,,14.51,CIGNA,Commercial,,50,,4.21,4.21,4.21,1 through 10,percent of total billed charges,10.70333333,15.29,
"ANA Scr,IFA w/R Tit/Ptn/MPX Ab Casc QSTC",8764642,LOCAL,86038,CPT,,,,,,Outpatient,,,,14.51,CIGNA,Commercial,,50,,4.21,4.21,4.21,1 through 10,percent of total billed charges,10.70333333,15.29,
"Bacterial Identification, Aerobic QST",13344175,LOCAL,87077,CPT,,,,,,Outpatient,,,,9.7,CIGNA,Commercial,,50,,18.04,10.07,26,1 through 10,percent of total billed charges,10.57,16.47987421,
T3 Uptake QSTC,9039244,LOCAL,84479,CPT,,,,,,Outpatient,,,,7.76,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COLLAR CERVICAL SOFT MEDIUM,11071045,LOCAL,,,L0120,HCPCS,,,,Outpatient,,,,44,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HYDROmorphone 1 mg/mL Sol,11202620,LOCAL,J1171,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,3.12,8.215,13.31,17,percent of total billed charges,1.836603774,1.836603774,
tacrolimus 1 mg oral capsule [CULL],11205998,LOCAL,J7507,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Measles Antibody (IgG) QSTC,8764682,LOCAL,86765,CPT,,,,,,Outpatient,,,,15.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
gentamicin 60 mg/50 mL-NaCl 0.9% intravenous solution 50 mL [CULL],11201825,LOCAL,J1580,CPT,,,,,,Outpatient,50,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLING ARM LARGE,11071011,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,,158,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HYDROmorphone 10 mg/mL Sol [CULL],11202625,LOCAL,J1171,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,3.12,8.215,13.31,17,percent of total billed charges,1.836603774,1.836603774,
"hCG, Total, QN Male Only QSTC",8853229,LOCAL,84702,CPT,,,,,,Outpatient,,,,18.06,CIGNA,Commercial,,50,,23.4,23.4,23.4,1 through 10,percent of total billed charges,15.05,18.43,
"Herpes Simplex Virus 2 (IgG), with Reflex to HSV-2 Inhibition QST",14811888,LOCAL,86696,CPT,,,,,,Outpatient,,,,23.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
gentamicin 80 mg/50 mL-NaCl 0.9% intravenous solution 50 mL [CULL],11201824,LOCAL,J1580,CPT,,,,,,Outpatient,50,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
gentamicin 40 mg/mL injectable solution 2 mL [CULL],11282205,LOCAL,J1580,CPT,,,,,,Outpatient,2,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HYDROmorphone 0.5 mg/0.5 mL Sol [CULL],11202622,LOCAL,J1171,CPT,,,,,,Outpatient,0.5,ML,,,CIGNA,Commercial,,50,,3.12,8.215,13.31,17,percent of total billed charges,1.836603774,1.836603774,
gentamicin 120 mg/100 mL-NaCl 0.9% intravenous solution 100 mL [CULL],11209100,LOCAL,J1580,CPT,,,,,,Outpatient,100,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
alpha 1-proteinase inhibitor human Sol 10 mg [CULL],11211124,LOCAL,J0256,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chloride, Random Urine without Creatinine QSTC",10011691,LOCAL,82436,CPT,,,,,,Outpatient,,,,6.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Potassium, U24 w/o Creatinine QSTC",13864422,LOCAL,84133,CPT,,,,,,Outpatient,,,,5.68,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sickle Cell Screen QSTC,10073685,LOCAL,85660,CPT,,,,,,Outpatient,,,,6.61,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
gentamicin 100 mg/100 mL-NaCl 0.9% intravenous solution 100 mL [CULL],11201827,LOCAL,J1580,CPT,,,,,,Outpatient,100,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Creatinine, Random Ur, Microalbumin QSTC",9041589,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,28.64,5.07,45.51,1 through 10,percent of total billed charges,7.16,40.97514925,
"Ratio, Microalbumin Random Ur QSTC",9041592,LOCAL,82043,CPT,,,,,,Outpatient,,,,6.94,CIGNA,Commercial,,50,,11.54,3.48,11.54,1 through 10,percent of total billed charges,4.02,20.15557971,
Protein Level 24 Hour Urine,633811,LOCAL,84156,CPT,,,,,,Outpatient,,,,4.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Thrombin Clotting Time QSTC,8764547,LOCAL,85670,CPT,,,,,,Outpatient,,,,6.92,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Urea Nitrogen Ur, Rand QSTC",13864416,LOCAL,84540,CPT,,,,,,Outpatient,,,,6.67,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
nalbuphine 10 mg/mL Sol,J2300,CPT,,,,,,,,Outpatient,10,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
cycloSPORINE modified 100 mg oral capsule [CULL],11210500,LOCAL,J7502,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT WRIST FOREARM LEFT LG,11071054,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT WRIST FOREARM LT MED,11071053,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT WRIST FOREARM LT SM,11071052,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT WRIST FOREARM RT LG,11071050,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT WRIST FOREARM RT MED,11071049,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT WRIST FOREARM RT PED,11071047,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT WRIST FOREARM RT SM,11071048,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95852 RANGE OF MOTION-HAND 15 MIN CHARGE,9410221,LOCAL,95852,CPT,,,,,GP,Outpatient,,,,12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT WRIST FOREARM LEFT X L,11074363,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT XLG WRIST FOREARM RIGHT,11074362,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Creatine Kinase Isoenzyme Interp. QSTC,8852390,LOCAL,82550,CPT,,,,,,Outpatient,,,,7.81,CIGNA,Commercial,,50,,79.56,15.73,116.34,19,percent of total billed charges,7.16,23.7373913,
Creatine Kinase Isoenzyme w/ Tot CK QSTC,8764767,LOCAL,82552,CPT,,,,,,Outpatient,,,,16.07,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Creatine Kinase Isoenzymes w/o Ttl QSTC,13864524,LOCAL,82552,CPT,,,,,,Outpatient,,,,16.07,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Creatine Kinase, Total QSTC",8852386,LOCAL,82552,CPT,,,,,,Outpatient,,,,16.07,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rubella Antibody (IgG) QSTC,8853250,LOCAL,86762,CPT,,,,,,Outpatient,,,,17.27,CIGNA,Commercial,,50,,8.71,5.62,16.88,1 through 10,percent of total billed charges,14.39,15.29,
Urine Creatinine,7050475,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,28.64,5.07,45.51,1 through 10,percent of total billed charges,7.16,40.97514925,
Urine Protein Level,7412757,LOCAL,84156,CPT,,,,,,Outpatient,,,,4.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
phytonadione 1 mg/0.5 mL injectable solution 0.5 mL [CULL],11212147,LOCAL,J3430,CPT,,,,,,Outpatient,0.5,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SPLINT WRIST FOREARM LT PED,11070883,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
fosphenytoin 100 mgPE/2 mL Sol [CULL],11205072,LOCAL,Q2009,CPT,,,,,,Outpatient,2,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methylPREDNISolone 40 mg Pow [CULL],11204478,LOCAL,J2919,CPT,,,,,,Outpatient,1,UN,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Almond (F20) IgE QST,14586519,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alternaria Alternata (M6) IgE QST,14586545,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Brazil Nut (F18) IgE QST,14586553,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cashew Nut (F202) IgE QST,14586555,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cat Dander (E1) IgE QST,14586539,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cladosporium Herbarum (M2) IgE QST,14586543,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cockroach (I6) IgE QST,14586549,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Codfish (F3) IgE QST,14586521,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cow's Milk (F2) IgE QST,14586529,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dermatophagoides Farinae (D2) IgE QST,14586537,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dermatophagoides Pteronyssinu D1 IgE QST,14586535,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dog Dander (E5) IgE QST,14586541,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Egg White (F1) IgE QST,14586527,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hazelnut (F17) IgE QST,14586551,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin E QST,14586516,LOCAL,82785,CPT,,,,,,Outpatient,,,,19.75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Macadamia Nut (RF345) IgE QST,14586525,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouse Urine Proteins (E72) IgE QST,14586547,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peanut (F13) IgE QST,14586517,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Shrimp (F24) IgE QST,14586523,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soybean (F14) IgE QST,14586533,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Walnut (F256) IgE QST,14586557,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wheat (F4) IgE QST,14586531,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
droNABinol 2.5 mg Cap [CULL],11220183,LOCAL,Q0167,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"HPV mRNA E6/E7, POST-$HYST, VAGINAL W/REFL QST",14782711,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lead Capillary QSTC,14116315,LOCAL,83655,CPT,,,,,,Outpatient,,,,14.53,CIGNA,Commercial,,50,,15.5,12.11,18.89,1 through 10,percent of total billed charges,13.99076923,16.07,
"Lead, Blood QSTC",8764839,LOCAL,83655,CPT,,,,,,Outpatient,,,,14.53,CIGNA,Commercial,,50,,15.5,12.11,18.89,1 through 10,percent of total billed charges,13.99076923,16.07,
"Lead, Blood QSTC",13864923,LOCAL,83655,CPT,,,,,,Outpatient,,,,14.53,CIGNA,Commercial,,50,,15.5,12.11,18.89,1 through 10,percent of total billed charges,13.99076923,16.07,
fluconazole 100 mg/50 mL-NaCl 0.9% intravenous solution 50 mL [CULL],11291246,LOCAL,J1450,CPT,,,,,,Outpatient,50,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Albumin, Peritoneal Fluid QSTC",8972935,LOCAL,82042,CPT,,,,,,Outpatient,,,,9.34,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Albumin, Pleural Fluid QST",12130816,LOCAL,82042,CPT,,,,,,Outpatient,,,,9.34,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Albumin, Pleural Fluid QSTC",12130706,LOCAL,82042,CPT,,,,,,Outpatient,,,,9.34,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Glucose, Peritoneal Fluid QSTC",9039310,LOCAL,82945,CPT,,,,,,Outpatient,,,,4.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiolipin Ab (IgA)QSTC,9215429,LOCAL,86147,CPT,,,,,,Outpatient,,,,30.54,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiolipin Antibody IgG QSTC,10100354,LOCAL,86147,CPT,,,,,,Outpatient,,,,30.54,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiolipin Antibody IgM QSTC,10100355,LOCAL,86147,CPT,,,,,,Outpatient,,,,30.54,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
24hr Urine Creatinine QSTC,10005155,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,28.64,5.07,45.51,1 through 10,percent of total billed charges,7.16,40.97514925,
"Creatinine, Random U QSTC",12290061,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,28.64,5.07,45.51,1 through 10,percent of total billed charges,7.16,40.97514925,
Interp: QSTC,8851928,LOCAL,84166,CPT,,,,,,Outpatient,,,,21.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interp: QSTC,8851952,LOCAL,84166,CPT,,,,,,Outpatient,,,,21.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Protein, Total, Random Urine QSTC",8851945,LOCAL,84156,CPT,,,,,,Outpatient,,,,4.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SHOE POST OP MALE LARGE,11070723,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,,223,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SHOE POST OP MALE MD,11071019,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SHOE POST OP MALE SMALL,11070721,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,,223,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methotrexate 2.5 mg oral tablet [CULL],11240138,LOCAL,J8610,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
cefTAZidime 1 g injection [CULL],11201385,LOCAL,J0713,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carbon Dioxide Level,7903173,LOCAL,82374,CPT,,,,,,Outpatient,,,,5.86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Creatinine,3454470,LOCAL,82565,CPT,,,,,,Outpatient,,,,6.14,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COLLAR CERVICAL SOFT SMALL,11071044,LOCAL,,,L0120,HCPCS,,,,Outpatient,,,,44,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastric Occult Blood,7974128,LOCAL,82271,CPT,,,,,,Outpatient,,,,6.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin A QSTC,8764567,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin M QSTC,8853219,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"PSA, Free QSTC",8852652,LOCAL,84154,CPT,,,,,,Outpatient,,,,22.07,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COLLAR CERVICAL SOFT LARGE,11071046,LOCAL,,,L0120,HCPCS,,,,Outpatient,,,,44,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
gentamicin 10 mg/mL injectable solution 2 mL [CULL],11201813,LOCAL,J1580,CPT,,,,,,Outpatient,2,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.Manual Differential (CULL),13467987,LOCAL,85007,CPT,,,,,,Outpatient,,,,4.56,CIGNA,Commercial,,50,,6.49,4.61,20.36,14,percent of total billed charges,3.338698061,8.21,
.Manual Differential (CULL_AL),6237143,LOCAL,85007,CPT,,,,,,Outpatient,,,,4.56,CIGNA,Commercial,,50,,6.49,4.61,20.36,14,percent of total billed charges,3.338698061,8.21,
cefuroxime 1.5 g injection [CULL],11201459,LOCAL,J0697,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Albumin, CSF QSTC",13873322,LOCAL,82042,CPT,,,,,,Outpatient,,,,9.34,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"IgG, CSF QSTC",13873321,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amylase, Pleural Fluid QSTC",9039309,LOCAL,82150,CPT,,,,,,Outpatient,,,,7.78,CIGNA,Commercial,,50,,22.91,22.82,69.87,20,percent of total billed charges,1.237209302,7.16,
"Calcium, Random Ur QSTC",13864744,LOCAL,82310,CPT,,,,,,Outpatient,,,,6.19,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Creatinine, Random U QSTC",13864745,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,28.64,5.07,45.51,1 through 10,percent of total billed charges,7.16,40.97514925,
Fructosamine QSTC,8853273,LOCAL,82985,CPT,,,,,,Outpatient,,,,20.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
butorphanol 1 mg/mL Sol [CULL],11202144,LOCAL,J0595,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Direct LDL QSTC,9039357,LOCAL,83721,CPT,,,,,,Outpatient,,,,12.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hemoglobin A1c QSTC,6213055,LOCAL,83036,CPT,,,,,,Outpatient,,,,11.65,CIGNA,Commercial,,50,,40.87,9.71,72.03,1 through 10,percent of total billed charges,7.16,28.59604426,
Varicella-Zoster Virus Ab (IgG) QSTC,8853252,LOCAL,86787,CPT,,,,,,Outpatient,,,,15.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serum Osmolality QSTC,8972765,LOCAL,83930,CPT,,,,,,Outpatient,,,,7.93,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
76376 3D RENDER W/O POSTPR CHARGE,9284912,LOCAL,76376,CPT,,,,,,Outpatient,,,,391.88,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
POC Hgb,7160347,LOCAL,83036,CPT,,,,,,Outpatient,,,,11.65,CIGNA,Commercial,,50,,40.87,9.71,72.03,1 through 10,percent of total billed charges,7.16,28.59604426,
Creatinine Level 24 Hour Urine,1634894,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,28.64,5.07,45.51,1 through 10,percent of total billed charges,7.16,40.97514925,
"Albumin, 24 Hour Urine w/o Creat QSTC",13864523,LOCAL,82043,CPT,,,,,,Outpatient,,,,6.94,CIGNA,Commercial,,50,,11.54,3.48,11.54,1 through 10,percent of total billed charges,4.02,20.15557971,
"Folate, RBC QSTS",13899938,LOCAL,82747,CPT,,,,,,Outpatient,,,,21.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatitis C Ab rfx HCV RNA Qnt PCR QSTC,8764583,LOCAL,86803,CPT,,,,,,Outpatient,,,,17.12,CIGNA,Commercial,,50,,21.84,14.21,66.04,20,percent of total billed charges,15.29,32.10014925,
IMMOBILIZER  SHOULDER MEDIUM,11070739,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMMOBILIZER SHOULDER XL,11070165,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"PSA, Total QSTC",8852651,LOCAL,84153,CPT,,,,,,Outpatient,,,,22.07,CIGNA,Commercial,,50,,64.54,32.24,202.73,14,percent of total billed charges,17.73,104.8447059,
"T4, Free QSTC",9291013,LOCAL,84439,CPT,,,,,,Outpatient,,,,10.82,CIGNA,Commercial,,50,,34.42,9.02,59.82,12,percent of total billed charges,18.43,28.58065455,
DRAIN ROUND JP 10FR----OR,11071535,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Heterophile, Mono Screen QSTC",13864506,LOCAL,86308,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"T3, Free QSTC",8972902,LOCAL,84481,CPT,,,,,,Outpatient,,,,20.33,CIGNA,Commercial,,50,,20.9,10.14,64.97,1 through 10,percent of total billed charges,18.43,34.46424242,
IMMOBILIZER SHOULDER SMALL,11071014,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COLLECTION: Venous Draw,1779389,LOCAL,36415,CPT,,,,,,Outpatient,,,,10.91,CIGNA,Commercial,,50,,8.83,11.055,13.28,34,percent of total billed charges,3.41,6.740753664,
IMMOBILIZER SHOULDER LARGE,11071760,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urine Eosinophil Smear,8690390,LOCAL,85008,CPT,,,,,,Outpatient,,,,4.12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urine Eosinophils,7974116,LOCAL,89051,CPT,,,,,,Outpatient,,,,6.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sodium Level Urine,4185817,LOCAL,84300,CPT,,,,,,Outpatient,,,,6.07,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Almond (F20) IgE QST,13344505,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Almond (f20) IgE QSTC,8764712,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Beef (f27) IgE QSTC,8764717,LOCAL,86003,CPT,86003,HCPCS,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Brazil Nut (F18) IgE QST,13344495,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Brazil Nut (f18) IgE QSTC,8764711,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cashew Nut (F202) IgE QST,13344499,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cashew Nut (f202) IgE QSTC,8764689,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cat Dander (e1) IgE QSTC,6241002,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Catfish (f369) IgE QSTC,8764761,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chicken Meat (f83) IgE QSTC,8761426,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Clam (f207) IgE QSTC,8764592,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cocoa (f93) IgE QSTC,8764728,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coconut (f36) IgE QSTC,8764719,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cow'S Milk (F2) IgE w/Rflx to Panel QST,12886535,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cow'S Milk(F2) IgE W/Rfx Panel QSTC,14129187,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Crab (f23) IgE QSTC,6210507,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Crayfish (Rf320) IgE** QSTC,9039458,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
D. Pteronyssinus (d1) IgE QST,6241001,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dermatophagoides Farinae (d2) IgE QST,10217085,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dog Dander (e5) IgE QSTC,6241003,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Egg White (f1) IgE QSTC,8764699,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Egg White (F2) IgE w/Rflx to Panel QST,12886536,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Egg Yolk (f75) IgE QSTC,8764725,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fire Ant (i70) IgE QSTC,8764698,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gluten (f79) IgE QSTC,9039341,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hazelnut (F17) IgE QST,13344503,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hazelnut (f17) IgE QSTC,8764710,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lobster (f80) IgE QSTC,6210505,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Macadamia Nut (RF345) IgE QST,13344491,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Milk Component Panel QST,10217179,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Oyster (f290) IgE QSTC,6210503,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peanut (F13) IgE QST,13344507,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peanut (f13) IgE QSTC,8764708,LOCAL,86003,CPT,86003,HCPCS,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peanut,Tot w/rfx to Peanut Comp Pnl QSTC",8764811,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pecan Nut (F201) IgE QST,13344493,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pecan Nut (f201) IgE QSTC,8764727,LOCAL,86003,CPT,86003,HCPCS,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Perch Ocean IgE QSTC,8764760,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pistachio (F203) IgE QST,13344501,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pork (f26) IgE QSTC,8764716,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Scallop (f338) IgE QSTC,6210506,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Shrimp (f24) IgE QSTC,6241010,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soybean (f14) IgE QSTC,8764709,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Strawberry (f44) IgE QSTC,8764722,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tilapia IgE* QSTC,8972793,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tomato (f25) IgE QSTC,8764715,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Walnut (F256) IgE QST,13344497,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Walnut (f256) IgE QSTC,8764747,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wheat (f4) IgE QSTC,6241013,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95851 ROM MEASUREMENT(EXCLUDE HANDS) CHARGE,9410226,LOCAL,95851,CPT,,,,,GP,Outpatient,,,,15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
digoxin 250 mcg/mL (0.25 mg/mL) injectable solution 2 mL [CULL],11282125,LOCAL,J1160,CPT,,,,,,Outpatient,2,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
sulfamethoxazole-trimethoprim 80 mg-16 mg/mL Sol [CULL],11211277,LOCAL,J2865,CPT,,,,,,Outpatient,5,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin G QSTC,8764569,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sjogren's Antibody (SS-A) QSTC,8860711,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sjogren's Antibody (SS-A) QSTC,9039451,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sjogren's Antibody (SS-B) QSTC,8860712,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sjogren's Antibody (SS-B) QSTC,9039452,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methylPREDNISolone 125 mg Pow [CULL],11247586,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
STRAP CLAVACLE LARGE,11070713,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
STRAP CLAVICLE MED 3IN,11098246,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aerobic Bacterium ID/ Susceptibility QST,13344167,LOCAL,87077,CPT,,,,,,Outpatient,,,,9.7,CIGNA,Commercial,,50,,18.04,10.07,26,1 through 10,percent of total billed charges,10.57,16.47987421,
"Catecholamines, Fractionated, Plasma QSTC",11335672,LOCAL,82384,CPT,,,,,,Outpatient,,,,30.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Clinical Impression QST,10148697,LOCAL,88300,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Comment QST,10148702,LOCAL,88302,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Diagnosis QST,10148701,LOCAL,88304,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Gross Description QST,10148699,LOCAL,88305,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Micro Description QST,10148700,LOCAL,88307,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Procedure QST,10148698,LOCAL,88309,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Childhood Allergy Profile QSTC,8972792,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Expanded Childhood Allergy Profile ADD ON,14019143,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Albumin, CSF QSTC",8861454,LOCAL,82042,CPT,,,,,,Outpatient,,,,9.34,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Albumin, Serum QSTC",8861457,LOCAL,82040,CPT,,,,,,Outpatient,,,,5.94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin G QSTC,8861456,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Maternal Serum AFP QST,8972825,LOCAL,82105,CPT,,,,,,Outpatient,,,,20.12,CIGNA,Commercial,,50,,10.14,10.14,10.14,1 through 10,percent of total billed charges,17.73,26.22,
Maternal Serum AFP QSTC,8972825,LOCAL,82105,CPT,,,,,,Outpatient,,,,20.12,CIGNA,Commercial,,50,,10.14,10.14,10.14,1 through 10,percent of total billed charges,17.73,26.22,
"G-6-PD, RBC QSTC",8764537,LOCAL,82955,CPT,,,,,,Outpatient,,,,11.64,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ampicillin 1 g injection [CULL],11201129,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOBUTamine 12.5 mg/mL intravenous solution 20 mL [CULL],11201690,LOCAL,J1250,CPT,,,,,,Outpatient,20,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 1 (1) QST,10243602,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 12 (12F) QST,10243608,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 14 (14) QST,10243609,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 17 (17F) QST,10242538,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 19 (19F) QST,10243610,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 2 (2) QST,10242514,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 20 (20) QST,10242544,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 22 (22F) QST,10242547,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 23 (23F) QST,10243611,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 26 (6B) QST,10243612,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 3 (3) QST,10243603,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 34 (10A) QST,10242556,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 4 (4) QST,10243604,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 43 (11A) QST,10242559,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 5 (5) QST,10243605,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 51 (7F) QST,10243613,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 54 (15B) QST,10242565,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 56 (18C) QST,10243614,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 57 (19A) QST,10242571,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 68 (9V) QST,10243615,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 70 (33F) QST,10242577,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 8 (8) QST,10243606,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serotype 9 (9N) QST,10243607,LOCAL,86317,CPT,,,,,,Outpatient,,,,17.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ciprofloxacin 400 mg/200 mL-5% Sol,11201486,LOCAL,J0744,CPT,,,,,,Outpatient,200,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aldolase QSTC,8764531,LOCAL,82085,CPT,,,,,,Outpatient,,,,11.65,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glucose Fingerstick Clinic POC (RE),4192199,LOCAL,82962,CPT,,,,,,Outpatient,,,,3.94,CIGNA,Commercial,,50,,8.4,2.28,50.5,25,percent of total billed charges,7.16,9.084767596,
".Smooth Muscle Ab, Titer QSTC",13864540,LOCAL,86256,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DNA (ds) Antibody QSTC,8764566,LOCAL,86225,CPT,,,,,,Outpatient,,,,16.49,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatitis B Core Ab (IgM) QSTC,8764681,LOCAL,86705,CPT,,,,,,Outpatient,,,,14.12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mumps Virus Antibody (IgG) QSTC,8764679,LOCAL,86735,CPT,,,,,,Outpatient,,,,15.66,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prolactin QSTC,8972761,LOCAL,84146,CPT,,,,,,Outpatient,,,,23.26,CIGNA,Commercial,,50,,147.2,19.38,275.01,1 through 10,percent of total billed charges,18.43,19.38,
Smooth Muscle Ab w/refl Titer QSTC,13864539,LOCAL,83497,CPT,,,,,,Outpatient,,,,15.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Smooth Muscle Ab w/rfx Titer QSTC,13864539,LOCAL,86015,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Treponema pall Ab, Particle Agg QSTC",8972906,LOCAL,86780,CPT,,,,,,Outpatient,,,,15.89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Protein Level Urine,4186691,LOCAL,84156,CPT,,,,,,Outpatient,,,,4.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lipid Panel w/ Rfx to Direct LDL QSTC,13864433,LOCAL,80061,CPT,,,,,,Outpatient,,,,16.07,CIGNA,Commercial,,50,,57.36,13.39,101.32,1 through 10,percent of total billed charges,12.14,16.59934459,
cyanocobalamin 1000 mcg/mL injectable solution 1 mL [CULL],11202258,LOCAL,J3420,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0109 DM OP SMT GRP PER 30 MIN CHARGE,8709096,LOCAL,,,G0109,HCPCS,,,,Outpatient,,,,18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ID,8131550,LOCAL,87077,CPT,,,,,,Outpatient,,,,9.7,CIGNA,Commercial,,50,,18.04,10.07,26,1 through 10,percent of total billed charges,10.57,16.47987421,
ID Add On,13661571,LOCAL,87077,CPT,,,,,,Outpatient,,,,9.7,CIGNA,Commercial,,50,,18.04,10.07,26,1 through 10,percent of total billed charges,10.57,16.47987421,
Mitochondria M2 Ab (IgG) QSTC,8764575,LOCAL,86381,CPT,,,,,,Outpatient,,,,30.54,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DOPP LOWER EXT ART/ABI,8200227,LOCAL,93922,CPT,,,,,,Outpatient,,,,265,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
clindamycin 300 mg/50 mL-NaCl 0.9% Sol [CULL],11290065,LOCAL,J0737,CPT,,,,,,Outpatient,50,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
butorphanol 2 mg/mL Sol [CULL],11202147,LOCAL,J0595,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Gastrin, Serum QSTC",8764526,LOCAL,82941,CPT,,,,,,Outpatient,,,,21.16,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hep B Core Ab (Total)w/Rfx to IgM QSTC,9039408,LOCAL,86704,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatitis A IgM QSTC,8764600,LOCAL,86709,CPT,,,,,,Outpatient,,,,13.51,CIGNA,Commercial,,50,,6.81,6.81,6.81,1 through 10,percent of total billed charges,11.26,15.29,
"Hepatitis B Core Ab, Total QSTC",8764579,LOCAL,86704,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complement Component C3c QSTC,8972768,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complement Component C4c QSTC,8972769,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Insulin QSTC,9039285,LOCAL,83525,CPT,,,,,,Outpatient,,,,13.72,CIGNA,Commercial,,50,,9.36,9.36,9.36,1 through 10,percent of total billed charges,11.43,18.43,
Clozapine QSTC,8764629,LOCAL,80159,CPT,,,,,,Outpatient,,,,24.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HSV 1 and 2 IgG Antibodies QSTC,8853241,LOCAL,86695,CPT,,,,,,Outpatient,,,,15.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"HSV 1/2 IgG,Type Specific Ab QST",8389465,LOCAL,86695,CPT,,,,,,Outpatient,,,,15.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97804 Medical Nutrit Group 30Min CHARGE,9323172,LOCAL,97804,CPT,,,,,,Outpatient,,,,20,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Insulin Level Total,3454335,LOCAL,83525,CPT,,,,,,Outpatient,,,,13.72,CIGNA,Commercial,,50,,9.36,9.36,9.36,1 through 10,percent of total billed charges,11.43,18.43,
budesonide 0.25 mg/2 mL inhalation suspension 2 mL [CULL],11205254,LOCAL,J7626,CPT,,,,,,Outpatient,2,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
cefTRIAXone 2 g injection ADDV [CULL],11282070,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,4.99,3.28,11.9,18,percent of total billed charges,5.161428571,5.161428571,
labetalol 5 mg/mL intravenous solution 20 mL [CULL],11201873,LOCAL,J1920,CPT,,,,,,Outpatient,20,ML,,,CIGNA,Commercial,,50,,16.5,10.92,19.25,1 through 10,percent of total billed charges,5.464225352,5.464225352,
triamcinolone acetonide 40 mg/mL injectable suspension 1 mL [CULL],11212390,LOCAL,J3301,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,9.83,9.83,29.53,1 through 10,percent of total billed charges,3.025614035,3.025614035,
clindamycin 300 mg/50 mL-D5% intravenous solution 50 mL [CULL],11290065,LOCAL,J0736,CPT,,,,,,Outpatient,50,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
".ANA, Titer and Pattern QSTC",8764643,LOCAL,86039,CPT,,,,,,Outpatient,,,,13.39,CIGNA,Commercial,,50,,9.83,9.83,9.83,1 through 10,percent of total billed charges,15.29,21.22,
Cytomegalovirus Antibody (IgG) QSTC,13972135,LOCAL,86644,CPT,,,,,,Outpatient,,,,17.27,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cytomegalovirus Antibody (IgG) QSTC,8853227,LOCAL,86644,CPT,,,,,,Outpatient,,,,17.27,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C-Reactive Protein,1628890,LOCAL,86140,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,5.18,31.89,31.9,1 through 10,percent of total billed charges,13.29690962,15.29,
Fecal WBC,4123047,LOCAL,87205,CPT,,,,,,Outpatient,,,,5.12,CIGNA,Commercial,,50,,12.99,2.53,40.32,1 through 10,percent of total billed charges,10.57,12.26595628,
Stool WBC,10294481,LOCAL,87205,CPT,,,,,,Outpatient,,,,5.12,CIGNA,Commercial,,50,,12.99,2.53,40.32,1 through 10,percent of total billed charges,10.57,12.26595628,
"Complement, Total (CH50) QSTC",8764582,LOCAL,86162,CPT,,,,,,Outpatient,,,,24.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DHEA Sulfate QSTC,9696140,LOCAL,82627,CPT,,,,,,Outpatient,,,,26.68,CIGNA,Commercial,,50,,10.11,10.11,10.11,1 through 10,percent of total billed charges,18.43,27.095,
Haptoglobin QSTC,8764542,LOCAL,83010,CPT,,,,,,Outpatient,,,,15.1,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hepatitis A Ab, Total QSTC",8764599,LOCAL,86708,CPT,,,,,,Outpatient,,,,14.87,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Jo-1 Antibody QSTC,8764688,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"RNP Antibody, QSTC",10100359,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sm Antibody, QSTC",10100362,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"STRAP, CLAVICLE SMALL-3004-06",6010605,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Albumin, CSF QSTC",13873031,LOCAL,82042,CPT,,,,,,Outpatient,,,,9.34,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Albumin, Serum QSTC",13873034,LOCAL,82040,CPT,,,,,,Outpatient,,,,5.94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin G QSTC,13873033,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Oligoclonal Bands (IgG),CSF QSTC",13873028,LOCAL,83916,CPT,,,,,,Outpatient,,,,32.87,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin A QSTC,13904383,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tTG IgA Ab QSTC,13904382,LOCAL,86364,CPT,,,,,,Outpatient,,,,13.84,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Delta-Aminolevulinic Acid, Random Urine QSTC",12329984,LOCAL,82135,CPT,,,,,,Outpatient,,,,19.74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilirubin Cord Blood,10237211,LOCAL,82247,CPT,,,,,,Outpatient,,,,6.02,CIGNA,Commercial,,50,,20.91,10.44,31.37,1 through 10,percent of total billed charges,5.02,7.16,
Bilirubin Neonatal (Bu/Bc),14541767,LOCAL,82248,CPT,,,,,,Outpatient,,,,6.02,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilirubin Neonatal 2,8883195,LOCAL,82247,CPT,,,,,,Outpatient,,,,6.02,CIGNA,Commercial,,50,,20.91,10.44,31.37,1 through 10,percent of total billed charges,5.02,7.16,
Bilirubin Total,633672,LOCAL,82247,CPT,,,,,,Outpatient,,,,6.02,CIGNA,Commercial,,50,,20.91,10.44,31.37,1 through 10,percent of total billed charges,5.02,7.16,
Bilirubin Total,7939102,LOCAL,82247,CPT,,,,,,Outpatient,,,,6.02,CIGNA,Commercial,,50,,20.91,10.44,31.37,1 through 10,percent of total billed charges,5.02,7.16,
Bilirubin Total,8443661,LOCAL,82247,CPT,,,,,,Outpatient,,,,6.02,CIGNA,Commercial,,50,,20.91,10.44,31.37,1 through 10,percent of total billed charges,5.02,7.16,
Cyclic Citrull Peptide (CCP) Ab IgG QSTC,8764613,LOCAL,86200,CPT,,,,,,Outpatient,,,,15.54,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cholinesterase, Plasma QSTC",13873320,LOCAL,82482,CPT,,,,,,Outpatient,,,,11.77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cholinesterase, RBC QSTC",13873317,LOCAL,82480,CPT,,,,,,Outpatient,,,,9.44,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
STRAP CLAVICLE PED.,11071010,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Calcium, 24 hour Urine QSTC",13864700,LOCAL,82340,CPT,,,,,,Outpatient,,,,7.24,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Citric Acid, 24 Hour Urine QSTC",13864703,LOCAL,82507,CPT,,,,,,Outpatient,,,,33.36,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Creatinine, 24 Hour Urine QSTC",13864712,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,28.64,5.07,45.51,1 through 10,percent of total billed charges,7.16,40.97514925,
"Magnesium, 24 Hour Urine QSTC",13864709,LOCAL,83735,CPT,,,,,,Outpatient,,,,8.04,CIGNA,Commercial,,50,,11.08,4.75,33.28,51,percent of total billed charges,3.657824427,7.16,
"Oxalate, 24 Hour Urine QSTC",13864701,LOCAL,83945,CPT,,,,,,Outpatient,,,,17.34,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
pH Urine QSTC,13864699,LOCAL,83986,CPT,,,,,,Outpatient,,,,4.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Phosphorus, 24 Hour Urine QSTC",13864707,LOCAL,84105,CPT,,,,,,Outpatient,,,,6.94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Potassium, 24 Hour Urine QSTC",13864711,LOCAL,84133,CPT,,,,,,Outpatient,,,,5.68,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sodium, 24 Hour Urine QSTC",13864704,LOCAL,84300,CPT,,,,,,Outpatient,,,,6.07,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sulfate, 24 Hour Urine QSTC",13864705,LOCAL,84392,CPT,,,,,,Outpatient,,,,6.59,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uric Acid QSTC,13864716,LOCAL,84560,CPT,,,,,,Outpatient,,,,6.1,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ammonium Urine QSTC,8997190,LOCAL,82140,CPT,,,,,,Outpatient,,,,17.48,CIGNA,Commercial,,50,,50.03,50.03,156.19,1 through 10,percent of total billed charges,17.73,22.62909091,
"Calcium, 24 hour Urine QSTC",8997182,LOCAL,82340,CPT,,,,,,Outpatient,,,,7.24,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Citric Acid, 24 Hour Urine QSTC",8997185,LOCAL,82507,CPT,,,,,,Outpatient,,,,33.36,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Creatinine, 24 Hour Urine QSTC",8997192,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,28.64,5.07,45.51,1 through 10,percent of total billed charges,7.16,40.97514925,
"Magnesium, 24 Hour Urine QSTC",8997189,LOCAL,83735,CPT,,,,,,Outpatient,,,,8.04,CIGNA,Commercial,,50,,11.08,4.75,33.28,51,percent of total billed charges,3.657824427,7.16,
"Oxalate, 24 Hour Urine QSTC",8997183,LOCAL,83945,CPT,,,,,,Outpatient,,,,17.34,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
pH Urine QSTC,8997180,LOCAL,83986,CPT,,,,,,Outpatient,,,,4.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Phosphorus, 24 Hour Urine QSTC",8997188,LOCAL,84105,CPT,,,,,,Outpatient,,,,6.94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Potassium, 24 Hour Urine QSTC",8997191,LOCAL,84133,CPT,,,,,,Outpatient,,,,5.68,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sodium, 24 Hour Urine QSTC",8997186,LOCAL,84300,CPT,,,,,,Outpatient,,,,6.07,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sulfate, 24 Hour Urine QSTC",8997187,LOCAL,84392,CPT,,,,,,Outpatient,,,,6.59,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Uric Acid, 24 Hour Urine QSTC",8997184,LOCAL,84560,CPT,,,,,,Outpatient,,,,6.1,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BINDER ABDOMINAL MALE,11070715,LOCAL,,,L0625,HCPCS,,,,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lipase Level,633776,LOCAL,83690,CPT,,,,,,Outpatient,,,,8.27,CIGNA,Commercial,,50,,10.69,10.69,32.13,49,percent of total billed charges,1.304132029,7.16,
fluconazole 200 mg/100 mL-NaCl 0.9% intravenous solution 100 mL [CULL],11220720,LOCAL,J1450,CPT,,,,,,Outpatient,100,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
vancomycin 500 mg/100 mL intravenous solution 100 mL [CULL],11290008,LOCAL,J3375,CPT,,,,,,Outpatient,100,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ceruloplasmin QSTC,8764535,LOCAL,82390,CPT,,,,,,Outpatient,,,,12.89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
labetalol 5 mg/mL intravenous solution 4 mL [CULL],11201874,LOCAL,J1920,CPT,,,,,,Outpatient,4,ML,,,CIGNA,Commercial,,50,,16.5,10.92,19.25,1 through 10,percent of total billed charges,5.464225352,5.464225352,
Amikacin Level,9034955,LOCAL,80150,CPT,,,,,,Outpatient,,,,18.1,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"ANA Screen, IFA QSTC",14116751,LOCAL,86038,CPT,,,,,,Outpatient,,,,14.51,CIGNA,Commercial,,50,,4.21,4.21,4.21,1 through 10,percent of total billed charges,10.70333333,15.29,
Breath Alcohol,9687753,LOCAL,82075,CPT,,,,,,Outpatient,,,,36,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"CCP, Antibody (IgG) QSTC",14116753,LOCAL,86200,CPT,,,,,,Outpatient,,,,15.54,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"MCV, Antibody QSTC",14116754,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rheumatoid Factor QSTC,14116752,LOCAL,86431,CPT,,,,,,Outpatient,,,,6.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
T4 Total,633845,LOCAL,84436,CPT,,,,,,Outpatient,,,,8.24,CIGNA,Commercial,,50,,10.95,10.95,10.95,1 through 10,percent of total billed charges,17.54230769,18.43,
Rheumatoid Factor Qualitative,7906954,LOCAL,86430,CPT,,,,,,Outpatient,,,,7.37,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Protein Tot & Protein Electrophore QSTC,8764768,LOCAL,84155,CPT,,,,,,Outpatient,,,,4.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glucose 2 Hour Post Prandial,7973897,LOCAL,82947,CPT,,,,,,Outpatient,,,,4.72,CIGNA,Commercial,,50,,3.8,3.8,3.8,1 through 10,percent of total billed charges,7.16,10.29541667,
Lithium Level,2046348,LOCAL,80178,CPT,,,,,,Outpatient,,,,7.93,CIGNA,Commercial,,50,,11.08,11.08,11.08,1 through 10,percent of total billed charges,15.38,20.99,
Magnesium Level,633781,LOCAL,83735,CPT,,,,,,Outpatient,,,,8.04,CIGNA,Commercial,,50,,11.08,4.75,33.28,51,percent of total billed charges,3.657824427,7.16,
BINDER ABDOMINAL FEMALE,11070714,LOCAL,,,L0625,HCPCS,,,,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Crystal Analysis QSTC,9658951,LOCAL,89060,CPT,,,,,,Outpatient,,,,8.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glucose 1 Hour,7973889,LOCAL,82951,CPT,,,,,,Outpatient,,,,15.44,CIGNA,Commercial,,50,,11.2,11.2,11.2,1 through 10,percent of total billed charges,12.87,17.73,
Glucose 2 Hour,7973890,LOCAL,82952,CPT,,,,,,Outpatient,,,,4.7,CIGNA,Commercial,,50,,30.6,30.6,30.6,1 through 10,percent of total billed charges,3.92,7.16,
Glucose Level,633594,LOCAL,82947,CPT,,,,,,Outpatient,,,,4.72,CIGNA,Commercial,,50,,3.8,3.8,3.8,1 through 10,percent of total billed charges,7.16,10.29541667,
Thyroid Peroxidase Abs QSTC,8861417,LOCAL,86376,CPT,,,,,,Outpatient,,,,17.46,CIGNA,Commercial,,50,,11.2,11.2,11.2,1 through 10,percent of total billed charges,15.29,25.085,
Thyroid Peroxidase Antibodies QSTC,8764563,LOCAL,86376,CPT,,,,,,Outpatient,,,,17.46,CIGNA,Commercial,,50,,11.2,11.2,11.2,1 through 10,percent of total billed charges,15.29,25.085,
"Alpha-1-Antitrypsin, Qn QSTC",9039253,LOCAL,82103,CPT,,,,,,Outpatient,,,,16.13,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alpha-Fetoprotein, Tumor Marker QSTC",8764596,LOCAL,82105,CPT,,,,,,Outpatient,,,,20.12,CIGNA,Commercial,,50,,10.14,10.14,10.14,1 through 10,percent of total billed charges,17.73,26.22,
"B2 Microglobulin, Serum QSTC",8764794,LOCAL,82232,CPT,,,,,,Outpatient,,,,19.42,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Decalcification Procedure,8489589,LOCAL,88311,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CA 125 QSTC,8764680,LOCAL,86304,CPT,,,,,,Outpatient,,,,24.97,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CA 19-9 QSTC,8764669,LOCAL,86301,CPT,,,,,,Outpatient,,,,24.97,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CA 27.29 QSTC,8764762,LOCAL,86300,CPT,,,,,,Outpatient,,,,24.97,CIGNA,Commercial,,50,,12.51,12.51,12.51,1 through 10,percent of total billed charges,15.29,43.34448276,
Copper QSTC,8764536,LOCAL,82525,CPT,,,,,,Outpatient,,,,14.89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fungal Identification, Molds QSTC",8873558,LOCAL,87107,CPT,,,,,,Outpatient,,,,12.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Gliadin(Deamidated) Ab,IgA QSTC",9039363,LOCAL,86258,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Gliadin(Deamidated) Ab,IgG QSTC",9039362,LOCAL,86258,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lamotrigine QSTC,8853218,LOCAL,80175,CPT,,,,,,Outpatient,,,,15.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Protein, Total, w/Creat, Random Ur QSTC",9291011,LOCAL,84156,CPT,,,,,,Outpatient,,,,4.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Testosterone, Total, MS QSTC",8848606,LOCAL,84402,CPT,,,,,,Outpatient,,,,30.56,CIGNA,Commercial,,50,,24.91,36.07,47.23,1 through 10,percent of total billed charges,18.43,30.485,
SLING PED/INFANT 5'X9,6000156,LOCAL,,,A4565,HCPCS,,,,Outpatient,,,,19,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Copper, 24-Hour Urine QSTC",9390117,LOCAL,82525,CPT,,,,,,Outpatient,,,,14.89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MALDI ID,X87077,LOCAL,87077,CPT,,,,,,Outpatient,,,,9.7,CIGNA,Commercial,,50,,18.04,10.07,26,1 through 10,percent of total billed charges,10.57,16.47987421,
cefTAZidime 2 g injection [CULL],11201395,LOCAL,J0713,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"ANA Screen, IFA QST",9110748,LOCAL,86038,CPT,,,,,,Outpatient,,,,14.51,CIGNA,Commercial,,50,,4.21,4.21,4.21,1 through 10,percent of total billed charges,10.70333333,15.29,
Complement Component C3C QST,12876950,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complement Component C4C QST,12876951,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DNA (DS) Antibody QST,9110747,LOCAL,86225,CPT,,,,,,Outpatient,,,,16.49,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Microalbumin Level Urine,7974117,LOCAL,82043,CPT,,,,,,Outpatient,,,,6.94,CIGNA,Commercial,,50,,11.54,3.48,11.54,1 through 10,percent of total billed charges,4.02,20.15557971,
Rheumatoid Factor QST,9110751,LOCAL,86431,CPT,,,,,,Outpatient,,,,6.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ribosomal P Antibody QST,9110754,LOCAL,83516,CPT,,,,,,Outpatient,,,,13.84,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SCL-70 Antibody QST,9110757,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sjogren's Antibody (SS-A) QST,9110760,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sjogren's Antibody (SS-B) QST,9110763,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sm Antibody QST,9110766,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SM/RNP Antibody QST,9110769,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Thyroid Peroxidase Antibodies QST,9110772,LOCAL,86376,CPT,,,,,,Outpatient,,,,17.46,CIGNA,Commercial,,50,,11.2,11.2,11.2,1 through 10,percent of total billed charges,15.29,25.085,
EBV EBNA Ab (IgG) Interp QSTC,8849012,LOCAL,86664,CPT,,,,,,Outpatient,,,,18.35,CIGNA,Commercial,,50,,11.59,11.59,11.59,1 through 10,percent of total billed charges,15.29,15.29,
EBV VCA Ab (IgM) QSTC,8849009,LOCAL,86665,CPT,,,,,,Outpatient,,,,21.77,CIGNA,Commercial,,50,,11.58,11.58,11.58,1 through 10,percent of total billed charges,15.29,18.14,
".B. henselae Ab(IgG),Titer QSTC",8764830,LOCAL,86611,CPT,,,,,,Outpatient,,,,12.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
".B. henselae Ab(IgM),Titer QSTC",8764831,LOCAL,86611,CPT,,,,,,Outpatient,,,,12.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
".B. quintana Ab(IgG),Titer QSTC",10128892,LOCAL,86611,CPT,,,,,,Outpatient,,,,12.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMMOBLIZER KNEE XX-LARGE,11070340,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,,158,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methocarbamol 100 mg/mL injectable solution 10 mL [CULL],11201939,LOCAL,J2800,CPT,,,,,,Outpatient,10,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
calcium gluconate 100 mg/mL injectable solution 10 mL [CULL],11201252,LOCAL,J0612,CPT,,,,,,Outpatient,10,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLING & SWATHE W/SLEEVE,11071056,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TBG QSTC,8853216,LOCAL,84442,CPT,,,,,,Outpatient,,,,17.74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Culture, Fungus, Skin, Hair, Nails QSTC",8972785,LOCAL,87101,CPT,,,,,,Outpatient,,,,9.25,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostate Specific Antigen Total,7939094,LOCAL,84153,CPT,,,,,,Outpatient,,,,22.07,CIGNA,Commercial,,50,,64.54,32.24,202.73,14,percent of total billed charges,17.73,104.8447059,
Prealbumin,3454341,LOCAL,84134,CPT,,,,,,Outpatient,,,,17.51,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
20560 DRY NEEDLING 1 OR 2 MUSCLES WO INJECTION,9650048,LOCAL,20560,CPT,,,,,,Outpatient,,,,26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Beef (F27) IgE Class QSTC,14129407,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glucose Body Fluid,1628896,LOCAL,82945,CPT,,,,,,Outpatient,,,,4.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lamb (F88) IgE Class QSTC,14129413,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pork (F26) IgE Class QSTC,14129419,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RESULTS_QSTC,14755730,LOCAL,86008,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pyruvic Acid (Pyruvate),B QSTC",13864526,LOCAL,84210,CPT,,,,,,Outpatient,,,,17.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"VDRL, CSF QSTC",8764738,LOCAL,86592,CPT,,,,,,Outpatient,,,,5.12,CIGNA,Commercial,,50,,28.77,2.53,28.77,1 through 10,percent of total billed charges,15.29,19.99375,
Angiotensin Converting Enzyme QSTC,8764564,LOCAL,82164,CPT,,,,,,Outpatient,,,,17.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intrinsic Factor Blocking Antibody QSTC,8764611,LOCAL,86340,CPT,,,,,,Outpatient,,,,18.1,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osmolality Serum,9414322,LOCAL,83930,CPT,,,,,,Outpatient,,,,7.93,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97018 OT PARAFFIN BATH 1+ AREAS APPLIC CHARGE,9850020,LOCAL,97018,CPT,,,,,GO,Outpatient,,,,27,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97018 OT PARAFFIN BATH CHARGE,9860020,LOCAL,97018,CPT,,,,,GO|CO,Outpatient,,,,27,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Paraffin Bath Assistant Units,7895270,LOCAL,97018,CPT,,,,,CQ,Outpatient,,,,27,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Paraffin Bath Units,1373447,LOCAL,97018,CPT,,,,,GO,Outpatient,,,,27,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Paraffin Bath Charge,7895270,LOCAL,97018,CPT,,,,,GO,Outpatient,,,,27,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Centromere B Antibody QSTC,8764633,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COLLAR LG HARD C,11070731,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,,223,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COLLAR MED.HARD,11071039,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,,223,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COLLAR SM HARD C,11070729,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,,223,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
M. pneumoniae Ab (IgM) QSTC,8764773,LOCAL,86738,CPT,,,,,,Outpatient,,,,15.89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL Pre-MRI Device Screening,14536295,LOCAL,76014,CPT,,,,,,Outpatient,,,,19.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Safety Screening,14536295,LOCAL,76014,CPT,,,,,,Outpatient,,,,19.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Zinc QSTC,8764557,LOCAL,84630,CPT,,,,,,Outpatient,,,,13.67,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gram Stain (General Lab),8726050,LOCAL,87205,CPT,,,,,,Outpatient,,,,5.12,CIGNA,Commercial,,50,,12.99,2.53,40.32,1 through 10,percent of total billed charges,10.57,12.26595628,
Gram Stain Intraoperative,13436049,LOCAL,87205,CPT,,,,,,Outpatient,,,,5.12,CIGNA,Commercial,,50,,12.99,2.53,40.32,1 through 10,percent of total billed charges,10.57,12.26595628,
Gram Stain Report,634217,LOCAL,87205,CPT,,,,,,Outpatient,,,,5.12,CIGNA,Commercial,,50,,12.99,2.53,40.32,1 through 10,percent of total billed charges,10.57,12.26595628,
"Bile Acids, Fractionated and Total QSTC",13864500,LOCAL,82542,CPT,,,,,,Outpatient,,,,28.91,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Calcium, 24 hr Ur (w/o Creatinine) QSTC",9039238,LOCAL,82340,CPT,,,,,,Outpatient,,,,7.24,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Drug Panel (10),13954356,LOCAL,80306,CPT,,,,,,Outpatient,,,,20.57,CIGNA,Commercial,,50,,32.45,8.87,103.11,41,percent of total billed charges,0.2416,17.73,
Bill Intraoperative Additonal,14048005,LOCAL,88332,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Toxoplasma Antibody (IgG) QSTC,8861628,LOCAL,86777,CPT,,,,,,Outpatient,,,,17.27,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Toxoplasma Antibody (IgM) QSTC,8861629,LOCAL,86778,CPT,,,,,,Outpatient,,,,17.29,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
clindamycin 600 mg/50 mL-NaCl 0.9% Sol [CULL],11290024,LOCAL,J0737,CPT,,,,,,Outpatient,50,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cadmium, Blood, QSTC",13864925,LOCAL,82300,CPT,,,,,,Outpatient,,,,28.37,CIGNA,Commercial,,50,,32.96,23.64,42.28,1 through 10,percent of total billed charges,16.07,29.91,
"Vitamin B1 (Thiamine), B QSTC",8972833,LOCAL,84425,CPT,,,,,,Outpatient,,,,25.48,CIGNA,Commercial,,50,,31.78,21.23,42.33,1 through 10,percent of total billed charges,17.73,30.04654545,
"Calcium, Ionized QSTC",9039239,LOCAL,82330,CPT,,,,,,Outpatient,,,,16.42,CIGNA,Commercial,,50,,13.48,13.48,13.48,1 through 10,percent of total billed charges,17.73,28.305,
"Cortisol, Free, U24 QSTC",8764823,LOCAL,82530,CPT,,,,,,Outpatient,,,,20.05,CIGNA,Commercial,,50,,26.99,13.48,40.5,1 through 10,percent of total billed charges,17.73,29.79,
"Vanillylmandelic Acid, U24 QSTC",8764683,LOCAL,84585,CPT,,,,,,Outpatient,,,,18.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aspergillus fumigatus, IgG Ab QSTC",13864492,LOCAL,86606,CPT,,,,,,Outpatient,,,,18.06,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Blastomyces Ab,Immunodiff QSTC",10100364,LOCAL,86612,CPT,,,,,,Outpatient,,,,15.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cryptococcal Antigen Latex QSTC,8972754,LOCAL,86403,CPT,,,,,,Outpatient,,,,13.85,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"5HIAA, 24-Hour Urine QSTC",8764545,LOCAL,83497,CPT,,,,,,Outpatient,,,,15.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
betamethasone 12 mg/mL injectable suspension 2mL [CULL],11205515,LOCAL,J0702,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O2 Saturation Arterial,12487723,LOCAL,82810,CPT,,,,,,Outpatient,,,,11.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O2 Saturation Venous,12487723,LOCAL,82810,CPT,,,,,,Outpatient,,,,11.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Creatinine Random Ur, QSTC",10127838,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,28.64,5.07,45.51,1 through 10,percent of total billed charges,7.16,40.97514925,
"Metanephrine Ur, Total QSTC",10127837,LOCAL,83835,CPT,,,,,,Outpatient,,,,20.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CA 15-3 QSTC,8764684,LOCAL,86300,CPT,,,,,,Outpatient,,,,24.97,CIGNA,Commercial,,50,,12.51,12.51,12.51,1 through 10,percent of total billed charges,15.29,43.34448276,
"Electrolytes, Urine",12312936,LOCAL,84166,CPT,,,,,,Outpatient,,,,21.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Occult Blood Stool Screen,7909957,LOCAL,82272,CPT,,,,,,Outpatient,,,,5.08,CIGNA,Commercial,,50,,14,13.46,41.51,1 through 10,percent of total billed charges,4.457272727,7.16,
"Carbamazepine, Total QSTC",9039320,LOCAL,80156,CPT,,,,,,Outpatient,,,,17.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastric Parietal Cell AB QSTC,8764524,LOCAL,83516,CPT,,,,,,Outpatient,,,,13.84,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"ACTH, Plasma QSTC",8764544,LOCAL,82024,CPT,,,,,,Outpatient,,,,46.34,CIGNA,Commercial,,50,,14.04,14.04,14.04,1 through 10,percent of total billed charges,18.43,38.62,
Beta2-Glycoprotein IgA QSTC,10100357,LOCAL,86146,CPT,,,,,,Outpatient,,,,30.54,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin G Subclass 4 QSTC,10100372,LOCAL,82787,CPT,,,,,,Outpatient,,,,9.62,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testosterone Free & Total MS QSTC,8764632,LOCAL,84403,CPT,,,,,,Outpatient,,,,30.97,CIGNA,Commercial,,50,,53.65,25.81,81.49,1 through 10,percent of total billed charges,18.43,52.3775,
Tissue Transglutaminase IgA Ab QSTC,8764753,LOCAL,86364,CPT,,,,,,Outpatient,,,,13.84,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
acetaminophen 10 mg/mL intravenous solution 100 mL [CULL],11200037,LOCAL,J0134,CPT,,,,,,Outpatient,100,ML,,,CIGNA,Commercial,,50,,14.51,14.51,14.51,1 through 10,percent of total billed charges,3.159596774,3.159596774,
Scl-70 Antibody QSTC,8853206,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Egg Component Panel QSTC,9039428,LOCAL,86008,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Total Iron Binding Capacity,7909796,LOCAL,83550,CPT,,,,,,Outpatient,,,,10.49,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
amikacin 250 mg/mL injectable solution 2 mL [CULL],11201051,LOCAL,J0278,CPT,,,,,,Outpatient,2,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
cefTRIAXone 250 mg injection [CULL],11202192,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,4.99,3.28,11.9,18,percent of total billed charges,5.161428571,5.161428571,
clindamycin 600 mg/50 mL-D5% intravenous solution 50 mL [CULL],11290024,LOCAL,J0736,CPT,,,,,,Outpatient,50,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Yeast Culture,7909554,LOCAL,87101,CPT,,,,,,Outpatient,,,,9.25,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
T3 Total,633833,LOCAL,84480,CPT,,,,,,Outpatient,,,,17.02,CIGNA,Commercial,,50,,14.98,9.84,14.98,1 through 10,percent of total billed charges,18.43,33.01411765,
97035 OT ULTRASOUND,9850026,LOCAL,97035,CPT,,,,,GO,Outpatient,,,,31,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97035 OT Ultrasound Assistant Units,9860026,LOCAL,97035,CPT,,,,,GO|CO,Outpatient,,,,31,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97035 PT ULTRASOUND,9640026,LOCAL,97035,CPT,,,,,GP,Outpatient,,,,31,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97035 PT Ultrasound Assistant Units,9650026,LOCAL,97035,CPT,,,,,GP|CQ,Outpatient,,,,31,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97035 ULTRASOUND EA 15 MIN CHARGE,9410126,LOCAL,97035,CPT,,,,,GP,Outpatient,,,,31,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Ultrasound Assistant Units,1366376,LOCAL,97035,CPT,,,,,CQ,Outpatient,,,,31,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Ultrasound Charges,1366376,LOCAL,97035,CPT,,,,,GO,Outpatient,,,,31,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Ultrasound Units,1373448,LOCAL,97035,CPT,,,,,GO,Outpatient,,,,31,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Ultrasound Assistant Units,9390428,LOCAL,97035,CPT,,,,,CQ,Outpatient,,,,31,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Charges,1366376,LOCAL,97035,CPT,,,,,GO,Outpatient,,,,31,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Charges,7895933,LOCAL,97035,CPT,,,,,GP,Outpatient,,,,31,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Phenobarbital QSTC,8972760,LOCAL,80184,CPT,,,,,,Outpatient,,,,18.36,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"penicillin G potassium 5,000,000 units injection [CULL]",11211091,LOCAL,J2540,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Semen Analysis Post Vasectomy,3454457,LOCAL,89320,CPT,,,,,,Outpatient,,,,14.77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"HIV Ag/Ab, 4th Gen w reflexes QSTC",8764806,LOCAL,87389,CPT,,,,,,Outpatient,,,,28.9,CIGNA,Commercial,,50,,17.08,14.57,55.98,12,percent of total billed charges,10.57,36.55,
"Phenytoin, Free QSTC",8764686,LOCAL,80186,CPT,,,,,,Outpatient,,,,16.51,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"T3, Reverse, LCMSMS QSTC",8764804,LOCAL,84482,CPT,,,,,,Outpatient,,,,18.91,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"82140 Ammonium, 24 HR, U",14789403,LOCAL,82140,CPT,,,,,,Outpatient,,,,17.48,CIGNA,Commercial,,50,,50.03,50.03,156.19,1 through 10,percent of total billed charges,17.73,22.62909091,
"82340 Calcium, 24 HR, U",14797185,LOCAL,82340,CPT,,,,,,Outpatient,,,,7.24,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"82436 Chloride, 24 HR, U",14797182,LOCAL,82436,CPT,,,,,,Outpatient,,,,6.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"82507 Citrate Excretion, 24 HR, U",14787436,LOCAL,82507,CPT,,,,,,Outpatient,,,,33.36,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"82570 Creatinine, 24 HR, U",14798767,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,28.64,5.07,45.51,1 through 10,percent of total billed charges,7.16,40.97514925,
"83735 Magnesium, 24 HR, U",14789401,LOCAL,83735,CPT,,,,,,Outpatient,,,,8.04,CIGNA,Commercial,,50,,11.08,4.75,33.28,51,percent of total billed charges,3.657824427,7.16,
"83945 Oxalate, 24 HR, U",14797186,LOCAL,83945,CPT,,,,,,Outpatient,,,,17.34,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"84105 Phosphorus, 24 HR, U",14787442,LOCAL,84105,CPT,,,,,,Outpatient,,,,6.94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"84133 Potassium, 24 HR, U",14797183,LOCAL,84133,CPT,,,,,,Outpatient,,,,5.68,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"84300 Sodium, 24 HR, U",14797184,LOCAL,84300,CPT,,,,,,Outpatient,,,,6.07,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"84540 Urea Nitrogen, 24 HR, U",14789404,LOCAL,84540,CPT,,,,,,Outpatient,,,,6.67,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"84560 Uric Acid, 24 HR, U",14787441,LOCAL,84560,CPT,,,,,,Outpatient,,,,6.1,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BUPivacaine 0.5% preservative-free injectable solution 30 mL [CULL],11282051,LOCAL,J0665,CPT,,,,,,Outpatient,30,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
deferoxamine 500 mg injection [CULL],11214520,LOCAL,J0895,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C-Peptide,12252873,LOCAL,84681,CPT,,,,,,Outpatient,,,,24.97,CIGNA,Commercial,,50,,15.6,15.6,15.6,1 through 10,percent of total billed charges,17.73,33.24444444,
D-Dimer,3454398,LOCAL,85380,CPT,,,,,,Outpatient,,,,12.22,CIGNA,Commercial,,50,,15.6,15.6,35,1 through 10,percent of total billed charges,5.76079096,8.21,
G0447 BEHAVIORAL COUNSIL OBESITY 15 MIN CHARGE,8635988,LOCAL,,,G0447,HCPCS,,,,Outpatient,,,,33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatitis B S Ab,1628908,LOCAL,86706,CPT,,,,,,Outpatient,,,,12.89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatitis B Surface Antibody w/ Interp,9299896,LOCAL,86706,CPT,,,,,,Outpatient,,,,12.89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lactate Dehydrogenase Body Fluid,3454444,LOCAL,83615,CPT,,,,,,Outpatient,,,,7.25,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cytomegalovirus Antibodies (IgG,IgM) QSTC",8972893,LOCAL,86645,CPT,,,,,,Outpatient,,,,20.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cytomegalovirus Antibody (IgM) QSTC,8764581,LOCAL,86645,CPT,,,,,,Outpatient,,,,20.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Micronutrient Vitamin E QSTC,14116320,LOCAL,84446,CPT,,,,,,Outpatient,,,,17.02,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vitamin A (Retinol) QSTC,8764529,LOCAL,84590,CPT,,,,,,Outpatient,,,,13.93,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ethosuximide QSTC,8764552,LOCAL,80168,CPT,,,,,,Outpatient,,,,19.61,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
77061 MG Diagnostic Tomo Charge: AddOn Left,13960722,LOCAL,G0279,CPT,,,,,LT,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
77061 MG Diagnostic Tomo Charge: AddOn Right,13960723,LOCAL,G0279,CPT,,,,,RT,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
77061 MG Diagnostic Tomo Charge: AddOn Right,13969683,LOCAL,G0279,CPT,,,,,RT,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
77063 MG Tomo Charge: AddOn Left,13621442,LOCAL,77063,CPT,,,,,LT,Outpatient,,,,54.45,CIGNA,Commercial,,50,,73.79,46.67,100.91,1 through 10,percent of total billed charges,20.75,74,
77063 MG Tomo Charge: AddOn Right,13621441,LOCAL,77063,CPT,,,,,RT,Outpatient,,,,54.45,CIGNA,Commercial,,50,,73.79,46.67,100.91,1 through 10,percent of total billed charges,20.75,74,
PC DOPP ART BIL REST,8200579,LOCAL,93923,CPT,,,,,,Outpatient,,,,401,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
acyclovir 50 mg/mL intravenous solution 10 mL [CULL],11201009,LOCAL,J0133,CPT,,,,,,Outpatient,10,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chloride Level,633621,LOCAL,82435,CPT,,,,,,Outpatient,,,,5.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KOH POCT,10913182,LOCAL,87220,CPT,,,,,,Outpatient,,,,5.12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E-Stim for Wound Other Charge,7895924,LOCAL,G0283,CPT,G0283,HCPCS,,,GP,Outpatient,,,,33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0283 INTERFERENCE CHARGES,9640019,LOCAL,,,G0283,HCPCS,,,GP,Outpatient,,,,33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0283 PT Elect Stim Unattended Assistant Units Charge,9650019,LOCAL,,,G0283,HCPCS,,,GP,Outpatient,,,,33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0283 OT ELEC STIM MEDICARE CHARGE,9860018,LOCAL,,,G0283,HCPCS,,,GO|CO,Outpatient,,,,33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0283 OT ESTIM UNATTENDED CHARGE,9850018,LOCAL,,,G0283,HCPCS,,,GO,Outpatient,,,,33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Unattended E-Stim Assistant Units,7895266,LOCAL,,,G0283,HCPCS,,,CQ,Outpatient,,,,33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OTElectrical Stim (Unattended) - Non-Wound,1373552,LOCAL,,,G0283,HCPCS,,,GO,Outpatient,,,,33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
UA w Micro if Ind,1148022,LOCAL,81003,CPT,,,,,,Outpatient,,,,2.7,CIGNA,Commercial,,50,,16.1,16.1,16.1,1 through 10,percent of total billed charges,3.795286195,4.02,
UA w Micro if Ind & Cult if Ind,8088555,LOCAL,81003,CPT,,,,,,Outpatient,,,,2.7,CIGNA,Commercial,,50,,16.1,16.1,16.1,1 through 10,percent of total billed charges,3.795286195,4.02,
Urinalysis Macroscopic,633863,LOCAL,81003,CPT,,,,,,Outpatient,,,,2.7,CIGNA,Commercial,,50,,16.1,16.1,16.1,1 through 10,percent of total billed charges,3.795286195,4.02,
"T4, Free, Direct Dialysis QSTC",13864535,LOCAL,84439,CPT,,,,,,Outpatient,,,,10.82,CIGNA,Commercial,,50,,34.42,9.02,59.82,12,percent of total billed charges,18.43,28.58065455,
"Immunofixation, Serum QSTC",8764779,LOCAL,86334,CPT,,,,,,Outpatient,,,,26.81,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
77061 MG Diagnostic Tomo Charge: AddOn Left,13960724,LOCAL,G0279,CPT,,,,,LT,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"CtrachomatisRNA, TMA, Urog QSTC",8996973,LOCAL,87491,CPT,,,,,QW,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
"NgonorrhoeaeRNA, TMA, Urog QSTC",8996974,LOCAL,87591,CPT,,,,,QW,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
"Chlamydia Trachomatis RNA, TMA QST",8395007,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",8395010,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
"N. Gonorrhoeae RNA, TMA, Urogenital QSTC",13864518,LOCAL,87591,CPT,,,,,QW,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
Homocysteine QSTC,8764574,LOCAL,83090,CPT,,,,,,Outpatient,,,,21.5,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Mycobact Culture, w Fluorochrome Sm QSTC",9039257,LOCAL,87116,CPT,,,,,,Outpatient,,,,12.96,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Mycobacteria, Cult, w Fluoro Smear QST",9039257,LOCAL,87116,CPT,,,,,,Outpatient,,,,12.96,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ampicillin 2 g injection [CULL],11201144,LOCAL,J0290,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOBUTamine 2 mg/mL-D5% intravenous solution 250 mL [CULL],11201692,LOCAL,J1250,CPT,,,,,,Outpatient,250,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
acetylcysteine 20% inhalation solution 4 mL [CULL],11205094,LOCAL,J7608,CPT,,,,,,Outpatient,4,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Angiotensin Converting Enzyme (ACE), CSF QSTC",10170069,LOCAL,82164,CPT,,,,,,Outpatient,,,,17.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Endomysial Ab Screen IgA, Rfx Titer QSTC",8764677,LOCAL,86231,CPT,,,,,,Outpatient,,,,14.51,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hexagonal Phase Confirm. QSTC,9039456,LOCAL,85598,CPT,,,,,,Outpatient,,,,21.58,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
hs-CRP QSTC,8853237,LOCAL,86141,CPT,,,,,,Outpatient,,,,15.54,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lipoprotein (a) QSTC,8853258,LOCAL,83695,CPT,,,,,,Outpatient,,,,17.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Oligoclonal Bands (IgG), CSF QSTC",8764540,LOCAL,83916,CPT,,,,,,Outpatient,,,,32.87,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Plasma Renin Activity, LC/MS/MS QSTC",8764647,LOCAL,84244,CPT,,,,,,Outpatient,,,,26.39,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vitamin D, 1,25-Dihydroxy QSTC",8764639,LOCAL,82652,CPT,,,,,,Outpatient,,,,46.2,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Apolipoprotein Evaluation QSTC,13864521,LOCAL,82172,CPT,,,,,,Outpatient,,,,25.31,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
nitroglycerin 5 mg/mL intravenous solution 10 mL [CULL],11211028,LOCAL,J2305,CPT,,,,,,Outpatient,10,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"C1 Esterase Inhibitor, Protein QSTC",8764554,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
droNABinol 5 mg Cap [CULL],11200011,LOCAL,Q0167,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatitis B Surface Antigen,633752,LOCAL,87340,CPT,,,,,,Outpatient,,,,12.4,CIGNA,Commercial,,50,,11.67,6.18,17.16,1 through 10,percent of total billed charges,10.57,22.20058824,
Hepatitis B Surface Antigen w/ Interp,9517997,LOCAL,87340,CPT,,,,,,Outpatient,,,,12.4,CIGNA,Commercial,,50,,11.67,6.18,17.16,1 through 10,percent of total billed charges,10.57,22.20058824,
HIV 1/2 Antibody Screen (exposure only),9609059,LOCAL,86701,CPT,,,,,,Outpatient,,,,10.67,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMMOBILIZER KNEE LARGE,11071020,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,,158,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMMOBILIZER KNEE XL 79-80028,11070735,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,,158,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Potassium POCT,9616981,LOCAL,84132,CPT,,,,,,Outpatient,,,,5.71,CIGNA,Commercial,,50,,41.3,20.62,64.04,1 through 10,percent of total billed charges,7.16,8.697880184,
IMMOBILIZER KNEE MEDIUM,11071084,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,,158,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMMOBILIZER KNEE SMALL,11071082,LOCAL,,,L1830,HCPCS,,,,Outpatient,,,,158,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Additional Testing PTT-LA QSTC,9004754,LOCAL,85730,CPT,,,,,,Outpatient,,,,7.21,CIGNA,Commercial,,50,,24.82,11.84,72.01,13,percent of total billed charges,1.648553055,5.42,
dRVVT Mix Interpretation: QSTC,9004757,LOCAL,85613,CPT,,,,,,Outpatient,,,,11.5,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Valproic Acid Level,3170351,LOCAL,80164,CPT,,,,,,Outpatient,,,,16.25,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.RMSF IgG Titer QSTC,8764766,LOCAL,86757,CPT,,,,,,Outpatient,,,,23.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.RMSF IgM Titer QSTC,8764765,LOCAL,86757,CPT,,,,,,Outpatient,,,,23.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HIV 1 Antibody QSTC,8852095,LOCAL,86701,CPT,,,,,,Outpatient,,,,10.67,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HIV 2 Antibody QSTC,8852096,LOCAL,86702,CPT,,,,,,Outpatient,,,,16.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aldosterone, LC/MS QSTC",8853271,LOCAL,82088,CPT,,,,,,Outpatient,,,,48.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Calcium Level Total,1628887,LOCAL,82310,CPT,,,,,,Outpatient,,,,6.19,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPINEPHrine 1 mg/mL injectable solution 1 mL [CULL],11202413,LOCAL,J0169,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill UA With Microscopic,14634624,LOCAL,81001,CPT,,,,,,Outpatient,,,,3.8,CIGNA,Commercial,,50,,17.97,17.97,54.48,1 through 10,percent of total billed charges,4.02,6.910081301,
PC DOPP ART BIL EXERCISE,8200578,LOCAL,93924,CPT,,,,,,Outpatient,,,,302,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticulocyte Count,7909814,LOCAL,85044,CPT,,,,,,Outpatient,,,,5.17,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticulocyte Count with Immature Reticulocyte Fraction,3454466,LOCAL,85044,CPT,,,,,,Outpatient,,,,5.17,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
clindamycin 900 mg/50 mL-D5% intravenous solution 50 mL [CULL],11212348,LOCAL,J0736,CPT,,,,,,Outpatient,50,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
milrinone 200 mcg/mL-D5% intravenous solution 100 mL [CULL],11290134,LOCAL,J2260,CPT,,,,,,Outpatient,100,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vitamin B6, Plasma QSTC",8853234,LOCAL,84207,CPT,,,,,,Outpatient,,,,33.72,CIGNA,Commercial,,50,,17.6,16.95,18.25,1 through 10,percent of total billed charges,17.73,40.33125,
Total Iron Binding Capacity,7050172,LOCAL,84466,CPT,,,,,,Outpatient,,,,15.31,CIGNA,Commercial,,50,,18.33,18.33,18.33,1 through 10,percent of total billed charges,17.73,29.64248366,
Total Iron Binding Capacity,10543521,LOCAL,84466,CPT,,,,,,Outpatient,,,,15.31,CIGNA,Commercial,,50,,18.33,18.33,18.33,1 through 10,percent of total billed charges,17.73,29.64248366,
"Varicella-Zoster Virus Abs(IgG,IgM) QSTC",8853253,LOCAL,86787,CPT,,,,,,Outpatient,,,,15.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
protamine 10 mg/mL injectable solution 5 mL [CULL],11211135,LOCAL,J2720,CPT,,,,,,Outpatient,5,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin E QSTC,8764571,LOCAL,82785,CPT,,,,,,Outpatient,,,,19.75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMMOBILIZER SHOULDER XXXLARGE,4803390,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
orphenadrine 30 mg/mL injectable solution 2 mL [CULL],11212051,LOCAL,J2360,CPT,,,,,,Outpatient,2,ML,,,CIGNA,Commercial,,50,,18.18,18.18,18.18,1 through 10,percent of total billed charges,1.756666667,1.756666667,
Cortisol,3352314,LOCAL,82533,CPT,,,,,,Outpatient,,,,19.56,CIGNA,Commercial,,50,,18.72,18.72,18.72,1 through 10,percent of total billed charges,15.196,18.43,
Cortisol 60 Min,8373789,LOCAL,82533,CPT,,,,,,Outpatient,,,,19.56,CIGNA,Commercial,,50,,18.72,18.72,18.72,1 through 10,percent of total billed charges,15.196,18.43,
Free T4 Level,3170324,LOCAL,84439,CPT,,,,,,Outpatient,,,,10.82,CIGNA,Commercial,,50,,34.42,9.02,59.82,12,percent of total billed charges,18.43,28.58065455,
Hepatitis A Antibody IgM,1628904,LOCAL,86709,CPT,,,,,,Outpatient,,,,13.51,CIGNA,Commercial,,50,,6.81,6.81,6.81,1 through 10,percent of total billed charges,11.26,15.29,
HIV 1/2 Antibody and P24 Screen,633757,LOCAL,87389,CPT,,,,,,Outpatient,,,,28.9,CIGNA,Commercial,,50,,17.08,14.57,55.98,12,percent of total billed charges,10.57,36.55,
HIV 1/2 Antibody and P24 Screen,633757,LOCAL,G0475,CPT,,,,,,Outpatient,,,,28.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Protein Body Fluid,1634879,LOCAL,84157,CPT,,,,,,Outpatient,,,,4.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMMOBILIZER SHOULDER XXLARGE 9008-05,4803139,LOCAL,,,L3650,HCPCS,,,,Outpatient,,,,12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aspergillus fumigatus QSTC,9966204,LOCAL,86331,CPT,,,,,,Outpatient,,,,14.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
S. viridis QSTC,9966214,LOCAL,86609,CPT,,,,,,Outpatient,,,,15.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
T. candidus QSTC,9966205,LOCAL,86606,CPT,,,,,,Outpatient,,,,18.06,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
adenosine 3 mg/mL intravenous solution 2 mL [CULL],11201015,LOCAL,J0153,CPT,,,,,,Outpatient,2,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Mercury, Blood QSTC",13864924,LOCAL,83825,CPT,,,,,,Outpatient,,,,19.51,CIGNA,Commercial,,50,,38.57,16.26,60.87,1 through 10,percent of total billed charges,16.07,35.86038462,
Sex Hormone Binding Glob QSTC,8764670,LOCAL,84270,CPT,,,,,,Outpatient,,,,26.08,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Stone Analysis w/ Image QSTC,9777240,LOCAL,82365,CPT,,,,,,Outpatient,,,,15.48,CIGNA,Commercial,,50,,7.76,7.76,7.76,1 through 10,percent of total billed charges,17.73,24.61666667,
97012 APPLICATION OF TRACTION/MECH CHARGE,8133034,LOCAL,97012,CPT,,,,,GP,Outpatient,,,,40,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97012 MECH TRACTION THERAPY Assistant Charge,9860050,LOCAL,97012,CPT,,,,,GO|CO,Outpatient,,,,40,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97012 Mechanical Traction PT,9850050,LOCAL,97012,CPT,,,,,GO,Outpatient,,,,40,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97012 TRACTION - MECHANICAL,9640018,LOCAL,97012,CPT,,,,,GP,Outpatient,,,,40,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mechanical Traction Charge -> Yes,13786833,LOCAL,97012,CPT,,,,,GP,Outpatient,,,,40,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mechanical Traction Provided,8510678,LOCAL,97012,CPT,,,,,GP,Outpatient,,,,40,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Mechanical Trac Therapy Asist Units,7897758,LOCAL,97012,CPT,,,,,CQ,Outpatient,,,,40,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Mechanical Traction Therapy Units,7897758,LOCAL,97012,CPT,,,,,GO,Outpatient,,,,40,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Mechanical Traction Assistant Units,9390392,LOCAL,97012,CPT,,,,,CQ,Outpatient,,,,40,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT TRACTION MECHANICAL,9650018,LOCAL,97012,CPT,,,,,GP|CQ,Outpatient,,,,40,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ethylene Glycol, Blood QSTC",8764539,LOCAL,82693,CPT,,,,,,Outpatient,,,,17.88,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
vancomycin 1 g/200 mL intravenous solution 200 mL [CULL],11291267,LOCAL,J3372,CPT,,,,,,Outpatient,200,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HIV 1/2 Antibody Screen,7939338,LOCAL,86703,CPT,,,,,,Outpatient,,,,16.45,CIGNA,Commercial,,50,,19.25,19.25,19.25,1 through 10,percent of total billed charges,15.29,37.57,
"Alprazolam (Xanax), Serum QSTC",8972830,LOCAL,80299,CPT,,,,,,Outpatient,,,,22.37,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glucose 3 Hour,7973891,LOCAL,82952,CPT,,,,,,Outpatient,,,,4.7,CIGNA,Commercial,,50,,30.6,30.6,30.6,1 through 10,percent of total billed charges,3.92,7.16,
Glucose 4 Hour,7973892,LOCAL,82952,CPT,,,,,,Outpatient,,,,4.7,CIGNA,Commercial,,50,,30.6,30.6,30.6,1 through 10,percent of total billed charges,3.92,7.16,
Glucose 5 Hour,7973894,LOCAL,82952,CPT,,,,,,Outpatient,,,,4.7,CIGNA,Commercial,,50,,30.6,30.6,30.6,1 through 10,percent of total billed charges,3.92,7.16,
"Cyclosporine Trough,LCMSMS QSTC",8764656,LOCAL,80158,CPT,,,,,,Outpatient,,,,21.66,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ova&Parasite,Conc&Perm Smear Result QSTC",8873966,LOCAL,87177,CPT,,,,,,Outpatient,,,,10.68,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97150  Group Therapeutic Procedure,9640074,LOCAL,97150,CPT,,,,,GP,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97150 OT Group Therapy Charge,9850058,LOCAL,97150,CPT,,,,,GO,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97150 OT Group Therapy Modifier Charge,9860058,LOCAL,97150,CPT,,,,,GO|CO,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97150 PT Group Therapy Assistant Units,9650074,LOCAL,97150,CPT,,,,,GP|CQ,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Group Therapy Charge,7895938,LOCAL,97150,CPT,,,,,GP,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Group Therapy Provided,7895280,LOCAL,97150,CPT,,,,,GO,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Group Therapy Assistant Units,7895280,LOCAL,97150,CPT,,,,,CQ,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Group Therapy Assistant Units,7897695,LOCAL,97150,CPT,,,,,CQ,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Group Therapy Rehab Units,7897695,LOCAL,97150,CPT,,,,,GO,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Group Therapy Assistant Units,9390418,LOCAL,97150,CPT,,,,,CQ,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Giardia Antigen, EIA, Stool QSTC",8972764,LOCAL,87329,CPT,,,,,,Outpatient,,,,14.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Methylmalonic Acid QSTC,8853212,LOCAL,83921,CPT,,,,,,Outpatient,,,,25.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nortriptyline QSTC,8853203,LOCAL,80299,CPT,,,,,,Outpatient,,,,22.37,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97034 CONTRAST BATH THERAPY,9860025,LOCAL,97034,CPT,,,,,GO|CO,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97034 CONTRAST BATHS EACH 15 MIN CHARGE,9640025,LOCAL,97034,CPT,,,,,GP,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97034 OT CONTRAST BATH 15 MIN APPL CHARGE,9850025,LOCAL,97034,CPT,,,,,GO,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97034 PT CONTRAST BATH 15 MIN ASST,9650025,LOCAL,97034,CPT,,,,,GP|CQ,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Contrast Bath Assistant Units,7895283,LOCAL,97034,CPT,,,,,CQ,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Contrast Bath Assistant Units,1373567,LOCAL,97034,CPT,,,,,CQ,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Contrast Bath Charges,7895283,LOCAL,97034,CPT,,,,,GO,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Contrast Bath Units,1373567,LOCAL,97034,CPT,,,,,GO,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Attended E-Stim Assistant Units,9390422,LOCAL,97034,CPT,,,,,CQ,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Contrast Bath Charges,7895979,LOCAL,97034,CPT,,,,,GP,Outpatient,,,,41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BRACE ANKLE LG,9400076,LOCAL,,,L1902,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medium Ankle Brace,9400086,LOCAL,,,L1902,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"ANA Screen, IFA QSTC",14127792,LOCAL,86038,CPT,,,,,,Outpatient,,,,14.51,CIGNA,Commercial,,50,,4.21,4.21,4.21,1 through 10,percent of total billed charges,10.70333333,15.29,
Beta2-Glycoprotein I (IgA) QSTC,14127808,LOCAL,86146,CPT,,,,,,Outpatient,,,,30.54,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Beta2-Glycoprotein I (IgG) QSTC,14127809,LOCAL,86146,CPT,,,,,,Outpatient,,,,30.54,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Beta2-Glycoprotein I (IgM) QSTC,14127810,LOCAL,86146,CPT,,,,,,Outpatient,,,,30.54,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiolipin Ab (IgA) QSTC,14127805,LOCAL,86147,CPT,,,,,,Outpatient,,,,30.54,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiolipin Ab (IgG) QSTC,14127806,LOCAL,86147,CPT,,,,,,Outpatient,,,,30.54,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiolipin Ab (IgM) QSTC,14127807,LOCAL,86147,CPT,,,,,,Outpatient,,,,30.54,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"CCP, Antibody (IgG) QSTC",14127817,LOCAL,86200,CPT,,,,,,Outpatient,,,,15.54,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Centromere B Antibody QSTC,14127802,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chromatin (Nucleosomal) Ab QSTC,14127794,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complement Component C3c QSTC,14127803,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complement Component C4c QSTC,14127804,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"DNA Ab (DS) Crithidia, IFA QSTC",14127793,LOCAL,86255,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Jo-1 Antibody QSTC,14127801,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"MCV, Antibody QSTC",14127818,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rheumatoid Factor (IgA) QSTC,14127812,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rheumatoid Factor (IgG) QSTC,14127814,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rheumatoid Factor (IgM) QSTC,14127816,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RNP Antibody QSTC,14127797,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Scl-70 Antibody QSTC,14127800,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sjogren's Antibody (SS-A) QSTC,14127798,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sjogren's Antibody (SS-B) QSTC,14127799,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sm Antibody QSTC,14127795,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sm/RNP Antibody QSTC,14127796,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Thyroid Peroxidase Abs QSTC,14127819,LOCAL,86376,CPT,,,,,,Outpatient,,,,17.46,CIGNA,Commercial,,50,,11.2,11.2,11.2,1 through 10,percent of total billed charges,15.29,25.085,
Calcitonin QSTC,8764739,LOCAL,82308,CPT,,,,,,Outpatient,,,,32.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"DHEA, Unconjugated QSTC",8853248,LOCAL,82626,CPT,,,,,,Outpatient,,,,30.32,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sjogren's Antibodies (SS-A, SS-B) QSTC",8853207,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Special Stains Group II,8489591,LOCAL,88313,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
17-Hydroxyprogesterone QSTC,8853287,LOCAL,83498,CPT,,,,,,Outpatient,,,,32.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carcinoembryonic Antigen,633697,LOCAL,82378,CPT,,,,,,Outpatient,,,,22.75,CIGNA,Commercial,,50,,11.4,11.4,11.4,1 through 10,percent of total billed charges,17.73,36.03017241,
Hepatitis B Core Antibody IgM,1628907,LOCAL,86705,CPT,,,,,,Outpatient,,,,14.12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Celiac Disease Comp w/Gliadin Ab IgG QSTC,13864455,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hep B Surface Ag w/Rflx to Confirm. QSTC,9039254,LOCAL,87340,CPT,,,,,,Outpatient,,,,12.4,CIGNA,Commercial,,50,,11.67,6.18,17.16,1 through 10,percent of total billed charges,10.57,22.20058824,
Immunoglobulin Panel QSTC,8764543,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Body Fluid Cell Count w/ Diff,6213822,LOCAL,89051,CPT,,,,,,Outpatient,,,,6.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Body Fluid Cell Count with Differential If Indicated,8127214,LOCAL,89051,CPT,,,,,,Outpatient,,,,6.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Body Fluid Differential,4240538,LOCAL,89051,CPT,,,,,,Outpatient,,,,6.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CSF Cell Count with Differential If Indicated,3454318,LOCAL,89051,CPT,,,,,,Outpatient,,,,6.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CSF Differential,3454393,LOCAL,89051,CPT,,,,,,Outpatient,,,,6.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digoxin Level,1628891,LOCAL,80162,CPT,,,,,,Outpatient,,,,15.94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Potassium Level,633616,LOCAL,84132,CPT,,,,,,Outpatient,,,,5.71,CIGNA,Commercial,,50,,41.3,20.62,64.04,1 through 10,percent of total billed charges,7.16,8.697880184,
24hr Urine Creatinine QSTC,10600648,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,28.64,5.07,45.51,1 through 10,percent of total billed charges,7.16,40.97514925,
"Aldosterone, 24-Hour Urine QSTC",8995528,LOCAL,82088,CPT,,,,,,Outpatient,,,,48.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aspergillus Ab, Immunodiffusion QSTC",13864516,LOCAL,86606,CPT,,,,,,Outpatient,,,,18.06,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
T3 Free,3170323,LOCAL,84481,CPT,,,,,,Outpatient,,,,20.33,CIGNA,Commercial,,50,,20.9,10.14,64.97,1 through 10,percent of total billed charges,18.43,34.46424242,
ANCA Screen w Reflex to ANCA Titer QSTC,8764789,LOCAL,86036,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Androstenedione QSTC,8764648,LOCAL,82157,CPT,,,,,,Outpatient,,,,35.14,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Antithrombin III Activity QSTC,8764597,LOCAL,85300,CPT,,,,,,Outpatient,,,,14.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Influenza A,7909953,LOCAL,87804,CPT,,,,,,Outpatient,,,,19.86,CIGNA,Commercial,,50,,46.8,46.8,46.8,1 through 10,percent of total billed charges,6.419753086,10.57,
Influenza B,7909954,LOCAL,87804,CPT,,,,,,Outpatient,,,,19.86,CIGNA,Commercial,,50,,46.8,46.8,46.8,1 through 10,percent of total billed charges,6.419753086,10.57,
"Protein C, Activity QSTC",8764685,LOCAL,85303,CPT,,,,,,Outpatient,,,,16.61,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Protein S Antigen, Free QSTC",9777259,LOCAL,85306,CPT,,,,,,Outpatient,,,,18.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Protein S, Activity QSTC",8764774,LOCAL,85306,CPT,,,,,,Outpatient,,,,18.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Shiga Toxin 1 and 2,7939191,LOCAL,87427,CPT,,,,,,Outpatient,,,,14.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Shiga Toxin 1 and 2,8875416,LOCAL,87427,CPT,,,,,,Outpatient,,,,14.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue Transglutaminase IgG Ab QSTC,8764825,LOCAL,86364,CPT,,,,,,Outpatient,,,,13.84,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vitamin B12 QSTC,9291002,LOCAL,82607,CPT,,,,,,Outpatient,,,,18.1,CIGNA,Commercial,,50,,99.8,15.08,184.52,1 through 10,percent of total billed charges,18.43,82.43266533,
Glucose CSF,1628897,LOCAL,82945,CPT,,,,,,Outpatient,,,,4.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Protein CSF,1634881,LOCAL,84157,CPT,,,,,,Outpatient,,,,4.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Erythropoietin (EPO) QSTC,8764551,LOCAL,82668,CPT,,,,,,Outpatient,,,,22.55,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT Vapotherm Subsequent CHARGE,8143879,LOCAL,94003,CPT,,,,,,Outpatient,,,,613,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hematocrit,633742,LOCAL,85014,CPT,,,,,,Outpatient,,,,2.84,CIGNA,Commercial,,50,,2.28,2.28,2.28,1 through 10,percent of total billed charges,8.21,12.62068493,
Hematocrit,1635636,LOCAL,85014,CPT,,,,,,Outpatient,,,,2.84,CIGNA,Commercial,,50,,2.28,2.28,2.28,1 through 10,percent of total billed charges,8.21,12.62068493,
Hemoglobin,633741,LOCAL,85018,CPT,,,,,,Outpatient,,,,2.84,CIGNA,Commercial,,50,,2.28,2.28,2.28,1 through 10,percent of total billed charges,8.21,10.94316176,
Hemoglobin,1635635,LOCAL,85018,CPT,,,,,,Outpatient,,,,2.84,CIGNA,Commercial,,50,,2.28,2.28,2.28,1 through 10,percent of total billed charges,8.21,10.94316176,
C1 Esterase Inhibitor QST,13870084,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"C1 Esterase Inhibitor, Functional QSTC",8853251,LOCAL,86161,CPT,,,,,,Outpatient,,,,14.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Antibody Screen Gel 2,8196056,LOCAL,86850,CPT,,,,,,Outpatient,,,,11.72,CIGNA,Commercial,,50,,21.49,7.76,64.58,1 through 10,percent of total billed charges,6.29,48.85,
Antibody Screen Tube.,8417431,LOCAL,86850,CPT,,,,,,Outpatient,,,,11.72,CIGNA,Commercial,,50,,21.49,7.76,64.58,1 through 10,percent of total billed charges,6.29,48.85,
BB RH (D) TYPE XX,6432042,LOCAL,86901,CPT,,,,,,Outpatient,,,,3.59,CIGNA,Commercial,,50,,21.49,1.74,21.49,1 through 10,percent of total billed charges,6.29,35.88,
Acid Fast Stain Report,634214,LOCAL,87206,CPT,,,,,,Outpatient,,,,6.47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Milk Component Panel QSTC,8912186,LOCAL,86008,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF TRXN Pathologist Interp,13479165,LOCAL,86078,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BB REF RH(D) TYPING TRANSFUSION RXN,6433001,LOCAL,86901,CPT,,,,,,Outpatient,,,,3.59,CIGNA,Commercial,,50,,21.49,1.74,21.49,1 through 10,percent of total billed charges,6.29,35.88,
BB REF XMATCH (IAT) TRANSFUSION RXN,6433004,LOCAL,86922,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF ABO/Rh (TRXN),13479164,LOCAL,86900,CPT,,,,,,Outpatient,,,,3.59,CIGNA,Commercial,,50,,28.93,1.74,28.93,1 through 10,percent of total billed charges,6.29,117.85,
REF Antibody Screen (TRXN),13479162,LOCAL,86850,CPT,,,,,,Outpatient,,,,11.72,CIGNA,Commercial,,50,,21.49,7.76,64.58,1 through 10,percent of total billed charges,6.29,48.85,
REF Crossmatch (TRXN),13481255,LOCAL,86920,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF DAT (TRXN),13479163,LOCAL,86880,CPT,,,,,,Outpatient,,,,6.47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Clostridium difficile Quik Chek Complete,10574492,LOCAL,87324,CPT,,,,,,Outpatient,,,,14.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hemoglobin (POCT),4192190,LOCAL,85018,CPT,,,,,,Outpatient,,,,2.84,CIGNA,Commercial,,50,,2.28,2.28,2.28,1 through 10,percent of total billed charges,8.21,10.94316176,
Hepatitis C Ab,1628911,LOCAL,86803,CPT,,,,,,Outpatient,,,,17.12,CIGNA,Commercial,,50,,21.84,14.21,66.04,20,percent of total billed charges,15.29,32.10014925,
RT Education/Instruction CHARGE,90840011,LOCAL,94664,CPT,,,,,,Outpatient,,,,46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"RT Evaluation, Respiratory CHARGE",90840013,LOCAL,94664,CPT,,,,,,Outpatient,,,,46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tacrolimus 5 mg oral capsule [CULL],11205997,LOCAL,J7507,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Gliadin (Deamidated) Ab (IgG, IgA) QSTC",8764748,LOCAL,86258,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HFO (L3929),10393294,LOCAL,,,L3929,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hemoglobin A1c,1383763,LOCAL,83036,CPT,,,,,,Outpatient,,,,11.65,CIGNA,Commercial,,50,,40.87,9.71,72.03,1 through 10,percent of total billed charges,7.16,28.59604426,
"Arsenic, Blood QSTC",13864922,LOCAL,82175,CPT,,,,,,Outpatient,,,,22.76,CIGNA,Commercial,,50,,45.43,18.97,71.89,1 through 10,percent of total billed charges,16.07,42.25673077,
97032 ELECTRIC STIM,8478060,LOCAL,97032,CPT,,,,,GN,Outpatient,,,,47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97032 ELECTRIC STIM OT,9630084,LOCAL,97032,CPT,,,,,GN,Outpatient,,,,47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97032 OT E STIM CON - EA 15MIN CHARGE,9856105,LOCAL,97032,CPT,,,,,GO,Outpatient,,,,47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97032 OT Elec Stim Attended Assistant Units,9866105,LOCAL,97032,CPT,,,,,GO|CO,Outpatient,,,,47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97032 PT E STIM CON - EA 15MIN CHARGE,9640023,LOCAL,97032,CPT,,,,,GP,Outpatient,,,,47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97032 PT Elect Stim Attended Assistant Units,9650023,LOCAL,97032,CPT,,,,,GP|CQ,Outpatient,,,,47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Attended E-Stim Charges,1366373,LOCAL,97032,CPT,,,,,GO,Outpatient,,,,47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Attended E-Stim Charges,7895926,LOCAL,97032,CPT,,,,,GP,Outpatient,,,,47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Attended E-Stim Assistant Units,1366373,LOCAL,97032,CPT,,,,,CQ,Outpatient,,,,47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Attended E-Stim Assistant Units,1373442,LOCAL,97032,CPT,,,,,CQ,Outpatient,,,,47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Attended E-Stim Charges,1366373,LOCAL,97032,CPT,,,,,GO,Outpatient,,,,47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Attended E-Stim Units,1373442,LOCAL,97032,CPT,,,,,GO,Outpatient,,,,47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Attended E-Stim Assistant Units,9396343,LOCAL,97032,CPT,,,,,CQ,Outpatient,,,,47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Newborn Hearing Test Type -> Auditory brainstem response,8982858,LOCAL,92700,CPT,,,,,,Outpatient,,,,47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"IGF-1, LC/MS QSTC",8764636,LOCAL,84305,CPT,,,,,,Outpatient,,,,25.51,CIGNA,Commercial,,50,,22.74,22.74,22.74,1 through 10,percent of total billed charges,18.43,46.87,
"Chlamydia Trachomatis RNA, TMA QST",10578255,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",10578245,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
Thinprep Review Cytotechnologist: QST,10590230,LOCAL,88175,CPT,,,,,,Outpatient,,,,31.93,CIGNA,Commercial,,50,,31.2,31.2,31.2,1 through 10,percent of total billed charges,25.25,26.61,
pyridoxine 100 mg/mL injectable solution 1 mL [CULL],11212249,LOCAL,J3415,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97803 RE-ASSESSMENT & INTERVENTION CHARGE,8821410,LOCAL,97803,CPT,,,,,,Outpatient,,,,48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amylase Level,631567,LOCAL,82150,CPT,,,,,,Outpatient,,,,7.78,CIGNA,Commercial,,50,,22.91,22.82,69.87,20,percent of total billed charges,1.237209302,7.16,
Prothrombin Time,7904947,LOCAL,85610,CPT,,,,,,Outpatient,,,,5.15,CIGNA,Commercial,,50,,38.82,11.2,66.44,1 through 10,percent of total billed charges,2.355196507,5.42,
Prothrombin Time and INR,633793,LOCAL,85610,CPT,,,,,,Outpatient,,,,5.15,CIGNA,Commercial,,50,,38.82,11.2,66.44,1 through 10,percent of total billed charges,2.355196507,5.42,
Vancomycin Level,1634895,LOCAL,80202,CPT,,,,,,Outpatient,,,,16.25,CIGNA,Commercial,,50,,22.91,22.91,22.91,1 through 10,percent of total billed charges,15.38,29.0215,
Vancomycin Level Peak,1634896,LOCAL,80202,CPT,,,,,,Outpatient,,,,16.25,CIGNA,Commercial,,50,,22.91,22.91,22.91,1 through 10,percent of total billed charges,15.38,29.0215,
Vancomycin Level Trough,1634897,LOCAL,80202,CPT,,,,,,Outpatient,,,,16.25,CIGNA,Commercial,,50,,22.91,22.91,22.91,1 through 10,percent of total billed charges,15.38,29.0215,
97016 OT VASOPNEUMATIC DEVICE CHARGE,9850019,LOCAL,97016,CPT,,,,,GO,Outpatient,,,,48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97016 PT JOBST COMPRESSION CHARGE,9640020,LOCAL,97016,CPT,,,,,GP,Outpatient,,,,48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97016 PT VASOPNEUMATIC DEVICE CHARGE,9650020,LOCAL,97016,CPT,,,,,GP|CQ,Outpatient,,,,48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Vasopneumatic Device Charge,7895255,LOCAL,97016,CPT,,,,,GO,Outpatient,,,,48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Vasopneumatic Devices Assistant Units,7895255,LOCAL,97016,CPT,,,,,CQ,Outpatient,,,,48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Vasopneumatic Devices Units,1373553,LOCAL,97016,CPT,,,,,GO,Outpatient,,,,48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Vasopneumatic Devices Assistant Units,9390396,LOCAL,97016,CPT,,,,,CQ,Outpatient,,,,48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vasopneumatic Device Charge,7895963,LOCAL,97016,CPT,,,,,GP,Outpatient,,,,48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Beta hCG Quantitative,633665,LOCAL,84702,CPT,,,,,,Outpatient,,,,18.06,CIGNA,Commercial,,50,,23.4,23.4,23.4,1 through 10,percent of total billed charges,15.05,18.43,
Flu A -Sofia,8267167,LOCAL,87804,CPT,,,,,,Outpatient,,,,19.86,CIGNA,Commercial,,50,,46.8,46.8,46.8,1 through 10,percent of total billed charges,6.419753086,10.57,
Flu B -Sofia,8267168,LOCAL,87804,CPT,,,,,,Outpatient,,,,19.86,CIGNA,Commercial,,50,,46.8,46.8,46.8,1 through 10,percent of total billed charges,6.419753086,10.57,
pH Venous,3454453,LOCAL,82800,CPT,,,,,,Outpatient,,,,13.2,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Protein, Total, 24 Hr Ur QSTC",8851917,LOCAL,84156,CPT,,,,,,Outpatient,,,,4.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SARS-CoV-2 (COVID-19) IgG Ab,9706404,LOCAL,86769,CPT,,,,,,Outpatient,,,,50.56,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Total hCG Quantitative,9299894,LOCAL,84702,CPT,,,,,,Outpatient,,,,18.06,CIGNA,Commercial,,50,,23.4,23.4,23.4,1 through 10,percent of total billed charges,15.05,18.43,
pH Pleural Fluid,9631697,LOCAL,83986,CPT,,,,,,Outpatient,,,,4.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
terbutaline 1 mg/mL injectable solution 1 mL [CULL],11212324,LOCAL,J3105,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Estradiol Lvl,3170319,LOCAL,82670,CPT,,,,,,Outpatient,,,,33.53,CIGNA,Commercial,,50,,23.68,16.79,74.21,11,percent of total billed charges,18.43,51.64,
"Metanephrines, Fraction, LCMSMS,U24 QSTC",8764626,LOCAL,83835,CPT,,,,,,Outpatient,,,,20.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Mycobacteria Stain, Acid Fast, Fluorochrome QST",12126168,LOCAL,87206,CPT,,,,,,Outpatient,,,,6.47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C1 Esterase Inhibitor Protein QST,13870086,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complement Component C4C QST,13870085,LOCAL,86161,CPT,,,,,,Outpatient,,,,14.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Serotonin, Serum QSTC",8853235,LOCAL,84260,CPT,,,,,,Outpatient,,,,37.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.Thyroglobulin QSTC,13864485,LOCAL,84432,CPT,,,,,,Outpatient,,,,19.27,CIGNA,Commercial,,50,,42.23,9.66,74.8,1 through 10,percent of total billed charges,18.43,46.235,
dexAMETHasone 4 mg/mL Sol [CULL],11202297,LOCAL,J1100,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,48.05,2.5,153.96,49,percent of total billed charges,10.48743758,10.48743758,
CT PCR,12526323,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
NG PCR,12526324,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
Alkaline Phosphatase,1620878,LOCAL,84075,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0008 MC ADMIN INFLUENZA VIRUS VACCINE CHARGE,7923017,LOCAL,,,G0008,HCPCS,,,,Outpatient,,,,50,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0009 VACCINE ADMINISTRATION PNEUMONIA,12214659,LOCAL,,,G0009,HCPCS,,,,Outpatient,,,,50,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64461 THORACIC PARAVERTEBRAL BLOCK,5661020,LOCAL,64461,CPT,,,,,,Outpatient,,,,50,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cryoglobulin (% Cryocrit), Serum QSTC",8764756,LOCAL,82595,CPT,,,,,,Outpatient,,,,7.76,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Group B Strep Culture,7842541,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,CIGNA,Commercial,,50,,34.31,5.23,63.39,1 through 10,percent of total billed charges,10.57,67.60639535,
Partial Thromboplastin Time,633794,LOCAL,85730,CPT,,,,,,Outpatient,,,,7.21,CIGNA,Commercial,,50,,24.82,11.84,72.01,13,percent of total billed charges,1.648553055,5.42,
Partial Thromboplastin Time,7904949,LOCAL,85730,CPT,,,,,,Outpatient,,,,7.21,CIGNA,Commercial,,50,,24.82,11.84,72.01,13,percent of total billed charges,1.648553055,5.42,
Strep Confirmation,8019111,LOCAL,87081,CPT,,,,,,Outpatient,,,,7.96,CIGNA,Commercial,,50,,43.03,6.63,79.43,1 through 10,percent of total billed charges,10.57,37.17627685,
99152 MOD SED SAME PHYS/QHP 5/>YRS,8653149,LOCAL,99152,CPT,,,,,,Outpatient,,,,52,CIGNA,Commercial,,50,,11.91,11.91,11.91,1 through 10,percent of total billed charges,10.38,34.95,
fluconazole 400 mg/200 mL-NaCl 0.9% intravenous solution 200 mL [CULL],11220722,LOCAL,J1450,CPT,,,,,,Outpatient,200,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
20561 DRY NEEDLING 3+ MUSCLES WO INJECTION,9650049,LOCAL,20561,CPT,,,,,,Outpatient,,,,52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GC Culture,633895,LOCAL,87081,CPT,,,,,,Outpatient,,,,7.96,CIGNA,Commercial,,50,,43.03,6.63,79.43,1 through 10,percent of total billed charges,10.57,37.17627685,
Lactate Dehydrogenase,633770,LOCAL,83615,CPT,,,,,,Outpatient,,,,7.25,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRSA Screen Culture,8244872,LOCAL,87081,CPT,,,,,,Outpatient,,,,7.96,CIGNA,Commercial,,50,,43.03,6.63,79.43,1 through 10,percent of total billed charges,10.57,37.17627685,
Protein Total,633818,LOCAL,84155,CPT,,,,,,Outpatient,,,,4.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bill Only ABID Panel, Selected Cell",8629507,LOCAL,86885,CPT,,,,,,Outpatient,,,,6.86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chromium, Serum QSTC",9701437,LOCAL,82495,CPT,,,,,,Outpatient,,,,24.34,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Levetiracetam QSTC,8764628,LOCAL,80177,CPT,,,,,,Outpatient,,,,15.9,CIGNA,Commercial,,50,,56.7,50.22,56.7,1 through 10,percent of total billed charges,9.399,15.38,
"Chlamydia Trachomatis RNA, TMA QST",10585658,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
HPV mRNA E6/E7 QST,10585657,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neisseria Gonorrhoeae RNA, TMA QST",10585659,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
Thinprep Review Cytotechnologist: QST,10585654,LOCAL,88175,CPT,,,,,,Outpatient,,,,31.93,CIGNA,Commercial,,50,,31.2,31.2,31.2,1 through 10,percent of total billed charges,25.25,26.61,
Testosterone Level Total,3170320,LOCAL,84403,CPT,,,,,,Outpatient,,,,30.97,CIGNA,Commercial,,50,,53.65,25.81,81.49,1 through 10,percent of total billed charges,18.43,52.3775,
methadone 10 mg/mL Injectable Sol 20 mL UD [CULL],11240064,LOCAL,J1230,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malaria/Babesia/Other Blood Parasites QSTC,10707969,LOCAL,87207,CPT,,,,,,Outpatient,,,,7.19,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
H. Pylori CLO,9517164,LOCAL,86677,CPT,,,,,,Outpatient,,,,20.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Phosphorus Level,633803,LOCAL,84100,CPT,,,,,,Outpatient,,,,5.69,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Estrogen, Total, Serum QSTC",8764701,LOCAL,82672,CPT,,,,,,Outpatient,,,,26.04,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PHENobarbital 65 mg/mL Sol [CULL],11211087,LOCAL,J2560,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,52.42,52.42,52.42,1 through 10,percent of total billed charges,29.077,29.077,
97129 ST COG/ATTEN/MEM/PROD CHARGE,9600117,LOCAL,97129,CPT,,,,,GN,Outpatient,,,,114,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97130 ST Cognitive skills development each additional 15 minutes,9600118,LOCAL,97130,CPT,,,,,GN,Outpatient,,,,114,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"SLP Cog Ther Intervent, Addl 15Min Units",9399379,LOCAL,97130,CPT,,,,,GN,Outpatient,,,,114,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"SLP Cog Ther Intervent,First 15Min Units",9399375,LOCAL,97129,CPT,,,,,GN,Outpatient,,,,114,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97802 MEDICAL NUTRITIONAL THERAPY CHARGE,13475610,LOCAL,97802,CPT,,,,,,Outpatient,,,,55,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minimum Inhibitory Concentration,294946,LOCAL,87186,CPT,,,,,,Outpatient,,,,10.38,CIGNA,Commercial,,50,,46.74,16.27,77.21,1 through 10,percent of total billed charges,10.57,35.67132075,
"HPV mRNA E6/E7, POST-$HYSTERECTOMY, VAGINAL QST",14782713,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BB REF LAB RH (D) TYPING,6413256,LOCAL,86901,CPT,,,,,,Outpatient,,,,3.59,CIGNA,Commercial,,50,,21.49,1.74,21.49,1 through 10,percent of total billed charges,6.29,35.88,
"Ehrlichia chaffeensis Ab (IgG,IgM) QSTC",8853255,LOCAL,86666,CPT,,,,,,Outpatient,,,,12.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF ABO/Rh,7939266,LOCAL,86900,CPT,,,,,,Outpatient,,,,3.59,CIGNA,Commercial,,50,,28.93,1.74,28.93,1 through 10,percent of total billed charges,6.29,117.85,
Uric Acid,633858,LOCAL,84550,CPT,,,,,,Outpatient,,,,5.42,CIGNA,Commercial,,50,,26.73,2.69,43.61,18,percent of total billed charges,7.16,35.17852564,
cefTRIAXone 500 mg injection [CULL],11202193,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,4.99,3.28,11.9,18,percent of total billed charges,5.161428571,5.161428571,
chloroprocaine 3% preservative-free Sol [CULL],11202203,LOCAL,J2401,CPT,,,,,,Outpatient,20,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chol/HDL C QSTC,14129541,LOCAL,80061,CPT,,,,,,Outpatient,,,,16.07,CIGNA,Commercial,,50,,57.36,13.39,101.32,1 through 10,percent of total billed charges,12.14,16.59934459,
HDL P QSTC,14129559,LOCAL,83704,CPT,,,,,,Outpatient,,,,41.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HPV mRNA E6/E7 QST,9773934,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HPV mRNA E6/E7 QST,9773934,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HPV mRNA E6/E7 QSTC,9773934,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOBUTamine 1 mg/mL-D5% Sol [CULL],11201073,LOCAL,J1250,CPT,,,,,,Outpatient,250,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Estrone QSTC,8853208,LOCAL,82679,CPT,,,,,,Outpatient,,,,29.94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
fosphenytoin 500 mgPE/10 mL injectable solution 10 mL [CULL],11205071,LOCAL,Q2009,CPT,,,,,,Outpatient,10,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methacholine varying strength inhalation solution [CULL],11290186,LOCAL,J7674,CPT,,,,,,Outpatient,3,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cyanide QSTC,13864508,LOCAL,82600,CPT,,,,,,Outpatient,,,,23.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
nitroglycerin 200 mcg/mL-D5% intravenous solution 250 mL [CULL],11211024,LOCAL,J2305,CPT,,,,,,Outpatient,250,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Electrolyte Panel,633610,LOCAL,80051,CPT,,,,,,Outpatient,,,,8.41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sodium Level,633611,LOCAL,84295,CPT,,,,,,Outpatient,,,,5.77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
76377 Requiring image post processing on an independent workstation,10740136,LOCAL,76377,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
acetylcysteine 20% inhalation solution 30 mL [CULL],11203022,LOCAL,J7608,CPT,,,,,,Outpatient,30,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Measles Antibody (IgM) QSTC,8853259,LOCAL,86765,CPT,,,,,,Outpatient,,,,15.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Maize/Corn (F8) IgE QSTC,14116318,LOCAL,86001,CPT,,,,,,Outpatient,,,,9.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97022 FLUIDOTHERAPY CHARGES,9646093,LOCAL,97022,CPT,,,,,GP,Outpatient,,,,57,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97022 OT WHIRLPOOL - ASEPTIC,9856111,LOCAL,97022,CPT,,,,,GO,Outpatient,,,,57,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97022 OT WHIRLPOOL 1+ AREAS APPL CHARGE,9866111,LOCAL,97022,CPT,,,,,GO|CO,Outpatient,,,,57,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97022 PT SMALL WHIRLPOOL CHARGE,9656093,LOCAL,97022,CPT,,,,,GP|CQ,Outpatient,,,,57,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97022 WHIRLPOOL CHARGE,9410091,LOCAL,97022,CPT,,,,,GP,Outpatient,,,,57,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Whirlpool Therapy Assitant Units,9401114,LOCAL,97022,CPT,,,,,CQ,Outpatient,,,,57,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Whirlpool Units,9401114,LOCAL,97022,CPT,,,,,GO,Outpatient,,,,57,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Whirlpool, Fluidotherapy Assistant Units",1373554,LOCAL,97022,CPT,,,,,CQ,Outpatient,,,,57,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Whirlpool, Fluidotherapy Units",1373554,LOCAL,97022,CPT,,,,,GO,Outpatient,,,,57,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Whirlpool Full Body Charge,7895951,LOCAL,97022,CPT,,,,,GP,Outpatient,,,,57,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Whirlpool, 1+ Areas 97022",9640021,LOCAL,97022,CPT,,,,,,Outpatient,,,,57,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Factor XI Activity, Clotting QSTC",10358416,LOCAL,85270,CPT,,,,,,Outpatient,,,,21.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99151 MOD SED SAME PHYS/QHP <5 YRS,8653147,LOCAL,99151,CPT,,,,,,Outpatient,,,,58,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Selenium QSTC,8972757,LOCAL,84255,CPT,,,,,,Outpatient,,,,30.64,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Theophylline Level,1634886,LOCAL,80198,CPT,,,,,,Outpatient,,,,16.97,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97552 OT Caregiver Training Group,13649812,LOCAL,97552,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97552 Speech Caregiver Training Group,13767339,LOCAL,97552,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Beta-2-Glycoprotein I Antibodies (IgG, IgM) QSTC",10094523,LOCAL,86146,CPT,,,,,,Outpatient,,,,30.54,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only ABO,7936964,LOCAL,86900,CPT,,,,,,Outpatient,,,,3.59,CIGNA,Commercial,,50,,28.93,1.74,28.93,1 through 10,percent of total billed charges,6.29,117.85,
Bill Only Rh,7936965,LOCAL,86901,CPT,,,,,,Outpatient,,,,3.59,CIGNA,Commercial,,50,,21.49,1.74,21.49,1 through 10,percent of total billed charges,6.29,35.88,
B-Type Natriuretic Peptide,1383771,LOCAL,83880,CPT,,,,,,Outpatient,,,,47.11,CIGNA,Commercial,,50,,64.24,39.26,89.21,1 through 10,percent of total billed charges,13.36379562,46.74,
"GROUP CAREGIVER TRAINING IN STRATEGIES & TECHNIQUES, FACE TO FACE, INITIAL 30 MIN 97552",13788179,LOCAL,97552,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Helicobacter pylori Ag, EIA, Stool QSTC",8873559,LOCAL,87338,CPT,,,,,,Outpatient,,,,17.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heparin Induced Plt Ab QSTC,8995550,LOCAL,86022,CPT,,,,,,Outpatient,,,,22.04,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"HPV Genotypes 16,18/45 QST",9773953,LOCAL,87625,CPT,,,,,,Outpatient,,,,48.66,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"HPV GENOTYPES 16,18/45,$POST-HYST, VAGINAL QST",14782712,LOCAL,87625,CPT,,,,,,Outpatient,,,,48.66,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
N-Terminal Pro B-Type Natriuretic Peptide,1503769,LOCAL,83880,CPT,,,,,,Outpatient,,,,47.11,CIGNA,Commercial,,50,,64.24,39.26,89.21,1 through 10,percent of total billed charges,13.36379562,46.74,
OT Group Caregiver Training Units,13624357,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Group Caregiver Training Time,14466882,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tacrolimus, Highly Sens, LC/MS/MS QSTC",8764783,LOCAL,80197,CPT,,,,,,Outpatient,,,,16.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Topiramate QSTC,8764585,LOCAL,80201,CPT,,,,,,Outpatient,,,,14.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vitamin D 25 Hydroxy Level,4240407,LOCAL,82306,CPT,,,,,,Outpatient,,,,35.52,CIGNA,Commercial,,50,,28.08,17.9,28.08,1 through 10,percent of total billed charges,17.73,45.19775253,
NEUROPSYCHOLOGICAL TEST ADMINISTRATION,13472049,LOCAL,96146,CPT,,,,,,Outpatient,,,,59,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Creatinine Urine,1930782,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,28.64,5.07,45.51,1 through 10,percent of total billed charges,7.16,40.97514925,
Fibrinogen Level,633728,LOCAL,85384,CPT,,,,,,Outpatient,,,,11.66,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rapid Plasma Reagin,633820,LOCAL,86592,CPT,,,,,,Outpatient,,,,5.12,CIGNA,Commercial,,50,,28.77,2.53,28.77,1 through 10,percent of total billed charges,15.29,19.99375,
Rapid Plasma Reagin Qualitative,7948395,LOCAL,86592,CPT,,,,,,Outpatient,,,,5.12,CIGNA,Commercial,,50,,28.77,2.53,28.77,1 through 10,percent of total billed charges,15.29,19.99375,
Rapid Plasma Reagin Qualitative w/ Reflex,8166073,LOCAL,86592,CPT,,,,,,Outpatient,,,,5.12,CIGNA,Commercial,,50,,28.77,2.53,28.77,1 through 10,percent of total billed charges,15.29,19.99375,
Blood Type ABO/Rh Typing,634326,LOCAL,86900,CPT,,,,,,Outpatient,,,,3.59,CIGNA,Commercial,,50,,28.93,1.74,28.93,1 through 10,percent of total billed charges,6.29,117.85,
Cord ABORh,8019069,LOCAL,86900,CPT,,,,,,Outpatient,,,,3.59,CIGNA,Commercial,,50,,28.93,1.74,28.93,1 through 10,percent of total billed charges,6.29,117.85,
Neonatal ABORh,8070665,LOCAL,86900,CPT,,,,,,Outpatient,,,,3.59,CIGNA,Commercial,,50,,28.93,1.74,28.93,1 through 10,percent of total billed charges,6.29,117.85,
Fetal Screen,634335,LOCAL,85461,CPT,,,,,,Outpatient,,,,11.23,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methylPREDNISolone sodium succinate 500 mg injection [CULL],11201954,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99175 IPECAC EMESIS W/OBSERVATION TechFee,8057714,LOCAL,99175,CPT,,,,,,Outpatient,,,,61,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT Vapotherm Initial CHARGE,8144190,LOCAL,94002,CPT,,,,,,Outpatient,,,,663,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Coccidioides Antibody, CF & ID, S QSTC",8764815,LOCAL,86635,CPT,,,,,,Outpatient,,,,13.76,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chlamydia Trachomatis RNA, TMA QST",9774353,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
DAPTOmycin 350 mg intravenous injection [CULL],11210540,LOCAL,J0878,CPT,,,,,,Outpatient,1,EA,,480,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neisseria Gonorrhoeae RNA, TMA QST",9774354,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
"Trichomonas Vaginalis RNA, Ql, TMA QST",9774358,LOCAL,87661,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Creat Clear,633609,LOCAL,82575,CPT,,,,,,Outpatient,,,,11.35,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Creat Clear (No U24),8477916,LOCAL,82575,CPT,,,,,,Outpatient,,,,11.35,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
doxycycline 100 mg injection [CULL],11201705,LOCAL,J1271,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aspartate aminotransferase,633633,LOCAL,84450,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Blood Urea Nitrogen,633605,LOCAL,84520,CPT,,,,,,Outpatient,,,,4.74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mononucleosis Screen,633785,LOCAL,86308,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Monospot POCT,9038464,LOCAL,86308,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gentamicin Level,3454415,LOCAL,80170,CPT,,,,,,Outpatient,,,,19.66,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gentamicin Level Peak,633736,LOCAL,80170,CPT,,,,,,Outpatient,,,,19.66,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gentamicin Level Trough,633737,LOCAL,80170,CPT,,,,,,Outpatient,,,,19.66,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gamma Glutamyl Transferase,1628895,LOCAL,82977,CPT,,,,,,Outpatient,,,,8.64,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Function Panel,1634883,LOCAL,80069,CPT,,,,,,Outpatient,,,,10.42,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL NM Therapy I131 Cap Per MCI,13644969,LOCAL,,,A9517,HCPCS,,,,Outpatient,,,,64,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96423 CHEMO ARTRL INF EA ADDL HR CHARGE,9404493,LOCAL,96423,CPT,,,,,,Outpatient,,,,64,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
90913 - Bfb training ea addl 15 min.,9442436,LOCAL,90913,CPT,,,,,,Outpatient,,,,64,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Caregiver Agreement on Discipline,7355021,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Caregiver Agreement on Discipline,7355021,LOCAL,,,G0543,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholesterol Total,633705,LOCAL,82465,CPT,,,,,,Outpatient,,,,5.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Progesterone Level,3454459,LOCAL,84144,CPT,,,,,,Outpatient,,,,25.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Triglyceride,633852,LOCAL,84478,CPT,,,,,,Outpatient,,,,6.89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Histoplasma Antibody Panel, CF and ID, Serum QSTC",10185600,LOCAL,86698,CPT,,,,,,Outpatient,,,,16.55,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"64420 INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVE, SINGLE ProFee",13959631,LOCAL,64420,CPT,,,,,,Outpatient,,,,693,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E3581 Thawed Cryo AHF,7267123,LOCAL,,,P9012,HCPCS,,,,Outpatient,,,,65,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HPV mRNA E6/E7 QST,9775619,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HPV mRNA E6/E7 QST,10585636,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
POC Chem8+ Panel,8920330,LOCAL,80048,CPT,,,,,,Outpatient,,,,10.15,CIGNA,Commercial,,50,,133.16,8.11,174.64,1 through 10,percent of total billed charges,12.14,37.17170492,
Thinprep Review Cytotechnologist: QST,9775616,LOCAL,88175,CPT,,,,,,Outpatient,,,,31.93,CIGNA,Commercial,,50,,31.2,31.2,31.2,1 through 10,percent of total billed charges,25.25,26.61,
Thinprep Review Cytotechnologist: QST,10585633,LOCAL,88175,CPT,,,,,,Outpatient,,,,31.93,CIGNA,Commercial,,50,,31.2,31.2,31.2,1 through 10,percent of total billed charges,25.25,26.61,
97116  SB Pt Gait Train 15 mn,9640030,LOCAL,97116,CPT,,,,,GP,Outpatient,,,,65,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97116 GAIT TRAINING CHARGE,9410151,LOCAL,97116,CPT,,,,,GP,Outpatient,,,,65,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97116 PT Gait Training Assistant Units,9650030,LOCAL,97116,CPT,,,,,GP|CQ,Outpatient,,,,65,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gait Training Charges,7895941,LOCAL,97116,CPT,,,,,GP,Outpatient,,,,65,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Gait Training Assistant Units,9390436,LOCAL,97116,CPT,,,,,CQ,Outpatient,,,,65,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Activated PTT,7938959,LOCAL,85730,CPT,,,,,,Outpatient,,,,7.21,CIGNA,Commercial,,50,,24.82,11.84,72.01,13,percent of total billed charges,1.648553055,5.42,
Bilirubin Direct,4240528,LOCAL,82248,CPT,,,,,,Outpatient,,,,6.02,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilirubin Direct,7939101,LOCAL,82248,CPT,,,,,,Outpatient,,,,6.02,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilirubin Direct,8443662,LOCAL,82248,CPT,,,,,,Outpatient,,,,6.02,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
iSTAT Creatinine POCT,11673045,LOCAL,82565,CPT,,,,,,Outpatient,,,,6.14,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lipid Pnl,633777,LOCAL,80061,CPT,,,,,,Outpatient,,,,16.07,CIGNA,Commercial,,50,,57.36,13.39,101.32,1 through 10,percent of total billed charges,12.14,16.59934459,
77062 MG Diagnostic Tomo Charge: AddOn Bilateral,13969682,LOCAL,G0279,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
77063 MG Tomo Charge: AddOn Bilateral,13621440,LOCAL,77063,CPT,,,,,,Outpatient,,,,54.45,CIGNA,Commercial,,50,,73.79,46.67,100.91,1 through 10,percent of total billed charges,20.75,74,
CULL Mammo Tomo Add On,7867705,LOCAL,77063,CPT,,,,,,Outpatient,,,,54.45,CIGNA,Commercial,,50,,73.79,46.67,100.91,1 through 10,percent of total billed charges,20.75,74,
hepatitis B pediatric vaccine 10 mcg/0.5 mL intramuscular suspension 0.5 mL [CULL],11202559,LOCAL,90744,CPT,,,,,,Outpatient,0.5,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Immunoglobulin G Subclass 1 QSTC,8851875,LOCAL,82787,CPT,,,,,,Outpatient,,,,9.62,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Immunoglobulin G, Serum QSTC",8851879,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"HVA, 24h Urine w/o Creat QSTC",13864511,LOCAL,83150,CPT,,,,,,Outpatient,,,,26.89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CYSTOGRAM INJ,8210035,LOCAL,51600,CPT,,,,,,Outpatient,,,,246,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Therapeutic Phlebotomy,8118276,LOCAL,99195,CPT,,,,,,Outpatient,,,,67,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Strep A Xpress (GeneXpert),8642789,LOCAL,87651,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,32.29,32.29,32.29,1 through 10,percent of total billed charges,3.7,40.19,
Cerebrospinal Fluid Culture,4122737,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,CIGNA,Commercial,,50,,34.31,5.23,63.39,1 through 10,percent of total billed charges,10.57,67.60639535,
pamidronate 3 mg/mL intravenous solution 10 mL [CULL],11211072,LOCAL,J2430,CPT,,,,,,Outpatient,10,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronavirus SARS Ag (Sofia),9803641,LOCAL,87426,CPT,,,,,,Outpatient,,,,42.4,CIGNA,Commercial,,50,,32.45,32.45,32.45,1 through 10,percent of total billed charges,10.57,56.40806897,
COVID-19 Ag,11561110,LOCAL,87426,CPT,,,,,,Outpatient,,,,42.4,CIGNA,Commercial,,50,,32.45,32.45,32.45,1 through 10,percent of total billed charges,10.57,56.40806897,
Urine Drug Screen,3454403,LOCAL,80306,CPT,,,,,,Outpatient,,,,20.57,CIGNA,Commercial,,50,,32.45,8.87,103.11,41,percent of total billed charges,0.2416,17.73,
97533 PT SENSORY INTEGRATIVE TECH 15MIN,9866109,LOCAL,97533,CPT,,,,,GO|CO,Outpatient,,,,68,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97533 SENSORY INTEGATIVE TECHNIQUES EACH 15 MINS,9856109,LOCAL,97533,CPT,,,,,GO,Outpatient,,,,68,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Sensory Integrative Tech Assistant Units,7895276,LOCAL,97533,CPT,,,,,CQ,Outpatient,,,,68,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Sensory Integrative Techniques Units,1373568,LOCAL,97533,CPT,,,,,GO,Outpatient,,,,68,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sensory Stimulation Charge,7895276,LOCAL,97533,CPT,,,,,GO,Outpatient,,,,68,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3908 Clavicle Brace,9800048,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3908 Wrist/forearm Brace,9800047,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chlamydia Trachomatis RNA, TMA QST",14435138,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
HPV mRNA E6/E7 QST,14435137,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neisseria Gonorrhoeae RNA, TMA QST",14435139,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
Thinprep Review Cytotechnologist: QST,14435134,LOCAL,88175,CPT,,,,,,Outpatient,,,,31.93,CIGNA,Commercial,,50,,31.2,31.2,31.2,1 through 10,percent of total billed charges,25.25,26.61,
Iron Level,633765,LOCAL,83540,CPT,,,,,,Outpatient,,,,7.76,CIGNA,Commercial,,50,,32.84,26.27,53.89,19,percent of total billed charges,7.16,48.87820628,
Iron Level,7050169,LOCAL,83540,CPT,,,,,,Outpatient,,,,7.76,CIGNA,Commercial,,50,,32.84,26.27,53.89,19,percent of total billed charges,7.16,48.87820628,
Iron Level,10543519,LOCAL,83540,CPT,,,,,,Outpatient,,,,7.76,CIGNA,Commercial,,50,,32.84,26.27,53.89,19,percent of total billed charges,7.16,48.87820628,
"Vitamin B2 (Riboflavin), P QSTC",8972877,LOCAL,84252,CPT,,,,,,Outpatient,,,,24.29,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3908 Daytimer Wrist Support,9800046,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97537 COMMUNITY/WORK REINTEGRATION,9650036,LOCAL,97537,CPT,,,,,GP|CQ,Outpatient,,,,70,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97537 Community/work reintegration training; each 15 minutes,9860034,LOCAL,97537,CPT,,,,,GO|CO,Outpatient,,,,70,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97537 OT COMM WORK INTEGRATION CHARGE,9850034,LOCAL,97537,CPT,,,,,GO,Outpatient,,,,70,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97537 PT ERGONOMIC TRAINING,9640036,LOCAL,97537,CPT,,,,,GP,Outpatient,,,,70,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Community/Work Reintegration Charges,1366455,LOCAL,97537,CPT,,,,,GO,Outpatient,,,,70,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Community, Work Reintegration Assistant Units",1366455,LOCAL,97537,CPT,,,,,CQ,Outpatient,,,,70,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Community, Work Reintegration Assistant Units",1373453,LOCAL,97537,CPT,,,,,CQ,Outpatient,,,,70,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Community, Work Reintegration Units",1373453,LOCAL,97537,CPT,,,,,GO,Outpatient,,,,70,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Community/Work Reintegration Charges,1366455,LOCAL,97537,CPT,,,,,GO,Outpatient,,,,70,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"PT Community,Work Reintegration Assistant Units",9390450,LOCAL,97537,CPT,,,,,CQ,Outpatient,,,,70,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Community/Work Reintegration Charge,7895991,LOCAL,97537,CPT,,,,,GP,Outpatient,,,,70,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AChR Bind Ab w/rfx MuSK Ab QSTC,13864498,LOCAL,86041,CPT,,,,,,Outpatient,,,,22.08,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alpha-1-Antitrypsin QN QSTC,13873077,LOCAL,82103,CPT,,,,,,Outpatient,,,,16.13,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carnitine QSTC,8764784,LOCAL,82379,CPT,,,,,,Outpatient,,,,20.24,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EKG Charges - RT -> Routine ECG 12 lead/15 lead tracing only,5367589,LOCAL,93041,CPT,,,,,,Outpatient,,,,71,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97542  SB PT Wheelchair Mgt,9640037,LOCAL,97542,CPT,,,,,GP,Outpatient,,,,71,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97542 OT WHEELCHAIR MANAGE/TRAIN 15MIN,9820201,LOCAL,97542,CPT,,,,,GO,Outpatient,,,,71,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97542 PT WC SEATING EVAL CHARGE,9650037,LOCAL,97542,CPT,,,,,GP|CQ,Outpatient,,,,71,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"97542 Wheelchair management (eg, assessment, fitting, training), each 15 minutes",9860201,LOCAL,97542,CPT,,,,,GO|CO,Outpatient,,,,71,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97542 WHEELCHAIR MANAGEMENT CHARGE,9410201,LOCAL,97542,CPT,,,,,GP,Outpatient,,,,71,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Wheelchair Management Assistant Units,7895273,LOCAL,97542,CPT,,,,,CQ,Outpatient,,,,71,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Wheelchair Management Units,1373570,LOCAL,97542,CPT,,,,,GO,Outpatient,,,,71,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Wheelchair Management Assistant Units,9390452,LOCAL,97542,CPT,,,,,CQ,Outpatient,,,,71,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wheelchair Charge,7895273,LOCAL,97542,CPT,,,,,GO,Outpatient,,,,71,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wheelchair Management Charges,7895931,LOCAL,97542,CPT,,,,,GP,Outpatient,,,,71,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97551 OT Caregiver Training Ea Add'l 15 Mins,13647370,LOCAL,97551,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97551 PT Caregiver Training Ea Add'l 15 Mins,13645598,LOCAL,97551,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97551 ST Caregiver Training Ea  Addl 15 min,14017194,LOCAL,97551,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Facility Eval and Management Level 1 99211,10633491,LOCAL,99211,CPT,,,,,,Outpatient,,,,226,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medical Day Dressing Change,10633491,LOCAL,99211,CPT,,,,,,Outpatient,,,,226,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Caregiver Training, Addl 15 Min Asst",13623455,LOCAL,,,G0542,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Caregiver Training, First 30 Min Asst",13623453,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"SLP Caregiver Training, Addl 15 Min Time",14466886,LOCAL,,,G0542,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
% CD19 (B Cells) QSTC,9416397,LOCAL,86355,CPT,,,,,,Outpatient,,,,45.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
%CD 16+CD56 (NK Cells) QSTC,9416395,LOCAL,86357,CPT,,,,,,Outpatient,,,,45.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
%CD3 Mature T Cells QSTC,9416288,LOCAL,86359,CPT,,,,,,Outpatient,,,,45.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CD4/CD8 Ratio QSTC,8852258,LOCAL,86360,CPT,,,,,,Outpatient,,,,56.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Parvovirus B19 Antibodies(IgG, IgM) QSTC",8764577,LOCAL,86747,CPT,,,,,,Outpatient,,,,18.04,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
chlorproMAZINE 25 mg/mL injectable solution 1 mL [CULL],11202221,LOCAL,J3230,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CBC w/ Manual Differential,633682,LOCAL,85027,CPT,,,,,,Outpatient,,,,7.76,CIGNA,Commercial,,50,,34.74,34.74,34.74,1 through 10,percent of total billed charges,8.21,27.02937879,
CBC without Differential,3798345,LOCAL,85027,CPT,,,,,,Outpatient,,,,7.76,CIGNA,Commercial,,50,,34.74,34.74,34.74,1 through 10,percent of total billed charges,8.21,27.02937879,
gentamicin 40 mg/mL injectable solution 20 mL [CULL],11205229,LOCAL,J1580,CPT,,,,,,Outpatient,20,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DNase-B Antibody QSTC,8764548,LOCAL,86215,CPT,,,,,,Outpatient,,,,15.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tissue Transglutaminase Ab(IgG,IgA) QSTC",8972930,LOCAL,86364,CPT,,,,,,Outpatient,,,,13.84,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cord DAT Gel,8416626,LOCAL,86880,CPT,,,,,,Outpatient,,,,6.47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DAT IgG Gel,7906396,LOCAL,86880,CPT,,,,,,Outpatient,,,,6.47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neonatal DAT Gel,13460490,LOCAL,86880,CPT,,,,,,Outpatient,,,,6.47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LA Ven - Sepsis 2Hr,8485386,LOCAL,83605,CPT,,,,,,Outpatient,,,,13.88,CIGNA,Commercial,,50,,35.39,35.39,35.39,1 through 10,percent of total billed charges,0.901879518,17.73,
Lactic Acid (Venous),3454442,LOCAL,83605,CPT,,,,,,Outpatient,,,,13.88,CIGNA,Commercial,,50,,35.39,35.39,35.39,1 through 10,percent of total billed charges,0.901879518,17.73,
Lactic Acid (Venous) - Sepsis,8058058,LOCAL,83605,CPT,,,,,,Outpatient,,,,13.88,CIGNA,Commercial,,50,,35.39,35.39,35.39,1 through 10,percent of total billed charges,0.901879518,17.73,
Unstable Hemoglobin QSTC,13864449,LOCAL,83068,CPT,,,,,,Outpatient,,,,11.36,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97124 MASSAGE CHARGE,9640031,LOCAL,97124,CPT,,,,,GP,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97124 OT MASSAGE CHARGE,9850029,LOCAL,97124,CPT,,,,,GO,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97124 OT-MASSAGE EA 15 MIN,9860029,LOCAL,97124,CPT,,,,,GO|CO,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97124 PT Massage Assistant Units,9650031,LOCAL,97124,CPT,,,,,GP|CQ,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97140  Manual Therapy 15 min,9850047,LOCAL,97140,CPT,,,,,GO,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97140 MAN THER EA 15 MIN CHARGES,9640047,LOCAL,97140,CPT,,,,,GP,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97140 OT Manual Therapy Assistant Units,9860047,LOCAL,97140,CPT,,,,,GO|CO,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97140 PT Manual Therapy Assistant Units,9650047,LOCAL,97140,CPT,,,,,GP|CQ,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Manual Therapy Charge Units,7895928,LOCAL,97140,CPT,,,,,GP,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Manual Traction Charge,7895279,LOCAL,97140,CPT,,,,,GO,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Massage Charge Units,1041799,LOCAL,97124,CPT,,,,,GO,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Massage Charge Units,7895954,LOCAL,97124,CPT,,,,,GP,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Manual Therapy Assistant Units,1373444,LOCAL,97140,CPT,,,,,CQ,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Manual Therapy Units,1373444,LOCAL,97140,CPT,,,,,GO,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Massage Assistant Units,1041799,LOCAL,97124,CPT,,,,,CQ,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Massage Charge Units,1041799,LOCAL,97124,CPT,,,,,GO,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Massage Rehab Assist Units,7897698,LOCAL,97124,CPT,,,,,CQ,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Massage Rehab Units,7897698,LOCAL,97124,CPT,,,,,GO,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Manual Therapy Assistant Units,9390440,LOCAL,97140,CPT,,,,,CQ,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Massage Assistant Units,9390438,LOCAL,97124,CPT,,,,,CQ,Outpatient,,,,74,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methylergonovine 0.2 mg/mL injectable solution 1 mL [CULL],11202918,LOCAL,J2210,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Thinprep TIS Pap QST,9773891,LOCAL,88175,CPT,,,,,,Outpatient,,,,31.93,CIGNA,Commercial,,50,,31.2,31.2,31.2,1 through 10,percent of total billed charges,25.25,26.61,
Thinprep TIS Pap Rfx HPV mRNA E6/E7 QST,9773936,LOCAL,88175,CPT,,,,,,Outpatient,,,,31.93,CIGNA,Commercial,,50,,31.2,31.2,31.2,1 through 10,percent of total billed charges,25.25,26.61,
97033 IONTOPHORESIS CHARGE,9410271,LOCAL,97033,CPT,,,,,GP,Outpatient,,,,75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97033 IONTOPHORESIS EA 15 MIN CHARGES,9640077,LOCAL,97033,CPT,,,,,GP,Outpatient,,,,75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97033 OT IONTOPHORESIS,9850073,LOCAL,97033,CPT,,,,,GO,Outpatient,,,,75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97033 OT IONTOPHORESIS 15 MIN APPL CHARGE,9860073,LOCAL,97033,CPT,,,,,GO|CO,Outpatient,,,,75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97033 PT IONTOPHORESIS,9650077,LOCAL,97033,CPT,,,,,GP|CQ,Outpatient,,,,75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Iontophoresis Charges,1366374,LOCAL,97033,CPT,,,,,GO,Outpatient,,,,75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Iontophoresis Charges,7895927,LOCAL,97033,CPT,,,,,GP,Outpatient,,,,75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Iontophoresis Assistant Units,1366374,LOCAL,97033,CPT,,,,,CQ,Outpatient,,,,75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Iontophoresis Assistant Units,1373443,LOCAL,97033,CPT,,,,,CQ,Outpatient,,,,75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Iontophoresis Charges,1366374,LOCAL,97033,CPT,,,,,GO,Outpatient,,,,75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Iontophoresis Units,1373443,LOCAL,97033,CPT,,,,,GO,Outpatient,,,,75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Iontophoresis Assistant Units,9390424,LOCAL,97033,CPT,,,,,CQ,Outpatient,,,,75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergy Panel13 Stinging Insect Grp QSTC,9063178,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Honey Bee (I1) IgE QST,12866524,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peanut Component Panel QSTC,8764809,LOCAL,86008,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE Chest Physiotherapy -> PEP Therapy Initial,8699752,LOCAL,94668,CPT,,,,,,Outpatient,,,,75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chlamydia Trachomatis RNA, TMA QST",12762527,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
"Mycoplasma Genitalium, rRNA QST",12762530,LOCAL,87563,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neisseria Gonorrhoeae RNA, TMA QST",12762531,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
Trichomonas Vaginalis RNA QST,12762534,LOCAL,87661,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ferritin,1628893,LOCAL,82728,CPT,,,,,,Outpatient,,,,16.36,CIGNA,Commercial,,50,,36.66,36.66,36.66,21,percent of total billed charges,17.73,50.82956044,
97750 - Physical performance test or measurement,9640058,LOCAL,97750,CPT,,,,,GP,Outpatient,,,,77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97750 FCE-FUNCTIONAL CAPACITY EVAL 1 CHARGE,9640050,LOCAL,97750,CPT,,,,,GP,Outpatient,,,,77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97750 OT PERF TEST MEAS 15 MIN CHARGE,9850061,LOCAL,97750,CPT,,,,,GO,Outpatient,,,,77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97750 OT Strapping Shoulder Assistant Units,9860061,LOCAL,97750,CPT,,,,,GO|CO,Outpatient,,,,77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97750 PRE WORK SCREEN CHARGE,9650058,LOCAL,97750,CPT,,,,,GP|CQ,Outpatient,,,,77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97750 PT ISOKINETIC TEST 15 MIN,9640053,LOCAL,97750,CPT,,,,,GP,Outpatient,,,,77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97750 PT ISOKINETIC TEST 15 MIN ASST,9650053,LOCAL,97750,CPT,,,,,GP|CQ,Outpatient,,,,77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97750 PT PHYSICAL PERFORMANCE TEST CHARGE,9650050,LOCAL,97750,CPT,,,,,GP|CQ,Outpatient,,,,77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97761 (PROSTHETIC TRAINING CAWC),9650033,LOCAL,97761,CPT,,,,,GP|CQ,Outpatient,,,,77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97761 PROSTHETIC TRAINING 15 MINS,9640033,LOCAL,97761,CPT,,,,,GP,Outpatient,,,,77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97761 PT PROSTHETIC TRAINING CHARGE,9410181,LOCAL,97761,CPT,,,,,GP,Outpatient,,,,77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Functional Capacity Eval Charge,7895967,LOCAL,97750,CPT,,,,,GP,Outpatient,,,,77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Physical Performance Test Assistant Units,7895284,LOCAL,97750,CPT,,,,,CQ,Outpatient,,,,77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Physical Performance Test Charges,7895284,LOCAL,97750,CPT,,,,,GO,Outpatient,,,,77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Physical Performance Test Units,7897702,LOCAL,97750,CPT,,,,,GO,Outpatient,,,,77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prosthetic Training Charges,7895930,LOCAL,97761,CPT,,,,,GP,Outpatient,,,,77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Physical Performance Assistant Test,9390432,LOCAL,97750,CPT,,,,,CQ,Outpatient,,,,77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Physical Performance Test Charges,7895980,LOCAL,97750,CPT,,,,,GP,Outpatient,,,,77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"PT Prosthetic Management, Train Assistant Units",9390460,LOCAL,97761,CPT,,,,,CQ,Outpatient,,,,77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"29125 Application of short arm splint (forearm to hand); static, right",8584933,LOCAL,29125,CPT,,,,,,Outpatient,,,,129,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chlamydia Trachomatis RNA, TMA QST",14747186,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
Cortisol Baseline,7974014,LOCAL,80400,CPT,,,,,,Outpatient,,,,39.14,CIGNA,Commercial,,50,,37.44,37.44,37.44,1 through 10,percent of total billed charges,18.43,75.985,
Cyt Clinical Info QST,14754292,LOCAL,88104,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cyt Pathologist QST,14754294,LOCAL,88172,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cyt Report Notes QST,14754295,LOCAL,88173,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cyt Report Type QST,14754291,LOCAL,88121,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cyt Screener QST,14754293,LOCAL,87207,CPT,,,,,,Outpatient,,,,7.19,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Mycoplasma Genitalium, rRNA QST",14747189,LOCAL,87563,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neisseria Gonorrhoeae RNA, TMA QST",14747187,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
Tissue 1A Source QST,14754297,LOCAL,88108,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue 1B Source QST,14754303,LOCAL,88108,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue 1C Source QST,14754321,LOCAL,88108,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Clinical Impression QST,14754296,LOCAL,88160,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Comment QST,14754301,LOCAL,88161,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Diagnosis QST,14754300,LOCAL,88162,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue A Gross Description QST,14754299,LOCAL,88305,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue B Comment QST,14754307,LOCAL,88161,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue B Diagnosis QST,14754306,LOCAL,88162,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue B Gross Description QST,14754305,LOCAL,88305,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue C Clinical Impression QST,14754320,LOCAL,88160,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue C Comment QST,14754325,LOCAL,88161,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue C Diagnosis QST,14754324,LOCAL,88162,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue C Gross Description QST,14754323,LOCAL,88305,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Trichomonas Vaginalis RNA QST,14747188,LOCAL,87661,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
naloxone 1 mg/mL injectable solution 2 mL [CULL],11202975,LOCAL,J2312,CPT,,,,,,Outpatient,2,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
T. candidus QSTC,9010450,LOCAL,86606,CPT,,,,,,Outpatient,,,,18.06,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
T. vulgaris QSTC,9010456,LOCAL,86609,CPT,,,,,,Outpatient,,,,15.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Trichoderma viride IgG QSTC,9010474,LOCAL,86001,CPT,,,,,,Outpatient,,,,9.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3925 Fo pip dip jnt/sprng pre ots,9856100,LOCAL,,,L3925,HCPCS,,,,Outpatient,,,,79,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fecal Lipids, Total QSTC",8972795,LOCAL,82710,CPT,,,,,,Outpatient,,,,20.16,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Oxcarbazepine Metabolite QSTC,8764758,LOCAL,80183,CPT,,,,,,Outpatient,,,,15.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lactated Ringers Injection 1000 mL [CULL],11281275,LOCAL,J7120,CPT,,,,,,Outpatient,1000,ML,,,CIGNA,Commercial,,50,,3.55,3.43,10.66,1 through 10,percent of total billed charges,0.543820225,0.543820225,
97110  SB OT Thera Exer,9850027,LOCAL,97110,CPT,,,,,GO,Outpatient,,,,79,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97110  SB PT Thera Exer,9650027,LOCAL,97110,CPT,,,,,GP|CQ,Outpatient,,,,79,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97110 EXERCISE 1/MORE AREAS CHARGE,9410136,LOCAL,97110,CPT,,,,,GP,Outpatient,,,,79,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97110 OT Therapeutic Exercise Assistant Units,9860027,LOCAL,97110,CPT,,,,,GO|CO,Outpatient,,,,79,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97110 PT THERAPEUTIC EXERCISE,9640054,LOCAL,97110,CPT,,,,,GP,Outpatient,,,,79,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97110 PT Therapeutic Exercise Assistant Units,9650054,LOCAL,97110,CPT,,,,,GP|CQ,Outpatient,,,,79,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97110 THERAPEUTIC EXER 15 MIN CHARGES,9640027,LOCAL,97110,CPT,,,,,GP,Outpatient,,,,79,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Therapeutic Exercise Assistant Units,750901,LOCAL,97110,CPT,,,,,CQ,Outpatient,,,,79,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Therapeutic Exercise Charges,750901,LOCAL,97110,CPT,,,,,GO,Outpatient,,,,79,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Therapeutic Exercise Rehab Units,7897696,LOCAL,97110,CPT,,,,,GO,Outpatient,,,,79,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Therapeutic Exercise Assistant Units,9390430,LOCAL,97110,CPT,,,,,CQ,Outpatient,,,,79,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Therapeutic Exercise Charges,750901,LOCAL,97110,CPT,,,,,GO,Outpatient,,,,79,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Therapeutic Exercise Charges,7895934,LOCAL,97110,CPT,,,,,GP,Outpatient,,,,79,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Creatine Kinase,633712,LOCAL,82550,CPT,,,,,,Outpatient,,,,7.81,CIGNA,Commercial,,50,,79.56,15.73,116.34,19,percent of total billed charges,7.16,23.7373913,
Genital Culture,633894,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,CIGNA,Commercial,,50,,34.31,5.23,63.39,1 through 10,percent of total billed charges,10.57,67.60639535,
Respiratory Culture,4123062,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,CIGNA,Commercial,,50,,34.31,5.23,63.39,1 through 10,percent of total billed charges,10.57,67.60639535,
Sputum Culture,7909553,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,CIGNA,Commercial,,50,,34.31,5.23,63.39,1 through 10,percent of total billed charges,10.57,67.60639535,
Blood Culture,4122800,LOCAL,87040,CPT,,,,,,Outpatient,,,,12.38,CIGNA,Commercial,,50,,153.98,76.89,238.75,1 through 10,percent of total billed charges,10.57,19.45393258,
Blood Unit Culture,7967813,LOCAL,87040,CPT,,,,,,Outpatient,,,,12.38,CIGNA,Commercial,,50,,153.98,76.89,238.75,1 through 10,percent of total billed charges,10.57,19.45393258,
Folate Level,1628894,LOCAL,82746,CPT,,,,,,Outpatient,,,,17.64,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Troponin-I,1634892,LOCAL,84484,CPT,,,,,,Outpatient,,,,14.96,CIGNA,Commercial,,50,,38.85,22.85,118.04,54,percent of total billed charges,0.887987013,17.73,
influenza vaccine (Flucelvax PF) vaccine 2025-2026 [CULL],11292050,LOCAL,90661,CPT,,,,,,Outpatient,0.5,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methylPREDNISolone 1 g Pow,11201957,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
29584 PT APPLICATION OF MULTI-LAYER COMPRESSION SYSTEM,9109668,LOCAL,29584,CPT,,,,,GP,Outpatient,,,,81,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT MultiLayer Compress Below Knee Charge,7896004,LOCAL,29584,CPT,,,,,GP,Outpatient,,,,81,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR TMJ Open and Closed Left,9514710,LOCAL,70328,CPT,,,,,LT,Outpatient,,,,66.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR TMJ Open and Closed Right,9514712,LOCAL,70328,CPT,,,,,RT,Outpatient,,,,66.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Kidney Microsomal LKM1 Ab IgG QSTC,8764790,LOCAL,86376,CPT,,,,,,Outpatient,,,,17.46,CIGNA,Commercial,,50,,11.2,11.2,11.2,1 through 10,percent of total billed charges,15.29,25.085,
Medium Cam Walking Boot,9400074,LOCAL,,,L4387,HCPCS,,,,Outpatient,,,,67,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PTH-Related Protein (PTH-RP) QSTC,8764743,LOCAL,83519,CPT,,,,,,Outpatient,,,,22.08,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF DAT IgG,7939268,LOCAL,86880,CPT,,,,,,Outpatient,,,,6.47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Computer Crossmatch Interp -> Computer XM OK,8142426,LOCAL,86923,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serological Immediate Spin -> Compatible,8014366,LOCAL,86920,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serological Immediate Spin -> Corrected,10125801,LOCAL,86920,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Serological Immediate Spin -> Incompatible,9527535,LOCAL,86920,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XM AHG Gel Interp -> Compatible,8013754,LOCAL,86920,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XM AHG Gel Interp -> Incompatible,8013753,LOCAL,86920,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XM AHG Gel Interp -> Least Incompatible,8013752,LOCAL,86920,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XM AHG Tube Interp -> Compatible,8014220,LOCAL,86920,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XM AHG Tube Interp -> Incompatible,8014219,LOCAL,86920,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XM AHG Tube Interp -> Least Incompatible,8014218,LOCAL,86920,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alanine aminotransferase,633632,LOCAL,84460,CPT,,,,,,Outpatient,,,,6.36,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Erythrocyte Sedimentation Rate (ESR),7909828,LOCAL,85652,CPT,,,,,,Outpatient,,,,3.24,CIGNA,Commercial,,50,,2.7,126,126.02,1 through 10,percent of total billed charges,8.21,43.67975976,
97112 BAL ACT EA 15 MIN CHARGES,9640028,LOCAL,97112,CPT,,,,,GP,Outpatient,,,,83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97112 NEUROMUSCULAR RE-EDUCATION CHARGE,9410141,LOCAL,97112,CPT,,,,,GP,Outpatient,,,,83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97112 OT NEURO MUSCULAR RE ED EA 15 MIN,9850028,LOCAL,97112,CPT,,,,,GO,Outpatient,,,,83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97112 OT Neuromusc Re-education Assistant Units,9860028,LOCAL,97112,CPT,,,,,GO|CO,Outpatient,,,,83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97112 PT Neuromuscular Re-Ed Assistant Units,9650028,LOCAL,97112,CPT,,,,,GP|CQ,Outpatient,,,,83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuromuscular Reeducation Charges,750905,LOCAL,97112,CPT,,,,,GO,Outpatient,,,,83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuromuscular Reeducation Charges,7895932,LOCAL,97112,CPT,,,,,GP,Outpatient,,,,83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Neuromuscular Reeducation Assistant Units,750905,LOCAL,97112,CPT,,,,,CQ,Outpatient,,,,83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Neuromuscular Reeducation Charges,750905,LOCAL,97112,CPT,,,,,GO,Outpatient,,,,83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Neuromuscular Reeducation Rehab Units,7897697,LOCAL,97112,CPT,,,,,GO,Outpatient,,,,83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Neuromuscular Reeducation Assistant Units,9390444,LOCAL,97112,CPT,,,,,CQ,Outpatient,,,,83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Culture Fungus Smear not Hr Skn Bld QST,10217136,LOCAL,87102,CPT,,,,,,Outpatient,,,,10.09,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alcohol Level,1503765,LOCAL,,,G0480,HCPCS,,,,Outpatient,,,,84,CIGNA,Commercial,,50,,40.48,38.92,125.59,30,percent of total billed charges,46.74,114.43,
CBC w/ Differential,633683,LOCAL,85025,CPT,,,,,,Outpatient,,,,9.32,CIGNA,Commercial,,50,,7.77,68.675,129.58,24,percent of total billed charges,8.21,31.45666667,
Na Citrate Platelet Count,9472554,LOCAL,85049,CPT,,,,,,Outpatient,,,,5.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Platelet Count,2182297,LOCAL,85049,CPT,,,,,,Outpatient,,,,5.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Platelet Count Manual,7974157,LOCAL,85049,CPT,,,,,,Outpatient,,,,5.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
iron dextran 50 mg/mL injectable solution 2 mL [CULL],11205256,LOCAL,J1750,CPT,,,,,,Outpatient,2,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
70030 X-RAY EYE FOR FOREIGN BODY,8658473,LOCAL,70030,CPT,,,,,,Outpatient,,,,72.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Foreign Body Localization Eye,8658473,LOCAL,70030,CPT,,,,,,Outpatient,,,,72.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TSI(Thyroid Stimulating Immunoglob) QSTC,8764795,LOCAL,84445,CPT,,,,,,Outpatient,,,,61.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glucose Fasting GTT,8238854,LOCAL,82951,CPT,,,,,,Outpatient,,,,15.44,CIGNA,Commercial,,50,,11.2,11.2,11.2,1 through 10,percent of total billed charges,12.87,17.73,
Small Cam Walking Boot,9400073,LOCAL,,,L4387,HCPCS,,,,Outpatient,,,,67,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3908 Comfort cool thumb/wrist CMC orthosis,9800210,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3908 OT WRIST HAND ORTHOSIS,9800211,LOCAL,,,L3908,HCPCS,,,,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Large Cam Walking Boot,9400070,LOCAL,,,L4387,HCPCS,,,,Outpatient,,,,67,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97535  SB PT Act of Liv 15 m,9640035,LOCAL,97535,CPT,,,,,GP,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97535 OT HOME MAKING ACTIVITY CHARGE,9820191,LOCAL,97535,CPT,,,,,GO,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97535 OT SELF CARE/HOME MGMT/ADL 15 MIN,9860191,LOCAL,97535,CPT,,,,,GO|CO,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97535 PT ADL Training/Self Care Assistant Units,9650035,LOCAL,97535,CPT,,,,,GP|CQ,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97535 SELF CARE/HOME MGMT-ADL'S CHARGE,9410191,LOCAL,97535,CPT,,,,,GP,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ADL Training Charge,7895959,LOCAL,97535,CPT,,,,,GP,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ADL Training Charges,1366372,LOCAL,97535,CPT,,,,,GO,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT ADL Training Charges,1366372,LOCAL,97535,CPT,,,,,GO,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Self Care, Home Management Units",1373569,LOCAL,97535,CPT,,,,,GO,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Self Care, Home Mgmt Assistant Units",1373569,LOCAL,97535,CPT,,,,,CQ,Outpatient,,,,86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97530  SB OT Thera Act 15,9850032,LOCAL,97530,CPT,,,,,GO,Outpatient,,,,87,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97530 ACTIVITIES EACH 15 MIN CHARGE,9410270,LOCAL,97530,CPT,,,,,GP,Outpatient,,,,87,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97530 OT Therapeutic Activities Assistant Units,9860032,LOCAL,97530,CPT,,,,,GO|CO,Outpatient,,,,87,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97530 PT MAT\BED ACTIVITIES CHARGE,9640034,LOCAL,97530,CPT,,,,,GP,Outpatient,,,,87,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97530 PT Theraputic Activities Assistant Units,9650034,LOCAL,97530,CPT,,,,,GP|CQ,Outpatient,,,,87,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Therapeutic Activities Assistant Units,750903,LOCAL,97530,CPT,,,,,CQ,Outpatient,,,,87,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Therapeutic Activities Charges,750903,LOCAL,97530,CPT,,,,,GO,Outpatient,,,,87,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Therapeutic Activities Rehab Units,7897699,LOCAL,97530,CPT,,,,,GO,Outpatient,,,,87,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Therapeutic Activity Assistant Units,9390442,LOCAL,97530,CPT,,,,,CQ,Outpatient,,,,87,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Therapeutic Activities Charge,7895929,LOCAL,97530,CPT,,,,,GP,Outpatient,,,,87,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Therapeutic Activities Charges,750903,LOCAL,97530,CPT,,,,,GO,Outpatient,,,,87,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
amiodarone 150 mg/100 mL-D5% intravenous solution 100 mL [CULL],11200044,LOCAL,J0283,CPT,,,,,,Outpatient,100,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BB CROSSMATCH (AHG),6413027,LOCAL,86922,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BB CROSSMATCH (XMG INSTRUMENT),6413070,LOCAL,86922,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urine Culture,4126493,LOCAL,87086,CPT,,,,,,Outpatient,,,,9.68,CIGNA,Commercial,,50,,71.28,8.07,134.48,1 through 10,percent of total billed charges,10.57,31.43235995,
.dRVVT 1:1 Mix QSTC,6230328,LOCAL,85613,CPT,,,,,,Outpatient,,,,11.5,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glomerular Basement Memb. Ab (IgG) QSTC,8853257,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glutamic Acid Decarboxylase-65 Ab QSTC,8764746,LOCAL,86341,CPT,,,,,,Outpatient,,,,28.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Quad Screen QSTC,8972927,LOCAL,81511,CPT,,,,,,Outpatient,,,,184.2,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ribosomal P Antibody QSTC,8853260,LOCAL,83516,CPT,,,,,,Outpatient,,,,13.84,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Rickettsia RMSF IgG,IgM w rfx Titer QSTC",8764764,LOCAL,86757,CPT,,,,,,Outpatient,,,,23.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tryptase QSTC,8764744,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96523 Port Flush,14892040,LOCAL,96523,CPT,,,,,59,Outpatient,,,,153,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OLANZapine 10 mg VL [CULL],11240752,LOCAL,J2358,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.Endomysial Ab Titer QSTC,8853243,LOCAL,86231,CPT,,,,,,Outpatient,,,,14.51,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endomysial (IgG) Antibody Screen and Titer QSTC,10146198,LOCAL,86231,CPT,,,,,,Outpatient,,,,14.51,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3808 OT SPLINT - DORSAL HAND SPLINT CHARGE,9856068,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,,89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"L3808 WHFO, RIGID W/O JOINTS CHARGE",9856097,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,,89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"96361- Hydration, each additional hour",1928298,LOCAL,96361,CPT,,,,,,Outpatient,,,,89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96361 IV INFUSION HYDRATION ADDL HR Charge,8049102,LOCAL,96361,CPT,,,,,,Outpatient,,,,89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
90472 PO IMMUNIZATION ADM EA ADDTL VAC CHARGE,9279753,LOCAL,90472,CPT,,,,,,Outpatient,,,,90,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Phenytoin Lvl Total,7973985,LOCAL,80185,CPT,,,,,,Outpatient,,,,15.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
aztreonam 1 g injection [CULL],11201222,LOCAL,J0457,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Allergy Panel 19, Seafood QSTC",13864480,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Crystal Examination Body Fluid,3454316,LOCAL,89060,CPT,,,,,,Outpatient,,,,8.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Cyto Path Cell Enhance Tech,8489561,LOCAL,88112,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill FNA Eval Interp & Rpt,8489566,LOCAL,88173,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill IHC Antibody Additional,14048006,LOCAL,88341,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Tissue Exam Level 3,14047998,LOCAL,88304,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Tissue Exam Level 4,14036169,LOCAL,88305,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
70250 X-RAY EXAM OF SKULL,8658523,LOCAL,70250,CPT,,,,,,Outpatient,,,,286.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
hepatitis A pediatric vaccine 25 units/0.5 mL intramuscular suspension 0.5 mL [CULL],11202555,LOCAL,90632,CPT,,,,,,Outpatient,0.5,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
medroxyPROGESTERone 150 mg/mL intramuscular suspension 1 mL [CULL],11204480,LOCAL,J1050,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"West Nile Ab IgG, CSF QSTC",13872975,LOCAL,86789,CPT,,,,,,Outpatient,,,,17.27,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"West Nile Ab IgG, Serum QSTC",9010233,LOCAL,86789,CPT,,,,,,Outpatient,,,,17.27,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"West Nile Ab IgM, CSF QSTC",13872978,LOCAL,86788,CPT,,,,,,Outpatient,,,,20.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"West Nile Ab IgM, Serum QSTC",9010236,LOCAL,86788,CPT,,,,,,Outpatient,,,,20.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chlamydia Trachomatis RNA, TMA QST",14718353,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
HPV MRNA E6/E7 QSTA,14718356,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Thinprep Review Cytotechnologist: QST,14718368,LOCAL,88175,CPT,,,,,,Outpatient,,,,31.93,CIGNA,Commercial,,50,,31.2,31.2,31.2,1 through 10,percent of total billed charges,25.25,26.61,
"Trichomonas vaginalis, Ql TMA, Pap QST",14718355,LOCAL,87661,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardio IQ(R) Lipoprotein Fraction, Ion Mobility QSTC",9039426,LOCAL,83704,CPT,,,,,,Outpatient,,,,41.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Parathyroid Hormone Intact,3455483,LOCAL,83970,CPT,,,,,,Outpatient,,,,49.54,CIGNA,Commercial,,50,,44.62,44.62,44.62,1 through 10,percent of total billed charges,47.35,92.84111111,
"Factor VIII Activity, Clotting QSTC",9039263,LOCAL,85240,CPT,,,,,,Outpatient,,,,21.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sirolimus, LC/MS/MS QSTC",8764819,LOCAL,80195,CPT,,,,,,Outpatient,,,,16.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97760 ORTHOTICS FIT/TRAIN EA 15MN CHARGE,9410176,LOCAL,97760,CPT,,,,,GP,Outpatient,,,,94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97760 ORTHOTICS FITTING & TRAINING CHARGE,9850030,LOCAL,97760,CPT,,,,,GO,Outpatient,,,,94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97760 OT Orthotic Mgmt/Train Initial Charge Assistant Units,9860030,LOCAL,97760,CPT,,,,,GO|CO,Outpatient,,,,94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97760 PO ORTHOTIC EVALUATION CHARGE,9640032,LOCAL,97760,CPT,,,,,GP,Outpatient,,,,94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97760 PO ORTHOTIC FOLLOW UP CHARGE,9650032,LOCAL,97760,CPT,,,,,GP|CQ,Outpatient,,,,94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orthotic Mgmt and Training Charges,7895275,LOCAL,97760,CPT,,,,,GO,Outpatient,,,,94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orthotic Mgmt and Training Charges,7895953,LOCAL,97760,CPT,,,,,GP,Outpatient,,,,94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Orthotic Management, Train Assistant Units",1373573,LOCAL,97760,CPT,,,,,CQ,Outpatient,,,,94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Orthotic Management, Train Units",1373573,LOCAL,97760,CPT,,,,,GO,Outpatient,,,,94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"PT Orthotic Management, Train Assistant Units",9390458,LOCAL,97760,CPT,,,,,CQ,Outpatient,,,,94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Catheter Type:; -> Straight/Intermittent,4610954,LOCAL,51701,CPT,,,,,,Outpatient,,,,94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EVENT MONITOR RECORDING ONLY,8200120,LOCAL,93270,CPT,,,,,,Outpatient,,,,94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
desmopressin 4 mcg/mL injectable solution 1 mL [CULL],11201582,LOCAL,J2597,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
% CD3 (Mature T Cells) QSTC,13873423,LOCAL,86359,CPT,,,,,,Outpatient,,,,45.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CD4/CD8 Ratio QSTC,13873439,LOCAL,86360,CPT,,,,,,Outpatient,,,,56.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Beta hCG Qualitative,633663,LOCAL,84703,CPT,,,,,,Outpatient,,,,9.02,CIGNA,Commercial,,50,,45.83,45.83,116.51,1 through 10,percent of total billed charges,7.16,7.52,
Serum Pregnancy Qual POCT,10461706,LOCAL,84703,CPT,,,,,,Outpatient,,,,9.02,CIGNA,Commercial,,50,,45.83,45.83,116.51,1 through 10,percent of total billed charges,7.16,7.52,
Serum Pregnancy Test Qualitative,7909775,LOCAL,84703,CPT,,,,,,Outpatient,,,,9.02,CIGNA,Commercial,,50,,45.83,45.83,116.51,1 through 10,percent of total billed charges,7.16,7.52,
Serum Pregnancy Test Qualitative w/ Reflex,9384303,LOCAL,84703,CPT,,,,,,Outpatient,,,,9.02,CIGNA,Commercial,,50,,45.83,45.83,116.51,1 through 10,percent of total billed charges,7.16,7.52,
Urine Pregnancy POCT,8373784,LOCAL,81025,CPT,,,,,,Outpatient,,,,10.33,CIGNA,Commercial,,50,,45.83,45.83,137.71,24,percent of total billed charges,4.02,13.375,
Urine Pregnancy Test Qualitative,7909798,LOCAL,81025,CPT,,,,,,Outpatient,,,,10.33,CIGNA,Commercial,,50,,45.83,45.83,137.71,24,percent of total billed charges,4.02,13.375,
cefTRIAXone 1 g injection [CULL],11201426,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,4.99,3.28,11.9,18,percent of total billed charges,5.161428571,5.161428571,
"IgA, Serum QSTC",13873298,LOCAL,82787,CPT,,,,,,Outpatient,,,,9.62,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IgA1 QSTC,13873292,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tobramycin Level,1634888,LOCAL,80200,CPT,,,,,,Outpatient,,,,19.36,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Blood Gas Arterial RT,8172944,LOCAL,36600,CPT,,,,,,Outpatient,,,,96,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Blood Gas Draw Type -> Arterial (Puncture),5230102,LOCAL,36600,CPT,,,,,,Outpatient,,,,96,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT Arterial Puncture CHARGE,8143881,LOCAL,36600,CPT,,,,,,Outpatient,,,,96,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"RT CHARGE PFT -> Maximum breathing capacity, Maximal voluntary ventilation (M",5267133,LOCAL,94200,CPT,,,,,,Outpatient,,,,96,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR TMJ Open and Closed Bilateral,1170502,LOCAL,70330,CPT,,,,,,Outpatient,,,,80.85,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diphtheria Antitoxoid QSTC,14129477,LOCAL,86648,CPT,,,,,,Outpatient,,,,18.25,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tetanus Antitoxoid QSTC,14129478,LOCAL,86774,CPT,,,,,,Outpatient,,,,17.76,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatic Function Panel,633744,LOCAL,80076,CPT,,,,,,Outpatient,,,,9.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatic Panel,633744,LOCAL,80076,CPT,,,,,,Outpatient,,,,9.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dihydrotestosterone QSTC,8853275,LOCAL,82642,CPT,,,,,,Outpatient,,,,35.14,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
36430 BLOOD TRANSFUSION CHARGE,9284603,LOCAL,36430,CPT,,,,,,Outpatient,,,,99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BLOOD ADMINISTRATION Charge,5240125,LOCAL,36430,CPT,,,,,,Outpatient,,,,99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92608 ST EX FOR SPEECH DEVICE RX EACH 30 MIN ADDL TIM,9636007,LOCAL,92608,CPT,,,,,GN,Outpatient,,,,99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Speech AAC Eval Addl Half Hour Units,1373854,LOCAL,92608,CPT,,,,,GN,Outpatient,,,,99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Speech Generating Device Eval Additional 30 Min,1373854,LOCAL,92608,CPT,,,,,GN,Outpatient,,,,99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only REF Splitting,13514968,LOCAL,86985,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Quantiferon(R)-TB Gold Plus, 1 Tube QST",9384402,LOCAL,86480,CPT,,,,,,Outpatient,,,,74.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Quantiferon(R)-TB Gold Plus, 1 Tube QSTC",8983765,LOCAL,86480,CPT,,,,,,Outpatient,,,,74.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97113 AQUATIC THERAPY 15 MINS,9650029,LOCAL,97113,CPT,,,,,GP|CQ,Outpatient,,,,100,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97113 AQUATIC THERAPY 15 MINS OT,9860051,LOCAL,97113,CPT,,,,,GO|CO,Outpatient,,,,100,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97113 Occupational Therapy Aquatic charge,9850051,LOCAL,97113,CPT,,,,,GO,Outpatient,,,,100,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97113 OT AQUATIC THERAPY CHARGE,9640029,LOCAL,97113,CPT,,,,,GP,Outpatient,,,,100,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aquatic Charge,7895272,LOCAL,97113,CPT,,,,,GO,Outpatient,,,,100,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aquatic Therapy Charges,7895958,LOCAL,97113,CPT,,,,,GP,Outpatient,,,,100,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Aquatic Exercise Assistant Units,7895272,LOCAL,97113,CPT,,,,,CQ,Outpatient,,,,100,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Aquatic Exercise Assistant Units,7898597,LOCAL,97113,CPT,,,,,CQ,Outpatient,,,,100,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Aquatic Exercise Units,7897709,LOCAL,97113,CPT,,,,,GO,Outpatient,,,,100,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Aquatic Exercise Units,7898597,LOCAL,97113,CPT,,,,,GO,Outpatient,,,,100,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Aquatic Assistant Units,9390434,LOCAL,97113,CPT,,,,,CQ,Outpatient,,,,100,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0237 PULM REHAB EA 15 MIN,10470027,LOCAL,,,G0237,HCPCS,,,59,Outpatient,,,,101,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0239 PULMONARY EXERCISE,10470025,LOCAL,,,G0239,HCPCS,,,,Outpatient,,,,101,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Calcium Oxalate QSTC,8997193,LOCAL,82340,CPT,,,,,,Outpatient,,,,7.24,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sodium Urate QSTC,8997195,LOCAL,84300,CPT,,,,,,Outpatient,,,,6.07,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uric Acid QSTC,8997197,LOCAL,84560,CPT,,,,,,Outpatient,,,,6.1,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"LD, Pericardial Fluid QSTC",13864442,LOCAL,83615,CPT,,,,,,Outpatient,,,,7.25,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"16000 Initial treatment, first degree burn, when no more than local treatment required",9400038,LOCAL,16000,CPT,,,,,,Outpatient,,,,101,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diphtheria Antitoxoid QST,13824476,LOCAL,86648,CPT,,,,,,Outpatient,,,,18.25,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tetanus Antitoxoid QST,13824477,LOCAL,86774,CPT,,,,,,Outpatient,,,,17.76,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transferrin,633851,LOCAL,84466,CPT,,,,,,Outpatient,,,,15.31,CIGNA,Commercial,,50,,18.33,18.33,18.33,1 through 10,percent of total billed charges,17.73,29.64248366,
CANDIDA GLABRATA QST,12439000,LOCAL,87481,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CANDIDA SPECIES QST,12438999,LOCAL,87481,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chlamydia Trachomatis RNA, TMA QST",12439002,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
"Neisseria Gonorrhoeae RNA, TMA QST",12439003,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
SURESWAB(R) ADV BV QST,12438998,LOCAL,81513,CPT,,,,,,Outpatient,,,,171.16,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"TRICHOMONAS VAGINALIS (TV), TMA QST",12439001,LOCAL,87661,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CANDIDA GLABRATA QST,12433969,LOCAL,87481,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CANDIDA SPECIES QST,12433968,LOCAL,87481,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"CRYPTOSPORIDIUM ANTIGEN, EIA QSTC",12500635,LOCAL,87328,CPT,,,,,,Outpatient,,,,16.58,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Kappa/LambdaLt Chains,Freew/Ratio,S QSTC",8853285,LOCAL,83521,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Bone Age Studies,1170014,LOCAL,77072,CPT,,,,,,Outpatient,,,,84.98,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BB REF ABO DISCREP (RH),6432002,LOCAL,86901,CPT,,,,,,Outpatient,,,,3.59,CIGNA,Commercial,,50,,21.49,1.74,21.49,1 through 10,percent of total billed charges,6.29,35.88,
REF ABO/Rh Discrep,13484121,LOCAL,86900,CPT,,,,,,Outpatient,,,,3.59,CIGNA,Commercial,,50,,28.93,1.74,28.93,1 through 10,percent of total billed charges,6.29,117.85,
"Ammonia, Plasma",7974187,LOCAL,82140,CPT,,,,,,Outpatient,,,,17.48,CIGNA,Commercial,,50,,50.03,50.03,156.19,1 through 10,percent of total billed charges,17.73,22.62909091,
97164 CIS Prgm PT Re-Evaluation 20 min,9650016,LOCAL,97164,CPT,,,,,GP|CQ,Outpatient,,,,104,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97164 RE-EVALUATION CHARGE,9410061,LOCAL,97164,CPT,,,,,GP,Outpatient,,,,104,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97164 RE-EVALUATION PT CHARGES,9640016,LOCAL,97164,CPT,,,,,GP,Outpatient,,,,104,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT ReEval Time,7896016,LOCAL,97164,CPT,,,,,GP,Outpatient,,,,104,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tobramycin Level Peak,1634889,LOCAL,80200,CPT,,,,,,Outpatient,,,,19.36,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tobramycin Level Trough,1634890,LOCAL,80200,CPT,,,,,,Outpatient,,,,19.36,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11719 TRIM NAIL(S) ANY NUMBER WC CHARGE,8726774,LOCAL,11719,CPT,,,,,,Outpatient,,,,106,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.C-ANCA Titer QSTC,8764786,LOCAL,86037,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.P-ANCA Titer QSTC,6225794,LOCAL,86037,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Methicillin Resistant Staphylococcus aureus,PCR QSTC",9630594,LOCAL,87641,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
phytonadione 10 mg/mL injectable solution 1 mL [CULL],11212150,LOCAL,J3430,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Manual Tumor IM Histochem,14049347,LOCAL,88360,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill SB Consult 1st TB w FS SGL SP,14048002,LOCAL,88331,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill IHC Initial Antibody,14049345,LOCAL,88342,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
29105 - Long Arm Splint,9322359,LOCAL,29105,CPT,,,,,,Outpatient,,,,158,CIGNA,Commercial,,50,,266.28,142.87,389.68,1 through 10,percent of total billed charges,63.51,863,
Toxocara Ab (IgG) QSTC,13864452,LOCAL,86682,CPT,,,,,,Outpatient,,,,15.61,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Tissue Culture,633906,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,CIGNA,Commercial,,50,,34.31,5.23,63.39,1 through 10,percent of total billed charges,10.57,67.60639535,
acetaZOLAMIDE 500 mg intravenous injection [CULL],11200001,LOCAL,J1120,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97763 OT Orthotic Mgmt/Train Establish Charge,9650038,LOCAL,97763,CPT,,,,,GP|CQ,Outpatient,,,,110,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97763 OT Orthotic Mgmt/Train Established Assistant Units,9820206,LOCAL,97763,CPT,,,,,GO,Outpatient,,,,110,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97763 OT Orthotic/Prosthetic Mgmt/Training - each 15 min,9860206,LOCAL,97763,CPT,,,,,GO|CO,Outpatient,,,,110,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97763 PT ORTHO/PROST MNG/TRAIN EA 15,9410206,LOCAL,97763,CPT,,,,,GP,Outpatient,,,,110,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97763 PT Orthotic Mgmt/Train Establish Charge,9640038,LOCAL,97763,CPT,,,,,GP,Outpatient,,,,110,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Orthotic Mgmt/Train Est. Assit Units,7965332,LOCAL,97763,CPT,,,,,CQ,Outpatient,,,,110,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Orthotic Mgmt/Train Establish Charge,7965332,LOCAL,97763,CPT,,,,,GO,Outpatient,,,,110,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Orthotic Mgmt/Train Establish Rehab Units,7964942,LOCAL,97763,CPT,,,,,GO,Outpatient,,,,110,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Orthotic Mgmt/Train Establish Charge,7965252,LOCAL,97763,CPT,,,,,GP,Outpatient,,,,110,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"PT Orthotic/Prosthetic Manage,Train Assistant Units",9390462,LOCAL,97763,CPT,,,,,CQ,Outpatient,,,,110,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Total Glutathione QST,14799054,LOCAL,82978,CPT,,,,,,Outpatient,,,,18.54,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
epoetin alfa-epbx 4000 units/mL preservative-free injectable solution 1 mL [CULL],11202396,LOCAL,Q5106,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Heart Calcium Scoring,2424782,LOCAL,75571,CPT,,,,,,Outpatient,,,,90.75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cortisol, LC/MS, Saliva QSTC",8853249,LOCAL,82530,CPT,,,,,,Outpatient,,,,20.05,CIGNA,Commercial,,50,,26.99,13.48,40.5,1 through 10,percent of total billed charges,17.73,29.79,
Factor V (Leiden) Mutation Analysis QSTC,8764652,LOCAL,81241,CPT,,,,,,Outpatient,,,,88.04,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lyme Disease Ab (IgM), Blot QSTC",8849718,LOCAL,86617,CPT,,,,,,Outpatient,,,,18.59,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lyme Disease Ab(IgG),Blot QSTC",8849707,LOCAL,86617,CPT,,,,,,Outpatient,,,,18.59,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prothrombin Gene Analysis QSTC,8764653,LOCAL,81240,CPT,,,,,,Outpatient,,,,78.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholesterol HDL,3170344,LOCAL,83718,CPT,,,,,,Outpatient,,,,9.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Glucagon QSTC,13864528,LOCAL,82943,CPT,,,,,,Outpatient,,,,17.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
fondaparinux 2.5 mg/0.5 mL subcutaneous solution 0.5 mL [CULL],11260583,LOCAL,J1652,CPT,,,,,,Outpatient,0.5,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL MG Wire Loc Needle,13721990,LOCAL,10035,CPT,A4648,HCPCS,,,,Outpatient,,,,114,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
90912 - Bfb training 1st 15 min.,9442435,LOCAL,90912,CPT,,,,,,Outpatient,,,,114,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97129 Cognition Ther Intervent First 15 min,9850048,LOCAL,97129,CPT,,,,,GO,Outpatient,,,,114,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97129 Cognition Ther Intervent First 15 min Assistant Units,9860048,LOCAL,97129,CPT,,,,,GO|CO,Outpatient,,,,114,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97130 Cognition Ther Intervent Addlt 15 min,9850049,LOCAL,97130,CPT,,,,,GO,Outpatient,,,,114,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97130 Cognition Ther Intervent Addlt 15 min Assistant Units,9860049,LOCAL,97130,CPT,,,,,GO|CO,Outpatient,,,,114,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Cog Ther Intervent, Addl 15 Min Asst",9401146,LOCAL,97130,CPT,,,,,CQ,Outpatient,,,,114,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Cog Ther Intervent, Addl 15 Min Units",9401146,LOCAL,97130,CPT,,,,,GO,Outpatient,,,,114,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Cog Ther Intervent, First 15 Min Asst",9401140,LOCAL,97129,CPT,,,,,CQ,Outpatient,,,,114,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"OT Cog Ther Intervent,First 15 Min Units",9401140,LOCAL,97129,CPT,,,,,GO,Outpatient,,,,114,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Pheno Non-Rh EA/Ag,13517193,LOCAL,86905,CPT,,,,,,Outpatient,,,,4.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only REF Thawing,13514966,LOCAL,86927,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ref Hgb S,9527497,LOCAL,85660,CPT,,,,,,Outpatient,,,,6.61,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Basic Metabolic Panel,633628,LOCAL,80048,CPT,,,,,,Outpatient,,,,10.15,CIGNA,Commercial,,50,,133.16,8.11,174.64,1 through 10,percent of total billed charges,12.14,37.17170492,
gemcitabine 1 g injection [CULL],11292094,LOCAL,J9201,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE PFT -> Diffusion (DLCO),5267130,LOCAL,94729,CPT,,,,,,Outpatient,,,,115,CIGNA,Commercial,,50,,55.05,55.05,55.05,1 through 10,percent of total billed charges,47.24,76.09,
E0773 Thawed FFP CPD,7267127,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,,115,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E1237 Thawed Aph FFP ACDA,7267133,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,,115,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E2701 Thawed Plasma CPD <24h,7267161,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,,115,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E2737 Thawed Plasma CP2D <24h,7267171,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,,115,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4713 Thawed Aph FFP ACDA 1,7267173,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,,115,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4717 Thawed Aph FFP ACDA 2,7267174,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,,115,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4721 Thawed Aph FFP ACDA 3,7267175,LOCAL,,,P9017,HCPCS,,,,Outpatient,,,,115,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
amiodarone 360 mg/200 mL-D5% intravenous solution 200 mL [CULL],11200046,LOCAL,J0283,CPT,,,,,,Outpatient,200,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
protamine 10 mg/mL injectable solution 25 mL [CULL],11211130,LOCAL,J2720,CPT,,,,,,Outpatient,25,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anti-Mullerian Hormone (AMH) Female QSTC,8972886,LOCAL,82166,CPT,,,,,,Outpatient,,,,46.34,CIGNA,Commercial,,50,,56.16,56.16,56.16,1 through 10,percent of total billed charges,17.73,38.62,
"Chlamydia Trachomatis RNA, TMA QST",14718336,LOCAL,87491,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
"Chromogranin A, LC/MS/MS QSTC",10319690,LOCAL,86316,CPT,,,,,,Outpatient,,,,24.97,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Estriol, Serum QSTC",9039351,LOCAL,82677,CPT,,,,,,Outpatient,,,,29.02,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
H. pylori Urea Breath Test QSTC,8764622,LOCAL,83013,CPT,,,,,,Outpatient,,,,80.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Metanephrines, Fract Free LCMSMS, P QSTC",8764672,LOCAL,83835,CPT,,,,,,Outpatient,,,,20.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mycophenolic Acid QSTC,9039269,LOCAL,80180,CPT,,,,,,Outpatient,,,,21.66,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neisseria Gonorrhoeae RNA, TMA QST",14718337,LOCAL,87591,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,24.01,24.01,24.01,1 through 10,percent of total billed charges,35.09,40.19,
Thinprep Review Cytotechnologist: QST,14718350,LOCAL,88175,CPT,,,,,,Outpatient,,,,31.93,CIGNA,Commercial,,50,,31.2,31.2,31.2,1 through 10,percent of total billed charges,25.25,26.61,
"Trichomonas vaginalis, Ql TMA, Pap QST",14718338,LOCAL,87661,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Galactose-Alpha-1,3-Galactose IgE QSTC",8764840,LOCAL,86008,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HOLTER MONITOR  24H,8200090,LOCAL,93225,CPT,,,,,,Outpatient,,,,198,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DRAIN TRU-CLOSE 500CC (BUY BY EACH-10/CS,6800045,LOCAL,,,A7048,HCPCS,,,,Outpatient,,,,88,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
FLUORO CENTRAL LINE PLACEMENT,8201221,LOCAL,77001,CPT,,,,,,Outpatient,,,,177.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vitamin B12 Level,633871,LOCAL,82607,CPT,,,,,,Outpatient,,,,18.1,CIGNA,Commercial,,50,,99.8,15.08,184.52,1 through 10,percent of total billed charges,18.43,82.43266533,
XR Port Placement,10460170,LOCAL,77001,CPT,,,,,,Outpatient,,,,177.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE Chest Physiotherapy -> PEP Therapy Subsequent,8699751,LOCAL,94667,CPT,,,,,,Outpatient,,,,120,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE Mechanical Oscillation -> Yes,10417130,LOCAL,94667,CPT,,,,,,Outpatient,,,,120,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Streptococcus pneumoniae Ag, Ur QSTC",13864418,LOCAL,87899,CPT,,,,,,Outpatient,,,,19.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"FVIII Act, Clotting QSTC",13873492,LOCAL,85240,CPT,,,,,,Outpatient,,,,21.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"PTT, Activated QSTC",13873491,LOCAL,85730,CPT,,,,,,Outpatient,,,,7.21,CIGNA,Commercial,,50,,24.82,11.84,72.01,13,percent of total billed charges,1.648553055,5.42,
Ristocetin Cofactor QSTC,13873494,LOCAL,85245,CPT,,,,,,Outpatient,,,,27.53,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
von Willebrand Factor Ag QSTC,13873493,LOCAL,85246,CPT,,,,,,Outpatient,,,,27.53,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"vWf Ag, Multimeric QSTC",13873495,LOCAL,85247,CPT,,,,,,Outpatient,,,,27.53,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
benztropine 1 mg/mL injectable solution 2 mL [CULL],11202065,LOCAL,J0515,CPT,,,,,,Outpatient,2,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.T. pallidum Ab QSTC,13864522,LOCAL,86780,CPT,,,,,,Outpatient,,,,15.89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Syphilis Antibody Cascading Reflex QSTC,8972904,LOCAL,86780,CPT,,,,,,Outpatient,,,,15.89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3923 HFO W/O JOINTS PRE CST CHARGE,9646078,LOCAL,,,L3923,HCPCS,,,,Outpatient,,,,124,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"MAG-SGPG Ab IgM, EIA QSTC",13864465,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
amphotericin B 50 mg Pow [CULL],J0285,CPT,,,,,,,,Outpatient,50,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"96366 IV INFUSION, MEDICATIONS, ADDITIONAL",7904532,LOCAL,96366,CPT,,,,,,Outpatient,,,,125,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"96366- IV tx, each additional hour",1928300,LOCAL,96366,CPT,,,,,,Outpatient,,,,125,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"96367 IV INFUSION, SEQUENTIAL, NEW OR DIFF",7904533,LOCAL,96367,CPT,,,,,,Outpatient,,,,125,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"96367- IV tx, sequential infusion",1928301,LOCAL,96367,CPT,,,,,,Outpatient,,,,125,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"96374- IV Injection, single/initial",1928305,LOCAL,96374,CPT,,,,,59,Outpatient,,,,125,CIGNA,Commercial,,50,,194.68,188.87,206.3,1 through 10,percent of total billed charges,64.56,192.63,
96374 IV PUSH MEDS INIT INJ 15 MIN OR LESS,7904536,LOCAL,96374,CPT,,,,,59,Outpatient,,,,125,CIGNA,Commercial,,50,,194.68,188.87,206.3,1 through 10,percent of total billed charges,64.56,192.63,
"96375- IV Injection, add new drug",1928306,LOCAL,96375,CPT,,,,,59,Outpatient,,,,125,CIGNA,Commercial,,50,,118.64,45.18,192.1,1 through 10,percent of total billed charges,42.18,64.56,
"96375 IV PUSH INJECTION ADD, NEW OR DIFF",7904537,LOCAL,96375,CPT,,,,,59,Outpatient,,,,125,CIGNA,Commercial,,50,,118.64,45.18,192.1,1 through 10,percent of total billed charges,42.18,64.56,
INJ IV PUSH THER/PROPH SUBSTANCE INTIAL,8210021,LOCAL,96374,CPT,,,,,59,Outpatient,,,,125,CIGNA,Commercial,,50,,194.68,188.87,206.3,1 through 10,percent of total billed charges,64.56,192.63,
"Beryllium, Serum/Plasma QSTC",10704808,LOCAL,83018,CPT,,,,,,Outpatient,,,,26.35,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
9581626 EEG AWAKE/DROWSY PRO FEE CHARGES,8795941,LOCAL,95816,CPT,,,,,26,Outpatient,,,,533,CIGNA,Commercial,,50,,82.5,55,110,1 through 10,percent of total billed charges,284.7,466.96,
95819 EEG AWAKE AND ASLEEP PRO-FEE CHARGE,13508139,LOCAL,95819,CPT,,,,,26,Outpatient,,,,599,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95822 EEG COMA or SLEEP ONLY PRO,10049176,LOCAL,95822,CPT,,,,,26,Outpatient,,,,499,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vitamin B3 QSTC,8972908,LOCAL,84591,CPT,,,,,,Outpatient,,,,20.47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Thyroid Stimulating Hormone,633844,LOCAL,84443,CPT,,,,,,Outpatient,,,,20.16,CIGNA,Commercial,,50,,106.15,16.8,195.5,12,percent of total billed charges,18.43,87.63697303,
TSH with Reflex to FT4,7948309,LOCAL,84439,CPT,,,,,,Outpatient,,,,10.82,CIGNA,Commercial,,50,,34.42,9.02,59.82,12,percent of total billed charges,18.43,28.58065455,
"Mumps Virus Ab IgG, IgM, Diagnostic QSTC",13864479,LOCAL,86735,CPT,,,,,,Outpatient,,,,15.66,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deoxycorticosterone QSTC,13864487,LOCAL,82633,CPT,,,,,,Outpatient,,,,37.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Q Fever Ab IgG IgM w/rfx Titers QSTC,13864460,LOCAL,86638,CPT,,,,,,Outpatient,,,,14.54,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0108 Diabetes Management Treatment 30 Minutes CHARGE,10255367,LOCAL,,,G0108,HCPCS,,,,Outpatient,,,,128,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
94799 Pulm Function Screen Charge,10440012,LOCAL,94799,CPT,,,,,,Outpatient,,,,129,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97168 CIS Prgm OT Re-Evaluation 30 min,9850016,LOCAL,97168,CPT,,,,,GO,Outpatient,,,,131,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97168 RE-EVALUATION CHARGE,9860016,LOCAL,97168,CPT,,,,,GO|CO,Outpatient,,,,131,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT ReEval Units,7895298,LOCAL,97168,CPT,,,,,GO,Outpatient,,,,131,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT ReEvaluation Units,7897819,LOCAL,97168,CPT,,,,,GO,Outpatient,,,,131,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gabapentin QSTC,8764562,LOCAL,80171,CPT,,,,,,Outpatient,,,,26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TRAb (TSH Receptor Binding Ab) QSTC,8764674,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Coccidioides Ab, CF w/ ID, CSF QSTC",13864531,LOCAL,86635,CPT,,,,,,Outpatient,,,,13.76,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Body Fluid Culture,4122803,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,CIGNA,Commercial,,50,,34.31,5.23,63.39,1 through 10,percent of total billed charges,10.57,67.60639535,
Ear Culture,633890,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,CIGNA,Commercial,,50,,34.31,5.23,63.39,1 through 10,percent of total billed charges,10.57,67.60639535,
Eye Culture,633892,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,CIGNA,Commercial,,50,,34.31,5.23,63.39,1 through 10,percent of total billed charges,10.57,67.60639535,
Medical Device Culture,633898,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,CIGNA,Commercial,,50,,34.31,5.23,63.39,1 through 10,percent of total billed charges,10.57,67.60639535,
Nasal Culture,633900,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,CIGNA,Commercial,,50,,34.31,5.23,63.39,1 through 10,percent of total billed charges,10.57,67.60639535,
"Porphyrins, Fract, Quant, Random Ur QSTC",13864457,LOCAL,84120,CPT,,,,,,Outpatient,,,,17.65,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Stool Culture,633904,LOCAL,87045,CPT,,,,,,Outpatient,,,,11.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Throat Culture,633905,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,CIGNA,Commercial,,50,,34.31,5.23,63.39,1 through 10,percent of total billed charges,10.57,67.60639535,
Wound Culture,633908,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,CIGNA,Commercial,,50,,34.31,5.23,63.39,1 through 10,percent of total billed charges,10.57,67.60639535,
Wound Culture Deep,8395521,LOCAL,87070,CPT,,,,,,Outpatient,,,,10.34,CIGNA,Commercial,,50,,34.31,5.23,63.39,1 through 10,percent of total billed charges,10.57,67.60639535,
micafungin 100 mg intravenous injection [CULL],11220353,LOCAL,J2248,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vitamin K QSTC,8972880,LOCAL,84597,CPT,,,,,,Outpatient,,,,16.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PSA Diagnostic,1634882,LOCAL,84153,CPT,,,,,,Outpatient,,,,22.07,CIGNA,Commercial,,50,,64.54,32.24,202.73,14,percent of total billed charges,17.73,104.8447059,
PSA Screening,4123035,LOCAL,,,G0103,HCPCS,,,,Outpatient,,,,134,CIGNA,Commercial,,50,,64.54,26.47,64.54,14,percent of total billed charges,15.29,19.31,
Chromatin (Nucleosomal) Antibody QSTC,10148609,LOCAL,86235,CPT,,,,,,Outpatient,,,,21.52,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
94640 UDN SPECIAL MED 2 CHARGE,13515633,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,CIGNA,Commercial,,50,,173.5,202.945,232.39,1 through 10,percent of total billed charges,76.09,185.95,
94640 UDN SPECIAL MED CHARGE,13522003,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,CIGNA,Commercial,,50,,173.5,202.945,232.39,1 through 10,percent of total billed charges,76.09,185.95,
RT CHARGE Aerosol Therapy -> Subsequent,5397112,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,CIGNA,Commercial,,50,,173.5,202.945,232.39,1 through 10,percent of total billed charges,76.09,185.95,
RT CHARGE EZPAP -> Initial,9429159,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,CIGNA,Commercial,,50,,173.5,202.945,232.39,1 through 10,percent of total billed charges,76.09,185.95,
RT CHARGE EZPAP -> Subsequent,9429160,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,CIGNA,Commercial,,50,,173.5,202.945,232.39,1 through 10,percent of total billed charges,76.09,185.95,
RT CHARGE MDI -> Initial,12111660,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,CIGNA,Commercial,,50,,173.5,202.945,232.39,1 through 10,percent of total billed charges,76.09,185.95,
RT CHARGE MDI -> Subsequent,12111659,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,CIGNA,Commercial,,50,,173.5,202.945,232.39,1 through 10,percent of total billed charges,76.09,185.95,
RT CHARGE Suction -> BBG/Nasopharyngeal,6690655,LOCAL,31720,CPT,,,,,,Outpatient,,,,136,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT Continuous Neb Subsequent CHARGE,8144096,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,CIGNA,Commercial,,50,,173.5,202.945,232.39,1 through 10,percent of total billed charges,76.09,185.95,
RT IPV Subsequent CHARGE,8144062,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,CIGNA,Commercial,,50,,173.5,202.945,232.39,1 through 10,percent of total billed charges,76.09,185.95,
Sputum Collection Method -> Cough,13657418,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,CIGNA,Commercial,,50,,173.5,202.945,232.39,1 through 10,percent of total billed charges,76.09,185.95,
Sputum Collection Method -> ET tube,13657417,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,CIGNA,Commercial,,50,,173.5,202.945,232.39,1 through 10,percent of total billed charges,76.09,185.95,
Sputum Collection Method -> Medication aerosol,8846461,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,CIGNA,Commercial,,50,,173.5,202.945,232.39,1 through 10,percent of total billed charges,76.09,185.95,
Sputum Collection Method -> Nasal aspirate,13650046,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,CIGNA,Commercial,,50,,173.5,202.945,232.39,1 through 10,percent of total billed charges,76.09,185.95,
Sputum Collection Method -> Nasal wash,13650044,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,CIGNA,Commercial,,50,,173.5,202.945,232.39,1 through 10,percent of total billed charges,76.09,185.95,
L3912 HFO FLEXION,9856101,LOCAL,,,L3912,HCPCS,,,,Outpatient,,,,137,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"penicillin G potassium 20,000,000 units injection [CULL]",11211080,LOCAL,J2540,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF Antibody Screen,7939320,LOCAL,86850,CPT,,,,,,Outpatient,,,,11.72,CIGNA,Commercial,,50,,21.49,7.76,64.58,1 through 10,percent of total billed charges,6.29,48.85,
US Unlisted Procedure,8733482,LOCAL,76999,CPT,,,,,,Outpatient,,,,113.85,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
%CDT QSTC,13864781,LOCAL,82373,CPT,,,,,,Outpatient,,,,21.67,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transferrin - QSTC,13864778,LOCAL,84466,CPT,,,,,,Outpatient,,,,15.31,CIGNA,Commercial,,50,,18.33,18.33,18.33,1 through 10,percent of total billed charges,17.73,29.64248366,
hyaluronidase 150 units/mL injectable solution 1 mL [CULL],11282257,LOCAL,J3470,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"96372 INJECTIONS (IM, SC) OP",7904535,LOCAL,96372,CPT,,,,,59,Outpatient,,,,139,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96372- Subq/IM Injection,1928303,LOCAL,96372,CPT,,,,,59,Outpatient,,,,139,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE PFT -> Lung Volume,9004829,LOCAL,94727,CPT,,,,,,Outpatient,,,,140,CIGNA,Commercial,,50,,67.31,67.31,67.31,1 through 10,percent of total billed charges,76.09,143.05,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,90471,CPT,G0010,HCPCS,,,,Outpatient,,,,140,CIGNA,Commercial,,50,,67.44,67.44,67.44,1 through 10,percent of total billed charges,42.18,65.07,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,G0010,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CATH LAB US INTRAOPERATIVE,8200550,LOCAL,76998,CPT,,,,,,Outpatient,,,,116.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bladder Scan,649589,LOCAL,51798,CPT,,,,,,Outpatient,,,,59,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOPP LOWER EXT ARTERIAL/ABI,8200450,LOCAL,93922,CPT,,,,,,Outpatient,,,,265,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
69209 REM IMPACT CERUMEN REQ IRRIGAT CHARGE,8020086,LOCAL,69209,CPT,,,,,,Outpatient,,,,143,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97550 CAREGIVER TRAINING 1ST 30 MIN,14015178,LOCAL,97550,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97550 OT Caregiver Training Init 30 Mins,13649811,LOCAL,97550,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97550 ST Caregiver Training 1st 30 min,14013233,LOCAL,97550,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"SLP Caregiver Training, First 30 Min Time",14466884,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only ABSC,7936968,LOCAL,86850,CPT,,,,,,Outpatient,,,,11.72,CIGNA,Commercial,,50,,21.49,7.76,64.58,1 through 10,percent of total billed charges,6.29,48.85,
"Platelet Antibody Screen, Serum QSTC",10736090,LOCAL,86022,CPT,,,,,,Outpatient,,,,22.04,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92524 BEHAVIORAL AND QUALITATIVE ANALYSIS OF VOICE AND RESONANCE,9630059,LOCAL,92524,CPT,,,,,GN,Outpatient,,,,144,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Behav/Qual Analysis of Voice and Resonance Charge,7897211,LOCAL,92524,CPT,,,,,GN,Outpatient,,,,144,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Analysis of Voice & Resonance Units,7897212,LOCAL,92524,CPT,,,,,GN,Outpatient,,,,144,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92597 EVAL FOR USE AND/OR FITTING OF VOICE PROSTHETIC TO SUPPLEMENT ORAL SPEECH,9630068,LOCAL,92597,CPT,,,,,GN,Outpatient,,,,146,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Eval for Use/Fitting of Voice Prosthetic Dvc Chg,1373846,LOCAL,92597,CPT,,,,,GN,Outpatient,,,,146,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"SLP Use,Fit Speech Prosthetic Eval Units",1373846,LOCAL,92597,CPT,,,,,GN,Outpatient,,,,146,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64418- Suprascapular nerve block,10452404,LOCAL,64418,CPT,,,,,,Outpatient,,,,693,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
75809 SHUNTOGRAM PREV PLCMNT INDWELLING NONVASC SHUNT,13650394,LOCAL,75809,CPT,,,,,,Outpatient,,,,87.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hantavirus Antibody IgG,IgM QSTC",13864534,LOCAL,86790,CPT,,,,,,Outpatient,,,,15.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Histoplasma Quantitative Antigen, EIA QSTC",9752803,LOCAL,87385,CPT,,,,,,Outpatient,,,,15.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Potassium w/o Creatinine, Random Ur QSTC",9039260,LOCAL,84133,CPT,,,,,,Outpatient,,,,5.68,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soluble Transferrin Receptor QSTC,9777250,LOCAL,84238,CPT,,,,,,Outpatient,,,,43.88,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Shunt Series,13650394,LOCAL,75809,CPT,,,,,,Outpatient,,,,87.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dengue Fever Ab (IgG) QSTC,13873177,LOCAL,86790,CPT,,,,,,Outpatient,,,,15.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dengue Fever Ab (IgM) QSTC,13873183,LOCAL,86790,CPT,,,,,,Outpatient,,,,15.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Mycoplasma pneumoniae Ab (IgG, IgM) QSTC",8972832,LOCAL,86738,CPT,,,,,,Outpatient,,,,15.89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF DAT Polyspecific,7939270,LOCAL,86880,CPT,,,,,,Outpatient,,,,6.47,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
voriconazole 200 mg intravenous injection [CULL],11211371,LOCAL,J3465,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92610  Bedside Swallowing Eval,9630082,LOCAL,92610,CPT,,,,,GN,Outpatient,,,,151,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Eval of Oral and Pharyngeal Swallowing Fx Chg  nd Pharyngeal Swallowing Fx Chg,7896918,LOCAL,92610,CPT,,,,,GN,Outpatient,,,,151,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Eval of Oral and Pharyngeal Swallowing Fx Chg  nd Pharyngeal Swallowing Fx Chg -> Yes,7896918,LOCAL,92610,CPT,,,,,GN,Outpatient,,,,151,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Pharyngeal Swallow Eval Units,1373843,LOCAL,92610,CPT,,,,,GN,Outpatient,,,,151,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Caregiver / patient demonstrates understanding of substance abuse, triggers, treatment",4517330,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Caregiver / patient demonstrates understanding of substance abuse, triggers, treatment",4517330,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT CAREGIVER TRAINING INT 30 MIN,4517330,LOCAL,,,G0541,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96523 FLUSH VAD CHARGE,8213318,LOCAL,96523,CPT,,,,,,Outpatient,,,,153,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Follicle Stimulating Hormone Level,3170314,LOCAL,83001,CPT,,,,,,Outpatient,,,,22.3,CIGNA,Commercial,,50,,74.47,17.99,236.88,21,percent of total billed charges,18.43,98.80384615,
Antibody ID,634330,LOCAL,86870,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BB THAW FFP,6413062,LOCAL,86931,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill IHC Multiplex Antibody,14048007,LOCAL,88344,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bill Only Antigen Type, Patient",8872565,LOCAL,86905,CPT,,,,,,Outpatient,,,,4.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bill Only Antigen Type, Product",8872566,LOCAL,86902,CPT,,,,,,Outpatient,,,,7.62,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Tissue Exam Level 5,14049344,LOCAL,88307,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11732 AVULSION OF EACH ADDITIONAL NAIL PLATE,13029593,LOCAL,11732,CPT,,,,,,Outpatient,,,,156,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93463 Pharmacologic Agent Administration,8230065,LOCAL,93463,CPT,,,,,,Outpatient,,,,156,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
36591 COLLECT BLOOD FROM IMPL VEN DEVICE CHARGE,10451346,LOCAL,36591,CPT,,,,,,Outpatient,,,,157,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Central Line Activity. -> Blood drawn,12856467,LOCAL,36592,CPT,,,,,,Outpatient,,,,157,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anaerobic Culture,4122782,LOCAL,87075,CPT,,,,,,Outpatient,,,,11.36,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only ABID Panel,7936969,LOCAL,86870,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US OB Greater Than 14 Weeks,1169850,LOCAL,76805,CPT,,,,,,Outpatient,,,,130.35,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US OB Greater Than 14 Weeks,1169851,LOCAL,76805,CPT,,,,,,Outpatient,,,,130.35,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
FLUOROSCOPY <1 HOUR,8210790,LOCAL,76000,CPT,,,,,,Outpatient,,,,380.33,CIGNA,Commercial,,50,,221.3,221.3,221.3,1 through 10,percent of total billed charges,176.48,220.99,
.Hep C Viral RNA Quant RealTime PCR QSTC,8764584,LOCAL,87522,CPT,,,,,,Outpatient,,,,51.41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HCV RNA Quan Progress to Genotyping QSTC,9039270,LOCAL,87522,CPT,,,,,,Outpatient,,,,51.41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hepatitis C, RNA, Quantitative, PCR QSTC",8764755,LOCAL,87522,CPT,,,,,,Outpatient,,,,51.41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"HSV Type 1&2 DNA, Qual RT PCR QSTC",8873562,LOCAL,87529,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pancreatic Elastase-1 QSTC,8764835,LOCAL,82653,CPT,,,,,,Outpatient,,,,27.56,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF PLT Screening,13475613,LOCAL,86022,CPT,,,,,,Outpatient,,,,22.04,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE Aerosol Therapy -> Initial,12502774,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,CIGNA,Commercial,,50,,173.5,202.945,232.39,1 through 10,percent of total billed charges,76.09,185.95,
RT Continuous Neb Initial CHARGE,8144200,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,CIGNA,Commercial,,50,,173.5,202.945,232.39,1 through 10,percent of total billed charges,76.09,185.95,
RT IPV Initial CHARGE,8144187,LOCAL,94640,CPT,,,,,,Outpatient,,,,136,CIGNA,Commercial,,50,,173.5,202.945,232.39,1 through 10,percent of total billed charges,76.09,185.95,
96415 CHEMO IV INFUSION EA ADDL HR INF CHARGE,9665726,LOCAL,96415,CPT,,,,,,Outpatient,,,,161,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
aztreonam 2 g injection [CULL],11201229,LOCAL,J0457,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Clobazam and Metabolite, Serum/Plasma QSTC",8764736,LOCAL,80299,CPT,,,,,,Outpatient,,,,22.37,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95977 - device analysis and complex programming,14685299,LOCAL,95977,CPT,,,,,,Outpatient,,,,92,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hep Acute Pnl,633756,LOCAL,80074,CPT,,,,,,Outpatient,,,,57.16,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hep Acute Pnl Post Exposure,9517262,LOCAL,80074,CPT,,,,,,Outpatient,,,,57.16,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COLLAR HARD PED 8 -11,6000015,LOCAL,,,L0172,HCPCS,,,,Outpatient,,,,223,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Albumin Level,1620877,LOCAL,82040,CPT,,,,,,Outpatient,,,,5.94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Luteinizing Hormone,4240834,LOCAL,83002,CPT,,,,,,Outpatient,,,,22.22,CIGNA,Commercial,,50,,78.29,17.74,249.15,1 through 10,percent of total billed charges,18.43,18.52,
Rufinamide QSTC,13864436,LOCAL,80210,CPT,,,,,,Outpatient,,,,32.53,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hand 2 Views Left,1170215,LOCAL,73120,CPT,,,,,LT,Outpatient,,,,135.3,CIGNA,Commercial,,50,,164.48,164.48,164.48,1 through 10,percent of total billed charges,83.69,97.22,
XR Hand 2 Views Right,1170217,LOCAL,73120,CPT,,,,,RT,Outpatient,,,,135.3,CIGNA,Commercial,,50,,164.48,164.48,164.48,1 through 10,percent of total billed charges,83.69,97.22,
XR Lower Extremity Infant 2 Views Bilat,8455866,LOCAL,73592,CPT,,,,,,Outpatient,,,,136.13,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Lower Extremity Infant 2 Views Left,8455869,LOCAL,73592,CPT,,,,,LT,Outpatient,,,,136.13,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Lower Extremity Infant 2 Views Right,8455872,LOCAL,73592,CPT,,,,,RT,Outpatient,,,,136.13,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
hepatitis B adult vaccine 20 mcg/mL intramuscular suspension 1 mL [CULL],11202558,LOCAL,90746,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Chest 1 View,8132832,LOCAL,71045,CPT,,,,,,Outpatient,,,,136.13,CIGNA,Commercial,,50,,83.41,79.19,252.15,1 through 10,percent of total billed charges,80.5,83.69,
XR Elbow 1 View Left,13554981,LOCAL,73070,CPT,,,,,52|LT,Outpatient,,,,136.13,CIGNA,Commercial,,50,,85.97,85.97,85.97,1 through 10,percent of total billed charges,80.5,83.69,
XR Elbow 1 View Right,13554984,LOCAL,73070,CPT,,,,,52|RT,Outpatient,,,,136.13,CIGNA,Commercial,,50,,85.97,85.97,85.97,1 through 10,percent of total billed charges,80.5,83.69,
69210 REM IMPACT CERUMEN REQ INSTRU CHARGE,8020194,LOCAL,69210,CPT,,,,,,Outpatient,,,,166,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Computer Search EA/Ag,13517192,LOCAL,86902,CPT,,,,,,Outpatient,,,,7.62,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Fresh Unit (<5 Days Old),13517198,LOCAL,86999,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Pelvic Ltd,8206967,LOCAL,76857,CPT,,,,,,Outpatient,,,,137.78,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE PFT -> Spirometry,5274349,LOCAL,94010,CPT,,,,,,Outpatient,,,,168,CIGNA,Commercial,,50,,126.92,126.92,126.92,1 through 10,percent of total billed charges,76.09,143.05,
97161  SB PT Eval Low Comp,9640014,LOCAL,97161,CPT,,,,,GP,Outpatient,,,,170,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97161 EVAL - LOW COMPLEXITY CHARGE,9410054,LOCAL,97161,CPT,,,,,GP,Outpatient,,,,170,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97161 PHYSICAL THERAPY EVALUATION CHARGE,9650014,LOCAL,97161,CPT,,,,,GP|CQ,Outpatient,,,,170,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Low Complex Units,7896010,LOCAL,97161,CPT,,,,,GP,Outpatient,,,,170,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lactoferrin, QL, Stool QSTC",9039266,LOCAL,83630,CPT,,,,,,Outpatient,,,,23.64,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"92521 EVALUATION OF SPEECH FLUENCY (STUTTERING, CLUTTERING)",9630056,LOCAL,92521,CPT,,,,,GN,Outpatient,,,,172,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Speech Fluency Eval Units,7897205,LOCAL,92521,CPT,,,,,GN,Outpatient,,,,172,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Speech Fluency Eval Charge,7897205,LOCAL,92521,CPT,,,,,GN,Outpatient,,,,172,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methylPREDNISolone 1 g preservative-free Pow,11287452,LOCAL,J2919,CPT,,,,,,Outpatient,1,UN,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92526  Treatment of Swallow,9630083,LOCAL,92526,CPT,,,,,GN,Outpatient,,,,172,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
dihydroergotamine 1 mg/mL injectable solution 1 mL [CULL],11202330,LOCAL,J1110,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Swallow Dysfunction Oral Feed Units,1373842,LOCAL,92526,CPT,,,,,GN,Outpatient,,,,172,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Treatment of Swallowing Dysfunction Charge,7896917,LOCAL,92526,CPT,,,,,GN,Outpatient,,,,172,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Treatment of Swallowing Dysfunction Charge -> Yes,7896917,LOCAL,92526,CPT,,,,,GN,Outpatient,,,,172,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RNA Polymerase III Antibody QSTC,10067478,LOCAL,83516,CPT,,,,,,Outpatient,,,,13.84,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Sinuses Paranasal < 3 Views,1170432,LOCAL,70210,CPT,,,,,,Outpatient,,,,142.73,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Pelvis 1 or 2 Views,1170351,LOCAL,72170,CPT,,,,,,Outpatient,,,,142.73,CIGNA,Commercial,,50,,83.19,83.19,83.19,1 through 10,percent of total billed charges,83.69,97.22,
Zonisamide QSTC,8764609,LOCAL,80203,CPT,,,,,,Outpatient,,,,15.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Iodine, U24 QSTC",13864440,LOCAL,82542,CPT,,,,,,Outpatient,,,,28.91,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
.Atypical P-ANCA Titer QSTC,8764788,LOCAL,86037,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acylcarnitine, Plasma QSTC",9215425,LOCAL,82017,CPT,,,,,,Outpatient,,,,20.24,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C. difficile Toxin B Qual PCR QSTC,13864437,LOCAL,87493,CPT,,,,,,Outpatient,,,,44.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cytomegalovirus DNA, QN, Real-T PCR QSTC",8764608,LOCAL,87497,CPT,,,,,,Outpatient,,,,51.41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Kappa/Lambda Lght Chn, Free w Rat U QSTC",9039383,LOCAL,83883,CPT,,,,,,Outpatient,,,,16.32,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Kappa/Lambda Light Chains, Tot Ur QSTC",9039383,LOCAL,83883,CPT,,,,,,Outpatient,,,,16.32,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Mycoplasma Genitalium,R-T PCR QST",9773947,LOCAL,87624,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reference Lab Crossmatch -> Compatible,8185614,LOCAL,86920,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reference Lab Crossmatch -> Incompatible,8185613,LOCAL,86920,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reference Lab Crossmatch -> Least Incompatible,8185612,LOCAL,86920,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
von Willebrand Factor Ag QSTC,8764731,LOCAL,85246,CPT,,,,,,Outpatient,,,,27.53,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99281 Emergency Department Visit. Level 1,2644297,LOCAL,99281,CPT,,,,,25,Outpatient,,,,177,CIGNA,Commercial,,50,,172.01,102.39,241.63,1 through 10,percent of total billed charges,80.5,80.5,
XR Finger(s) 1 View Left,13554987,LOCAL,73140,CPT,,,,,52|LT,Outpatient,,,,146.03,CIGNA,Commercial,,50,,33.6,33.6,33.6,1 through 10,percent of total billed charges,80.5,83.69,
XR Finger(s) 1 View Right,13554990,LOCAL,73140,CPT,,,,,52|RT,Outpatient,,,,146.03,CIGNA,Commercial,,50,,33.6,33.6,33.6,1 through 10,percent of total billed charges,80.5,83.69,
Electrocardiogram 12 Lead.,9696149,LOCAL,93005,CPT,,,,,,Outpatient,,,,178,CIGNA,Commercial,,50,,85.48,11.26,202.21,1 through 10,percent of total billed charges,38.53,54.31,
93242 Holter 3 to 7 Days Recording,90820010,LOCAL,93242,CPT,,,,,,Outpatient,,,,179,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prolactin Level,3170316,LOCAL,84146,CPT,,,,,,Outpatient,,,,23.26,CIGNA,Commercial,,50,,147.2,19.38,275.01,1 through 10,percent of total billed charges,18.43,19.38,
XR Elbow 2 Views Left,1170121,LOCAL,73070,CPT,,,,,LT,Outpatient,,,,136.13,CIGNA,Commercial,,50,,85.97,85.97,85.97,1 through 10,percent of total billed charges,80.5,83.69,
XR Elbow 2 Views Right,1170123,LOCAL,73070,CPT,,,,,RT,Outpatient,,,,136.13,CIGNA,Commercial,,50,,85.97,85.97,85.97,1 through 10,percent of total billed charges,80.5,83.69,
.TR Interpretation,1173781,LOCAL,86078,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BB REF LAB PHYSICIAN INTERP,6413086,LOCAL,86077,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Crossmatch IS,8419033,LOCAL,86920,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
hepatitis B immune globulin intramuscular solution 0.5 mL [CULL],11202561,LOCAL,J1571,CPT,,,,,,Outpatient,0.5,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine 1 View Specify Level,8058789,LOCAL,72020,CPT,,,,,,Outpatient,,,,150.98,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Knee 1 View Standing AP Bilateral,1170291,LOCAL,73565,CPT,,,,,,Outpatient,,,,151.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Iodine QSTC,13864439,LOCAL,82542,CPT,,,,,,Outpatient,,,,28.91,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Neck Soft Tissue,1170331,LOCAL,70360,CPT,,,,,,Outpatient,,,,152.63,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97162  SB PT Eval Mod Comp,9640015,LOCAL,97162,CPT,,,,,GP,Outpatient,,,,187,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97162 EVAL - MODERATE COMPLEXITY CHARGE,9410055,LOCAL,97162,CPT,,,,,GP,Outpatient,,,,187,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97162 PT EVAL MOD COMPLEX CHARGES,9650015,LOCAL,97162,CPT,,,,,GP|CQ,Outpatient,,,,187,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT Moderate Complex Units,7896012,LOCAL,97162,CPT,,,,,GP,Outpatient,,,,187,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soluble Liver Antigen (SLA) Autoantibody QSTC,10148492,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Shoulder 1 View Left,1170409,LOCAL,73020,CPT,,,,,LT,Outpatient,,,,155.1,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Shoulder 1 View Right,1170411,LOCAL,73020,CPT,,,,,RT,Outpatient,,,,155.1,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR AC Joints Bilateral,1169922,LOCAL,73050,CPT,,,,,,Outpatient,,,,155.1,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Calcaneus Limited Left,13554972,LOCAL,73650,CPT,,,,,52|LT,Outpatient,,,,174.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Calcaneus Limited Right,13554975,LOCAL,73650,CPT,,,,,52|RT,Outpatient,,,,174.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BD Bone Density DEXA Vert Fracture Assmt,8206345,LOCAL,77086,CPT,,,,,,Outpatient,,,,155.93,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Foreign Body Localization Child 1 Vw,1170207,LOCAL,76010,CPT,,,,,,Outpatient,,,,155.93,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
cefTRIAXone 2 g injection [CULL],11202189,LOCAL,J0696,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,4.99,3.28,11.9,18,percent of total billed charges,5.161428571,5.161428571,
"Cytomegalovirus DNA, QL R-T PCR QSTC",9777223,LOCAL,87496,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Factor IX Activity,Clotting [352X]  QSTC",12534660,LOCAL,85250,CPT,,,,,,Outpatient,,,,22.85,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"HIV-1 RNA, QN, Real-Time PCR QSTC",8764763,LOCAL,87536,CPT,,,,,,Outpatient,,,,102.12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Chest Decubitus,1170049,LOCAL,71046,CPT,,,,,,Outpatient,,,,212.85,CIGNA,Commercial,,50,,248.28,148.84,347.72,1 through 10,percent of total billed charges,80.5,83.69,
"Factor VIII Inhibitor, EIA QSTC",13873092,LOCAL,85335,CPT,,,,,,Outpatient,,,,15.44,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"FVIII Act, Clotting QSTC",13873093,LOCAL,85240,CPT,,,,,,Outpatient,,,,21.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Upper Extremity Infant 2 Views Left,8455878,LOCAL,73092,CPT,,,,,LT,Outpatient,,,,159.23,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Upper Extremity Infant 2 Views Right,8455881,LOCAL,73092,CPT,,,,,RT,Outpatient,,,,159.23,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ref Rh Phenotyping,9527485,LOCAL,86906,CPT,,,,,,Outpatient,,,,9.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92611 ST VIDEOFLUOR SWALLOW CHARGE,9630067,LOCAL,92611,CPT,,,,,GN,Outpatient,,,,193,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fluoroscopic Evaluation of Swallow Function Charge,7896919,LOCAL,92611,CPT,,,,,GN,Outpatient,,,,193,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Fluoroscopic Evaluation Units,1373839,LOCAL,92611,CPT,,,,,GN,Outpatient,,,,193,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97165 EVAL -  LOW COMPLEXITY CHARGE,9850014,LOCAL,97165,CPT,,,,,GO,Outpatient,,,,194,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97165 OT Evaluation Low Complexity 30 min,9860014,LOCAL,97165,CPT,,,,,GO|CO,Outpatient,,,,194,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Evaluation Low Complexity Units,7897807,LOCAL,97165,CPT,,,,,GO,Outpatient,,,,194,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Low Complex Units,7895291,LOCAL,97165,CPT,,,,,GO,Outpatient,,,,194,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aspergillus Antigen, EIA, Serum QSTC",9777227,LOCAL,87305,CPT,,,,,,Outpatient,,,,14.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
29581 PT Lower Extremity Application of Strapping,9640079,LOCAL,29581,CPT,,,,,GP,Outpatient,,,,195,CIGNA,Commercial,,50,,360.97,94.01,578.32,1 through 10,percent of total billed charges,144.26,863,
PT Lymphedema Wrap below Knee Charge,7895901,LOCAL,29581,CPT,,,,,GP,Outpatient,,,,195,CIGNA,Commercial,,50,,360.97,94.01,578.32,1 through 10,percent of total billed charges,144.26,863,
Lacosamide QSTC,8764635,LOCAL,80235,CPT,,,,,,Outpatient,,,,32.53,CIGNA,Commercial,,50,,180.9,180.9,180.9,1 through 10,percent of total billed charges,15.38,27.11,
tetanus/diphth/pertussis (Tdap) adult/adol 5 units-2 units-15.5 mcg/0.5 mL intramuscular suspension 0.5 mL [CULL],11202346,LOCAL,90714,CPT,,,,,,Outpatient,0.5,ML,,,CIGNA,Commercial,,50,,62.4,62.4,62.4,1 through 10,percent of total billed charges,14.45070423,39.58,
XR Toe(s) 2 PLUS Views Right,1170522,LOCAL,73660,CPT,,,,,RT,Outpatient,,,,161.7,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Toe(s) 2+ Views Left,1170520,LOCAL,73660,CPT,,,,,LT,Outpatient,,,,161.7,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
influenza vaccine (Fluzone HD) vaccine 2025-2026 [CULL],11292055,LOCAL,90662,CPT,,,,,,Outpatient,0.5,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Large Humeral Fracture Brace,9400080,LOCAL,,,L3982,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medium Humeral Fracture Brace,9400079,LOCAL,,,L3982,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CV Holter Monitor Recording up to 48 Hrs,8230053,LOCAL,93225,CPT,,,,,,Outpatient,,,,198,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Holter Monitor 48 Hr,8230053,LOCAL,93225,CPT,,,,,,Outpatient,,,,198,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Rh Phenotyping,7936966,LOCAL,86906,CPT,,,,,,Outpatient,,,,9.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COV19/Flu/RSV (GeneXpert Plus),10791321,LOCAL,87637,CPT,,,,,,Outpatient,,,,171.16,CIGNA,Commercial,,50,,219.4,95.47,303.15,1 through 10,percent of total billed charges,40.19,69.4761107,
US OB Less Than 14 Weeks,8206952,LOCAL,76801,CPT,,,,,,Outpatient,,,,165,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chlamydia/Chlamydophila Ab 2 IgM QSTC,13864537,LOCAL,86632,CPT,,,,,,Outpatient,,,,15.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPINEPHrine 8 mg/250 mL-NaCl 0.9% Sol [CULL],11200040,LOCAL,J0165,CPT,,,,,,Outpatient,250,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Comprehensive Metabolic Panel,633709,LOCAL,80053,CPT,,,,,,Outpatient,,,,12.67,CIGNA,Commercial,,50,,10.56,158.785,307.01,24,percent of total billed charges,12.14,82.75523053,
XR Ankle 1 View Left,13554963,LOCAL,73600,CPT,,,,,52|LT,Outpatient,,,,165,CIGNA,Commercial,,50,,173.92,99.42,248.42,1 through 10,percent of total billed charges,80.5,83.69,
XR Ankle 1 View Right,13554966,LOCAL,73600,CPT,,,,,52|RT,Outpatient,,,,165,CIGNA,Commercial,,50,,173.92,99.42,248.42,1 through 10,percent of total billed charges,80.5,83.69,
XR Foot 2 Views Left,1170185,LOCAL,73620,CPT,,,,,LT,Outpatient,,,,165.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Foot 2 Views Right,1170187,LOCAL,73620,CPT,,,,,RT,Outpatient,,,,165.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bill Only ABID Panel, Enzyme (Ab)",13517190,LOCAL,86870,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bill Only ABID Panel, Enzyme (Ezym)",13517194,LOCAL,86971,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Insulin Autoantibody QSTC,8764818,LOCAL,86337,CPT,,,,,,Outpatient,,,,25.69,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Finger(s) 2 Plus Views Left,1170151,LOCAL,73140,CPT,,,,,LT,Outpatient,,,,146.03,CIGNA,Commercial,,50,,33.6,33.6,33.6,1 through 10,percent of total billed charges,80.5,83.69,
XR Finger(s) 2 Plus Views Right,1170153,LOCAL,73140,CPT,,,,,RT,Outpatient,,,,146.03,CIGNA,Commercial,,50,,33.6,33.6,33.6,1 through 10,percent of total billed charges,80.5,83.69,
97163  SB PT Eval High Comp,9640017,LOCAL,97163,CPT,,,,,GP,Outpatient,,,,203,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97163 EVAL - HIGH COMPLEXITY CHARGE,9410062,LOCAL,97163,CPT,,,,,GP,Outpatient,,,,203,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97163 IND EDUCATION EVAL CHARGE,9650017,LOCAL,97163,CPT,,,,,GP|CQ,Outpatient,,,,203,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PT High Complex Units,7896014,LOCAL,97163,CPT,,,,,GP,Outpatient,,,,203,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Factor II Activity QSTC,8972859,LOCAL,85210,CPT,,,,,,Outpatient,,,,15.58,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Implant Screening Lt w/ Tomo.,8146654,LOCAL,77067,CPT,,,,,LT,Outpatient,,,,363,CIGNA,Commercial,,50,,393.12,112.04,674.19,1 through 10,percent of total billed charges,74,79.68,
MG Mammo Implant Screening Rt w/ Tomo.,8146657,LOCAL,77067,CPT,,,,,RT,Outpatient,,,,363,CIGNA,Commercial,,50,,393.12,112.04,674.19,1 through 10,percent of total billed charges,74,79.68,
MG Mammo Screening Left w/ Tomo.,8146660,LOCAL,77067,CPT,,,,,LT,Outpatient,,,,363,CIGNA,Commercial,,50,,393.12,112.04,674.19,1 through 10,percent of total billed charges,74,79.68,
MG Mammo Screening Right w/ Tomo.,8146663,LOCAL,77067,CPT,,,,,RT,Outpatient,,,,363,CIGNA,Commercial,,50,,393.12,112.04,674.19,1 through 10,percent of total billed charges,74,79.68,
92609 ST USE OF SPEECH DEVICE SERVICES,9636008,LOCAL,92609,CPT,,,,,GN,Outpatient,,,,204,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Speech-Gen Dev Prog and Mod,7896913,LOCAL,92609,CPT,,,,,GN,Outpatient,,,,204,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Speech-Gen Dev Prog and Mod Time,1373849,LOCAL,92609,CPT,,,,,GN,Outpatient,,,,204,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Tx Generating Device Units,1373849,LOCAL,92609,CPT,,,,,GN,Outpatient,,,,204,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Factor V Activity, Clotting QSTC",9777239,LOCAL,85220,CPT,,,,,,Outpatient,,,,21.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatitis B Virus DNA Qnt RT PCR QSTC,8764549,LOCAL,87517,CPT,,,,,,Outpatient,,,,51.41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inhibin A QSTC,8972775,LOCAL,86336,CPT,,,,,,Outpatient,,,,18.71,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Viral Respiratory, Rapid Culture with Reflex QST",12126195,LOCAL,87140,CPT,,,,,,Outpatient,,,,6.68,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Porphyrins, Total QSTC",13864419,LOCAL,82542,CPT,,,,,,Outpatient,,,,28.91,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"73040 Radiologic examination, shoulder, arthrography: AddOn",14917589,LOCAL,73040,CPT,,,,,,Outpatient,,,,777.98,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Forearm 1 View Left,13554993,LOCAL,73090,CPT,,,,,52|LT,Outpatient,,,,170.78,CIGNA,Commercial,,50,,108.36,108.36,108.36,1 through 10,percent of total billed charges,80.5,83.69,
XR Forearm 1 View Right,13554996,LOCAL,73090,CPT,,,,,52|RT,Outpatient,,,,170.78,CIGNA,Commercial,,50,,108.36,108.36,108.36,1 through 10,percent of total billed charges,80.5,83.69,
XR Ankle 2 Views Left,1169936,LOCAL,73600,CPT,,,,,LT,Outpatient,,,,165,CIGNA,Commercial,,50,,173.92,99.42,248.42,1 through 10,percent of total billed charges,80.5,83.69,
XR Ankle 2 Views Right,1169938,LOCAL,73600,CPT,,,,,RT,Outpatient,,,,165,CIGNA,Commercial,,50,,173.92,99.42,248.42,1 through 10,percent of total billed charges,80.5,83.69,
tobramycin 1.2 g injection [CULL],11211303,LOCAL,J3260,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complement Component C1q QSTC,8972752,LOCAL,86160,CPT,,,,,,Outpatient,,,,14.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97166  SB OT Eval Mod Comp,9860015,LOCAL,97166,CPT,,,,,GO|CO,Outpatient,,,,210,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97166 EVAL -  MODERATE COMPLEXITY CHARGE,9850015,LOCAL,97166,CPT,,,,,GO,Outpatient,,,,210,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Evaluation Moderate Complexity Units,7897808,LOCAL,97166,CPT,,,,,GO,Outpatient,,,,210,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Moderate Complex Units,7895293,LOCAL,97166,CPT,,,,,GO,Outpatient,,,,210,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Calcaneus Left,1170032,LOCAL,73650,CPT,,,,,LT,Outpatient,,,,174.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Calcaneus Right,1170034,LOCAL,73650,CPT,,,,,RT,Outpatient,,,,174.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
94618 PULM STRESS TEST - 6 MIN WALK CHARGE,10470023,LOCAL,94618,CPT,,,,,59,Outpatient,,,,212,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
94618 PULMONARY STRESS TEST CHARGE,10470022,LOCAL,94618,CPT,,,,,,Outpatient,,,,212,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hips 2 Views w/AP Pelvis Bilat,7520609,LOCAL,73521,CPT,,,,,,Outpatient,,,,175.73,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neutrophil Funct, Oxidative Burst QSTC",13864519,LOCAL,82657,CPT,,,,,,Outpatient,,,,26.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Clavicle Limited Left,13554978,LOCAL,73000,CPT,,,,,52|LT,Outpatient,,,,198.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Clavicle Limited Right,13575896,LOCAL,73000,CPT,,,,,52|RT,Outpatient,,,,198.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR CV Line Injection,10153535,LOCAL,77001,CPT,,,,,,Outpatient,,,,177.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Portogram,8602535,LOCAL,36598,CPT,,,,,,Outpatient,,,,587,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neuron Specific Enolase, CSF QSTC",13864472,LOCAL,86316,CPT,,,,,,Outpatient,,,,24.97,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Sternum 2+ Views,1170496,LOCAL,71120,CPT,,,,,,Outpatient,,,,179.85,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Borrelia species DNA, QL RT PCR QSTC",13864432,LOCAL,87801,CPT,,,,,,Outpatient,,,,84.24,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Calprotectin, Stool QSTC",8764641,LOCAL,83993,CPT,,,,,,Outpatient,,,,23.56,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Factor VII Activity, Clotting QSTC",12530023,LOCAL,85230,CPT,,,,,,Outpatient,,,,21.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Rheumatoid Factor (IgA, IgG, IgM) QSTC",9743436,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SURESWAB(R) ADV BV QST,12432150,LOCAL,81513,CPT,,,,,,Outpatient,,,,171.16,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Estrogens, Fractionated, LC/MS QSTC",8972883,LOCAL,82671,CPT,,,,,,Outpatient,,,,38.76,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"86617-Lyme Disease Abs (IgG, IgM) IBL CSF QSTC",14825580,LOCAL,86617,CPT,,,,,,Outpatient,,,,18.59,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"BK Virus DNA, Quant, RT PCR QSTC",8853280,LOCAL,87799,CPT,,,,,,Outpatient,,,,51.41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lyme Disease Ab Rfx Blot IgG, IgM QSTC",8764732,LOCAL,86618,CPT,,,,,,Outpatient,,,,20.44,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lyme Disease Abs (IgG, IgM) IBL CSF QSTC",14114578,LOCAL,86617,CPT,,,,,,Outpatient,,,,18.59,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lyme Disease Antibodies (IgG, IgM), Immunoblot, CSF QST",6232109,LOCAL,86617,CPT,,,,,,Outpatient,,,,18.59,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
sodium thiosulfate 25% intravenous solution 50 mL [CULL],11260081,LOCAL,J0208,CPT,,,,,,Outpatient,50,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chlamydia/Chlamydophila Ab 1 IgG QSTC,13864536,LOCAL,86631,CPT,,,,,,Outpatient,,,,14.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"TRICHOMONAS VAGINALIS (TV), TMA QST",12432301,LOCAL,87661,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CANDIDA GLABRATA QST,12432300,LOCAL,87481,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CANDIDA SPECIES QST,12432293,LOCAL,87481,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CANDIDA SPECIES QST,12432299,LOCAL,87481,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SURESWAB(R) ADV BV QST,12432298,LOCAL,81513,CPT,,,,,,Outpatient,,,,171.16,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"EBV DNA, QN PCR QSTC",8764620,LOCAL,87799,CPT,,,,,,Outpatient,,,,51.41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Wrist 2 Views Left,1170606,LOCAL,73100,CPT,,,,,LT,Outpatient,,,,184.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Wrist 2 Views Right,1170608,LOCAL,73100,CPT,,,,,RT,Outpatient,,,,184.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF LAB IAT CROSSMATCH,13797753,LOCAL,86922,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Forearm 2 Views Left,1170197,LOCAL,73090,CPT,,,,,LT,Outpatient,,,,170.78,CIGNA,Commercial,,50,,108.36,108.36,108.36,1 through 10,percent of total billed charges,80.5,83.69,
XR Forearm 2 Views Right,1170199,LOCAL,73090,CPT,,,,,RT,Outpatient,,,,170.78,CIGNA,Commercial,,50,,108.36,108.36,108.36,1 through 10,percent of total billed charges,80.5,83.69,
97167 EVAL -  HIGH COMPLEXITY CHARGE,9850017,LOCAL,97167,CPT,,,,,GO,Outpatient,,,,226,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97167 IND EDUCATION EVAL CHARGE,9860017,LOCAL,97167,CPT,,,,,GO|CO,Outpatient,,,,226,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT Evaluation High Complexity Units,7897809,LOCAL,97167,CPT,,,,,GO,Outpatient,,,,226,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT High Complex Units,7895295,LOCAL,97167,CPT,,,,,GO,Outpatient,,,,226,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99211 LEVEL I VISIT CHARGE,9319019,LOCAL,99211,CPT,,,,,,Outpatient,,,,226,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99211 Office Visit Established Pt. Level 1,10168485,LOCAL,99211,CPT,,,,,,Outpatient,,,,226,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Scapula Left,1170401,LOCAL,73010,CPT,,,,,LT,Outpatient,,,,187.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Scapula Right,1170403,LOCAL,73010,CPT,,,,,RT,Outpatient,,,,187.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mycobacterium Slow Grower MIC QST,13864520,LOCAL,87186,CPT,,,,,,Outpatient,,,,10.38,CIGNA,Commercial,,50,,46.74,16.27,77.21,1 through 10,percent of total billed charges,10.57,35.67132075,
Mycobacterium Slow Grower MIC QSTC,13864520,LOCAL,87186,CPT,,,,,,Outpatient,,,,10.38,CIGNA,Commercial,,50,,46.74,16.27,77.21,1 through 10,percent of total billed charges,10.57,35.67132075,
CPAP Charge -> Subsequent,8365858,LOCAL,94660,CPT,,,,,,Outpatient,,,,279,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
17110 CRYOSURGERY REMOVAL OF LESIONS CHARGE,9038957,LOCAL,17110,CPT,,,,,,Outpatient,,,,228,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
94625 PHY/QHP OP PULM RHB W/O MNTR,10470028,LOCAL,94625,CPT,,,,,,Outpatient,,,,407,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11730 AVULSION OF NAIL PLATE SINGLE,8715870,LOCAL,11730,CPT,,,,,,Outpatient,,,,228,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
94618 PULMONARY STRESS TEST 6 MINUTE WALK,10440014,LOCAL,94618,CPT,,,,,,Outpatient,,,,212,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
linezolid 2 mg/mL-D5% intravenous solution 300 mL [CULL],11201931,LOCAL,J2020,CPT,,,,,,Outpatient,300,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE PFT -> Bedside Spirometry,8860673,LOCAL,94060,CPT,,,,,,Outpatient,,,,230,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE PFT -> Spirometry before & after,5267139,LOCAL,94060,CPT,,,,,,Outpatient,,,,230,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alpha Subunit QSTC,9849271,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Thoracic 2 Views,1170484,LOCAL,72070,CPT,,,,,,Outpatient,,,,192.23,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
micafungin 50 mg intravenous injection [CULL],11220352,LOCAL,J2248,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acetylcholine Recept. Modulating Ab QSTC,13864533,LOCAL,86043,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adenovirus DNA Qual RT PCR QSTC,10100374,LOCAL,87798,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"B.pertussis/para DNA,Ql Rl-Time PCR QSTC",8873570,LOCAL,87798,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bartonella Sp Ab IgG,IgM w/rf Titer QSTC",9777261,LOCAL,86611,CPT,,,,,,Outpatient,,,,12.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Copeptin QSTC,9039409,LOCAL,86255,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatitis C Viral RNA Genotype LiPA QSTC,8764578,LOCAL,87902,CPT,,,,,,Outpatient,,,,308.94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Histamine QSTC,13864456,LOCAL,83088,CPT,,,,,,Outpatient,,,,35.44,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HSV 1 QST,9775428,LOCAL,87529,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HSV 2 QST,9775429,LOCAL,87529,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mycobacterium Avium Complex MIC QST,13344174,LOCAL,87186,CPT,,,,,,Outpatient,,,,10.38,CIGNA,Commercial,,50,,46.74,16.27,77.21,1 through 10,percent of total billed charges,10.57,35.67132075,
methylPREDNISolone sodium succinate 2 g injection [CULL],11201958,LOCAL,J2919,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Mandible Less Than 4 Views,1170303,LOCAL,70100,CPT,,,,,,Outpatient,,,,194.7,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Babesia microti Ab (IgG) QSTC,13872991,LOCAL,86753,CPT,,,,,,Outpatient,,,,14.87,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ehrlichia chaffeensis Ab IgG QSTC,13872999,LOCAL,86753,CPT,,,,,,Outpatient,,,,14.87,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lyme Ab Screen QSTC,13872998,LOCAL,86618,CPT,,,,,,Outpatient,,,,20.44,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Clavicle Left,1170075,LOCAL,73000,CPT,,,,,LT,Outpatient,,,,198.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Clavicle Right,1170077,LOCAL,73000,CPT,,,,,RT,Outpatient,,,,198.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Humerus Limited Left,13554999,LOCAL,73060,CPT,,,,,52|LT,Outpatient,,,,223.58,CIGNA,Commercial,,50,,130.11,130.11,130.11,1 through 10,percent of total billed charges,80.5,83.69,
XR Humerus Limited Right,13555002,LOCAL,73060,CPT,,,,,52|RT,Outpatient,,,,223.58,CIGNA,Commercial,,50,,130.11,130.11,130.11,1 through 10,percent of total billed charges,80.5,83.69,
Reptilase Clotting Time QSTC,13864513,LOCAL,85635,CPT,,,,,,Outpatient,,,,11.82,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Tibia/Fibula Left,1170516,LOCAL,73590,CPT,,,,,LT,Outpatient,,,,200.48,CIGNA,Commercial,,50,,232.92,116.46,671.75,1 through 10,percent of total billed charges,80.5,83.69,
XR Tibia/Fibula Right,1170518,LOCAL,73590,CPT,,,,,RT,Outpatient,,,,200.48,CIGNA,Commercial,,50,,232.92,116.46,671.75,1 through 10,percent of total billed charges,80.5,83.69,
27095 INJ PROC FOR HIP ARTHROGRAPHY W/ ANESTH,5661071,LOCAL,27095,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"64454 - Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imagin",12897048,LOCAL,64454,CPT,,,,,,Outpatient,,,,244,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"64454 Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging",9520502,LOCAL,64454,CPT,,,,,,Outpatient,,,,244,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
caspofungin 50 mg intravenous injection [CULL],11201273,LOCAL,J0637,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bill Only Adsorption (Pheno, Rest, Wrm)",13517195,LOCAL,86978,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bill Only Rare Unit, Outside Search",13517199,LOCAL,86999,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tuberculin purified protein derivative 5 tuberculin units/0.1 mL intradermal solution 1 mL [CULL],11200764,LOCAL,86580,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"SureSwab(R) Trich. Vag. RNA,QL TMA QSTC",8853247,LOCAL,87661,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trichomonas Vaginalis RNA, Ql, TMA QST",8853247,LOCAL,87661,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Femur 1 View Left,7520564,LOCAL,73551,CPT,,,,,LT,Outpatient,,,,205.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Femur 1 View Right,7520567,LOCAL,73551,CPT,,,,,RT,Outpatient,,,,205.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hereditary Hemochroma DNA Mut Analy QSTC,8764601,LOCAL,81256,CPT,,,,,,Outpatient,,,,78.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Absorption,7967780,LOCAL,86978,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Food and Tree Nut Allergy Panel QSTC,14884175,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99282 - Level 2,2644298,LOCAL,99282,CPT,,,,,25,Outpatient,,,,256,CIGNA,Commercial,,50,,122.82,319.64,516.46,1 through 10,percent of total billed charges,144.78,144.78,
BRACE COOL X-ACT DON-JOY (USE),4852073,LOCAL,,,L1833,HCPCS,,,,Outpatient,,,,994,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93797 Cardiac Rehab without ECG monitoring,10411210,LOCAL,93797,CPT,,,,,,Outpatient,,,,256,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93798 Cardiac Rehab Phase II,10411000,LOCAL,93798,CPT,,,,,,Outpatient,,,,256,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUP ARTERIAL & VENOUS MAPPING UNI,8200502,LOCAL,93986,CPT,,,,,,Outpatient,,,,257,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Vein Mapping Lower Extremity Left,12175098,LOCAL,93986,CPT,,,,,LT,Outpatient,,,,257,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Vein Mapping Lower Extremity Right,12175101,LOCAL,93986,CPT,,,,,RT,Outpatient,,,,257,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Vein Mapping Upper Extremity Left,12175107,LOCAL,93986,CPT,,,,,LT,Outpatient,,,,257,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Vein Mapping Upper Extremity Right,12175110,LOCAL,93986,CPT,,,,,RT,Outpatient,,,,257,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
caspofungin 70 mg intravenous injection [CULL],11201274,LOCAL,J0637,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
71046 XR Chest 2 Views: AddOn,13632841,LOCAL,71046,CPT,,,,,,Outpatient,,,,212.85,CIGNA,Commercial,,50,,248.28,148.84,347.72,1 through 10,percent of total billed charges,80.5,83.69,
XR Chest 2 Views,689607,LOCAL,71046,CPT,,,,,,Outpatient,,,,212.85,CIGNA,Commercial,,50,,248.28,148.84,347.72,1 through 10,percent of total billed charges,80.5,83.69,
Heparin Anti-Xa QSTC,8972922,LOCAL,85520,CPT,,,,,,Outpatient,,,,15.71,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Abdomen KUB 1 View,1169926,LOCAL,74018,CPT,,,,,,Outpatient,,,,215.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Knee 1 or 2 Views Left,1170263,LOCAL,73560,CPT,,,,,LT,Outpatient,,,,215.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Knee 1 or 2 Views Right,1170265,LOCAL,73560,CPT,,,,,RT,Outpatient,,,,215.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
21- Hydroxylase Antibody QSTC,9708927,LOCAL,83516,CPT,,,,,,Outpatient,,,,13.84,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"96360 - Hydration, first hour",1928297,LOCAL,96360,CPT,,,,,,Outpatient,,,,262,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"96360 IV HYDRATION, INITIAL 31-90 MINS",7904529,LOCAL,96360,CPT,,,,,,Outpatient,,,,262,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inhibin B QSTC,6210082,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rituxan Sensitivity (CD20) QSTC,13864421,LOCAL,86356,CPT,,,,,,Outpatient,,,,32.14,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hip 1 View Left,1170225,LOCAL,73501,CPT,,,,,LT,Outpatient,,,,218.63,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hip 1 View Right,1170227,LOCAL,73501,CPT,,,,,RT,Outpatient,,,,218.63,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
A. phagocytophilum Ab IgG IgM QSTC,13864527,LOCAL,86666,CPT,,,,,,Outpatient,,,,12.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Bone Length Studies Scanograms,1170016,LOCAL,77073,CPT,,,,,,Outpatient,,,,218.63,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOP ABI-ANKLE BRACHIAL INDEX,8230017,LOCAL,93922,CPT,,,,,,Outpatient,,,,265,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US ABI,8206802,LOCAL,93922,CPT,,,,,,Outpatient,,,,265,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Segmental Pressures LE 1-2 Lvls Bilat,1169757,LOCAL,93922,CPT,,,,,,Outpatient,,,,265,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Sacrum/Coccyx 2+ Views,1170391,LOCAL,72220,CPT,,,,,,Outpatient,,,,219.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Sniff Test,8602547,LOCAL,71046,CPT,,,,,,Outpatient,,,,212.85,CIGNA,Commercial,,50,,248.28,148.84,347.72,1 through 10,percent of total billed charges,80.5,83.69,
XR Sternoclavicular Joint(s),1170494,LOCAL,71130,CPT,,,,,,Outpatient,,,,220.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Antigen Type Group 1,13517191,LOCAL,86902,CPT,,,,,,Outpatient,,,,7.62,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Proinsulin QSTC,8972777,LOCAL,84206,CPT,,,,,,Outpatient,,,,32.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Elbow Complete 3+ Views Left,1170127,LOCAL,73080,CPT,,,,,LT,Outpatient,,,,221.93,CIGNA,Commercial,,50,,129.26,129.26,129.26,1 through 10,percent of total billed charges,80.5,83.69,
XR Elbow Complete 3+ Views Right,1170129,LOCAL,73080,CPT,,,,,RT,Outpatient,,,,221.93,CIGNA,Commercial,,50,,129.26,129.26,129.26,1 through 10,percent of total billed charges,80.5,83.69,
DOPP ART EXT BIL MULTIPLE,8200300,LOCAL,93923,CPT,,,,,,Outpatient,,,,401,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOPP ART EXT BIL W/EXERCISE,8200310,LOCAL,93924,CPT,,,,,,Outpatient,,,,302,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Shoulder Complete 2 Plus Views Left,1170415,LOCAL,73030,CPT,,,,,LT,Outpatient,,,,222.75,CIGNA,Commercial,,50,,129.83,30.01,393.9,1 through 10,percent of total billed charges,80.5,83.69,
XR Shoulder Complete 2 Plus Views Right,1170417,LOCAL,73030,CPT,,,,,RT,Outpatient,,,,222.75,CIGNA,Commercial,,50,,129.83,30.01,393.9,1 through 10,percent of total billed charges,80.5,83.69,
XR Femur 2 Views Left,7520570,LOCAL,73552,CPT,,,,,LT,Outpatient,,,,223.58,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Femur 2 Views Right,7520573,LOCAL,73552,CPT,,,,,RT,Outpatient,,,,223.58,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Humerus Left,1170245,LOCAL,73060,CPT,,,,,LT,Outpatient,,,,223.58,CIGNA,Commercial,,50,,130.11,130.11,130.11,1 through 10,percent of total billed charges,80.5,83.69,
XR Humerus Right,1170247,LOCAL,73060,CPT,,,,,RT,Outpatient,,,,223.58,CIGNA,Commercial,,50,,130.11,130.11,130.11,1 through 10,percent of total billed charges,80.5,83.69,
XR Hip 1 View w/ AP Pelvis Left,7520576,LOCAL,73501,CPT,,,,,LT,Outpatient,,,,218.63,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hip 1 View w/ AP Pelvis Right,7520579,LOCAL,73501,CPT,,,,,RT,Outpatient,,,,218.63,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15272 APP SKN SUB GRFT TAL 100 SQ CM ADDT FAC CHARGE,12831013,LOCAL,15272,CPT,,,,,,Outpatient,,,,273,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"epoetin alfa-epbx 10,000 units/mL preservative-free injectable solution 1 mL [CULL]",11202387,LOCAL,Q5105,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11055 BENIGN LESION PARING/CUTTING, SINGLE",13043366,LOCAL,11055,CPT,,,,,,Outpatient,,,,278,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Enterovirus RNA, QL Real-Time PCR QSTC",8873564,LOCAL,87498,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL US Echo Dop w/ Spectr Ltd,13734793,LOCAL,93321,CPT,,,,,,Outpatient,,,,278,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ECHO DOP W/SPECTR LTD,8200175,LOCAL,93321,CPT,,,,,,Outpatient,,,,278,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CPAP Charge -> Initial,8365859,LOCAL,94660,CPT,,,,,,Outpatient,,,,279,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"S. pneumoniae Ab (IgG), MAID QSTC",13864418,LOCAL,87899,CPT,,,,,,Outpatient,,,,19.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Foot Complete 3 Plus Views Left,1170191,LOCAL,73630,CPT,,,,,LT,Outpatient,,,,231,CIGNA,Commercial,,50,,306.32,302,310.63,1 through 10,percent of total billed charges,80.5,83.69,
XR Foot Complete 3 plus Views Right,1170193,LOCAL,73630,CPT,,,,,RT,Outpatient,,,,231,CIGNA,Commercial,,50,,306.32,302,310.63,1 through 10,percent of total billed charges,80.5,83.69,
ER US VASCULAR ACCESS GUIDANCE,8200565,LOCAL,76937,CPT,,,,,,Outpatient,,,,231.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US VASCULAR ACCESS GUIDANCE,8200560,LOCAL,76937,CPT,,,,,,Outpatient,,,,231.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E0181 RBC CPD 500 LR,7266548,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E0226 RBC CPDA1 500 LR,7266556,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E0366 RBC CP2D AS3 500,7266579,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E0382 RBC CP2D AS3 500 LR,7266659,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E0424 RBC CPD AS5 500 LR,7266667,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4531 Aph RBC ACDA AS1 LR,7266601,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4532 Aph RBC ACDA AS1 LR 1,7266602,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4533 Aph RBC ACDA AS1 LR 2,7266603,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4543 Aph RBC ACDA AS3 LR,7266613,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4544 Aph RBC ACDA AS3 LR 1,7266614,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4545 Aph RBC ACDA AS3 LR 2,7266615,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E5157 RBC CPD AS1 LR LV,8069011,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hip 2-3 Views Left,7520582,LOCAL,73502,CPT,,,,,LT,Outpatient,,,,232.65,CIGNA,Commercial,,50,,139.25,83.41,432.7,1 through 10,percent of total billed charges,80.5,83.69,
XR Hip 2-3 Views Right,7520585,LOCAL,73502,CPT,,,,,RT,Outpatient,,,,232.65,CIGNA,Commercial,,50,,139.25,83.41,432.7,1 through 10,percent of total billed charges,80.5,83.69,
fondaparinux 7.5 mg/0.6 mL subcutaneous solution 0.6 mL [CULL],11260585,LOCAL,J1652,CPT,,,,,,Outpatient,0.6,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Ankle Complete 3 Plus Views Left,1169942,LOCAL,73610,CPT,,,,,LT,Outpatient,,,,233.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Ankle Complete 3 Plus Views Right,1169944,LOCAL,73610,CPT,,,,,RT,Outpatient,,,,233.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hand Complete 3 Plus Views Right,1170223,LOCAL,73130,CPT,,,,,RT,Outpatient,,,,235.13,CIGNA,Commercial,,50,,260.33,83.41,437.24,1 through 10,percent of total billed charges,80.5,83.69,
XR Hand Complete 3 Views Left,1170221,LOCAL,73130,CPT,,,,,LT,Outpatient,,,,235.13,CIGNA,Commercial,,50,,260.33,83.41,437.24,1 through 10,percent of total billed charges,80.5,83.69,
E0336 RBC CPD AS1 500 LR,7266574,LOCAL,,,P9016,HCPCS,,,,Outpatient,,,,282,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11056 BENIGN LESION PARING(2-4),13029575,LOCAL,11056,CPT,,,,,,Outpatient,,,,285,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11103 TANGENTIAL BIOP EA ADDT CHARGE,9322081,LOCAL,11103,CPT,,,,,,Outpatient,,,,285,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11721 DEBRIDE NAIL 6 OR MORE WC CHARGE,8726776,LOCAL,11721,CPT,,,,,,Outpatient,,,,285,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97602 DEBRIDE MAGGOT THERAPY NON-EXC,11633062,LOCAL,97602,CPT,,,,,,Outpatient,,,,285,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97605 Wound VAC <=50 sq cm,10015643,LOCAL,97605,CPT,,,,,,Outpatient,,,,285,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Sacroiliac Joints 3+ Views,1170387,LOCAL,72202,CPT,,,,,,Outpatient,,,,235.95,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BD Bone Density DEXA Axial w/Frac Assess,5017920,LOCAL,77085,CPT,,,,,,Outpatient,,,,237.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US PSEUDOANEURYSM COMPRESSION,8200520,LOCAL,76936,CPT,,,,,,Outpatient,,,,237.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Pseudoaneurysm Compression Repair,7936316,LOCAL,76936,CPT,,,,,,Outpatient,,,,237.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Sinuses Paranasal Complete,1170434,LOCAL,70220,CPT,,,,,,Outpatient,,,,238.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92523 SPEECH SOUND LANGUAGE COMPREHENS CHARGE,9630058,LOCAL,92523,CPT,,,,,GN,Outpatient,,,,290,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Analysis of Voice & Resonance Minutes,7897211,LOCAL,92523,CPT,,,,,GN,Outpatient,,,,290,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Sound Prod w/ Lang Comp Eval Units,7897209,LOCAL,92523,CPT,,,,,GN,Outpatient,,,,290,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Speech Sound Prod w/ Language Charge,7896929,LOCAL,92523,CPT,,,,,GN,Outpatient,,,,290,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hip 2-3 Views w/AP Pelvis Left,7520588,LOCAL,73502,CPT,,,,,LT,Outpatient,,,,232.65,CIGNA,Commercial,,50,,139.25,83.41,432.7,1 through 10,percent of total billed charges,80.5,83.69,
XR Hip 2-3 Views w/AP Pelvis Right,7520591,LOCAL,73502,CPT,,,,,RT,Outpatient,,,,232.65,CIGNA,Commercial,,50,,139.25,83.41,432.7,1 through 10,percent of total billed charges,80.5,83.69,
L3931 Forearm based radial nerve orthosis,9646083,LOCAL,,,L3931,HCPCS,,,GP,Outpatient,,,,291,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3931 OT WRIST HAND FINGER ORTHOSIS,9856104,LOCAL,,,L3931,HCPCS,,,,Outpatient,,,,291,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3931 Wrst/thmb Spic Spnt,9800062,LOCAL,,,L3931,HCPCS,,,,Outpatient,,,,291,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Breast Limited Left.,8068444,LOCAL,76642,CPT,,,,,LT,Outpatient,,,,240.9,CIGNA,Commercial,,50,,94.31,94.31,94.31,1 through 10,percent of total billed charges,80.5,161.71,
US Breast Limited Right.,8068447,LOCAL,76642,CPT,,,,,RT,Outpatient,,,,240.9,CIGNA,Commercial,,50,,94.31,94.31,94.31,1 through 10,percent of total billed charges,80.5,161.71,
pneumococcal 23-polyvalent vaccine injectable solution 0.5 mL [CULL],11212160,LOCAL,90732,CPT,,,,,,Outpatient,0.5,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adalimumab Level for IBD QSTC,13864453,LOCAL,80145,CPT,,,,,,Outpatient,,,,46.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amino Acid Analysis, Plasma QSTC",9039235,LOCAL,82139,CPT,,,,,,Outpatient,,,,20.24,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"BK Virus DNA, Quant, RT PCR, Ur QSTC",8764640,LOCAL,87799,CPT,,,,,,Outpatient,,,,51.41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL CV Nurse MRI Monitoring,14671862,LOCAL,76018,CPT,,,,,,Outpatient,,,,75.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Histamine Release Chronic Urticaria QSTC,8764646,LOCAL,86343,CPT,,,,,,Outpatient,,,,14.95,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infliximab Anti-drug Antibody for IBD QSTC,12552286,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infliximab Level for IBD QSTC,13864454,LOCAL,80230,CPT,,,,,,Outpatient,,,,46.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Interleukin-6 (IL-6), Serum QSTC",9708918,LOCAL,83529,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SJMC 76018 MR Safety Implant Electronics Preparation,14671862,LOCAL,76018,CPT,,,,,,Outpatient,,,,75.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"VZV DNA, QL RT PCR QSTC",9777241,LOCAL,87798,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"99202 LEVEL II INITIAL VISIT, FAC CHARGE",12832515,LOCAL,99202,CPT,,,,,,Outpatient,,,,294,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99202 Office Visit New Pt. Level 2,10168481,LOCAL,99202,CPT,,,,,,Outpatient,,,,294,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99212 LEVEL II VISIT CHARGE,9319021,LOCAL,99212,CPT,,,,,,Outpatient,,,,294,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99212 Office Visit Established Pt. Level 2,10168486,LOCAL,99212,CPT,,,,,,Outpatient,,,,294,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
12001 SIMPLE REPAIR OF WOUND TRUNK,13029607,LOCAL,12001,CPT,,,,,,Outpatient,,,,295,CIGNA,Commercial,,50,,129.59,129.59,129.59,1 through 10,percent of total billed charges,181.66,863,
FIRST HOUR DIRECT OBSERVATION CHARGE,8566355,LOCAL,,,G0379,HCPCS,,,25,Outpatient,,,,297,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CHOLANGIO W EXIST CATH S&I,8210339,LOCAL,47531,CPT,,,,,,Outpatient,,,,298,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
esmolol 10 mg/mL-sterile water Sol 250 mL [CULL],11201727,LOCAL,J1806,CPT,,,,,,Outpatient,250,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pregabalin QSTC,8853245,LOCAL,80299,CPT,,,,,,Outpatient,,,,22.37,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
29580 Application of a Paste Boot (Bilateral),12642335,LOCAL,29580,CPT,,,,,,Outpatient,,,,301,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
29580 PT UNNA BOOT APPL,9410275,LOCAL,29580,CPT,,,,,GP,Outpatient,,,,301,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US EXT NONVASC COMPLETE,8230013,LOCAL,76881,CPT,,,,,,Outpatient,,,,248.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US EXT NONVASC LIMITED ANATOMIC SPEC,8230014,LOCAL,76882,CPT,,,,,,Outpatient,,,,248.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Elution,7967778,LOCAL,86860,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Pelvis Complete 3+ Views,1170353,LOCAL,72190,CPT,,,,,,Outpatient,,,,248.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOP ART - LEA W/ TREADMILL,8230021,LOCAL,93924,CPT,,,,,,Outpatient,,,,302,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Lower Ext Doppler w/ Stress Test,1169765,LOCAL,93924,CPT,,,,,,Outpatient,,,,302,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Osseous Survey Infant,1170020,LOCAL,77076,CPT,,,,,,Outpatient,,,,249.98,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Facial Bones < 3 Views,1170139,LOCAL,70140,CPT,,,,,,Outpatient,,,,253.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Orbits Limited,13555005,LOCAL,70140,CPT,,,,,,Outpatient,,,,253.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Hips Infant Limited/Static,8206871,LOCAL,76886,CPT,,,,,,Outpatient,,,,253.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Spinal Canal,1169879,LOCAL,76800,CPT,,,,,,Outpatient,,,,253.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Rare Donor Fee,13517197,LOCAL,86999,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96373- Intra-Arterial Injection,1928304,LOCAL,96373,CPT,,,,,59,Outpatient,,,,308,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96373 S-INJ NON CHEMO IA CHARGE,8049127,LOCAL,96373,CPT,,,,,59,Outpatient,,,,308,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOP VENOUS LOWER EXT UNILATERAL,8200430,LOCAL,93971,CPT,,,,,,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOP VENOUS UPPER EXT UNI OR LTD,8200431,LOCAL,93971,CPT,,,,,,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUP AO IVC ILIAC LIMITED,8200531,LOCAL,93979,CPT,,,,,,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Aorta IVC Iliac Duplex Limited,1169579,LOCAL,93979,CPT,,,,,,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Lower Ext Venous Duplex Left,1169771,LOCAL,93971,CPT,,,,,LT,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Lower Ext Venous Duplex Right,1169773,LOCAL,93971,CPT,,,,,RT,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Upper Ext Venous Duplex Left,1169903,LOCAL,93971,CPT,,,,,LT,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Upper Ext Venous Duplex Right,1169905,LOCAL,93971,CPT,,,,,RT,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUP AV FISTULA OR DIALYSIS GRAFT,8200500,LOCAL,93990,CPT,,,,,,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUPLEX ARTERAL UPPER EXT UNI OR LTD,8200490,LOCAL,93931,CPT,,,,,,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUPLEX ARTERIAL LOWER EXT UNI OR LTD,8200470,LOCAL,93926,CPT,,,,,,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Hemodialysis Duplex Access Lt,8206865,LOCAL,93990,CPT,,,,,,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Hemodialysis Duplex Access Rt,8206868,LOCAL,93990,CPT,,,,,RT,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Lower Ext Arterial Duplex Left,1169761,LOCAL,93926,CPT,,,,,LT,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Lower Ext Arterial Duplex Right,1169763,LOCAL,93926,CPT,,,,,RT,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Upper Ext Arterial Duplex Left,1169897,LOCAL,93931,CPT,,,,,LT,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Upper Ext Arterial Duplex Right,1169899,LOCAL,93931,CPT,,,,,RT,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DAPTOmycin 500 mg intravenous injection [CULL],11210536,LOCAL,J0878,CPT,,,,,,Outpatient,1,EA,,480,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL MG Needle/Wire Loc Breast,13720943,LOCAL,19281,CPT,,,,,,Outpatient,,,,313,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Guided Needle Loc Left,8206592,LOCAL,19281,CPT,,,,,LT,Outpatient,,,,313,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Guided Needle Loc Right,8206595,LOCAL,19281,CPT,,,,,RT,Outpatient,,,,313,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Tissue Exam Level 6,14048000,LOCAL,88309,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IA-2 Antibody QSTC,9039410,LOCAL,86341,CPT,,,,,,Outpatient,,,,28.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Low LSO,9400072,LOCAL,,,L0642,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96422 CHEMO ARTERIAL INFUS UP TO 1HR CHARGE,9404492,LOCAL,96422,CPT,,,,,,Outpatient,,,,318,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3933 OT FINGER ORTHOSIS,9856060,LOCAL,,,L3933,HCPCS,,,,Outpatient,,,,318,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Reticulocyte Separation,8629513,LOCAL,86972,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11105 Punch Biopsy of Skin, Ea Separate/Additional CRRH_GA",13243078,LOCAL,11105,CPT,,,,,,Outpatient,,,,319,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
A. phagocytophilum/E chaffeensis Ab QSTC,13864420,LOCAL,86666,CPT,,,,,,Outpatient,,,,12.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Cervical 2 or 3 Views,1170452,LOCAL,72040,CPT,,,,,,Outpatient,,,,266.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96125 ST-COGNITIVE TEST PER 1HR,9630086,LOCAL,96125,CPT,,,,,GN,Outpatient,,,,323,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Cognitive Test Units,7897180,LOCAL,96125,CPT,,,,,GN,Outpatient,,,,323,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Standardized Cognitive Eval Charge,7897180,LOCAL,96125,CPT,,,,,GN,Outpatient,,,,323,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"45300 PROCTOSIGMOIDOSCOPY, RIGID, DIAGNOSTIC, W OR W/O COLLECTION BY BRUSHING OR WASHING",8934255,LOCAL,45300,CPT,,,,,,Outpatient,,,,129,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BD Bone Density DEXA Axial Skeleton,1167839,LOCAL,77080,CPT,,,,,,Outpatient,,,,267.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OASIS MATRIX WOUND 3X3.5,13962593,LOCAL,,,Q4102,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0463 CR REHAB ASSESSMENT CHARGE,10470016,LOCAL,,,G0463,HCPCS,,,,Outpatient,,,,326,CIGNA,Commercial,,50,,463.2,121.33,500.47,1 through 10,percent of total billed charges,117.82,117.82,
G0463 HOSPITAL OP CLINIC VISIT W PROC MCR ONLY,13436347,LOCAL,,,G0463,HCPCS,,,25,Outpatient,,,,326,CIGNA,Commercial,,50,,463.2,121.33,500.47,1 through 10,percent of total billed charges,117.82,117.82,
G0463 HOSPITAL OUTPATIENT VISIT CHARGE,10470015,LOCAL,,,G0463,HCPCS,,,25,Outpatient,,,,326,CIGNA,Commercial,,50,,463.2,121.33,500.47,1 through 10,percent of total billed charges,117.82,117.82,
G0463 OUTPATIENT CLINIC VISIT,13043743,LOCAL,,,G0463,HCPCS,,,25,Outpatient,,,,326,CIGNA,Commercial,,50,,463.2,121.33,500.47,1 through 10,percent of total billed charges,117.82,117.82,
IVUS ADDL VESSEL,8230049,LOCAL,92979,CPT,,,,,,Outpatient,,,,329,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Susceptibility Aerobic Bacteria,MIC QSTC",9039459,LOCAL,87186,CPT,,,,,,Outpatient,,,,10.38,CIGNA,Commercial,,50,,46.74,16.27,77.21,1 through 10,percent of total billed charges,10.57,35.67132075,
"Susceptibility, Aerobic Bacterium QST",8389539,LOCAL,87186,CPT,,,,,,Outpatient,,,,10.38,CIGNA,Commercial,,50,,46.74,16.27,77.21,1 through 10,percent of total billed charges,10.57,35.67132075,
Administration of Blood (Bridge),8019084,LOCAL,36430,CPT,,,,,,Outpatient,,,,99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TRANSFUSE Fresh Frozen Plasma (Bridge),8482691,LOCAL,36430,CPT,,,,,,Outpatient,,,,99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TRANSFUSE Platelet Product (Bridge),8482692,LOCAL,36430,CPT,,,,,,Outpatient,,,,99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TRANSFUSE Red Blood Cells Leukoreduced (Bridge),8482690,LOCAL,36430,CPT,,,,,,Outpatient,,,,99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Nasal Bones 3+ Views,1170329,LOCAL,70160,CPT,,,,,,Outpatient,,,,273.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bill Only RBC Pretreatment, Chemicals",8629511,LOCAL,86970,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bill Only RBC Pretreatment, Enyzme",8629512,LOCAL,86971,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Injection Ankle Left,1169950,LOCAL,20605,CPT,,,,,LT,Outpatient,,,,336,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Injection Ankle Right,1169952,LOCAL,20605,CPT,,,,,RT,Outpatient,,,,336,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Injection Elbow Right,1169958,LOCAL,20605,CPT,,,,,RT,Outpatient,,,,336,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Injection Wrist Left,1169996,LOCAL,20605,CPT,,,,,LT,Outpatient,,,,336,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Injection Wrist Right,1169998,LOCAL,20605,CPT,,,,,RT,Outpatient,,,,336,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT ALLODERM 1/2,13962573,LOCAL,,,Q4116,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ECHO DOP COLOR FLOW MAPPING,8200220,LOCAL,93325,CPT,,,,,,Outpatient,,,,336,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Lumbosacral 2 or 3 Views,1170470,LOCAL,72100,CPT,,,,,,Outpatient,,,,278.85,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"G0399 HOME SLEEP STUDY, CHARGE",8303751,LOCAL,,,G0399,HCPCS,,,,Outpatient,,,,340,CIGNA,Commercial,,50,,163.26,85.73,514.69,1 through 10,percent of total billed charges,143.05,206.62,
11057 BENIGN LESION PARING(4+),13029576,LOCAL,11057,CPT,,,,,,Outpatient,,,,340,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
16030 Dressing/Debridement Large More than one ext or >10% total body,9400041,LOCAL,16030,CPT,,,,,,Outpatient,,,,863,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15276 APPL-HC SKSB GRT F/N/H/G-AD 25CM CHARGE,9709030,LOCAL,15276,CPT,,,,,,Outpatient,,,,342,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Knee 3 Views Left,1170269,LOCAL,73562,CPT,,,,,LT,Outpatient,,,,282.98,CIGNA,Commercial,,50,,337.98,164.66,511.3,1 through 10,percent of total billed charges,80.5,83.69,
XR Knee 3 Views Right,1170271,LOCAL,73562,CPT,,,,,RT,Outpatient,,,,282.98,CIGNA,Commercial,,50,,337.98,164.66,511.3,1 through 10,percent of total billed charges,80.5,83.69,
XR Barium Swallow,9756897,LOCAL,74220,CPT,,,,,,Outpatient,,,,282.98,CIGNA,Commercial,,50,,164.67,164.67,164.67,1 through 10,percent of total billed charges,83.69,162.76,
XR Swallowing Function w/ Speech,1170500,LOCAL,74230,CPT,,,,,,Outpatient,,,,282.98,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RT CHARGE PFT -> Bronchoprovocation,5267129,LOCAL,94070,CPT,,,,,,Outpatient,,,,345,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ertapenem Sodium 1 gram intravenous injection [CULL],11201820,LOCAL,J1335,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Mandible Complete 4+ Views,1170301,LOCAL,70110,CPT,,,,,,Outpatient,,,,286.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Facial Bones 3+ Views,1170141,LOCAL,70150,CPT,,,,,,Outpatient,,,,286.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Skull < 4 Views,1170436,LOCAL,70250,CPT,,,,,,Outpatient,,,,286.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hips 3-4 Views Bilat,7520612,LOCAL,73522,CPT,,,,,,Outpatient,,,,286.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hips 3-4 Views w/AP Pelvis Bilat,7520615,LOCAL,73522,CPT,,,,,,Outpatient,,,,286.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93799 INPATIENT TEACH CARDIAC REHAB CHARGE,8230066,LOCAL,93799,CPT,,,,,,Outpatient,,,,348,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Wrist Complete 3 Plus Views Right,1170614,LOCAL,73110,CPT,,,,,RT,Outpatient,,,,288.75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Wrist Complete 3+ Views Left,1170612,LOCAL,73110,CPT,,,,,LT,Outpatient,,,,288.75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"COVID-19, Respiratory Panel 2.1(Biofire)",9624028,LOCAL,0202U,CPT,,,,,,Outpatient,,,,500.14,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Antigen Type Group 2,10312940,LOCAL,86902,CPT,,,,,,Outpatient,,,,7.62,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Abdomen 2 Views,8132826,LOCAL,74019,CPT,,,,,,Outpatient,,,,292.88,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3807 Tko Splint,9646038,LOCAL,,,L3807,HCPCS,,,,Outpatient,,,,357,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96132 NEUROPSYCH TESTING EVAL; FIRST HOUR CHARGE,9496220,LOCAL,96132,CPT,,,,,,Outpatient,,,,357,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Cervical 4 or 5 Views,1170454,LOCAL,72050,CPT,,,,,,Outpatient,,,,296.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
albumin human 25% intravenous solution 100 mL [CULL],11281015,LOCAL,P9047,CPT,,,,,,Outpatient,100,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0277 HBO Full Body 30 Min Interval,10015694,LOCAL,,,G0277,HCPCS,,,,Outpatient,,,,360,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Knee Complete 4 Plus Views Left,1170287,LOCAL,73564,CPT,,,,,LT,Outpatient,,,,297,CIGNA,Commercial,,50,,473.81,233.08,523.28,1 through 10,percent of total billed charges,83.69,97.22,
XR Knee Complete 4 Plus Views Right,1170289,LOCAL,73564,CPT,,,,,RT,Outpatient,,,,297,CIGNA,Commercial,,50,,473.81,233.08,523.28,1 through 10,percent of total billed charges,83.69,97.22,
"penicillin G benzathine 600,000 units/mL intramuscular suspension 1 mL [CULL]",11202082,LOCAL,J0561,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ADAMTS13 Activity w/Rfx Inhibitor QSTC,9777262,LOCAL,85397,CPT,,,,,,Outpatient,,,,37.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chromosome Analysis, Blood QSTC",8848485,LOCAL,88262,CPT,,,,,,Outpatient,,,,150.59,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Clinical Indication: QSTC,8848484,LOCAL,88230,CPT,,,,,,Outpatient,,,,139.79,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kleihauer-Betke Stain QSTC,9956031,LOCAL,85460,CPT,,,,,,Outpatient,,,,9.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respirat. Allergy Profile Region VI QSTC,9039268,LOCAL,86003,CPT,,,,,,Outpatient,,,,6.26,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respirat. Allergy Profile Region VI QSTC,9041102,LOCAL,82785,CPT,,,,,,Outpatient,,,,19.75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Allergy Panel Region VI with Reflexes QSTC,14884176,LOCAL,82785,CPT,,,,,,Outpatient,,,,19.75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Thoracic 3 Views,1170486,LOCAL,72072,CPT,,,,,,Outpatient,,,,304.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Ribs 2 Views Left,1170371,LOCAL,71100,CPT,,,,,LT,Outpatient,,,,304.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Ribs 2 Views Right,1170373,LOCAL,71100,CPT,,,,,RT,Outpatient,,,,304.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Breast ABUS Left,8746657,LOCAL,76641,CPT,,,,,LT,Outpatient,,,,306.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Breast ABUS Left.,8567804,LOCAL,76641,CPT,,,,,LT,Outpatient,,,,306.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Breast ABUS Right.,8567807,LOCAL,76641,CPT,,,,,RT,Outpatient,,,,306.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Breast Complete Left.,8068438,LOCAL,76641,CPT,,,,,LT,Outpatient,,,,306.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Breast Complete Right.,8068441,LOCAL,76641,CPT,,,,,RT,Outpatient,,,,306.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Electrocardiogram 12 Lead,2322786,LOCAL,93005,CPT,,,,,,Outpatient,,,,178,CIGNA,Commercial,,50,,85.48,11.26,202.21,1 through 10,percent of total billed charges,38.53,54.31,
99283 - Level 3,2644299,LOCAL,99283,CPT,,,,,25,Outpatient,,,,376,CIGNA,Commercial,,50,,417.63,261.89,573.36,1 through 10,percent of total billed charges,253.15,253.15,
pneumococcal 21-valent conjugate vaccine (cvx 327) - Sus [CULL],11200021,LOCAL,90684,CPT,,,,,,Outpatient,0.5,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
29581 APPL MULTLAY COMPRS LWR LEG,9739188,LOCAL,29581,CPT,,,,,,Outpatient,,,,195,CIGNA,Commercial,,50,,360.97,94.01,578.32,1 through 10,percent of total billed charges,144.26,863,
XR Ribs 3 Views Bilateral,1170375,LOCAL,71110,CPT,,,,,,Outpatient,,,,311.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Thoracic 4+ Views,1170488,LOCAL,72074,CPT,,,,,,Outpatient,,,,311.85,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Sinus Tract SI,2425614,LOCAL,76080,CPT,,,,,,Outpatient,,,,312.68,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Rare Unit,8196052,LOCAL,86999,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Oviduct chromotubation 58350,9093091,LOCAL,58350,CPT,,,,,,Outpatient,,,,4936,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ER ECHOCARDIOGRAM 2D LIMITED,8200203,LOCAL,93308,CPT,,,,,,Outpatient,,,,564,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TRANSPAC REUSABLE CABLE 42661-03,8200204,LOCAL,93308,CPT,,,,,,Outpatient,,,,564,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64445 NERV BLOCK SCIATIC,5661029,LOCAL,64445,CPT,,,,,,Outpatient,,,,382,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"FISH, Chromosome Specific 1 Pr QSTC",13864683,LOCAL,88271,CPT,,,,,,Outpatient,,,,25.7,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Specimen Source: FISH Chrom Pr x1 QSTC,13864676,LOCAL,88273,CPT,,,,,,Outpatient,,,,41.77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
rifAMPin 600 mg intravenous injection [CULL],11211144,LOCAL,J2804,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF Antibody ID,7032173,LOCAL,86870,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Head Newborn,8206862,LOCAL,76506,CPT,,,,,,Outpatient,,,,316.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Very Long Chain Fatty Acids QSTC,8764801,LOCAL,82726,CPT,,,,,,Outpatient,,,,23.7,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Fetal Biophysical Profile w/ Non-Str,1169687,LOCAL,76818,CPT,,,,,,Outpatient,,,,316.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99203  New Patient-Detailed,12642291,LOCAL,99203,CPT,,,,,,Outpatient,,,,387,CIGNA,Commercial,,50,,136.33,74.13,198.52,1 through 10,percent of total billed charges,67.57,67.57,
99203 Office Visit New Pt. Level 3,10168482,LOCAL,99203,CPT,,,,,,Outpatient,,,,387,CIGNA,Commercial,,50,,136.33,74.13,198.52,1 through 10,percent of total billed charges,67.57,67.57,
99203 Office Visit New Pt. Level 3,10168482,LOCAL,99203,CPT,,,,,,Outpatient,,,,387,CIGNA,Commercial,,50,,136.33,74.13,198.52,1 through 10,percent of total billed charges,67.57,67.57,
99213 Established patient visit- level 3,7947777,LOCAL,99213,CPT,,,,,,Outpatient,,,,387,CIGNA,Commercial,,50,,80,52.18,133.96,1 through 10,percent of total billed charges,54.77,54.77,
99213 Established patient visit- level 3,7947777,LOCAL,99213,CPT,,,,,,Outpatient,,,,387,CIGNA,Commercial,,50,,80,52.18,133.96,1 through 10,percent of total billed charges,54.77,54.77,
99213 LEVEL III VISIT CHARGE,9319022,LOCAL,99213,CPT,,,,,,Outpatient,,,,387,CIGNA,Commercial,,50,,80,52.18,133.96,1 through 10,percent of total billed charges,54.77,54.77,
99213 Office Visit Established Pt. Level 3,10168487,LOCAL,99213,CPT,,,,,,Outpatient,,,,387,CIGNA,Commercial,,50,,80,52.18,133.96,1 through 10,percent of total billed charges,54.77,54.77,
LENS #SA60AT,4832535,LOCAL,,,V2632,HCPCS,,,,Outpatient,,,,392,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Creatinine, Random, Ur QSTC",13873086,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,28.64,5.07,45.51,1 through 10,percent of total billed charges,7.16,40.97514925,
"N-Methylhistamine, Random, Ur QSTC",13873083,LOCAL,82542,CPT,,,,,,Outpatient,,,,28.91,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Ribs w/ PA Chest Bilateral,1170377,LOCAL,71111,CPT,,,,,,Outpatient,,,,322.58,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
36010 INTRO CATH SUP/INF VENA CAVA,8266890,LOCAL,36010,CPT,,,,,,Outpatient,,,,393,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INTRO CATH VENA CAVA,8267101,LOCAL,36010,CPT,,,,,,Outpatient,,,,393,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Antenatal Testing Type -> Contraction stress test,10446024,LOCAL,59020,CPT,,,,,,Outpatient,,,,94,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97597 ACTIVE WOUND CARE MANAGEMENT FIRST 20 CM,13048047,LOCAL,97597,CPT,,,,,59,Outpatient,,,,395,CIGNA,Commercial,,50,,33.14,11.61,187.76,19,percent of total billed charges,181.66,863,
97597 DEBRIDE SCISSOR/SCAPEL 20SQ CM,9410251,LOCAL,97597,CPT,,,,,GP,Outpatient,,,,395,CIGNA,Commercial,,50,,33.14,11.61,187.76,19,percent of total billed charges,181.66,863,
97597 DEBRIDEMENT,9866113,LOCAL,97597,CPT,,,,,GO|CO,Outpatient,,,,395,CIGNA,Commercial,,50,,33.14,11.61,187.76,19,percent of total billed charges,181.66,863,
97597 OT SELECT DEBRIDE ME CHARGE,9856113,LOCAL,97597,CPT,,,,,GO,Outpatient,,,,395,CIGNA,Commercial,,50,,33.14,11.61,187.76,19,percent of total billed charges,181.66,863,
97598 Debrid Open wound > 20 sq cm charge,12511973,LOCAL,97598,CPT,,,,,,Outpatient,,,,395,CIGNA,Commercial,,50,,52.63,22.71,82.55,1 through 10,percent of total billed charges,20.42,1466.58,
OT Removal Devitalized Tissue < 20 cm Units,7897756,LOCAL,97597,CPT,,,,,GO,Outpatient,,,,395,CIGNA,Commercial,,50,,33.14,11.61,187.76,19,percent of total billed charges,181.66,863,
OT Removal Tissue <20 Assist Units,7897756,LOCAL,97597,CPT,,,,,CQ,Outpatient,,,,395,CIGNA,Commercial,,50,,33.14,11.61,187.76,19,percent of total billed charges,181.66,863,
OT Selective Debridement Charge,7895252,LOCAL,97597,CPT,,,,,GO,Outpatient,,,,395,CIGNA,Commercial,,50,,33.14,11.61,187.76,19,percent of total billed charges,181.66,863,
Selective Debridement Charge,7895942,LOCAL,97597,CPT,,,,,GP,Outpatient,,,,395,CIGNA,Commercial,,50,,33.14,11.61,187.76,19,percent of total billed charges,181.66,863,
"Selective Debridement Charge -> Yes, total wound surface area, first 20 sq cm or less",8968080,LOCAL,97597,CPT,,,,,GP,Outpatient,,,,395,CIGNA,Commercial,,50,,33.14,11.61,187.76,19,percent of total billed charges,181.66,863,
XR Cystogram Limited,13703435,LOCAL,74430,CPT,,,,,52,Outpatient,,,,554.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Chest,1169635,LOCAL,76604,CPT,,,,,,Outpatient,,,,328.35,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Ribs w/ PA Chest Left,1170379,LOCAL,71101,CPT,,,,,LT,Outpatient,,,,330,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Ribs w/ PA Chest Right,1170381,LOCAL,71101,CPT,,,,,RT,Outpatient,,,,330,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Strep Pneumoniae Ab IgG 23 Serotypes QST,10217037,LOCAL,86581,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Strep pneumoniae IgG Abs, 23 Serotypes QST",14006318,LOCAL,86581,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUP ARTERIAL & VENOUS MAPPING BIL,8200501,LOCAL,93985,CPT,,,,,,Outpatient,,,,401,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Vein Mapping Lower Extremity Bilat,12175095,LOCAL,93985,CPT,,,,,,Outpatient,,,,401,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Vein Mapping Upper Extremity Bilat,12175104,LOCAL,93985,CPT,,,,,,Outpatient,,,,401,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Vessel Mapping for Hemo Access Bilat,10216429,LOCAL,93985,CPT,,,,,,Outpatient,,,,401,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOP ART-LEA WITH ABI SEG PRESSURES,8230018,LOCAL,93923,CPT,,,,,,Outpatient,,,,401,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOP ART-UEA W/ PRESSURES UPPER,8230064,LOCAL,93923,CPT,,,,,,Outpatient,,,,401,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Segmental Pressures LE 3+ Lvls Bilat,1169755,LOCAL,93923,CPT,,,,,,Outpatient,,,,401,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Segmental Pressures UE 3+ Lvls Bilat,9759154,LOCAL,93923,CPT,,,,,,Outpatient,,,,401,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3913 Hand finger orthosis (HFO) without joints may include soft interface straps custom fabricated,9856095,LOCAL,,,L3913,HCPCS,,,,Outpatient,,,,403,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3913 HFO W/O JOINTS CF CHARGE,9856102,LOCAL,,,L3913,HCPCS,,,,Outpatient,,,,403,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Diagnostic Left w/ Tomo.,8058649,LOCAL,77065,CPT,,,,,LT,Outpatient,,,,334.13,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Diagnostic Right w/ Tomo.,8058652,LOCAL,77065,CPT,,,,,RT,Outpatient,,,,334.13,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Digital Diagnostic Left.,7918560,LOCAL,77065,CPT,,,,,LT,Outpatient,,,,334.13,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Digital Diagnostic Right.,7918563,LOCAL,77065,CPT,,,,,RT,Outpatient,,,,334.13,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Implant Diag Left w/ Tomo.,8058658,LOCAL,77065,CPT,,,,,LT,Outpatient,,,,334.13,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Implant Diag Right w/ Tomo.,8058661,LOCAL,77065,CPT,,,,,RT,Outpatient,,,,334.13,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Implant Digital Diag Left.,8058667,LOCAL,77065,CPT,,,,,LT,Outpatient,,,,334.13,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Implant Digital Diag Right.,8058670,LOCAL,77065,CPT,,,,,RT,Outpatient,,,,334.13,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Osseous Survey Limited,1170022,LOCAL,77074,CPT,,,,,,Outpatient,,,,335.78,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
94625 OUTPATIENT PULMONARY REHAB W/O CONTINIOUS MONITORING,10470029,LOCAL,94625,CPT,,,,,,Outpatient,,,,407,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Newborn Screen,8165282,LOCAL,84035,CPT,,,,,,Outpatient,,,,4.78,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Phenylketonuria, Blood SO",9565050,LOCAL,84030,CPT,,,,,,Outpatient,,,,6.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Susceptibility, Yeast, Comp. Panel QSTC",6250013,LOCAL,87186,CPT,,,,,,Outpatient,,,,10.38,CIGNA,Commercial,,50,,46.74,16.27,77.21,1 through 10,percent of total billed charges,10.57,35.67132075,
US OB Limited,1169856,LOCAL,76815,CPT,,,,,,Outpatient,,,,339.08,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"L3702 Elbow orthosis, without joints, may include soft interface, straps, custom fabricated",9646073,LOCAL,,,L3702,HCPCS,,,,Outpatient,,,,412,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3702 ELBOW SPLINT,9856096,LOCAL,,,L3702,HCPCS,,,,Outpatient,,,,412,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL US Echo Dop w/ Spectral Complete,13736513,LOCAL,93320,CPT,,,,,,Outpatient,,,,414,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ECHO DOP W/SPECTRAL COMPLETE,8200180,LOCAL,93320,CPT,,,,,,Outpatient,,,,414,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"epoetin alfa 10,000 units/mL preservative-free Sol 1 mL [CULL]",11202387,LOCAL,J0885,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
74248 XR Small Bowel Follow Thru: AddOn,13626886,LOCAL,74248,CPT,,,,,,Outpatient,,,,341.55,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL XR Small Bowel Follow Thru,13626886,LOCAL,74248,CPT,,,,,,Outpatient,,,,341.55,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64486 TAP BLOCK UNILATERAL BY INJECTION(S),5661023,LOCAL,64486,CPT,,,,,,Outpatient,,,,415,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INTRO CATH RT HEART PA,8267102,LOCAL,36013,CPT,,,,,,Outpatient,,,,415,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
alteplase 2 mg injection [CULL],11201047,LOCAL,J2997,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Supersaturation, U24 SO",13938669,LOCAL,83945,CPT,,,,,,Outpatient,,,,17.34,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
10060 DRAINAGE OF SKIN ABSCESS CHARGE,9704026,LOCAL,10060,CPT,,,,,,Outpatient,,,,420,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
10061 I & D COMPLEX,13048116,LOCAL,10061,CPT,,,,,,Outpatient,,,,420,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Prostate Biopsy,14048008,LOCAL,,,G0416,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Thoracolumbar 2 Views,1170490,LOCAL,72080,CPT,,,,,,Outpatient,,,,349.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
High LSO,9400071,LOCAL,,,L0648,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11102 Tangential Biopsy of Skin, 1 lesion",9620037,LOCAL,11102,CPT,,,,,,Outpatient,,,,427,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
16020 BURN DEBRIDEMENT/DRESSING INITIAL OR SUB,13043448,LOCAL,16020,CPT,,,,,,Outpatient,,,,427,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
16020 Chemical Canterizaiton,9400039,LOCAL,16020,CPT,,,,,,Outpatient,,,,427,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
17250 CAUTERY OF WOUND (ELECTRICAL),13033473,LOCAL,17250,CPT,,,,,,Outpatient,,,,427,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97606 Wound VAC >50 sq cm HBO,10015644,LOCAL,97606,CPT,,,,,,Outpatient,,,,427,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF ABO Discrep (ABSC),13481254,LOCAL,86850,CPT,,,,,,Outpatient,,,,11.72,CIGNA,Commercial,,50,,21.49,7.76,64.58,1 through 10,percent of total billed charges,6.29,48.85,
TELEMETRY DAILY CHARGE,9341351,LOCAL,93229,CPT,,,,,,Outpatient,,,,311,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
13133 >  Each additional 5 cm or less (List separately in addition to primary procedure),12788295,LOCAL,13133,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"13133-Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; e",14746903,LOCAL,13133,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
82570 QST,14798876,LOCAL,82570,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,28.64,5.07,45.51,1 through 10,percent of total billed charges,7.16,40.97514925,
"Leukotriene E4, Random, Urine QST",14798876,LOCAL,82542,CPT,,,,,,Outpatient,,,,28.91,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Antigen Type Group 3,10312933,LOCAL,86902,CPT,,,,,,Outpatient,,,,7.62,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"JC Polyoma Virus DNA, Qual PCR CSF QSTC",10170129,LOCAL,87798,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Skull Complete,1170438,LOCAL,70260,CPT,,,,,,Outpatient,,,,360.53,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only REF Washing,13514969,LOCAL,86999,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US AAA Screening,8058767,LOCAL,76706,CPT,,,,,,Outpatient,,,,362.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Abdomen Limited,1169569,LOCAL,76705,CPT,,,,,,Outpatient,,,,362.18,CIGNA,Commercial,,50,,385.27,108.07,664.6,12,percent of total billed charges,97.22,161.71,
US Renal,7936319,LOCAL,76770,CPT,,,,,,Outpatient,,,,362.18,CIGNA,Commercial,,50,,210.64,101.13,673.1,1 through 10,percent of total billed charges,97.22,245.49,
US Retroperitoneal Complete,1169867,LOCAL,76770,CPT,,,,,,Outpatient,,,,362.18,CIGNA,Commercial,,50,,210.64,101.13,673.1,1 through 10,percent of total billed charges,97.22,245.49,
MG Mammo Digital Screening Bilateral.,7918566,LOCAL,77067,CPT,,,,,,Outpatient,,,,363,CIGNA,Commercial,,50,,393.12,112.04,674.19,1 through 10,percent of total billed charges,74,79.68,
MG Mammo Digital Screening Left.,7949062,LOCAL,77067,CPT,,,,,52|LT,Outpatient,,,,363,CIGNA,Commercial,,50,,393.12,112.04,674.19,1 through 10,percent of total billed charges,74,79.68,
MG Mammo Digital Screening Right.,7949065,LOCAL,77067,CPT,,,,,52|RT,Outpatient,,,,363,CIGNA,Commercial,,50,,393.12,112.04,674.19,1 through 10,percent of total billed charges,74,79.68,
MG Mammo Implant Digital Screening Bil.,8058673,LOCAL,77067,CPT,,,,,,Outpatient,,,,363,CIGNA,Commercial,,50,,393.12,112.04,674.19,1 through 10,percent of total billed charges,74,79.68,
MG Mammo Implant Screening Bil w/ Tomo.,8058682,LOCAL,77067,CPT,,,,,,Outpatient,,,,363,CIGNA,Commercial,,50,,393.12,112.04,674.19,1 through 10,percent of total billed charges,74,79.68,
MG Mammo Screening Bilateral w/ Tomo.,8058685,LOCAL,77067,CPT,,,,,,Outpatient,,,,363,CIGNA,Commercial,,50,,393.12,112.04,674.19,1 through 10,percent of total billed charges,74,79.68,
64450 INJECTION PERIPHERAL NERVE OR BRANCH,5661030,LOCAL,64450,CPT,,,,,,Outpatient,,,,1613,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
57105 - BIOPSY VAGINAL MUCOSA EXTENSIVE,14749499,LOCAL,57105,CPT,,,,,,Outpatient,,,,3180,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
adenosine 3 mg/mL intravenous solution 30 mL [CULL],11201017,LOCAL,J0153,CPT,,,,,,Outpatient,30,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Immunoglobulins Panel, CSF QSTC",13864507,LOCAL,82784,CPT,,,,,,Outpatient,,,,11.16,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LENS PRELOADED #PCB00,4851541,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,CIGNA,Commercial,,50,,421.74,210.6,632.88,1 through 10,percent of total billed charges,145.73,145.73,
LENS PRELOADED DCB00,4855985,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,CIGNA,Commercial,,50,,421.74,210.6,632.88,1 through 10,percent of total billed charges,145.73,145.73,
US Fetal Biophysical Profile w/o N-Str,1169689,LOCAL,76819,CPT,,,,,,Outpatient,,,,369.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"FISH, Prenatal Scr Interp QSTC",13864670,LOCAL,88274,CPT,,,,,,Outpatient,,,,50.86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"FISH, Prenatal Screen QSTC",13864673,LOCAL,88271,CPT,,,,,,Outpatient,,,,25.7,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
zoledronic acid 4 mg/100 mL intravenous solution 100 mL [CULL],11211397,LOCAL,J3489,CPT,,,,,,Outpatient,100,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11104 Punch Biopsy,10017193,LOCAL,11104,CPT,,,,,,Outpatient,,,,449,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Abdomen Series Chest 1 View,1169932,LOCAL,74022,CPT,,,,,,Outpatient,,,,53.63,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Osseous Survey Complete,1170018,LOCAL,77075,CPT,,,,,,Outpatient,,,,372.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Cervical 6+ Views,1170461,LOCAL,72052,CPT,,,,,,Outpatient,,,,376.2,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"96365 IV INFUSION, MEDS, INITIAL 16-90 MINS",7904531,LOCAL,96365,CPT,,,,,,Outpatient,,,,457,CIGNA,Commercial,,50,,582.66,196.74,701.13,1 through 10,percent of total billed charges,192.63,442.94,
"96365- IV tx, first hour",1928299,LOCAL,96365,CPT,,,,,,Outpatient,,,,457,CIGNA,Commercial,,50,,582.66,196.74,701.13,1 through 10,percent of total billed charges,192.63,442.94,
US Aorta,7936256,LOCAL,76775,CPT,,,,,,Outpatient,,,,377.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Retroperitoneal Limited,1169869,LOCAL,76775,CPT,,,,,,Outpatient,,,,377.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
F/U EMBOLIZATION/INFUSION,8210730,LOCAL,75898,CPT,,,,,,Outpatient,,,,379.5,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Extremity Nonvascular Limited Left,2425338,LOCAL,76882,CPT,,,,,LT,Outpatient,,,,248.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Extremity Nonvascular Limited Right,2425341,LOCAL,76882,CPT,,,,,RT,Outpatient,,,,248.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Head/Neck Soft Tissue,1169729,LOCAL,76536,CPT,,,,,,Outpatient,,,,380.33,CIGNA,Commercial,,50,,402.97,121.78,684.15,1 through 10,percent of total billed charges,97.22,161.71,
76000 XR Fluoroscopy Under 1 Hour: AddOn,13658083,LOCAL,76000,CPT,,,,,,Outpatient,,,,380.33,CIGNA,Commercial,,50,,221.3,221.3,221.3,1 through 10,percent of total billed charges,176.48,220.99,
64495 - INJ PARAVERT F JNT L/S 3 LEV,5661079,LOCAL,64495,CPT,,,,,,Outpatient,,,,462,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INTRO CAROTID VERTEBRAL ARTERY,8267188,LOCAL,36100,CPT,,,,,,Outpatient,,,,462,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Urography Retrograde,10454609,LOCAL,74420,CPT,,,,,,Outpatient,,,,383.63,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97607 Disp NP Wound Tx <=50 Sq Cm.,10017200,LOCAL,97607,CPT,,,,,,Outpatient,,,,466,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
".Thyroglobulin, LC/MS/MS QSTC",13864486,LOCAL,84432,CPT,,,,,,Outpatient,,,,19.27,CIGNA,Commercial,,50,,42.23,9.66,74.8,1 through 10,percent of total billed charges,18.43,46.235,
93017 CARDIAC STRESS TEST CHARGE,7938407,LOCAL,93017,CPT,,,,,,Outpatient,,,,469,CIGNA,Commercial,,50,,225.09,456.715,688.34,18,percent of total billed charges,244.97,284.7,
CARDIAC STRESS W/TRACING,8200041,LOCAL,93017,CPT,,,,,,Outpatient,,,,469,CIGNA,Commercial,,50,,225.09,456.715,688.34,18,percent of total billed charges,244.97,284.7,
NM Stress Test Trace,2426005,LOCAL,93017,CPT,,,,,,Outpatient,,,,469,CIGNA,Commercial,,50,,225.09,456.715,688.34,18,percent of total billed charges,244.97,284.7,
64405 Occipital Nerve Block Unilateral,5661077,LOCAL,64405,CPT,,,,,,Outpatient,,,,879,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI 3D Reconstruction w/o Workstation,8108472,LOCAL,76376,CPT,,,,,,Outpatient,,,,391.88,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only REF Thawing & Washing RBC,13514967,LOCAL,86931,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3808 Forearm based orthosis w/o dynamic,9856093,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,,89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OT CARPAL TUNNEL SPLINTS,9646074,LOCAL,,,L3808,HCPCS,,,,Outpatient,,,,89,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF HLA ABSC,13484120,LOCAL,86829,CPT,,,,,,Outpatient,,,,77.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF HPA-1 Typing,13481256,LOCAL,81105,CPT,,,,,,Outpatient,,,,146.66,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93571 Cor Flow Wire 1st Measure,8230055,LOCAL,93571,CPT,,,,,,Outpatient,,,,477,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LENS #ACU0T0,4853561,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,CIGNA,Commercial,,50,,421.74,210.6,632.88,1 through 10,percent of total billed charges,145.73,145.73,
LENS #SN60WF,4891100,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,CIGNA,Commercial,,50,,421.74,210.6,632.88,1 through 10,percent of total billed charges,145.73,145.73,
XR Arthrocentesis Asp/Inj Intmed Jt Lt,14807134,LOCAL,20605,CPT,,,,,LT,Outpatient,,,,336,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrocentesis Asp/Inj Intmed Jt Rt,14807137,LOCAL,20605,CPT,,,,,RT,Outpatient,,,,336,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrocentesis Asp/Inj Major Jt Bilat,14807140,LOCAL,20610,CPT,,,,,50,Outpatient,,,,650,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrocentesis Asp/Inj Major Jt Lt,14807143,LOCAL,20610,CPT,,,,,LT,Outpatient,,,,650,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrocentesis Asp/Inj Major Jt Rt,14807146,LOCAL,20610,CPT,,,,,RT,Outpatient,,,,650,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrocentesis Asp/Inj Small Jt Lt,14807149,LOCAL,20600,CPT,,,,,LT,Outpatient,,,,295,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrocentesis Asp/Inj Small Jt Rt,14807152,LOCAL,20600,CPT,,,,,RT,Outpatient,,,,295,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Colon Barium Enema,9427624,LOCAL,74270,CPT,,,,,,Outpatient,,,,396.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DOP VENOUS LOWER EXT BILATERAL,8200420,LOCAL,93970,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,475.26,231.54,718.97,1 through 10,percent of total billed charges,220.99,245.49,
DOP VENOUS UPPER EXT BIL,8200421,LOCAL,93970,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,475.26,231.54,718.97,1 through 10,percent of total billed charges,220.99,245.49,
DUP AO IVC ILIAC COMPLETE,8200530,LOCAL,93978,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUP CAROTID BILATERAL,8200370,LOCAL,93880,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUP CAROTID UNI,8200380,LOCAL,93882,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUP HEPATOPORTAL INFLOW/OUTFLOW COMP,8200434,LOCAL,93975,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUP MESENTERIC/CELIAC ARTERY IN/OUT COMP,8200433,LOCAL,93975,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUP RENAL ARTERIES INFLOW/OUTFLOW COMP,8200432,LOCAL,93975,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUPLEX ARTERIAL LOWER EXT BIL,8200460,LOCAL,93925,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DUPLEX ARTERIAL UPPER EXT BIL,8200480,LOCAL,93930,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Abdomen Vascular Limited,8206811,LOCAL,93975,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Aorta IVC Iliac Duplex Complete,1169577,LOCAL,93978,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Art/Vein Abd/Pelvis/Scrotal Complete,1169581,LOCAL,93975,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Carotid Duplex Bilateral,1169631,LOCAL,93880,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Carotid Duplex Left,8814383,LOCAL,93882,CPT,,,,,LT,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Carotid Duplex Right,8814386,LOCAL,93882,CPT,,,,,RT,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Lower Ext Arterial Duplex Bilateral,1169759,LOCAL,93925,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Lower Ext Venous Duplex Bilateral,1169769,LOCAL,93970,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,475.26,231.54,718.97,1 through 10,percent of total billed charges,220.99,245.49,
US Renal Artery Duplex Bilateral,4246822,LOCAL,93975,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Upper Ext Arterial Duplex Bilateral,1169895,LOCAL,93930,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Upper Ext Venous Duplex Bilateral,1169901,LOCAL,93970,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,475.26,231.54,718.97,1 through 10,percent of total billed charges,220.99,245.49,
DUP RENAL ARTERIES UNI,8200585,LOCAL,93976,CPT,,,,,,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Renal Artery Duplex Left,4246828,LOCAL,93976,CPT,,,,,LT,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Renal Artery Duplex Right,4246843,LOCAL,93976,CPT,,,,,RT,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acetylcholine Receptor Binding Ab QSTC,8853232,LOCAL,86041,CPT,,,,,,Outpatient,,,,22.08,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Small Bowel Series,12908279,LOCAL,74250,CPT,,,,,,Outpatient,,,,401.78,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chlamydophila pneumoniae QSTC,9727429,LOCAL,87486,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Human RSV A QSTC,9727398,LOCAL,87633,CPT,,,,,,Outpatient,,,,500.14,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mycoplasma pneumoniae QSTC,9727431,LOCAL,87581,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF Antibody Titer,7943112,LOCAL,86886,CPT,,,,,,Outpatient,,,,6.22,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64494 - INJ PARAVERT F JNT L/S 2 LEV,5661036,LOCAL,64494,CPT,,,,,,Outpatient,,,,495,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF HLA PLT ABSC,13479160,LOCAL,86829,CPT,,,,,,Outpatient,,,,77.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF PLT ABSC,13484122,LOCAL,86022,CPT,,,,,,Outpatient,,,,22.04,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95822 EEG COMA OR SLEEP ONLY CHARGE,8687098,LOCAL,95822,CPT,,,,,,Outpatient,,,,499,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EEG EXTENDED 41-60 MINUTES CHARGE,13515636,LOCAL,95812,CPT,,,,,,Outpatient,,,,499,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Diagnostic Bilateral w/ Tomo.,8058646,LOCAL,77066,CPT,,,,,,Outpatient,,,,413.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Digital Diagnostic Bilat.,7918557,LOCAL,77066,CPT,,,,,,Outpatient,,,,413.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Implant Diag Bilateral w/ Tomo.,8058655,LOCAL,77066,CPT,,,,,,Outpatient,,,,413.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Implant Diag Bilateral w/ Tomo.,8058655,LOCAL,G0279,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Mammo Implant Digital Diag Bilateral.,8058664,LOCAL,77066,CPT,,,,,,Outpatient,,,,413.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pen G Benz/Proc (Bicillin CR) [CULL],11202075,LOCAL,J0558,CPT,,,,,,Outpatient,2,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97608 Disp NP Wound Tx >50 Sq Cm.,10017187,LOCAL,97608,CPT,,,,,,Outpatient,,,,505,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bill Only Antigen Type Group 4,10312939,LOCAL,86902,CPT,,,,,,Outpatient,,,,7.62,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64491 INJ PARAVER CERV/THOR 2ND LEVEL,5661064,LOCAL,64491,CPT,,,,,,Outpatient,,,,509,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64492 FACET CERV/THOR 3RD ADDTL LEVEL CHARGE,5661080,LOCAL,64492,CPT,,,,,,Outpatient,,,,509,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"FISH, Locus Specific X2 100 QSTC",13864693,LOCAL,88271,CPT,,,,,,Outpatient,,,,25.7,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - DISK 14MM 2,13962583,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Liver Fibrosis, Fibro-ActiTest Pnl QSTC",8764813,LOCAL,81596,CPT,,,,,,Outpatient,,,,86.63,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Specimen Source: FISH Locus Pr x2 QSTC,13864687,LOCAL,88275,CPT,,,,,,Outpatient,,,,61.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ICD DFT TESTING,8231015,LOCAL,93641,CPT,,,,,,Outpatient,,,,512,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99204 New patient-level 4 specialty clinic,13538609,LOCAL,,,G0463,HCPCS,,,,Outpatient,,,,326,CIGNA,Commercial,,50,,463.2,121.33,500.47,1 through 10,percent of total billed charges,117.82,117.82,
99204 Office Visit New Pt. Level 4,10168483,LOCAL,99204,CPT,,,,,,Outpatient,,,,513,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99204 Office Visit New Pt. Level 4,10168483,LOCAL,99204,CPT,,,,,,Outpatient,,,,513,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99214 LEVEL IV VISIT CHARGE,9319023,LOCAL,99214,CPT,,,,,,Outpatient,,,,513,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99214 Office Visit Established Pt. Level 4,10168488,LOCAL,99214,CPT,,,,,,Outpatient,,,,513,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
New Patient Level 4,13436278,LOCAL,99204,CPT,,,,,25,Outpatient,,,,513,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
New Patient Level 4,13436278,LOCAL,G0463,CPT,,,,,25,Outpatient,,,,326,CIGNA,Commercial,,50,,463.2,121.33,500.47,1 through 10,percent of total billed charges,110.67,117.82,
36593 DECLOT IMPLANT DEVICE/CATHETER CHARGE,8700839,LOCAL,36593,CPT,,,,,,Outpatient,,,,517,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64590  Insertion or replacement of peripheral or gastric neurostimulator pulse generator,8529396,LOCAL,64590,CPT,,,,,,Outpatient,,,,519,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Transvaginal Non-OB,1169889,LOCAL,76830,CPT,,,,,,Outpatient,,,,428.18,CIGNA,Commercial,,50,,747.87,248.98,758.23,1 through 10,percent of total billed charges,97.22,161.71,
JAK2 V617F Mutation Analysis QSTC,9039438,LOCAL,81270,CPT,,,,,,Outpatient,,,,109.99,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TPMT Genotype QSTC,10168397,LOCAL,81335,CPT,,,,,,Outpatient,,,,209.77,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LENS CLAREON CCA0T0,4802028,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,CIGNA,Commercial,,50,,421.74,210.6,632.88,1 through 10,percent of total billed charges,145.73,145.73,
LENS CLAREON CNA0T0,4890000,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,CIGNA,Commercial,,50,,421.74,210.6,632.88,1 through 10,percent of total billed charges,145.73,145.73,
95816 EEG AWAKE AND DROWSY CHARGE,8303772,LOCAL,95816,CPT,,,,,,Outpatient,,,,533,CIGNA,Commercial,,50,,82.5,55,110,1 through 10,percent of total billed charges,284.7,466.96,
ADD'L ART 2ND/3RD ABD,8267115,LOCAL,36248,CPT,,,,,,Outpatient,,,,533,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Lumbosacral 4 Plus Views,1170476,LOCAL,72110,CPT,,,,,,Outpatient,,,,441.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"GAD65, IA-2 and Insulin Autoantibody QSTC",14105691,LOCAL,86337,CPT,,,,,,Outpatient,,,,25.69,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"GAD65, IA-2 and Insulin Autoantibody QSTC.",14621959,LOCAL,86337,CPT,,,,,,Outpatient,,,,25.69,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LENS #DIB00,4803761,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,CIGNA,Commercial,,50,,421.74,210.6,632.88,1 through 10,percent of total billed charges,145.73,145.73,
92978 Cath IVUS First Vessel,8230048,LOCAL,92978,CPT,,,,,,Outpatient,,,,538,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Rho D Immune Globulin, Human, full dose, 300 micrograms, INJ",90620010,LOCAL,J2790,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Knee SI Left,2425410,LOCAL,73580,CPT,,,,,LT,Outpatient,,,,447.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Knee SI Right,2425413,LOCAL,73580,CPT,,,,,RT,Outpatient,,,,447.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abeta 40 - QST,13874686,LOCAL,82233,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abeta 42 - QST,13874685,LOCAL,82234,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PASSY-MUIR PMV2001- 703-2001,8800100,LOCAL,,,L8501,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"epoetin alfa-epbx 20,000 units/mL injectable solution 1 mL [CULL]",11202388,LOCAL,Q5106,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
36005 Venogram Injection,8212037,LOCAL,36005,CPT,,,,,,Outpatient,,,,551,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
levothyroxine 40 mcg (0.04 mg)/mL intravenous solution 5 mL [CULL],11202740,LOCAL,J0650,CPT,,,,,,Outpatient,5,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Upper GI w/ Air Contrast,1170566,LOCAL,74246,CPT,,,,,,Outpatient,,,,492.53,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Upper GI w/ Air w/ Small Bowel,1170570,LOCAL,74246,CPT,,,,,,Outpatient,,,,492.53,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPINEPHrine 1 mg/mL injectable solution 30 mL [CULL],11202381,LOCAL,J0165,CPT,,,,,,Outpatient,30,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Scrotum (Contents),8206982,LOCAL,76870,CPT,,,,,,Outpatient,,,,463.65,CIGNA,Commercial,,50,,540.34,269.82,817.25,1 through 10,percent of total billed charges,97.22,161.71,
US OB Transvaginal,1169861,LOCAL,76817,CPT,,,,,,Outpatient,,,,464.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93308 LMTD STUDENT ECHOCARDIOGRAM CHARGE,6011002,LOCAL,93308,CPT,,,,,,Outpatient,,,,564,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ECHO 2D LTD,8200150,LOCAL,93308,CPT,,,,,,Outpatient,,,,564,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Echo 2D Limited,8071400,LOCAL,93308,CPT,,,,,,Outpatient,,,,564,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumonia Panel (Biofire),9594219,LOCAL,87633,CPT,,,,,,Outpatient,,,,500.14,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tbo-filgrastim 300 mcg/0.5 mL subcutaneous solution 0.5 mL [CULL],11202449,LOCAL,J1447,CPT,,,,,,Outpatient,0.5,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Colon Barium Enema w/ Air Contrast,9427627,LOCAL,74280,CPT,,,,,,Outpatient,,,,467.78,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CARDIAC THROMBOLYTICS IV,8267127,LOCAL,92977,CPT,,,,,,Outpatient,,,,568,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Thyroid Imaging,2426008,LOCAL,78013,CPT,A9512,HCPCS,,,,Outpatient,,,,471.08,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92612 - ENDOSCOPY SWALLOW TST (FEES),9636010,LOCAL,92612,CPT,,,,,GN,Outpatient,,,,575,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92612 Fiber Endo Eval Swallow Video Charge,9410192,LOCAL,92612,CPT,,,,,GN,Outpatient,,,,575,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SLP Fiberoptic Swallow Eval Units,1373844,LOCAL,92612,CPT,,,,,GN,Outpatient,,,,575,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Speech Fiberoptic Swallow Eval Charge,1373844,LOCAL,92612,CPT,,,,,GN,Outpatient,,,,575,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99284 - Level 4,2644300,LOCAL,99284,CPT,,,,,25,Outpatient,,,,576,CIGNA,Commercial,,50,,406.54,276.63,879,1 through 10,percent of total billed charges,389.31,389.31,
3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase (HMGCR) Antibody (IgG) QSTC,13864471,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hips 5+ Views Bilat,7520618,LOCAL,73523,CPT,,,,,,Outpatient,,,,477.68,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Hips 5+ Views w/AP Pelvis Bilat,7520621,LOCAL,73523,CPT,,,,,,Outpatient,,,,477.68,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Barium Swallow w/ Upper GI + KUB,8912828,LOCAL,74240,CPT,,,,,,Outpatient,,,,477.68,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Upper GI,1170562,LOCAL,74240,CPT,,,,,,Outpatient,,,,477.68,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Upper GI w/ Small Bowel,1170574,LOCAL,74240,CPT,,,,,,Outpatient,,,,477.68,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ceftaroline 600 mg intravenous injection [CULL],11201425,LOCAL,J0712,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"ANNA3 Ab, IFA, CSF QSTC",13873554,LOCAL,86255,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"GAD65 Ab, IFA, CSF QSTC",13873575,LOCAL,86341,CPT,,,,,,Outpatient,,,,28.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TPMT Activity QSTC,8764663,LOCAL,84433,CPT,,,,,,Outpatient,,,,26.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CATH PL 1ST ORDER VENOUS,8267186,LOCAL,36011,CPT,,,,,,Outpatient,,,,590,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VENOGRAM INJ BILATERAL,8267755,LOCAL,36005,CPT,,,,,,Outpatient,,,,551,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Barium Swallow w/ Upper GI w/ Air,13554969,LOCAL,74246,CPT,,,,,,Outpatient,,,,492.53,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95819 EEG AWAKE & ASLEEP CHARGE,8704890,LOCAL,95819,CPT,,,,,,Outpatient,,,,599,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Biopsy Abdomen/Retroperitoneal Mass,8565247,LOCAL,76942,CPT,,,,,,Outpatient,,,,497.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Biopsy Liver,1169599,LOCAL,76942,CPT,,,,,,Outpatient,,,,497.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Breast Needle Loc Left,7936259,LOCAL,19285,CPT,,,,,LT,Outpatient,,,,603,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Breast Needle Loc Right,7936262,LOCAL,19285,CPT,,,,,RT,Outpatient,,,,603,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US NEEDLE PLACEMENT CVS,8200510,LOCAL,76942,CPT,,,,,,Outpatient,,,,497.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Cholangiogram T-Tube Check,8207012,LOCAL,47531,CPT,,,,,,Outpatient,,,,298,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - DISK 16MM 2,13962585,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Elbow SI Left,2425398,LOCAL,73085,CPT,,,,,LT,Outpatient,,,,500.78,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Elbow SI Right,2425401,LOCAL,73085,CPT,,,,,RT,Outpatient,,,,500.78,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Bartonella DNA, Qual, RT PCR QSTC",13864512,LOCAL,87471,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BiPAP Charge -> Subsequent,2678299,LOCAL,94003,CPT,,,,,,Outpatient,,,,613,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Lung Perfusion Imaging,1169328,LOCAL,78580,CPT,A9540,HCPCS,,,,Outpatient,,,,508.2,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64999 PERI-INFILTRATION HARDWARE,5661083,LOCAL,64999,CPT,,,,,,Outpatient,,,,620,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3806 OT WRIST HAND FINGER ORTHOSIS,9856094,LOCAL,,,L3806,HCPCS,,,,Outpatient,,,,628,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"penicillin G benzathine 1,200,000 units/2 mL intramuscular suspension 2 mL [CULL]",11202076,LOCAL,J0561,CPT,,,,,,Outpatient,2,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ADD'L ART 2ND/3RD THORAC,8267111,LOCAL,36218,CPT,,,,,,Outpatient,,,,631,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CATH PLACE SEG SUBSEG PA,8267104,LOCAL,36015,CPT,,,,,,Outpatient,,,,637,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Abdomen Complete,1169567,LOCAL,76700,CPT,,,,,,Outpatient,,,,528,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BiPAP Charge -> Initial,2678300,LOCAL,94002,CPT,,,,,,Outpatient,,,,663,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BiPAP/CPAP Mode -> NIMV,2678300,LOCAL,94002,CPT,,,,,,Outpatient,,,,663,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ECHOCARDIOGRAM 2D W/STRESS,8200440,LOCAL,93350,CPT,,,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
16025 DRESS AN/OR DEBMT BURN INI MED CHARGE,8020080,LOCAL,16025,CPT,,,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Heart/Coronary Arteries,9515210,LOCAL,75574,CPT,,,,,,Outpatient,,,,532.13,CIGNA,Commercial,,50,,555.69,132.41,978.97,1 through 10,percent of total billed charges,326.51,565.59,
20610 INJECT MAJOR JOINT,5661087,LOCAL,20610,CPT,,,,,,Outpatient,,,,650,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
methylene blue 5 mg/mL intravenous solution 10 mL [CULL],11202913,LOCAL,Q9968,CPT,,,,,,Outpatient,10,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OASIS MATRIX WOUND 3 X 7 CM,13962592,LOCAL,,,Q4102,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Parathyroid Imaging w/ Spect Inj/Scan,2425984,LOCAL,78071,CPT,A9500,HCPCS,,,,Outpatient,,,,331.65,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Hip SI Left,2425404,LOCAL,73525,CPT,,,,,LT,Outpatient,,,,538.73,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Hip SI Right,2425407,LOCAL,73525,CPT,,,,,RT,Outpatient,,,,538.73,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INTRO EXTREMITY ARTERY,8267105,LOCAL,36140,CPT,,,,,,Outpatient,,,,664,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PERC CHANGE TUBE OR DRAINAGE CATH S&I,8210742,LOCAL,75984,CPT,,,,,,Outpatient,,,,551.93,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Drainage Perc Cath Replace,9343679,LOCAL,75984,CPT,,,,,,Outpatient,,,,551.93,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11107 INCAL BX SKN EA SEP/ADDL CHARGE,9704096,LOCAL,11107,CPT,,,,,,Outpatient,,,,670,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CYSTOGRAM S&I,8211185,LOCAL,74430,CPT,,,,,,Outpatient,,,,554.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Cystogram,4126362,LOCAL,74430,CPT,,,,,,Outpatient,,,,554.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Lw Int Arth/Asp/Inj Left,3148332,LOCAL,20606,CPT,,,,,LT,Outpatient,,,,673,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Lw Int Arth/Asp/Inj Right,3148335,LOCAL,20606,CPT,,,,,RT,Outpatient,,,,673,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Lw Maj Arth/Asp/Inj Left,3148338,LOCAL,20611,CPT,,,,,LT,Outpatient,,,,673,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Lw Maj Arth/Asp/Inj Right,3148341,LOCAL,20611,CPT,,,,,RT,Outpatient,,,,673,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Lw Sm Arth/Asp/Inj Left,6130396,LOCAL,20604,CPT,,,,,LT,Outpatient,,,,673,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Lw Sm Arth/Asp/Inj Right,6130399,LOCAL,20604,CPT,,,,,RT,Outpatient,,,,673,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Up Int Arth/Asp/Inj Left,2425353,LOCAL,20606,CPT,,,,,LT,Outpatient,,,,673,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Up Int Arth/Asp/Inj Right,2425356,LOCAL,20606,CPT,,,,,RT,Outpatient,,,,673,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Up Maj Arth/Asp/Inj Left,2425359,LOCAL,20611,CPT,,,,,LT,Outpatient,,,,673,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Up Maj Arth/Asp/Inj Right,2425362,LOCAL,20611,CPT,,,,,RT,Outpatient,,,,673,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Up Sm Arth/Asp/Inj Left,6130402,LOCAL,20604,CPT,,,,,LT,Outpatient,,,,673,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Joint/Bursa Up Sm Arth/Asp/Inj Right,6130405,LOCAL,20604,CPT,,,,,RT,Outpatient,,,,673,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GASTRO-JEJUNOSTOMY TUBE REPLACEMENT,8200254,LOCAL,49452,CPT,,,,,,Outpatient,,,,676,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Chikungunya Virus RNA, Qual RT PCR QSTC",13864475,LOCAL,87798,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ARTERIAL LINE PLACEMENT,8210320,LOCAL,36620,CPT,,,,,,Outpatient,,,,684,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Hepatobiliary Imaging,2425957,LOCAL,78226,CPT,,,,,,Outpatient,,,,567.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
DART FIRE EDGE SCREW,4810328,LOCAL,,,C1716,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NEPHROSTOGRAM S&I,8212039,LOCAL,74425,CPT,,,,,,Outpatient,,,,575.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
glucagon 1 mg injection [CULL],11282210,LOCAL,J1610,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,688.75,335.56,1041.94,1 through 10,percent of total billed charges,182.45,233.26,
99205 LEVEL V INITIAL VISIT FAC CHARGE,12832503,LOCAL,99205,CPT,,,,,,Outpatient,,,,701,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99205 New patient-level 5 specialty clinic,13538610,LOCAL,,,G0463,HCPCS,,,,Outpatient,,,,326,CIGNA,Commercial,,50,,463.2,121.33,500.47,1 through 10,percent of total billed charges,117.82,117.82,
99205 Office Visit New Pt. Level 5,10168484,LOCAL,99205,CPT,,,,,,Outpatient,,,,701,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99205 Office Visit New Pt. Level 5,10168484,LOCAL,99205,CPT,,,,,,Outpatient,,,,701,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99215 LEVEL V VISIT CHARGE,9322144,LOCAL,99215,CPT,,,,,,Outpatient,,,,701,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99215 Office Visit Established Pt. Level 5,10168489,LOCAL,99215,CPT,,,,,,Outpatient,,,,701,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Leptospira DNA, Qual RT PCR QSTC",13864445,LOCAL,87798,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fungal Sequencing, ITS Region QSTC",13864438,LOCAL,87153,CPT,,,,,,Outpatient,,,,138.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cortisol, Free, LC/MS, Serum QSTC",8972878,LOCAL,82530,CPT,,,,,,Outpatient,,,,20.05,CIGNA,Commercial,,50,,26.99,13.48,40.5,1 through 10,percent of total billed charges,17.73,29.79,
acetylcysteine 20% intravenous solution 30 mL [CULL],11200013,LOCAL,J0132,CPT,,,,,,Outpatient,30,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pneumocystis jirovecii,Qual Real-Time PCR QSTC",9215420,LOCAL,87798,CPT,,,,,,Outpatient,,,,42.11,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CATH PL 2ND ORDER VENOUS,8267187,LOCAL,36012,CPT,,,,,,Outpatient,,,,730,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Gastrointestinal Blood Loss Imaging,1169242,LOCAL,78278,CPT,A9512,HCPCS,,,,Outpatient,,,,603.08,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bird Fancier's Precipitin Panel I QSTC,13864443,LOCAL,86331,CPT,,,,,,Outpatient,,,,14.38,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99285 - Level 5,2644301,LOCAL,99285,CPT,,,,,25,Outpatient,,,,738,CIGNA,Commercial,,50,,1074.3,547.69,1125.01,1 through 10,percent of total billed charges,560.53,560.53,
chlorothiazide 0.5 g intravenous injection [CULL],11240810,LOCAL,J1205,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Breast ABUS Bilateral.,13939856,LOCAL,76641,CPT,,,,,50,Outpatient,,,,306.9,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR ERCP Biliary,8649296,LOCAL,74328,CPT,,,,,,Outpatient,,,,612.98,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR ERCP Pancreatic,8649299,LOCAL,74329,CPT,,,,,,Outpatient,,,,612.98,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
amphotericin B liposomal 50 mg intravenous injection [CULL],11202015,LOCAL,J0289,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GUIDED PERC DRAIN W CATH S&I,8210333,LOCAL,75989,CPT,,,,,,Outpatient,,,,618.75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Pelvic Comp,8206964,LOCAL,76856,CPT,,,,,,Outpatient,,,,622.05,CIGNA,Commercial,,50,,759.64,441.33,1077.94,1 through 10,percent of total billed charges,97.22,245.49,
29445 APPL RIGID LEG CAST,9739196,LOCAL,29445,CPT,,,,,,Outpatient,,,,266,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Hyperthyroid Therapy,8567789,LOCAL,79005,CPT,A9517,HCPCS,,,,Outpatient,,,,622.88,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Scoliosis 1 View,7520627,LOCAL,72081,CPT,,,,,,Outpatient,,,,627.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Wrist SI Left,2425422,LOCAL,73115,CPT,,,,,LT,Outpatient,,,,631.13,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Arthrogram Wrist SI Right,2425425,LOCAL,73115,CPT,,,,,RT,Outpatient,,,,631.13,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E3077 Aph Plt ACDA LR,7266775,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E3087 Aph Plt ACDA LR 1,7266780,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E3088 Aph Plt ACDA LR 2,7266781,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E3089 Aph Plt ACDA LR 3,7266782,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E4643 Aph Plt ACDA LR <3E11,7266909,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E5030 Aph Plt ACDA LR BM,8058823,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E5032 Aph Plt ACDA LR BM 2,8029134,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E5033 Aph Plt ACDA LR BM 3,8058812,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E5036 Aph Plt ACDA LR Irr BM 2,8029108,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E5075 Aph Plt ACDA LR <3E11 BM,8058809,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E9232 Aph Plt ACDA LR BT6,10074919,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
E5031  Aph Plt ACDA LR BM 1,8029138,LOCAL,,,P9035,HCPCS,,,,Outpatient,,,,768,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64480 CERVICAL THORACIC TRANSFORAMINAL EACH AD,5661052,LOCAL,64480,CPT,,,,,,Outpatient,,,,776,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95824 EEG CEREBRAL DEATH EVALUATION ONLY CHARGE,9646722,LOCAL,95824,CPT,,,,,,Outpatient,,,,776,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BREAST SIZER SMOOTH ROUND HIGH 565CC,4850931,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE 505HP,4840154,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"RT CHARGE Ventilator Restart, Ongoing -> Yes",12109384,LOCAL,94003,CPT,,,,,,Outpatient,,,,613,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - 1.75 X 1.75CM,13962575,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Prostaglandin D2 (Pg D2), Urine QST",12667576,LOCAL,84150,CPT,,,,,,Outpatient,,,,50.12,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15274 App Skin Sub Graft (TWSA>100cm2) t/s/l ; add 100 cm 2,12642329,LOCAL,15274,CPT,,,,,,Outpatient,,,,800,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15278 APPL-HC SKSB GRT F/N/H/G-KD A100 CHARGE,9709036,LOCAL,15278,CPT,,,,,,Outpatient,,,,800,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11106 INCAL BX SKN SINGLE LES CHARGE,9704095,LOCAL,11106,CPT,,,,,,Outpatient,,,,800,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aquaporin-4 (AQP4) (NMO-IgG) Antibody with Reflex to Titer, Serum QSTC",10041610,LOCAL,86052,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"JC Polyoma Virus DNA, Qnt PCR, Serum QSTC",10274092,LOCAL,87799,CPT,,,,,,Outpatient,,,,51.41,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"NMO Spectrum Eval (AQP4 w/Rflx toMOG), Serum QSTC",10274088,LOCAL,86052,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"64520 Injection Lumbar or Thoracic, Paravertebral Sympathetic",5661043,LOCAL,64520,CPT,,,,,,Outpatient,,,,806,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
96413 CHEMO IV INFUSION 1ST HR INF CHARGE,9665725,LOCAL,96413,CPT,,,,,,Outpatient,,,,809,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF Genetic RBC Phenotyping,13481257,LOCAL,81403,CPT,,,,,,Outpatient,,,,222.24,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Liver/Spleen Imaging Injection/Scan,1169286,LOCAL,78215,CPT,A9541,HCPCS,,,,Outpatient,,,,669.08,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"CBFB/MYH11 inv(16), Quant RT PCR QSTC",13864502,LOCAL,81401,CPT,,,,,,Outpatient,,,,164.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF PLT Crossmatch,13481259,LOCAL,86022,CPT,,,,,,Outpatient,,,,22.04,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
epoetin alfa 20000 units/mL Sol 1 mL [CULL],11202388,LOCAL,J0885,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admark Phospho Tau/Ttl Ab42 Comments QST,13877904,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admark Phospho Tau/Ttl Ab42 Interp QST,13877902,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admark Phospho Tau/Ttl Ab42 Methods QST,13877905,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
62320 Cervical/Thoracic Epidural without Fluor,5661014,LOCAL,62320,CPT,,,,,,Outpatient,,,,835,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11042 DEB SQ TISSUE-1ST 20SQCM/< CHARGE,9704056,LOCAL,11042,CPT,,,,,,Outpatient,,,,836,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11043 DEB MUS/FASCIA-1ST 20SQCM/< CHARGE,9704059,LOCAL,11043,CPT,,,,,,Outpatient,,,,836,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11045 Debrid bone 1st 20 sq cm charge,12510099,LOCAL,11045,CPT,,,,,,Outpatient,,,,836,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11045 Debrid Sub Tissue > 20 sq cm charge,12511974,LOCAL,11045,CPT,,,,,,Outpatient,,,,836,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11046 DEB MUS/FASCIA-EA ADDL 20SQCM CHARGE,9704068,LOCAL,11046,CPT,,,,,,Outpatient,,,,836,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Urethrocystography Retrograde,1170578,LOCAL,74450,CPT,,,,,,Outpatient,,,,697.95,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MTB Complex Rifampin Resist PCR Sput QSTC,8873578,LOCAL,87801,CPT,,,,,,Outpatient,,,,84.24,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US OB Greater Than 14 Weeks Single,8583651,LOCAL,76805,CPT,,,,,,Outpatient,,,,130.35,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Parathyroid Imaging Injection/Scan,1169316,LOCAL,78070,CPT,A9500,HCPCS,,,,Outpatient,,,,710.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Bone Marrow Imaging Whole Body,1169186,LOCAL,78104,CPT,A9541,HCPCS,,,,Outpatient,,,,711.98,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
16030 DRESS AN/OR DEBMT BURN INI LG CHARGE,8020081,LOCAL,16030,CPT,,,,,,Outpatient,,,,863,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93660 STRESS TILT TABLE CHARGE,8200435,LOCAL,93660,CPT,,,,,,Outpatient,,,,870,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
JEJUNOSTOMY PERC,8200251,LOCAL,49441,CPT,,,,,,Outpatient,,,,870,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial 16S rDNA Sequencing QSTC,8873571,LOCAL,87153,CPT,,,,,,Outpatient,,,,138.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64620 DESTR INTERCOSTAL NERVE,5661066,LOCAL,64620,CPT,,,,,,Outpatient,,,,874,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64634 DESTR FACET CRV/THR EA ADL LVL,5661058,LOCAL,64634,CPT,,,,,,Outpatient,,,,874,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15002 SITE PREP -100 SQCM(TAL),12625535,LOCAL,15002,CPT,,,,,,Outpatient,,,,877,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64405 OCCIPITAL - BILATERAL CHARGE,5661078,LOCAL,64405,CPT,,,,,,Outpatient,,,,879,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
conjugated estrogens 25 mg injection [CULL],11201516,LOCAL,J1410,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
10120 Incision & removal of Foreign Body Simple,9620024,LOCAL,10120,CPT,,,,,,Outpatient,,,,893,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
62321 CERVICAL THORACIC EPIDURAL,5661016,LOCAL,62321,CPT,,,,,,Outpatient,,,,894,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64520 LUMBAR OR THORACIC Sympathetic Charge,5661033,LOCAL,64520,CPT,,,,,,Outpatient,,,,806,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64490 INJ PARAVER CERV/THOR 1ST LEVEL,5661063,LOCAL,64490,CPT,,,,,,Outpatient,,,,895,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INTRO CATH AORTA,8267107,LOCAL,36200,CPT,,,,,,Outpatient,,,,897,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tbo-filgrastim 480 mcg/0.8 mL subcutaneous solution 0.8 mL [CULL],11202451,LOCAL,J1447,CPT,,,,,,Outpatient,0.8,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64479 CERVICAL THORACIC TRANSFORAMINAL EPIDRL,5661051,LOCAL,64479,CPT,,,,,,Outpatient,,,,909,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BUPivacaine liposome 1.3% (13.3 mg/mL) injectable suspension 20 mL [CULL],11202119,LOCAL,J0666,CPT,,,,,,Outpatient,20,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
62323 LUMBAR OR CAUDAL EPIDURAL,5661015,LOCAL,62323,CPT,,,,,,Outpatient,,,,915,CIGNA,Commercial,,50,,145.38,145.38,145.38,1 through 10,percent of total billed charges,633.14,1291,
PERC ASPIRATION DISC,8230054,LOCAL,62267,CPT,,,,,,Outpatient,,,,916,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPIFIX SKIN SUBSTITUTE 14MM,13962560,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64510 NERV BLK STELLATE GANGLION,5661032,LOCAL,64510,CPT,,,,,,Outpatient,,,,922,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when per",9520503,LOCAL,64624,CPT,,,,,,Outpatient,,,,926,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64640 DESTR OTH PERIPHERAL NERVE/BRCH,5661065,LOCAL,64640,CPT,,,,,,Outpatient,,,,927,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
62290 INJ DISKOGRAPH LUMBAR EA LVL,5661062,LOCAL,62290,CPT,,,,,,Outpatient,,,,931,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11400 EXC BENIGN LES-T/A/L 0.5CM OR < CHARGE FACILITY,9704107,LOCAL,11400,CPT,,,,,,Outpatient,,,,935,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PLACE ART 2ND ABD & BELOW,8267113,LOCAL,36246,CPT,,,,,,Outpatient,,,,937,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Kidney Imaging Single w/ Pharm,1169262,LOCAL,78708,CPT,A9562,HCPCS,,,,Outpatient,,,,775.5,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"92950 Cardiopulmonary resuscitation (eg, in cardiac arrest)",7968980,LOCAL,92950,CPT,,,,,,Outpatient,,,,941,CIGNA,Commercial,,50,,1323.28,508.58,1420.4,1 through 10,percent of total billed charges,284.7,1328.28,
92950 Cardiopulmonary Resuscitation Cath Lab,8212013,LOCAL,92950,CPT,,,,,,Outpatient,,,,941,CIGNA,Commercial,,50,,1323.28,508.58,1420.4,1 through 10,percent of total billed charges,284.7,1328.28,
92950 CARDIOPULMONARY RESUSCITATION CHARGE,8207219,LOCAL,92950,CPT,,,,,,Outpatient,,,,941,CIGNA,Commercial,,50,,1323.28,508.58,1420.4,1 through 10,percent of total billed charges,284.7,1328.28,
RT CHARGE Ventilator Initiate -> Yes,12109383,LOCAL,94002,CPT,,,,,,Outpatient,,,,663,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Inflammation Loc Limited,1226092,LOCAL,78800,CPT,,,,,,Outpatient,,,,783.75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Inflammation Loc Limited - Ceretec,1169144,LOCAL,78800,CPT,A9521,HCPCS,,,,Outpatient,,,,783.75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11402 EXC BENIGN LES-T/A/L 1.1-2.0 CM CHARGE,9704151,LOCAL,11402,CPT,,,,,,Outpatient,,,,963,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
62273 BLOOD PATCH,5661017,LOCAL,62273,CPT,,,,,,Outpatient,,,,971,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"13131-Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1",14749500,LOCAL,13131,CPT,,,,,,Outpatient,,,,400,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Fingers w/ Contrast Left,9343664,LOCAL,73219,CPT,,,,,LT,Outpatient,,,,813.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Fingers w/ Contrast Right,9343667,LOCAL,73219,CPT,,,,,RT,Outpatient,,,,813.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Forearm w/ Contrast Left,8206725,LOCAL,73219,CPT,,,,,LT,Outpatient,,,,813.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Forearm w/ Contrast Right,8206727,LOCAL,73219,CPT,,,,,RT,Outpatient,,,,813.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hand w/ Contrast Left,1168924,LOCAL,73219,CPT,,,,,LT,Outpatient,,,,813.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hand w/ Contrast Right,1168926,LOCAL,73219,CPT,,,,,RT,Outpatient,,,,813.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Humerus w/ Contrast Left,8206756,LOCAL,73219,CPT,,,,,LT,Outpatient,,,,813.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Humerus w/ Contrast Right,8206758,LOCAL,73219,CPT,,,,,RT,Outpatient,,,,813.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Scapula w/ Contrast Left,12912778,LOCAL,73219,CPT,,,,,LT,Outpatient,,,,813.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Scapula w/ Contrast Right,12912781,LOCAL,73219,CPT,,,,,RT,Outpatient,,,,813.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Intestine Imaging Meckels,1169254,LOCAL,78290,CPT,A9512,HCPCS,,,,Outpatient,,,,823.35,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Scoliosis 2-3 Views,7520630,LOCAL,72082,CPT,,,,,,Outpatient,,,,827.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR ERCP Biliary and Pancreatic,8207021,LOCAL,74330,CPT,,,,,,Outpatient,,,,827.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR IVP,1170251,LOCAL,74400,CPT,,,,,,Outpatient,,,,831.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64493 - INJ PARAVERT F JNT L/S 1 LEV,5661035,LOCAL,64493,CPT,,,,,,Outpatient,,,,1016,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0260 INJ SACRO JNT ARTHR ANEST/STER,8132863,LOCAL,G0260,CPT,,,,,,Outpatient,,,,1017,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Bone Imaging Limited Injection,1169176,LOCAL,78300,CPT,,,,,,Outpatient,,,,839.85,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"62272 SPINAL PUNC, THERAP",5661019,LOCAL,62272,CPT,,,,,,Outpatient,,,,693,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64425 NERV BLK ILIOINGUINAL,5661024,LOCAL,64425,CPT,,,,,,Outpatient,,,,1032,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64483 TRANS INJ LUMB/SACR-UNILATERAL CHARGE,5661053,LOCAL,64483,CPT,,,,,,Outpatient,,,,1812,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64484 TRANS INJ LUMB/SACR EA ADD UIL CHARGE,5661054,LOCAL,64484,CPT,,,,,,Outpatient,,,,1812,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ECHO COMPLETE W/ DOPPLER,8200137,LOCAL,93306,CPT,,,,,,Outpatient,,,,1036,CIGNA,Commercial,,50,,506.37,105.21,1583.07,1 through 10,percent of total billed charges,501.29,678.38,
ECHOCARDIOGRAM 2D COMPLETE,8200140,LOCAL,93307,CPT,,,,,,Outpatient,,,,1036,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Echo Doppler Complete,7936277,LOCAL,93306,CPT,,,,,,Outpatient,,,,1036,CIGNA,Commercial,,50,,506.37,105.21,1583.07,1 through 10,percent of total billed charges,501.29,678.38,
XR Spine Scoliosis 4-5 Views,7520624,LOCAL,72083,CPT,,,,,,Outpatient,,,,856.35,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
phentolamine 5 mg injection [CULL],11211090,LOCAL,J2760,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TLSO,9400067,LOCAL,,,L0648,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64636 DESTR FACET LUM/SAC EA ADL LVL,5661056,LOCAL,64636,CPT,,,,,,Outpatient,,,,1049,CIGNA,Commercial,,50,,87.97,87.97,87.97,1 through 10,percent of total billed charges,48.01,1250.53,
"12020 SIMP CLOSURE, SUPERF WOUND CHARGE",9303466,LOCAL,12020,CPT,,,,,,Outpatient,,,,1050,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"rabies vaccine, human diploid cell 2.5 intl units intramuscular injection [CULL]",11212261,LOCAL,90675,CPT,,,,,,Outpatient,1,EA,,328,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BAL Fluid Count with Differential,12449847,LOCAL,0202U,CPT,,,,,,Outpatient,,,,500.14,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Spine Scoliosis 6+ Views,7520633,LOCAL,72084,CPT,,,,,,Outpatient,,,,886.05,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Non-Cardiac Vascular Flow Imaging,1169314,LOCAL,78445,CPT,,,,,,Outpatient,,,,886.05,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
63650 IMPLANT NEURSTIM ELEC EPIDURAL,10283945,LOCAL,63650,CPT,,,,,,Outpatient,,,,6563,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
63650 IMPLANT NEURSTIM ELEC EPIDURAL,8132877,LOCAL,63650,CPT,,,,,,Outpatient,,,,6563,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
63650-IMPLANT NEURSTIM ELEC EPIDURAL,8132877,LOCAL,63650,CPT,,,,,,Outpatient,,,,6563,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"rabies vaccine, human diploid cell 2.5 intl units Pow [CULL]",11212261,LOCAL,90675,CPT,,,,,,Outpatient,1,EA,,328,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Nephrostogram,8115644,LOCAL,50430,CPT,,,,,,Outpatient,,,,1389,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Nephrostogram Existing Access,10454588,LOCAL,50431,CPT,,,,,,Outpatient,,,,1389,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
36568 INTRO CATH VENA CAVA PICC CHARGE,13709100,LOCAL,36568,CPT,,,,,,Outpatient,,,,1091,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REPOSITION CVL UNDER FLUORO,8210300,LOCAL,36597,CPT,,,,,,Outpatient,,,,1091,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
omadacycline 100 mg injection [CULL],11290183,LOCAL,J0121,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15271 APP SKN SUB GRFT T/A/L 100 SQ CM FAC CHARGE,12831012,LOCAL,15271,CPT,,,,,,Outpatient,,,,1092,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"15275 App Skin Sub Graft (TWSA<100cm2) f/a/h-ft/aig; 1""25 sp cm",12641291,LOCAL,15275,CPT,,,,,,Outpatient,,,,1092,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Zika Virus RNA, Qual TMA QSTC",13864496,LOCAL,87662,CPT,,,,,,Outpatient,,,,61.57,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CATH LAB STRESS ECHO,8200161,LOCAL,93351,CPT,,,,,,Outpatient,,,,1104,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Stress Echo,7936322,LOCAL,93351,CPT,,,,,,Outpatient,,,,1104,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64581 Incision for implantation of neurostimulator electrode array; sacral nerve,8603595,LOCAL,64581,CPT,,,,,,Outpatient,,,,1108,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CASPR2 Ab QSTC,13864490,LOCAL,86255,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT 625CC 350-1695,4802349,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"KIT D816, Mutation Analysis  QSTC",13864489,LOCAL,81273,CPT,,,,,,Outpatient,,,,149.84,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ganglioside Ab Panel 6 QSTC,13864481,LOCAL,83520,CPT,,,,,,Outpatient,,,,20.72,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64418 - suprascapular nerve block,10452404,LOCAL,64418,CPT,,,,,,Outpatient,,,,693,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64420 NERV BLK INTERCSTL NERV SNGL,5661025,LOCAL,64420,CPT,,,,,,Outpatient,,,,693,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64454 Genicular block,13776911,LOCAL,64454,CPT,,,,,,Outpatient,,,,244,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64461 THORACIC PARAVERTEBRAL BLOCK,13786726,LOCAL,64461,CPT,,,,,,Outpatient,,,,50,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Injection Blood Patch Epidural,7633812,LOCAL,62273,CPT,,,,,,Outpatient,,,,971,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LGI1 Ab QSTC,13864491,LOCAL,86255,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PULM ANGIO DURING CORONARIES,8230012,LOCAL,93568,CPT,,,,,,Outpatient,,,,1134,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92960 ELEC CARDIOVERSION/DEFIBRILATION OP Tech Fee,7969852,LOCAL,92960,CPT,,,,,,Outpatient,,,,1144,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Perc Cor Stent-Drug Eluding LD,4221012,LOCAL,92960,CPT,,,,,,Outpatient,,,,1144,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
10030 FLUID DRAIN SOFT TIS PERC GUID,8266849,LOCAL,10030,CPT,,,,,,Outpatient,,,,704,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Thyroid Uptake Single/Multi,2426011,LOCAL,78014,CPT,,,,,,Outpatient,,,,952.05,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Thyroid w/ Uptake Single,12109219,LOCAL,78014,CPT,A9516,HCPCS,,,,Outpatient,,,,952.05,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NUSHIELD 1.6CM DISC,13962586,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MG Surgical Specimen,9437784,LOCAL,76098,CPT,,,,,,Outpatient,,,,953.7,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GASTROSTOMY TUBE REPLACEMENT,8200253,LOCAL,49450,CPT,,,,,,Outpatient,,,,1166,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
JEJUNOSTOMY REPLACEMENT PERC,8200252,LOCAL,49451,CPT,,,,,,Outpatient,,,,1166,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Critical Care Ill/Injured Patient Init 30-74 Min 99291,2389455,LOCAL,99291,CPT,,,,,25,Outpatient,,,,1181,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"13132 -Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet;",14751269,LOCAL,13132,CPT,,,,,,Outpatient,,,,612,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Myocardial Planar Single Study,2425978,LOCAL,78481,CPT,A9500,HCPCS,,,,Outpatient,,,,982.58,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Breast w/o Contrast Left.,9386272,LOCAL,77046,CPT,,,,,LT,Outpatient,,,,983.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Breast w/o Contrast Right.,9386275,LOCAL,77046,CPT,,,,,RT,Outpatient,,,,983.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL US OB Greater Than 14 Wks Add'l Gest,13579115,LOCAL,76810,CPT,,,,,,Outpatient,,,,990.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US OB Greater Than 14 Weeks Multi,8108499,LOCAL,76810,CPT,,,,,,Outpatient,,,,990.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Tumor Loc Limited,1169410,LOCAL,78800,CPT,,,,,,Outpatient,,,,783.75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Tumor Loc Multiple Areas,1169412,LOCAL,78801,CPT,,,,,,Outpatient,,,,2895.75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PARACENTESIS ABDOMINAL WITH IMAGING,8267134,LOCAL,49083,CPT,,,,,,Outpatient,,,,1208,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Cardiac MUGA,1169208,LOCAL,78472,CPT,A9512,HCPCS,,,,Outpatient,,,,998.25,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Meningitis Panel (BioFire),7909558,LOCAL,87483,CPT,,,,,,Outpatient,,,,500.14,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PLACE ART 1ST ABD & BELOW,8267112,LOCAL,36245,CPT,,,,,,Outpatient,,,,1224,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GRAFIX PRIME 16MM,13962570,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,,3671,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PLACE ART 1ST THORAC/BRAC,8267108,LOCAL,36215,CPT,,,,,,Outpatient,,,,1246,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PLACE ART 2ND THORAC/BRAC,8267109,LOCAL,36216,CPT,,,,,,Outpatient,,,,1246,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PLACE ART 3RD THORAC/BRAC,8267110,LOCAL,36217,CPT,,,,,,Outpatient,,,,1246,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Lung Vent/Perf Imaging,2425966,LOCAL,78582,CPT,A9540,HCPCS,,,,Outpatient,,,,1029.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PLACE ART 3RD ABD & BELOW,8267114,LOCAL,36247,CPT,,,,,,Outpatient,,,,1253,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Lymphoscintigraphy Injection/Scan,1169292,LOCAL,78195,CPT,,,,,,Outpatient,,,,1034.55,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alpha-Globin Gene Deletion/Dupl. QSTC,13864435,LOCAL,81269,CPT,,,,,,Outpatient,,,,242.88,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Kidney Imaging Single w/o Pharm,1169264,LOCAL,78707,CPT,A9562,HCPCS,,,,Outpatient,,,,1051.05,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REF HLA Antibody ID,13479161,LOCAL,86830,CPT,,,,,,Outpatient,,,,114.62,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PERICARDIOCENTESIS INITIAL,8230050,LOCAL,33016,CPT,,,,,,Outpatient,,,,1278,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REMOVAL BILIARY DRAIN CATH,8200538,LOCAL,47537,CPT,,,,,,Outpatient,,,,1278,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Apolipoprotein E Isoform, CSF QST",12677744,LOCAL,82542,CPT,,,,,,Outpatient,,,,28.91,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - DISK 14MM,13962582,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL Selective Add'l Vessel S&I,13635231,LOCAL,75774,CPT,,,,,,Outpatient,,,,1059.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SELECTIVE ADD'L VESSEL S&I,8210640,LOCAL,75774,CPT,,,,,,Outpatient,,,,1059.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CATH PLACE LT RT PA,8267103,LOCAL,36014,CPT,,,,,,Outpatient,,,,1291,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
remdesivir 100 mg Injection [CULL],11201128,LOCAL,J0248,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ECHO LIMITED WITH CONTRAST,8200178,LOCAL,,,C8924,HCPCS,,,,Outpatient,,,,1315,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Echo 2D Limited w/ Contrast,7936274,LOCAL,93308,CPT,C8924,HCPCS,,,,Outpatient,,,,564,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
".MOG Ab, CBA, Serum QSTC",10274091,LOCAL,86362,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Myelin Oligodendrocyte Glycoprotein w/Rfx Titer, Serum QSTC",12613098,LOCAL,86362,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PURAPLY AM COMMERCIAL 1.6CM DISC,13962603,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,,3861,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
36589 - Removal of tunneled central venous catheter,12431092,LOCAL,36589,CPT,,,,,,Outpatient,,,,1316,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
37253 Invasc US Each Addl Vessel,8230057,LOCAL,37253,CPT,,,,,,Outpatient,,,,1323,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"64449 N BLOCK INJ, LUMBAR PLEXUS",8882246,LOCAL,64449,CPT,,,,,,Outpatient,,,,890,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"CRMP5/CV2 Ab, LB QSTC",13873513,LOCAL,84182,CPT,,,,,,Outpatient,,,,35.05,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"GAD65 Ab, LB QSTC",13873519,LOCAL,86341,CPT,,,,,,Outpatient,,,,28.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tocilizumab 20 mg/mL Sol 4 mL [CULL],11260558,LOCAL,J3262,CPT,,,,,,Outpatient,4,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92953 TRANSCUTANEOUS PACING TechFee,8057710,LOCAL,92953,CPT,,,,,,Outpatient,,,,1339,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92953-Temp transcutaneous pacing Charge,8212036,LOCAL,92953,CPT,,,,,,Outpatient,,,,1339,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXTERNAL PACER,4221033,LOCAL,92953,CPT,,,,,,Outpatient,,,,1339,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Testicular Imaging w/ Vasc Flow,8733473,LOCAL,78761,CPT,A9512,HCPCS,,,,Outpatient,,,,1106.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11750 EXCISION NAIL MATRIX PERMANENT CHARGE,9303447,LOCAL,11750,CPT,,,,,,Outpatient,,,,1342,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
33967 Insertion Intra-aortic Percutaneous Device Charge,8211150,LOCAL,33967,CPT,,,,,,Outpatient,,,,1367,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - 3 X 3.5CM,13962577,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ibutilide 0.1 mg/mL intravenous solution 10 mL [CULL],11201842,LOCAL,J1742,CPT,,,,,,Outpatient,10,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Hepatobiliary Imaging w/ Drug,2425957,LOCAL,78226,CPT,A9537,HCPCS,,,,Outpatient,,,,567.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Hepatobiliary Imaging w/ EF,12894248,LOCAL,78227,CPT,A9537,HCPCS,,,,Outpatient,,,,1145.1,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VENOGRAM BILATERAL EXT S&I,8211110,LOCAL,75822,CPT,,,,,,Outpatient,,,,1157.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Venogram Extremity Bilateral,13085158,LOCAL,75822,CPT,,,,,,Outpatient,,,,1157.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NUSHIELD 1.6CM DISC,10510071,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64633 DESTR FACET CERV/THOR SNG LVL,5661057,LOCAL,64633,CPT,,,,,,Outpatient,,,,1416,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64635 DESTR FACET LUM/SAC SINGLE LVL,5661055,LOCAL,64635,CPT,,,,,,Outpatient,,,,1416,CIGNA,Commercial,,50,,325.03,325.03,325.03,1 through 10,percent of total billed charges,1250.53,2315,
93567 Inj Supra Aortography,8230011,LOCAL,93567,CPT,,,,,,Outpatient,,,,1422,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Gastric Emptying Study,1169236,LOCAL,78264,CPT,,,,,,Outpatient,,,,1176.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Bone Spect,1169188,LOCAL,78803,CPT,,,,,,Outpatient,,,,1181.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
APPLY SKIN SUB 1ST 255Q CM LEG UP TO 100,13531303,LOCAL,15271,CPT,,,,,25,Outpatient,,,,1092,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Ankle w/o Contrast Left,1167903,LOCAL,73700,CPT,,,,,LT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,693.22,1 through 10,percent of total billed charges,97.22,170.53,
CT Ankle w/o Contrast Right,1167905,LOCAL,73700,CPT,,,,,RT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,693.22,1 through 10,percent of total billed charges,97.22,170.53,
CT Clavicle w/o Contrast Left,12885310,LOCAL,73200,CPT,,,,,LT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,2152.54,1 through 10,percent of total billed charges,97.22,170.53,
CT Clavicle w/o Contrast Right,12885313,LOCAL,73200,CPT,,,,,RT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,2152.54,1 through 10,percent of total billed charges,97.22,170.53,
CT Elbow w/o Contrast Left,1168002,LOCAL,73200,CPT,,,,,LT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,2152.54,1 through 10,percent of total billed charges,97.22,170.53,
CT Elbow w/o Contrast Right,1168004,LOCAL,73200,CPT,,,,,RT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,2152.54,1 through 10,percent of total billed charges,97.22,170.53,
CT Femur w/o Contrast Left,8202922,LOCAL,73700,CPT,,,,,LT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,693.22,1 through 10,percent of total billed charges,97.22,170.53,
CT Femur w/o Contrast Right,8202924,LOCAL,73700,CPT,,,,,RT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,693.22,1 through 10,percent of total billed charges,97.22,170.53,
CT Foot w/o Contrast Left,1168040,LOCAL,73700,CPT,,,,,LT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,693.22,1 through 10,percent of total billed charges,97.22,170.53,
CT Foot w/o Contrast Right,1168042,LOCAL,73700,CPT,,,,,RT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,693.22,1 through 10,percent of total billed charges,97.22,170.53,
CT Forearm w/o Contrast Left,8202950,LOCAL,73200,CPT,,,,,LT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,2152.54,1 through 10,percent of total billed charges,97.22,170.53,
CT Forearm w/o Contrast Right,8202952,LOCAL,73200,CPT,,,,,RT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,2152.54,1 through 10,percent of total billed charges,97.22,170.53,
CT Hand w/o Contrast Left,1168086,LOCAL,73200,CPT,,,,,LT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,2152.54,1 through 10,percent of total billed charges,97.22,170.53,
CT Hand w/o Contrast Right,1168088,LOCAL,73200,CPT,,,,,RT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,2152.54,1 through 10,percent of total billed charges,97.22,170.53,
CT Hip w/o Contrast Left,1168116,LOCAL,73700,CPT,,,,,LT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,693.22,1 through 10,percent of total billed charges,97.22,170.53,
CT Hip w/o Contrast Right,1168118,LOCAL,73700,CPT,,,,,RT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,693.22,1 through 10,percent of total billed charges,97.22,170.53,
CT Humerus w/o Contrast Left,8202997,LOCAL,73200,CPT,,,,,LT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,2152.54,1 through 10,percent of total billed charges,97.22,170.53,
CT Humerus w/o Contrast Right,8202999,LOCAL,73200,CPT,,,,,RT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,2152.54,1 through 10,percent of total billed charges,97.22,170.53,
CT Knee w/o Contrast Left,1168158,LOCAL,73700,CPT,,,,,LT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,693.22,1 through 10,percent of total billed charges,97.22,170.53,
CT Knee w/o Contrast Right,1168160,LOCAL,73700,CPT,,,,,RT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,693.22,1 through 10,percent of total billed charges,97.22,170.53,
CT Shoulder w/o Contrast Left,1168220,LOCAL,73200,CPT,,,,,LT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,2152.54,1 through 10,percent of total billed charges,97.22,170.53,
CT Shoulder w/o Contrast Right,1168222,LOCAL,73200,CPT,,,,,RT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,2152.54,1 through 10,percent of total billed charges,97.22,170.53,
CT Tibia/Fibula w/o Contrast Left,8203045,LOCAL,73700,CPT,,,,,LT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,693.22,1 through 10,percent of total billed charges,97.22,170.53,
CT Tibia/Fibula w/o Contrast Right,8203047,LOCAL,73700,CPT,,,,,RT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,693.22,1 through 10,percent of total billed charges,97.22,170.53,
CT Wrist w/o Contrast Left,1168341,LOCAL,73200,CPT,,,,,LT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,2152.54,1 through 10,percent of total billed charges,97.22,170.53,
CT Wrist w/o Contrast Right,1168343,LOCAL,73200,CPT,,,,,RT,Outpatient,,,,1191.3,CIGNA,Commercial,,50,,693.22,693.22,2152.54,1 through 10,percent of total billed charges,97.22,170.53,
CT Angio Abdomen Aorta + Iliofemoral,1167851,LOCAL,75635,CPT,,,,,,Outpatient,,,,1202.85,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
37252 Invasc US Initial Vessel,8230056,LOCAL,37252,CPT,,,,,,Outpatient,,,,1464,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15277 App Skin Sub Graft(TWSA>100cm2 f/a/h-ft diag add 100 cm2,12635466,LOCAL,15277,CPT,,,,,,Outpatient,,,,1471,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93312 TEE 2D MM COMPLETE WO CHARGE,8200160,LOCAL,93312,CPT,,,,,,Outpatient,,,,1482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Echo Transesophageal,7936283,LOCAL,93312,CPT,,,,,,Outpatient,,,,1482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0278-CL ILIAC/FEM ANGIO FOR CLOSURE Charge,8212025,LOCAL,,,G0278,HCPCS,,,,Outpatient,,,,1496,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Gastric Emptying w/ SB,10110882,LOCAL,78265,CPT,,,,,,Outpatient,,,,1234.2,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
onabotulinumtoxinA 100 units injection [CULL],11212323,LOCAL,J0585,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Brachial Plexus w/o Contrast Lt,8784911,LOCAL,73221,CPT,,,,,LT,Outpatient,,,,1242.45,CIGNA,Commercial,,50,,806.26,806.26,806.26,1 through 10,percent of total billed charges,220.99,372.26,
MRI Brachial Plexus w/o Contrast Rt,8784914,LOCAL,73221,CPT,,,,,RT,Outpatient,,,,1242.45,CIGNA,Commercial,,50,,806.26,806.26,806.26,1 through 10,percent of total billed charges,220.99,372.26,
MRI Clavicle w/o Contrast Left,9647312,LOCAL,71550,CPT,,,,,LT,Outpatient,,,,1765.5,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Clavicle w/o Contrast Right,9647315,LOCAL,71550,CPT,,,,,RT,Outpatient,,,,1765.5,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Fingers w/o Contrast Left,8513078,LOCAL,73218,CPT,,,,,LT,Outpatient,,,,1242.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Fingers w/o Contrast Right,8513081,LOCAL,73218,CPT,,,,,RT,Outpatient,,,,1242.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Forearm w/o Contrast Lt,8058719,LOCAL,73218,CPT,,,,,LT,Outpatient,,,,1242.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Forearm w/o Contrast Rt,8058722,LOCAL,73218,CPT,,,,,RT,Outpatient,,,,1242.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hand w/o Contrast Left,1168930,LOCAL,73218,CPT,,,,,LT,Outpatient,,,,1242.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hand w/o Contrast Right,1168932,LOCAL,73218,CPT,,,,,RT,Outpatient,,,,1242.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Humerus w/o Contrast Left,8203080,LOCAL,73218,CPT,,,,,LT,Outpatient,,,,1242.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Humerus w/o Contrast Right,8203082,LOCAL,73218,CPT,,,,,RT,Outpatient,,,,1242.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Scapula w/o Contrast Left,9647339,LOCAL,73218,CPT,,,,,LT,Outpatient,,,,1242.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Scapula w/o Contrast Right,9647342,LOCAL,73218,CPT,,,,,RT,Outpatient,,,,1242.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Neck w/o Contrast,1168683,LOCAL,70547,CPT,,,,,,Outpatient,,,,1242.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - DISK 16MM,13962584,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Pelvis w/o Contrast,1168691,LOCAL,72198,CPT,,,,,,Outpatient,,,,1767.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Pelvis w/o Contrast,1168691,LOCAL,C8919,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Myelogram Cervical Spine,1170319,LOCAL,62302,CPT,,,,,,Outpatient,,,,1527,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Myelogram Thoracic Spine,1170327,LOCAL,62303,CPT,,,,,,Outpatient,,,,1527,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Spine Thoracic w/o Contrast,1169066,LOCAL,72146,CPT,,,,,,Outpatient,,,,1268.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ILR REMOVAL,8267777,LOCAL,33286,CPT,,,,,,Outpatient,,,,1548,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Spine Lumbar w/o Contrast,1168246,LOCAL,72131,CPT,,,,,,Outpatient,,,,1286.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Bone Three Phase Study Injection/Scan,1169190,LOCAL,78315,CPT,,,,,,Outpatient,,,,1301.85,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
36002 Pseudoanrsm Repair W Thrombin Us Gud,8212049,LOCAL,36002,CPT,,,,,,Outpatient,,,,1579,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AV FISTULAGRAM S&I,8210332,LOCAL,36901,CPT,,,,,,Outpatient,,,,1588,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"CRMP5/CV2 Ab, LB, CSF QSTC",13873605,LOCAL,84182,CPT,,,,,,Outpatient,,,,35.05,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"GAD65 Ab, LB, CSF QSTC",13873611,LOCAL,86341,CPT,,,,,,Outpatient,,,,28.28,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INTERNAL MAMMARY S&I,8210631,LOCAL,75756,CPT,,,,,,Outpatient,,,,1316.7,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PULMONARY NONSELECTIVE S&I,8210620,LOCAL,75746,CPT,,,,,,Outpatient,,,,1316.7,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Pelvis,1167881,LOCAL,72191,CPT,,,,,,Outpatient,,,,1317.53,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Thoracentesis w/ CT Guidance,2424869,LOCAL,77012,CPT,,,,,,Outpatient,,,,1318.35,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - 1.75 X 1.75 CM,13962574,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Neck Soft Tissue w/o Contrast,1168234,LOCAL,70490,CPT,,,,,,Outpatient,,,,1329.08,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64450 INJECTION ANESTHETIC AGENT PERIPHERAL NE,13437921,LOCAL,64450,CPT,,,,,,Outpatient,,,,1613,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tetanus immune globulin 250 units/mL intramuscular solution 1 mL [CULL],11212346,LOCAL,J1670,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Ankle w/ Contrast Left,1167897,LOCAL,73701,CPT,,,,,LT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,1598.01,778.54,2417.47,1 through 10,percent of total billed charges,162.76,461.98,
CT Ankle w/ Contrast Right,1167899,LOCAL,73701,CPT,,,,,RT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,1598.01,778.54,2417.47,1 through 10,percent of total billed charges,162.76,461.98,
CT Clavicle w/ Contrast Left,12885304,LOCAL,73201,CPT,,,,,LT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Clavicle w/ Contrast Right,12885307,LOCAL,73201,CPT,,,,,RT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Elbow w/ Contrast Left,1167996,LOCAL,73201,CPT,,,,,LT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Elbow w/ Contrast Right,1167998,LOCAL,73201,CPT,,,,,RT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Femur w/ Contrast Left,8202918,LOCAL,73701,CPT,,,,,LT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,1598.01,778.54,2417.47,1 through 10,percent of total billed charges,162.76,461.98,
CT Femur w/ Contrast Right,8202920,LOCAL,73701,CPT,,,,,RT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,1598.01,778.54,2417.47,1 through 10,percent of total billed charges,162.76,461.98,
CT Foot w/ Contrast Left,1168034,LOCAL,73701,CPT,,,,,LT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,1598.01,778.54,2417.47,1 through 10,percent of total billed charges,162.76,461.98,
CT Foot w/ Contrast Right,1168036,LOCAL,73701,CPT,,,,,RT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,1598.01,778.54,2417.47,1 through 10,percent of total billed charges,162.76,461.98,
CT Forearm w/ Contrast Left,8202943,LOCAL,73201,CPT,,,,,LT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Forearm w/ Contrast Right,8202945,LOCAL,73201,CPT,,,,,RT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Hand w/ Contrast Left,1168080,LOCAL,73201,CPT,,,,,LT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Hand w/ Contrast Right,1168082,LOCAL,73201,CPT,,,,,RT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Hip w/ Contrast Left,1168110,LOCAL,73701,CPT,,,,,LT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,1598.01,778.54,2417.47,1 through 10,percent of total billed charges,162.76,461.98,
CT Hip w/ Contrast Right,1168112,LOCAL,73701,CPT,,,,,RT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,1598.01,778.54,2417.47,1 through 10,percent of total billed charges,162.76,461.98,
CT Humerus w/ Contrast Left,8202990,LOCAL,73201,CPT,,,,,LT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Humerus w/ Contrast Right,8202992,LOCAL,73201,CPT,,,,,RT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Knee w/ Contrast Left,1168152,LOCAL,73701,CPT,,,,,LT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,1598.01,778.54,2417.47,1 through 10,percent of total billed charges,162.76,461.98,
CT Knee w/ Contrast Right,1168154,LOCAL,73701,CPT,,,,,RT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,1598.01,778.54,2417.47,1 through 10,percent of total billed charges,162.76,461.98,
CT Shoulder w/ Contrast Left,1168214,LOCAL,73201,CPT,,,,,LT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Shoulder w/ Contrast Right,1168216,LOCAL,73201,CPT,,,,,RT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Tibia/Fibula w/ Contrast Left,8203041,LOCAL,73701,CPT,,,,,LT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,1598.01,778.54,2417.47,1 through 10,percent of total billed charges,162.76,461.98,
CT Tibia/Fibula w/ Contrast Right,8203043,LOCAL,73701,CPT,,,,,RT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,1598.01,778.54,2417.47,1 through 10,percent of total billed charges,162.76,461.98,
CT Wrist w/ Contrast Left,1168335,LOCAL,73201,CPT,,,,,LT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Wrist w/ Contrast Right,1168337,LOCAL,73201,CPT,,,,,RT,Outpatient,,,,1338.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64454 - Injection of anesthetic agent into genicular nerve branches including imaging guidance.,14144343,LOCAL,64454,CPT,,,,,,Outpatient,,,,244,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"64624 Destruction by neurolytic agent, genicular nerve branches",9487180,LOCAL,64624,CPT,,,,,,Outpatient,,,,926,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64421 NERVE BLOCK INTERCOSTAL MULTIPLE NERVES,5661026,LOCAL,64421,CPT,,,,,,Outpatient,,,,890,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15273 ACELLULAR DERM REPL LTH 100 SQ CM,8716218,LOCAL,15273,CPT,,,,,,Outpatient,,,,1631,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PRIMATRIX 3X3,13962595,LOCAL,,,Q4110,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
dimethyl sulfoxide 50% irrigation solution 50 mL [CULL],11205390,LOCAL,J1212,CPT,,,,,,Outpatient,50,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INJ PERC CHOL W EXIS CATH,8210336,LOCAL,47531,CPT,,,,,,Outpatient,,,,298,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Elbow w/o Contrast Left,1168848,LOCAL,73221,CPT,,,,,LT,Outpatient,,,,1242.45,CIGNA,Commercial,,50,,806.26,806.26,806.26,1 through 10,percent of total billed charges,220.99,372.26,
MRI Elbow w/o Contrast Right,1168850,LOCAL,73221,CPT,,,,,RT,Outpatient,,,,1242.45,CIGNA,Commercial,,50,,806.26,806.26,806.26,1 through 10,percent of total billed charges,220.99,372.26,
MRI Shoulder w/o Contrast Left,1169044,LOCAL,73221,CPT,,,,,LT,Outpatient,,,,1242.45,CIGNA,Commercial,,50,,806.26,806.26,806.26,1 through 10,percent of total billed charges,220.99,372.26,
MRI Shoulder w/o Contrast Right,1169046,LOCAL,73221,CPT,,,,,RT,Outpatient,,,,1242.45,CIGNA,Commercial,,50,,806.26,806.26,806.26,1 through 10,percent of total billed charges,220.99,372.26,
MRI Wrist w/o Contrast Left,1169140,LOCAL,73221,CPT,,,,,LT,Outpatient,,,,1242.45,CIGNA,Commercial,,50,,806.26,806.26,806.26,1 through 10,percent of total billed charges,220.99,372.26,
MRI Wrist w/o Contrast Right,1169142,LOCAL,73221,CPT,,,,,RT,Outpatient,,,,1242.45,CIGNA,Commercial,,50,,806.26,806.26,806.26,1 through 10,percent of total billed charges,220.99,372.26,
ASPIRATION / INJECTION OF RENAL PELVIS,8210655,LOCAL,50390,CPT,,,,,,Outpatient,,,,1682,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Femur w/o Contrast Lt,8058707,LOCAL,73718,CPT,,,,,LT,Outpatient,,,,1389.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Femur w/o Contrast Rt,8058710,LOCAL,73718,CPT,,,,,RT,Outpatient,,,,1389.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Foot w/o Contrast Left,1168890,LOCAL,73718,CPT,,,,,LT,Outpatient,,,,1389.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Foot w/o Contrast Right,1168892,LOCAL,73718,CPT,,,,,RT,Outpatient,,,,1389.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Tibia/Fibula w/o Contrast Left,8206789,LOCAL,73718,CPT,,,,,LT,Outpatient,,,,1389.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Tibia/Fibula w/o Contrast Right,8206791,LOCAL,73718,CPT,,,,,RT,Outpatient,,,,1389.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Neck w/ Contrast,1168681,LOCAL,70548,CPT,,,,,,Outpatient,,,,1389.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOEXCEL SKIN SUBSTITUTE 18MM,13962552,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LENS TORIC #SA6AT4,4853560,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,CIGNA,Commercial,,50,,421.74,210.6,632.88,1 through 10,percent of total billed charges,145.73,145.73,
LENS TORIC ABSORBING SA6AT5,4853594,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,CIGNA,Commercial,,50,,421.74,210.6,632.88,1 through 10,percent of total billed charges,145.73,145.73,
IR Venogram Cava Superior1,8071895,LOCAL,75827,CPT,,,,,,Outpatient,,,,1392.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SUPERIOR VENA CAVA S&I,8210670,LOCAL,75827,CPT,,,,,,Outpatient,,,,1392.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VENOGRAM UNILATERAL EXT S&I,8211100,LOCAL,75820,CPT,,,,,,Outpatient,,,,1392.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Venogram Extremity Left,8115647,LOCAL,75820,CPT,,,,,LT,Outpatient,,,,1392.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Venogram Extremity Right,8115650,LOCAL,75820,CPT,,,,,RT,Outpatient,,,,1392.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Procedure Performed. -> Paracentesis,9739222,LOCAL,49082,CPT,,,,,,Outpatient,,,,1691,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Pelvis w/ Contrast,1168689,LOCAL,72198,CPT,,,,,,Outpatient,,,,1767.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Pelvis w/ Contrast,1168689,LOCAL,C8918,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Bone Imaging Whole Body Injection,1169180,LOCAL,78306,CPT,,,,,,Outpatient,,,,1407.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Lower Extremity Bilateral,8058637,LOCAL,73706,CPT,,,,,,Outpatient,,,,1414.88,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Lower Extremity Left,1167875,LOCAL,73706,CPT,,,,,LT,Outpatient,,,,1414.88,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Lower Extremity Right,1167877,LOCAL,73706,CPT,,,,,RT,Outpatient,,,,1414.88,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Spine Thoracic w/ Contrast,1169064,LOCAL,72147,CPT,,,,,,Outpatient,,,,1414.88,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOEXCEL PLUS 17MM,13962547,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C8925 TEE COMPLETE 2D WWO CHARGE,8200184,LOCAL,,,C8925,HCPCS,,,,Outpatient,,,,1718,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ECHO COMPLETE WITH DOP/CONTRAST,8200176,LOCAL,,,C8929,HCPCS,,,,Outpatient,,,,1718,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Echo Doppler Complete w/ Contrast,13780988,LOCAL,93306,CPT,C8929,HCPCS,,,,Outpatient,,,,1036,CIGNA,Commercial,,50,,506.37,105.21,1583.07,1 through 10,percent of total billed charges,678.38,722.32,
95805 MAINTENANCE OF WAKEFULNESS CHARGE,9569825,LOCAL,95805,CPT,,,,,,Outpatient,,,,1724,CIGNA,Commercial,,50,,1492.64,631.47,2353.81,1 through 10,percent of total billed charges,485.11,1113.98,
95805 MSLT CHARGES,8795717,LOCAL,95805,CPT,,,,,,Outpatient,,,,1724,CIGNA,Commercial,,50,,1492.64,631.47,2353.81,1 through 10,percent of total billed charges,485.11,1113.98,
95805 MSLT/MWT CHARGES,9442365,LOCAL,95805,CPT,,,,,,Outpatient,,,,1724,CIGNA,Commercial,,50,,1492.64,631.47,2353.81,1 through 10,percent of total billed charges,485.11,1113.98,
".MOG Ab, Titer QSTC",13864468,LOCAL,86362,CPT,,,,,,Outpatient,,,,14.46,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PURAPLY AM 2X2 COMMERCIAL 4SQ CM,13962597,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,,3861,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Spine Lumbar w/ Contrast,1168244,LOCAL,72132,CPT,,,,,,Outpatient,,,,1433.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Brain/Head w/o Contrast,1168653,LOCAL,70544,CPT,,,,,,Outpatient,,,,1442.93,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Lower Extremity w/ + w/o Cnt Left,1168663,LOCAL,73725,CPT,,,,,LT,Outpatient,,,,1442.93,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Lower Extremity w/ + w/o Cnt Right,1168665,LOCAL,73725,CPT,,,,,RT,Outpatient,,,,1442.93,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRV Head w/o Contrast,8450965,LOCAL,70544,CPT,,,,,,Outpatient,,,,1442.93,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Clavicle w/ + w/o Contrast Left,12885298,LOCAL,73202,CPT,,,,,LT,Outpatient,,,,1445.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Clavicle w/ + w/o Contrast Right,12885301,LOCAL,73202,CPT,,,,,RT,Outpatient,,,,1445.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Elbow w/ + w/o Contrast Left,8202901,LOCAL,73202,CPT,,,,,LT,Outpatient,,,,1445.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Elbow w/ + w/o Contrast Right,8202903,LOCAL,73202,CPT,,,,,RT,Outpatient,,,,1445.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Forearm w/ + w/o Contrast Left,8202936,LOCAL,73202,CPT,,,,,LT,Outpatient,,,,1445.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Forearm w/ + w/o Contrast Right,8202938,LOCAL,73202,CPT,,,,,RT,Outpatient,,,,1445.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Hand w/ + w/o Contrast Left,8202957,LOCAL,73202,CPT,,,,,LT,Outpatient,,,,1445.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Hand w/ + w/o Contrast Right,8202959,LOCAL,73202,CPT,,,,,RT,Outpatient,,,,1445.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Humerus w/ + w/o Contrast Left,8202983,LOCAL,73202,CPT,,,,,LT,Outpatient,,,,1445.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Humerus w/ + w/o Contrast Right,8202985,LOCAL,73202,CPT,,,,,RT,Outpatient,,,,1445.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Shoulder w/ + w/o Contrast Left,8203023,LOCAL,73202,CPT,,,,,LT,Outpatient,,,,1445.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Shoulder w/ + w/o Contrast Right,8203025,LOCAL,73202,CPT,,,,,RT,Outpatient,,,,1445.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Wrist w/ + w/o Contrast Left,8203057,LOCAL,73202,CPT,,,,,LT,Outpatient,,,,1445.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Wrist w/ + w/o Contrast Right,8203059,LOCAL,73202,CPT,,,,,RT,Outpatient,,,,1445.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Spine Thoracic w/o Contrast,1168252,LOCAL,72128,CPT,,,,,,Outpatient,,,,1450.35,CIGNA,Commercial,,50,,843.83,843.83,843.83,1 through 10,percent of total billed charges,97.22,170.53,
CT Spine Cervical w/o Contrast,1168240,LOCAL,72125,CPT,,,,,,Outpatient,,,,1454.48,CIGNA,Commercial,,50,,846.15,292.9,2628.08,30,percent of total billed charges,97.22,170.53,
CT Abdomen w/ Oral Contrast Only,8206354,LOCAL,74150,CPT,,,,,,Outpatient,,,,1459.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Abdomen w/o Contrast,1167849,LOCAL,74150,CPT,,,,,,Outpatient,,,,1459.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Pelvis w/ Oral Contrast Only,8206452,LOCAL,72192,CPT,,,,,,Outpatient,,,,1459.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Pelvis w/o Contrast,1168198,LOCAL,72192,CPT,,,,,,Outpatient,,,,1459.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Ankle w/o Contrast Left,1168750,LOCAL,73721,CPT,,,,,LT,Outpatient,,,,1466.03,CIGNA,Commercial,,50,,852.77,852.77,852.77,1 through 10,percent of total billed charges,220.99,372.26,
MRI Ankle w/o Contrast Right,1168752,LOCAL,73721,CPT,,,,,RT,Outpatient,,,,1466.03,CIGNA,Commercial,,50,,852.77,852.77,852.77,1 through 10,percent of total billed charges,220.99,372.26,
MRI Hip w/o Contrast Left,1168948,LOCAL,73721,CPT,,,,,LT,Outpatient,,,,1466.03,CIGNA,Commercial,,50,,852.77,852.77,852.77,1 through 10,percent of total billed charges,220.99,372.26,
MRI Hip w/o Contrast Right,1168950,LOCAL,73721,CPT,,,,,RT,Outpatient,,,,1466.03,CIGNA,Commercial,,50,,852.77,852.77,852.77,1 through 10,percent of total billed charges,220.99,372.26,
MRI Knee w/o Contrast Left,1168984,LOCAL,73721,CPT,,,,,LT,Outpatient,,,,1466.03,CIGNA,Commercial,,50,,852.77,852.77,852.77,1 through 10,percent of total billed charges,220.99,372.26,
MRI Knee w/o Contrast Right,1168986,LOCAL,73721,CPT,,,,,RT,Outpatient,,,,1466.03,CIGNA,Commercial,,50,,852.77,852.77,852.77,1 through 10,percent of total billed charges,220.99,372.26,
CT Neck Soft Tissue w/ Contrast,1168232,LOCAL,70491,CPT,,,,,,Outpatient,,,,1475.93,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Abdomen w/o Contrast,1168639,LOCAL,74185,CPT,,,,,,Outpatient,,,,2017.13,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64483 TRANS INJ LUMB/SACR-BILATERAL CHARGE,5661040,LOCAL,64483,CPT,,,,,,Outpatient,,,,1812,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64484 TRANS INJ LUMB/SACR EA ADD BIL CHARGE,5661049,LOCAL,64484,CPT,,,,,,Outpatient,,,,1812,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Chest w/o Contrast,1168647,LOCAL,71555,CPT,,,,,,Outpatient,,,,1645.05,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Chest w/o Contrast,1168647,LOCAL,C8910,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Abdomen w/o Contrast,1168734,LOCAL,74181,CPT,,,,,,Outpatient,,,,1503.98,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI MRCP w/o Contrast,8203102,LOCAL,74181,CPT,,,,,,Outpatient,,,,1503.98,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Spine Cervical w/o Contrast,1169054,LOCAL,72141,CPT,,,,,,Outpatient,,,,1503.98,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Spine Lumbar w/o Contrast,1169060,LOCAL,72148,CPT,,,,,,Outpatient,,,,1503.98,CIGNA,Commercial,,50,,874.95,874.95,874.95,1 through 10,percent of total billed charges,220.99,372.26,
CT Brain/Head Stroke Alert,8202967,LOCAL,70450,CPT,,,,,,Outpatient,,,,1510.58,CIGNA,Commercial,,50,,878.79,240.74,2775.26,54,percent of total billed charges,97.22,461.98,
CT Brain/Head w/o Contrast,1168094,LOCAL,70450,CPT,,,,,,Outpatient,,,,1510.58,CIGNA,Commercial,,50,,878.79,240.74,2775.26,54,percent of total billed charges,97.22,461.98,
PLACE CENTRAL VENOUS LINE,8210290,LOCAL,36556,CPT,,,,,,Outpatient,,,,1853,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Brachial Plexus w/ Contrast Lt,10558521,LOCAL,73222,CPT,,,,,LT,Outpatient,,,,1532.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Brachial Plexus w/ Contrast Rt,10558524,LOCAL,73222,CPT,,,,,RT,Outpatient,,,,1532.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Clavicle w/ Contrast Left,12912772,LOCAL,71551,CPT,,,,,LT,Outpatient,,,,1532.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Clavicle w/ Contrast Right,12912775,LOCAL,71551,CPT,,,,,RT,Outpatient,,,,1532.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Elbow w/ Contrast Left,1168842,LOCAL,73222,CPT,,,,,LT,Outpatient,,,,1532.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Elbow w/ Contrast Right,1168844,LOCAL,73222,CPT,,,,,RT,Outpatient,,,,1532.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Shoulder w/ Contrast Left,1169038,LOCAL,73222,CPT,,,,,LT,Outpatient,,,,1532.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Shoulder w/ Contrast Right,1169040,LOCAL,73222,CPT,,,,,RT,Outpatient,,,,1532.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Wrist w/ Contrast Left,1169134,LOCAL,73222,CPT,,,,,LT,Outpatient,,,,1532.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Wrist w/ Contrast Right,1169136,LOCAL,73222,CPT,,,,,RT,Outpatient,,,,1532.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOEXCEL SKIN SUBSTITUTE 1.5CM X 1.5CM,13962551,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Femur w/ Contrast Left,8206704,LOCAL,73719,CPT,,,,,LT,Outpatient,,,,1536.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Femur w/ Contrast Right,8206706,LOCAL,73719,CPT,,,,,RT,Outpatient,,,,1536.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Foot w/ Contrast Left,1168884,LOCAL,73719,CPT,,,,,LT,Outpatient,,,,1536.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Foot w/ Contrast Right,1168886,LOCAL,73719,CPT,,,,,RT,Outpatient,,,,1536.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Tibia/Fibula w/ Contrast Left,8206783,LOCAL,73719,CPT,,,,,LT,Outpatient,,,,1536.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Tibia/Fibula w/ Contrast Right,8206785,LOCAL,73719,CPT,,,,,RT,Outpatient,,,,1536.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Chest,1167863,LOCAL,71275,CPT,,,,,,Outpatient,,,,1539.45,CIGNA,Commercial,,50,,1794,313.55,2839.96,1 through 10,percent of total billed charges,162.76,565.59,
20220 BIOPSY BONE TROC/NDL SUPERFICL CHARGE,9709066,LOCAL,20220,CPT,,,,,,Outpatient,,,,1868,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Orbit Sella etc. or IAC w/o Cont,8362458,LOCAL,70480,CPT,,,,,,Outpatient,,,,1541.1,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Antenatal Testing Type -> Non-Stress test,9848446,LOCAL,59025,CPT,,,,,,Outpatient,,,,1876,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non Stress Test Charge,9919812,LOCAL,59025,CPT,,,,,,Outpatient,,,,1876,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abeta 40 QST,13873829,LOCAL,82542,CPT,,,,,,Outpatient,,,,28.91,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abeta 42/40 Ratio QST,13873830,LOCAL,82172,CPT,,,,,,Outpatient,,,,25.31,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Pelvis w/o Contrast,1169028,LOCAL,72195,CPT,,,,,,Outpatient,,,,1586.48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Lower Extremity w/o Contrast Left,1168675,LOCAL,73725,CPT,,,,,LT,Outpatient,,,,1442.93,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Lower Extremity w/o Contrast Right,1168677,LOCAL,73725,CPT,,,,,RT,Outpatient,,,,1442.93,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Abdomen,1167853,LOCAL,74175,CPT,,,,,,Outpatient,,,,1590.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI TMJ,1169068,LOCAL,70336,CPT,,,,,,Outpatient,,,,1594.73,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Spine Thoracic w/ Contrast,1168250,LOCAL,72129,CPT,,,,,,Outpatient,,,,1597.2,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Spine Cervical w/ Contrast,1168238,LOCAL,72126,CPT,,,,,,Outpatient,,,,1601.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Cisternography Injection,1169226,LOCAL,78630,CPT,A9548,HCPCS,,,,Outpatient,,,,1601.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Brain/Head,1167871,LOCAL,70496,CPT,,,,,,Outpatient,,,,1603.8,CIGNA,Commercial,,50,,2093.01,1101.3,2531.43,1 through 10,percent of total billed charges,162.76,565.59,
CT Angio Upper Extremity Bilateral,8058640,LOCAL,73206,CPT,,,,,,Outpatient,,,,1603.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Upper Extremity Left,1167885,LOCAL,73206,CPT,,,,,LT,Outpatient,,,,1603.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Upper Extremity Right,1167887,LOCAL,73206,CPT,,,,,RT,Outpatient,,,,1603.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Abdomen w/ Contrast,1167847,LOCAL,74160,CPT,,,,,,Outpatient,,,,1605.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Abdomen w/ Contrast + Oral,13452972,LOCAL,74160,CPT,,,,,,Outpatient,,,,1605.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Pelvis w/ Contrast,1168196,LOCAL,72193,CPT,,,,,,Outpatient,,,,1605.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Pelvis w/ Contrast + Oral,13554960,LOCAL,72193,CPT,,,,,,Outpatient,,,,1605.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Ankle w/ Contrast Left,1168744,LOCAL,73722,CPT,,,,,LT,Outpatient,,,,1612.05,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Ankle w/ Contrast Right,1168746,LOCAL,73722,CPT,,,,,RT,Outpatient,,,,1612.05,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hip w/ Contrast Left,1168942,LOCAL,73722,CPT,,,,,LT,Outpatient,,,,1612.05,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hip w/ Contrast Right,1168944,LOCAL,73722,CPT,,,,,RT,Outpatient,,,,1612.05,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Knee w/ Contrast Left,1168978,LOCAL,73722,CPT,,,,,LT,Outpatient,,,,1612.05,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Knee w/ Contrast Right,1168980,LOCAL,73722,CPT,,,,,RT,Outpatient,,,,1612.05,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST 360CC,4850676,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Neck,1167879,LOCAL,70498,CPT,,,,,,Outpatient,,,,1630.2,CIGNA,Commercial,,50,,2546.37,413.78,3033.49,1 through 10,percent of total billed charges,162.76,565.59,
CT Chest High Resolution,8658939,LOCAL,71250,CPT,,,,,,Outpatient,,,,1635.15,CIGNA,Commercial,,50,,951.31,358.28,2418.29,1 through 10,percent of total billed charges,97.22,461.98,
CT Chest High Resolution w/o Contrast,8658939,LOCAL,71250,CPT,,,,,,Outpatient,,,,1635.15,CIGNA,Commercial,,50,,951.31,358.28,2418.29,1 through 10,percent of total billed charges,97.22,461.98,
CT Chest w/o Contrast,8071395,LOCAL,71250,CPT,,,,,,Outpatient,,,,1635.15,CIGNA,Commercial,,50,,951.31,358.28,2418.29,1 through 10,percent of total billed charges,97.22,170.53,
CT Low Dose Lung Screening,8090304,LOCAL,71271,CPT,,,,,,Outpatient,,,,1635.15,CIGNA,Commercial,,50,,951.31,398.63,951.31,1 through 10,percent of total billed charges,97.22,170.53,
MRA Abdomen w/ Contrast,1168637,LOCAL,74185,CPT,,,,,,Outpatient,,,,2017.13,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Chest w/ Contrast,1168645,LOCAL,71555,CPT,,,,,,Outpatient,,,,1645.05,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Chest w/ Contrast,1168645,LOCAL,C8909,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Abdomen w/ Contrast,1168732,LOCAL,74182,CPT,,,,,,Outpatient,,,,1650.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Spine Cervical w/ Contrast,1169052,LOCAL,72142,CPT,,,,,,Outpatient,,,,1650.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Spine Lumbar w/ Contrast,1169058,LOCAL,72149,CPT,,,,,,Outpatient,,,,1650.83,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Brain/Head w/ Contrast,1168092,LOCAL,70460,CPT,,,,,,Outpatient,,,,1657.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
immune globulin intravenous and subcutaneous 10% injectable solution 50 mL [CULL],11205108,LOCAL,J1561,CPT,,,,,,Outpatient,50,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Maxillofacial w/o Contrast,1168186,LOCAL,70486,CPT,,,,,,Outpatient,,,,1678.88,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Central Line Access Type. -> Peripherally inserted central catheter (PICC),9344166,LOCAL,36569,CPT,,,,,,Outpatient,,,,2042,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Orbit Sella etc. or IAC w/ Cont,8362455,LOCAL,70481,CPT,,,,,,Outpatient,,,,1687.95,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Tumor Loc Whole Body 2+ Days,1169416,LOCAL,78804,CPT,,,,,,Outpatient,,,,1689.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Tumor Loc Whole Body 2+ Days Gallium,1169418,LOCAL,78804,CPT,A9556,HCPCS,,,,Outpatient,,,,1689.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Ankle w/ + w/o Contrast Left,8202894,LOCAL,73702,CPT,,,,,LT,Outpatient,,,,1704.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Ankle w/ + w/o Contrast Right,8202896,LOCAL,73702,CPT,,,,,RT,Outpatient,,,,1704.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Femur w/ + w/o Contrast Left,8202914,LOCAL,73702,CPT,,,,,LT,Outpatient,,,,1704.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Femur w/ + w/o Contrast Right,8202916,LOCAL,73702,CPT,,,,,RT,Outpatient,,,,1704.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Foot w/ + w/o Contrast Left,8202926,LOCAL,73702,CPT,,,,,LT,Outpatient,,,,1704.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Foot w/ + w/o Contrast Right,8202928,LOCAL,73702,CPT,,,,,RT,Outpatient,,,,1704.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Hip w/ + w/o Contrast Left,8202973,LOCAL,73702,CPT,,,,,LT,Outpatient,,,,1704.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Hip w/ + w/o Contrast Right,8202975,LOCAL,73702,CPT,,,,,RT,Outpatient,,,,1704.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Knee w/ + w/o Contrast Left,8203007,LOCAL,73702,CPT,,,,,LT,Outpatient,,,,1704.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Knee w/ + w/o Contrast Right,8203009,LOCAL,73702,CPT,,,,,RT,Outpatient,,,,1704.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Tibia/Fibula w/ + w/o Contrast Left,8203037,LOCAL,73702,CPT,,,,,LT,Outpatient,,,,1704.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Tibia/Fibula w/ + w/o Contrast Right,8203039,LOCAL,73702,CPT,,,,,RT,Outpatient,,,,1704.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CHOLECYSTOSTOMY DRAIN PLACEMENT,8267773,LOCAL,47490,CPT,,,,,,Outpatient,,,,2080,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11047  Debridement Sub-Q, bone each add l 20sq cm",10013082,LOCAL,11047,CPT,,,,,,Outpatient,,,,2092,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11047 Debrid bone > 20 sq cm charge,12508109,LOCAL,11047,CPT,,,,,,Outpatient,,,,2092,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Guided Perc Drain/Placement,7936217,LOCAL,75989,CPT,,,,,,Outpatient,,,,618.75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Drainage Perc Cath Placement,8058781,LOCAL,75989,CPT,,,,,,Outpatient,,,,618.75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LENS DIU450,4852298,LOCAL,,,V2630,HCPCS,,,,Outpatient,,,,410,CIGNA,Commercial,,50,,421.74,210.6,632.88,1 through 10,percent of total billed charges,145.73,145.73,
MRA Neck w/ + w/o Contrast,1168679,LOCAL,70549,CPT,,,,,,Outpatient,,,,1756.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Brachial Plexus w/ + w/o Contrast Lt,8784905,LOCAL,73223,CPT,,,,,LT,Outpatient,,,,1756.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Brachial Plexus w/ + w/o Contrast Rt,8784908,LOCAL,73223,CPT,,,,,RT,Outpatient,,,,1756.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Clavicle w/ + w/o Contrast Left,9647306,LOCAL,71552,CPT,,,,,LT,Outpatient,,,,2131.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Clavicle w/ + w/o Contrast Right,9647309,LOCAL,71552,CPT,,,,,RT,Outpatient,,,,2131.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Fingers w/ + w/o Contrast Left,8513072,LOCAL,73220,CPT,,,,,LT,Outpatient,,,,1756.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Fingers w/ + w/o Contrast Right,8513075,LOCAL,73220,CPT,,,,,RT,Outpatient,,,,1756.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Forearm w/ + w/o Contrast Lt,8058713,LOCAL,73220,CPT,,,,,LT,Outpatient,,,,1756.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Forearm w/ + w/o Contrast Rt,8058716,LOCAL,73220,CPT,,,,,RT,Outpatient,,,,1756.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hand w/ + w/o Contrast Left,1168918,LOCAL,73220,CPT,,,,,LT,Outpatient,,,,1756.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hand w/ + w/o Contrast Right,1168920,LOCAL,73220,CPT,,,,,RT,Outpatient,,,,1756.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Humerus w/ + w/o Contrast Left,8203076,LOCAL,73220,CPT,,,,,LT,Outpatient,,,,1756.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Humerus w/ + w/o Contrast Right,8203078,LOCAL,73220,CPT,,,,,RT,Outpatient,,,,1756.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Scapula w/ + w/o Contrast Left,9647333,LOCAL,73220,CPT,,,,,LT,Outpatient,,,,1756.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Scapula w/ + w/o Contrast Right,9647336,LOCAL,73220,CPT,,,,,RT,Outpatient,,,,1756.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Myelogram 2 or More Regions,10386814,LOCAL,62305,CPT,,,,,,Outpatient,,,,2134,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Chest w/o Contrast,1168824,LOCAL,71550,CPT,,,,,,Outpatient,,,,1765.5,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Pelvis w/ + w/o Contrast,1168687,LOCAL,72198,CPT,,,,,,Outpatient,,,,1767.15,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Pelvis w/ + w/o Contrast,1168687,LOCAL,C8920,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Chest w/ Contrast,8071392,LOCAL,71260,CPT,,,,,,Outpatient,,,,1782,CIGNA,Commercial,,50,,1036.63,1036.63,3262.18,1 through 10,percent of total billed charges,162.76,162.76,
US Echo Transesophag w/ Cont,13770878,LOCAL,93312,CPT,C8925,HCPCS,,,,Outpatient,,,,1482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PERC PLEURAL INSERTION/DRAINAGE AND S&I,8230068,LOCAL,32557,CPT,,,,,,Outpatient,,,,2166,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GRAFIX PRIME 1.5 X 2CM,13962569,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,,3671,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPIFIX SKIN SUBSTITUTE 18MM,13962561,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Spine Lumbar w/ + w/o Contrast,1168242,LOCAL,72133,CPT,,,,,,Outpatient,,,,1799.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPIFIX SKIN SUBSTITUTE 18MM,10510009,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Poliovirus 1, 3 Ab, Neutralization QSTC",13864497,LOCAL,86382,CPT,,,,,,Outpatient,,,,20.29,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Lower Extremity w/ Contrast Left,90720012,LOCAL,73725,CPT,,,,,LT,Outpatient,,,,1442.93,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Lower Extremity w/ Contrast Right,90720013,LOCAL,73725,CPT,,,,,RT,Outpatient,,,,1442.93,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Upper Extremity w/ Contrast Left,90720010,LOCAL,73225,CPT,,,,,LT,Outpatient,,,,2038.58,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Upper Extremity w/ Contrast Right,90720011,LOCAL,73225,CPT,,,,,RT,Outpatient,,,,2038.58,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Face Neck Orbit w/o Contrast,1168856,LOCAL,70540,CPT,,,,,,Outpatient,,,,1814.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Maxillofacial w/ Contrast,1168184,LOCAL,70487,CPT,,,,,,Outpatient,,,,1825.73,CIGNA,Commercial,,50,,2578.12,1062.23,3192.12,1 through 10,percent of total billed charges,162.76,461.98,
KERECIS OMEGA 3 - 3 X 3.5 CM,13962576,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TRANSCATH EMBOLIZATION S&I,8267120,LOCAL,75894,CPT,,,,,,Outpatient,,,,1838.93,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Neck Soft Tissue w/ + w/o Contrast,1168230,LOCAL,70492,CPT,,,,,,Outpatient,,,,1843.05,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Parathyroid 4-Phase Study,13554957,LOCAL,70492,CPT,,,,,,Outpatient,,,,1843.05,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Brain + IAC w/o Contrast,9427804,LOCAL,70551,CPT,,,,,,Outpatient,,,,1848,CIGNA,Commercial,,50,,3346.61,858.67,3424.43,1 through 10,percent of total billed charges,220.99,372.26,
MRI Brain w/o Contrast,1168800,LOCAL,70551,CPT,,,,,,Outpatient,,,,1848,CIGNA,Commercial,,50,,3346.61,858.67,3424.43,1 through 10,percent of total billed charges,220.99,372.26,
MRI Pituitary w/o Contrast,8203111,LOCAL,70551,CPT,,,,,,Outpatient,,,,1848,CIGNA,Commercial,,50,,3346.61,858.67,3424.43,1 through 10,percent of total billed charges,220.99,372.26,
DISKOGRAM LUMBAR S & I,8299004,LOCAL,72295,CPT,,,,,,Outpatient,,,,1851.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Tumor Loc Spect,1169408,LOCAL,78803,CPT,,,,,,Outpatient,,,,1181.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Tumor Loc Whole Body 1 Day,1169414,LOCAL,78802,CPT,,,,,,Outpatient,,,,2870.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NUSHIELD 2X3CM,13962587,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
28090 EXCISION GANGLION CYST FOOT,13436341,LOCAL,28090,CPT,,,,,,Outpatient,,,,2296,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ICD REMOVAL SC/DC LEAD TV EXTRACT,8231010,LOCAL,33244,CPT,,,,,,Outpatient,,,,2302,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Elbow w/ + w/o Contrast Left,1168836,LOCAL,73223,CPT,,,,,LT,Outpatient,,,,1756.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Elbow w/ + w/o Contrast Right,1168838,LOCAL,73223,CPT,,,,,RT,Outpatient,,,,1756.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Shoulder w/ + w/o Contrast Left,1169032,LOCAL,73223,CPT,,,,,LT,Outpatient,,,,1756.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Shoulder w/ + w/o Contrast Right,1169034,LOCAL,73223,CPT,,,,,RT,Outpatient,,,,1756.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Wrist w/ + w/o Contrast Left,1169128,LOCAL,73223,CPT,,,,,LT,Outpatient,,,,1756.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Wrist w/ + w/o Contrast Right,1169130,LOCAL,73223,CPT,,,,,RT,Outpatient,,,,1756.43,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Femur w/ + w/o Contrast Lt,8058701,LOCAL,73720,CPT,,,,,LT,Outpatient,,,,1902.45,CIGNA,Commercial,,50,,1107.02,1107.02,1107.02,1 through 10,percent of total billed charges,326.51,652.35,
MRI Femur w/ + w/o Contrast Rt,8058704,LOCAL,73720,CPT,,,,,RT,Outpatient,,,,1902.45,CIGNA,Commercial,,50,,1107.02,1107.02,1107.02,1 through 10,percent of total billed charges,326.51,652.35,
MRI Foot w/ + w/o Contrast Left,1168878,LOCAL,73720,CPT,,,,,LT,Outpatient,,,,1902.45,CIGNA,Commercial,,50,,1107.02,1107.02,1107.02,1 through 10,percent of total billed charges,326.51,652.35,
MRI Foot w/ + w/o Contrast Right,1168880,LOCAL,73720,CPT,,,,,RT,Outpatient,,,,1902.45,CIGNA,Commercial,,50,,1107.02,1107.02,1107.02,1 through 10,percent of total billed charges,326.51,652.35,
MRI Tibia/Fibula w/ + w/o Contrast Left,8206777,LOCAL,73720,CPT,,,,,LT,Outpatient,,,,1902.45,CIGNA,Commercial,,50,,1107.02,1107.02,1107.02,1 through 10,percent of total billed charges,326.51,652.35,
MRI Tibia/Fibula w/ + w/o Contrast Right,8206779,LOCAL,73720,CPT,,,,,RT,Outpatient,,,,1902.45,CIGNA,Commercial,,50,,1107.02,1107.02,1107.02,1 through 10,percent of total billed charges,326.51,652.35,
THERASKIN 1.75 X 1.75,13962605,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,,2431,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
L3900 WHFO DYNAMIC,9856098,LOCAL,,,L3900,HCPCS,,,,Outpatient,,,,2327,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"L3900 Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger",9856099,LOCAL,,,L3900,HCPCS,,,,Outpatient,,,,2327,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11044 DEBRID BONE FIRST 20SQ CM OR < CHARGE,8019965,LOCAL,11044,CPT,,,,,,Outpatient,,,,2328,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Face Neck Orbit w/ Contrast,1168854,LOCAL,70542,CPT,,,,,,Outpatient,,,,1948.65,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
bivalirudin 250 mg intravenous injection [CULL],11220339,LOCAL,J0583,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Pelvis w/ + w/o Contrast,1169024,LOCAL,72197,CPT,,,,,,Outpatient,,,,1953.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Prostate w/ + w/o Contrast,4126347,LOCAL,72197,CPT,,,,,,Outpatient,,,,1953.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Spine Thoracic w/ + w/o Contrast,1168248,LOCAL,72130,CPT,,,,,,Outpatient,,,,1963.5,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Breast w/o Contrast Bilateral.,8784923,LOCAL,77047,CPT,,,,,,Outpatient,,,,1966.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Spine Cervical w/ + w/o Contrast,1168236,LOCAL,72127,CPT,,,,,,Outpatient,,,,1967.63,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Abdomen w/ + w/o Contrast,1167845,LOCAL,74170,CPT,,,,,,Outpatient,,,,1972.58,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Pelvis w/ + w/o Contrast,1168194,LOCAL,72194,CPT,,,,,,Outpatient,,,,1972.58,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
28190 Appy Rigid Leg Cast (Professional Charge only if Provider Applies),12642333,LOCAL,28190,CPT,,,,,,Outpatient,,,,2392,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Ankle w/ + w/o Contrast Left,1168738,LOCAL,73723,CPT,,,,,LT,Outpatient,,,,1979.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Ankle w/ + w/o Contrast Right,1168740,LOCAL,73723,CPT,,,,,RT,Outpatient,,,,1979.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hip w/ + w/o Contrast Left,1168936,LOCAL,73723,CPT,,,,,LT,Outpatient,,,,1979.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Hip w/ + w/o Contrast Right,1168938,LOCAL,73723,CPT,,,,,RT,Outpatient,,,,1979.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Knee w/ + w/o Contrast Left,1168972,LOCAL,73723,CPT,,,,,LT,Outpatient,,,,1979.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Knee w/ + w/o Contrast Right,1168974,LOCAL,73723,CPT,,,,,RT,Outpatient,,,,1979.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-2004BC,4802098,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-3004 300cc,4801298,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-3504bc,4801299,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-4754BC,4852770,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-5504BC,4803723,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-6501BC,4805039,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST 445ML,4855517,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST GEL 700CC,4850683,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST MEMORY GEL 510CC,4853454,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT MEMORY GEL 225CC,4830332,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Brain/Head w/ + w/o Contrast,1168649,LOCAL,70546,CPT,,,,,,Outpatient,,,,1979.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Brain + IAC w/ Contrast,9427801,LOCAL,70552,CPT,,,,,,Outpatient,,,,1994.85,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Brain w/ Contrast,1168798,LOCAL,70552,CPT,,,,,,Outpatient,,,,1994.85,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THERASKIN 2.5 X 2.5 CM,13962606,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,,2431,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Abdomen w/ + w/o Contrast,1168635,LOCAL,74185,CPT,,,,,,Outpatient,,,,2017.13,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Abdomen w/ + w/o Contrast,1168730,LOCAL,74183,CPT,,,,,,Outpatient,,,,2017.13,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Brain/Head w/ + w/o Contrast,1168090,LOCAL,70470,CPT,,,,,,Outpatient,,,,2023.73,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
10140 DRAINAGE OF HEMATOMA,8715913,LOCAL,10140,CPT,,,,,,Outpatient,,,,2454,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Upper Extremity w/ + w/o Cnt Left,1168704,LOCAL,73225,CPT,,,,,LT,Outpatient,,,,2038.58,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Upper Extremity w/ + w/o Cnt Left,1168704,LOCAL,C8936,CPT,,,,,LT,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Upper Extremity w/ + w/o Cnt Right,1168707,LOCAL,73225,CPT,,,,,RT,Outpatient,,,,2038.58,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRA Upper Extremity w/ + w/o Cnt Right,1168707,LOCAL,C8936,CPT,,,,,RT,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Orbit Sella etc. or IAC w/ + w/o Cont,8362452,LOCAL,70482,CPT,,,,,,Outpatient,,,,2054.25,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-2504 250CC,4801300,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-3501BC,4803006,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST 565CC,4851020,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Abdomen and Pelvis w/ Oral Contrast,8206351,LOCAL,74176,CPT,,,,,,Outpatient,,,,2074.88,CIGNA,Commercial,,50,,3749.45,224.92,3867.35,1 through 10,percent of total billed charges,220.99,461.98,
CT Abdomen and Pelvis w/o Contrast,2424650,LOCAL,74176,CPT,,,,,,Outpatient,,,,2074.88,CIGNA,Commercial,,50,,3749.45,224.92,3867.35,1 through 10,percent of total billed charges,220.99,461.98,
AMNIOEXCEL SKIN SUBSTITUTE 2CM X 3CM,13962553,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11404 EXCISION BENIGN LESION 3.1 CM TO 4.0 CM CHARGE,8726719,LOCAL,11404,CPT,,,,,,Outpatient,,,,2544,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
OASIS ULTRA THIN DRESSING 7 X 10 CM,13962594,LOCAL,,,Q4124,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - 3 X 7CM,13962579,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Chest w/ + w/o Contrast,1168820,LOCAL,71552,CPT,,,,,,Outpatient,,,,2131.8,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-3754BC,4804163,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Chest High Resolution w/ + w/o Contrast,8658939,LOCAL,71270,CPT,,,,,,Outpatient,,,,2148.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Chest w/ + w/o Contrast,8071389,LOCAL,71270,CPT,,,,,,Outpatient,,,,2148.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Breast w/ + w/o Contrast Left.,8784917,LOCAL,77048,CPT,,,,,LT,Outpatient,,,,2161.5,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Breast w/ + w/o Contrast Left.,8784917,LOCAL,C8905,CPT,,,,,LT,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Breast w/ + w/o Contrast Right.,8784920,LOCAL,77048,CPT,,,,,RT,Outpatient,,,,2161.5,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Breast w/ + w/o Contrast Right.,8784920,LOCAL,C8905,CPT,,,,,RT,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PACEMAKER POCKET,8210140,LOCAL,33222,CPT,,,,,,Outpatient,,,,2620,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PURAPLY AM 2X4 COMMERCIAL 8SQ CM,13962598,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,,3861,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOEXCEL PLUS 2CMX2CM,13962548,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Face Neck Orbit w/ + w/o Contrast,1168852,LOCAL,70543,CPT,,,,,,Outpatient,,,,2181.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Maxillofacial w/ + w/o Contrast,1168182,LOCAL,70488,CPT,,,,,,Outpatient,,,,2192.03,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"64625 Radiofrequency ablation, nerves innervating the SI joint",5661090,LOCAL,64625,CPT,,,,,,Outpatient,,,,2665,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Abdomen and Pelvis w/ Contrast,2424647,LOCAL,74177,CPT,,,,,,Outpatient,,,,2221.73,CIGNA,Commercial,,50,,1292.57,1292.57,1292.57,1 through 10,percent of total billed charges,326.51,461.98,
CT Abdomen and Pelvis w/ Contrast + Oral,13452969,LOCAL,74177,CPT,,,,,,Outpatient,,,,2221.73,CIGNA,Commercial,,50,,1292.57,1292.57,1292.57,1 through 10,percent of total billed charges,326.51,461.98,
95808 SLEEP STAGING CHARGE,13485403,LOCAL,95808,CPT,,,,,,Outpatient,,,,2701,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PRIMATRIX 4X4 MESH,13962596,LOCAL,,,Q4110,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THERASKIN 2.5 X 5.1 CM,13962607,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,,2431,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Beta Amyloid 42/40 Ratio, CSF QST",13873765,LOCAL,82542,CPT,,,,,,Outpatient,,,,28.91,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INSERTION OF INTRAPERITONEAL CATHETER,8267131,LOCAL,49418,CPT,,,,,,Outpatient,,,,2723,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
US Insert Tun IP Cath Perc,10460131,LOCAL,49418,CPT,,,,,,Outpatient,,,,2723,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOEXCEL SKIN SUBSTITUTE 3.5CM X 3.5CM,13962554,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NUSHIELD 2X3CM,10510072,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NUSHIELD 2X4CM,13962588,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Breast w/ + w/o Contrast Bilateral.,8145272,LOCAL,77049,CPT,,,,,,Outpatient,,,,2333.1,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IR Nephro Plcmt New Access W Cath,8267190,LOCAL,50432,CPT,,,,,,Outpatient,,,,2829,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NEPHROSTOGRAM CATHETER PLACEMENT S&I,8267190,LOCAL,50432,CPT,,,,,,Outpatient,,,,2829,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXCHANGE NEPHROSTOMY TUBE,8212021,LOCAL,50435,CPT,,,,,,Outpatient,,,,2833,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ACTIGRAFT PRO-RD2301,10510000,LOCAL,,,G0460,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Brain + IAC w/ + w/o Contrast,9427798,LOCAL,70553,CPT,,,,,,Outpatient,,,,2361.15,CIGNA,Commercial,,50,,3118.99,1373.96,4180.04,1 through 10,percent of total billed charges,326.51,652.35,
MRI Brain w/ + w/o Contrast,1168796,LOCAL,70553,CPT,,,,,,Outpatient,,,,2361.15,CIGNA,Commercial,,50,,3118.99,1373.96,4180.04,1 through 10,percent of total billed charges,326.51,652.35,
MRI Pituitary w/ + w/o Contrast,8058740,LOCAL,70553,CPT,,,,,,Outpatient,,,,2361.15,CIGNA,Commercial,,50,,3118.99,1373.96,4180.04,1 through 10,percent of total billed charges,326.51,652.35,
AMNIOEXCEL SKIN SUBSTITUTE 4CM X 4CM,13962555,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PULMONARY UNILATERAL S&I,8210600,LOCAL,75741,CPT,,,,,,Outpatient,,,,2404.88,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VENOUS SAMPLING WO/W ANGIO,8210720,LOCAL,75893,CPT,,,,,,Outpatient,,,,2404.88,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VISCERAL S&I,8210570,LOCAL,75726,CPT,,,,,,Outpatient,,,,2404.88,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Angio Abdomen and Pelvis,2424686,LOCAL,74174,CPT,,,,,,Outpatient,,,,2433.75,CIGNA,Commercial,,50,,1416.16,1416.16,1416.16,1 through 10,percent of total billed charges,326.51,565.59,
THERASKIN 2.5 X 2.5 CM,10510018,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,,2431,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-4004BC,4803833,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-4504BC,4841089,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT MEMORY GEL 300CC,4852825,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GRAFIX PRIME 2 X 3CM,13962571,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,,3671,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PTA URETERAL STRICTURE WITH IMAGING,8267792,LOCAL,50706,CPT,,,,,,Outpatient,,,,3086,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Spine Cervical w/ + w/o Contrast,1169050,LOCAL,72156,CPT,,,,,,Outpatient,,,,2545.95,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPIFIX SKIN SUBSTITUTE 2 X 2 CM,13962562,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CT Abdomen and Pelvis w/ + w/o Contrast,2424644,LOCAL,74178,CPT,,,,,,Outpatient,,,,2588.03,CIGNA,Commercial,,50,,3337.73,1505.88,4823.14,1 through 10,percent of total billed charges,326.51,461.98,
CT Urogram,8203051,LOCAL,74178,CPT,,,,,,Outpatient,,,,2588.03,CIGNA,Commercial,,50,,3337.73,1505.88,4823.14,1 through 10,percent of total billed charges,326.51,461.98,
EPIFIX SKIN SUBSTITUTE 2 X 2 CM,10510011,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Inflammation Loc Spect,1169158,LOCAL,78803,CPT,,,,,,Outpatient,,,,1181.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
antivenin (Crotalidae equine) polyvalent intravenous injection [CULL],11250856,LOCAL,J0841,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THERASKIN 2.5 X 5.1 CM,10510019,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,,2431,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tocilizumab 20 mg/mL Sol 10 mL [CULL],11260565,LOCAL,J3262,CPT,,,,,,Outpatient,10,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Spine Thoracic w/ + w/o Contrast,1169062,LOCAL,72157,CPT,,,,,,Outpatient,,,,2736.53,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CATH LAB INSERTION OF PLEURAL CATHETER,8230067,LOCAL,32550,CPT,,,,,,Outpatient,,,,3336,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95782 PEDI POLYSOMNOGRAPHY (<6YO) CHARGE,9303178,LOCAL,95782,CPT,,,,,,Outpatient,,,,3342,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95810 POLYSOMNOGRAPHY CHARGE.,8303749,LOCAL,95810,CPT,,,,,,Outpatient,,,,3342,CIGNA,Commercial,,50,,5066.48,1781.05,5112.33,1 through 10,percent of total billed charges,930.16,1113.98,
NUSHIELD 2X4CM,10510073,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Cardiac Amyloid PYP Spect,9955566,LOCAL,78803,CPT,A9538,HCPCS,,,,Outpatient,,,,1181.4,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
MRI Spine Lumbar w/ + w/o Contrast,1169056,LOCAL,72158,CPT,,,,,,Outpatient,,,,2842.95,CIGNA,Commercial,,50,,3468.44,1653.92,5282.95,1 through 10,percent of total billed charges,326.51,652.35,
95783 POLYSOM <6 YRS SLP W/CPAP CHARGE,10732463,LOCAL,95783,CPT,,,,,,Outpatient,,,,3477,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
95811 POLYSOMMOGRAPHY w/ CPAP CHARGE,8303770,LOCAL,95811,CPT,,,,,,Outpatient,,,,3477,CIGNA,Commercial,,50,,1668.92,1668.92,5025.52,11,percent of total billed charges,930.16,930.16,
NM Inflammation Loc Whole Body - Ceretec,1169152,LOCAL,78802,CPT,A9521,HCPCS,,,,Outpatient,,,,2870.18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPIFIX SKIN SUBSTITUTE 2 X 3 CM,13962563,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Inflammation Loc Limited - Indium,1169148,LOCAL,78801,CPT,,,,,,Outpatient,,,,2895.75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Inflammation Loc Multi,12113627,LOCAL,78801,CPT,,,,,,Outpatient,,,,2895.75,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOEXCEL PLUS 3X3,13962549,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THROMBECTOMY VENOUS ADDL,8210394,LOCAL,37188,CPT,,,,,,Outpatient,,,,3523,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - 3 X 7,13962578,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THERASKIN 5.1 X 7.6 CM,13962608,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,,2431,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NEW ACCESS NEPHROSTOMY TUBE,8200537,LOCAL,50433,CPT,,,,,,Outpatient,,,,3545,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PTA RENAL ARTERY (ADD'L),8210240,LOCAL,37247,CPT,,,,,,Outpatient,,,,3567,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-6504BC 650CC,4801608,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST #350-8004BC,4803074,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST 700CC #350-7004BC MENTOR,4803075,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST SILICONE 500CC,4805180,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT SILICONE 750CC,4851569,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PURAPLY AM 3.76 CM X 4.76 CM,13962601,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,,3861,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
27603 DRAIN LOWER LEG LESION,13043453,LOCAL,27603,CPT,,,,,LT,Outpatient,,,,3592,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Myocardial Planar Rest and Stress,2425972,LOCAL,78454,CPT,A9500,HCPCS,,,,Outpatient,,,,2999.7,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPIFIX SKIN SUBSTITUTE 3.5 X 3.5 CM,13962565,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GRAFIX PRIME 2 X 3CM,10510014,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,,3671,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GRAFIX PL 3.0 X 4.0CM,13962568,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,,3671,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVISION REPLACE GENERATOR  BLADDER,8268108,LOCAL,64595,CPT,,,,,,Outpatient,,,,3699,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVISION REPLACE LEAD BLADDER STIMULATOR,8268107,LOCAL,64585,CPT,,,,,,Outpatient,,,,3699,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOEXCEL PLUS 2CMX2CM,10510060,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INTRO AV SHUNT W S&I,8267106,LOCAL,36902,CPT,,,,,,Outpatient,,,,11107,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
APLIGRAF-COM,13962557,LOCAL,,,Q4101,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPIFIX SKIN SUBSTITUTE 4 X 4.5 CM,13962566,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPIFIX SKIN SUBSTITUTE 4 X 4.5CM,13962567,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15120 SKN SPLT A-GRFT FAC/NCK/HF/G 100 SQ CM/1% BA,10006441,LOCAL,15120,CPT,,,,,,Outpatient,,,,3735,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REPOSITION IVC FILTER,8267129,LOCAL,37192,CPT,,,,,,Outpatient,,,,3751,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPICORD 2CM X 3CM,13962558,LOCAL,,,Q4187,HCPCS,,,,Outpatient,,,,3788,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VENOUS PTA EACH ADD'L,8267100,LOCAL,37249,CPT,,,,,,Outpatient,,,,3820,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PURAPLY AM 3 CM X 4 CM,13962599,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,,3861,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PURAPLY AM 3 X 4CM FEN FINISHED PROD,13962600,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,,3861,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Central Line Access Type. -> Tunneled,13449753,LOCAL,36810,CPT,,,,,,Outpatient,,,,3874,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NUSHIELD 3X4CM,13962589,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NUSHIELD 4X4CM,13962590,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
prothrombin complex - Pow [CULL],11220535,LOCAL,J7168,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AFFINITY 1.5 CM X 1.5 CM,10500119,LOCAL,,,Q4159,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPIFIX SKIN SUBSTITUTE 2 X 4 CM,13962564,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
33215 Reposition Pacing Defibrillator Lead,8212027,LOCAL,33215,CPT,,,,,,Outpatient,,,,3968,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ICD REMOVAL ONLY,8231005,LOCAL,33241,CPT,,,,,,Outpatient,,,,3968,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXTREMITY UNILATERAL S&I,8210530,LOCAL,75710,CPT,,,,,,Outpatient,,,,3288.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Angio Extremity in OR SI Left,2425383,LOCAL,75710,CPT,,,,,LT,Outpatient,,,,3288.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Angio Extremity in OR SI Right,2425386,LOCAL,75710,CPT,,,,,RT,Outpatient,,,,3288.45,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
immune globulin intravenous and subcutaneous 10% injectable solution 100 mL [CULL],11205089,LOCAL,J1561,CPT,,,,,,Outpatient,100,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TRANSCATH THER.ART.INF.(FINAL DAY),8210027,LOCAL,37214,CPT,,,,,,Outpatient,,,,4104,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
BULKAMID URETHRAL BULKING SYSTEM,4830058,LOCAL,,,L8603,HCPCS,,,,Outpatient,,,,3364,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE 750-900ML,4854109,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE DERMASPAN 600-720CC,4805041,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE LPP-FH13S,4832956,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE LPP-FH14S,4803623,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93503 INSERTION OF SWAN GANZ CHARGE,8210870,LOCAL,93503,CPT,,,,,,Outpatient,,,,4157,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PA CATHETER SV02,4221129,LOCAL,93503,CPT,,,,,,Outpatient,,,,4157,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GENERATOR REMOVAL ONLY,8210160,LOCAL,33233,CPT,,,,,,Outpatient,,,,4190,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
fomepizole 1 g/mL intravenous solution 1.5 mL [CULL],11290124,LOCAL,J1451,CPT,,,,,,Outpatient,1.5,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NM Myocardial SPECT Drug Stress Multi,8567792,LOCAL,78452,CPT,,,,,,Outpatient,,,,3625.05,CIGNA,Commercial,,50,,137.3,88.52,149,19,percent of total billed charges,1193.55,1409.71,
NM Myocardial SPECT Rest and Stress,2425975,LOCAL,78452,CPT,,,,,,Outpatient,,,,3625.05,CIGNA,Commercial,,50,,137.3,88.52,149,19,percent of total billed charges,1193.55,1409.71,
dalbavancin 500 mg Pow [CULL],11287452,LOCAL,J0875,CPT,,,,,,Outpatient,1,UN,,4440,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST SHPB-235,4852442,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST SHPB-585,4851979,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST SHPB-635,4805161,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GRAFIX PL 3.0 X 4.0CM,10510066,LOCAL,,,Q4133,HCPCS,,,,Outpatient,,,,3671,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PERC URETERAL STENT REMOVAL & REPLACE,8210741,LOCAL,50382,CPT,,,,,,Outpatient,,,,4500,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL NM TC99M Ceretec Per Dose,13644947,LOCAL,,,A9521,HCPCS,,,,Outpatient,,,,4544,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPICORD 2CM X 3CM,10510051,LOCAL,,,Q4187,HCPCS,,,,Outpatient,,,,3788,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST 775,4850675,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"BRCAvantage(R), Comprehensive QSTC",9039435,LOCAL,81162,CPT,,,,,,Outpatient,,,,2189.86,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PURAPLY AM 3 X 4CM FEN FINISHED PROD,10510076,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,,3861,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NUSHIELD 4X4CM,10510075,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THROMBECTOMY ARTERIAL SECONDARY PERC,8210390,LOCAL,37186,CPT,,,,,,Outpatient,,,,4799,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"15100 AUTO-SPLIT THICK T/A/L, 1ST 100 SQCM CHARGE",12816476,LOCAL,15100,CPT,,,,,,Outpatient,,,,4802,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AFFINITY 1.5CM X 1.5CM,10500119,LOCAL,,,Q4159,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THROMBECTOMY VENOUS PRIMARY,8210393,LOCAL,37187,CPT,,,,,,Outpatient,,,,4926,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GRAFT STRAVIX 2 X 4,13962572,LOCAL,,,Q4132,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPIFIX SKIN SUBSTITUTE 4 X 4.5 CM,10510064,LOCAL,,,Q4186,HCPCS,,,,Outpatient,,,,1755,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXCHANGE OF BILIARY DRAIN CATH,8267769,LOCAL,47536,CPT,,,,,,Outpatient,,,,5124,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PLACEMENT BILIARY DRAIN CATH INT/EXT,8201219,LOCAL,47534,CPT,,,,,,Outpatient,,,,5124,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
36253 Insertion Of Cath Renal Arterial 2Nd Unilateral,8212045,LOCAL,36253,CPT,,,,,,Outpatient,,,,5233,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CERVICOCEREBRAL S&I,8201615,LOCAL,36221,CPT,,,,,,Outpatient,,,,5233,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
COMMON CAROTID UNI S&I,8201600,LOCAL,36223,CPT,,,,,,Outpatient,,,,5233,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXTERNAL CAROTID UNI S&I,8201610,LOCAL,36222,CPT,,,,,,Outpatient,,,,5233,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INFERIOR VENA CAVA S&I,8210660,LOCAL,75825,CPT,,,,,,Outpatient,,,,4317.23,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IR Angio Pulmonary Bilateral,7949335,LOCAL,75743,CPT,,,,,,Outpatient,,,,4317.23,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PULMONARY BILATERAL S&I,8210610,LOCAL,75743,CPT,,,,,,Outpatient,,,,4317.23,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RENAL UNILATERAL PLACEMENT & SI,8210550,LOCAL,36251,CPT,,,,,,Outpatient,,,,5233,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VERTEBRAL SUBCLAVIAN OR INNOMINATE,8201625,LOCAL,36225,CPT,,,,,,Outpatient,,,,5233,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Venogram Cava Inferior,10386826,LOCAL,75825,CPT,,,,,,Outpatient,,,,4317.23,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
25040 FOREIGN BODY REMOVAL FOREARM LEFT,13416875,LOCAL,25040,CPT,,,,,LT,Outpatient,,,,5250,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
FOREIGN BODY RETRIEVAL,8201630,LOCAL,37197,CPT,,,,,,Outpatient,,,,5252,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
FOREIGN BODY RETRIEVAL S&I,8201635,LOCAL,37197,CPT,,,,,,Outpatient,,,,5252,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REMOVAL IVC FILTER,8267130,LOCAL,37193,CPT,,,,,,Outpatient,,,,5252,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL NM Indium WBC Per 0.5 MCI,13644939,LOCAL,,,A9547,HCPCS,,,,Outpatient,,,,5266,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL NM Kinevac Per 5 MCG Vial,13644941,LOCAL,,,A9547,HCPCS,,,,Outpatient,,,,5266,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PERC INTRO CATH/STENT URETERAL PREEXIST,8200532,LOCAL,50693,CPT,,,,,,Outpatient,,,,5280,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PERC INTRO URETERAL NEW ACCESS W CATH,8200534,LOCAL,50695,CPT,,,,,,Outpatient,,,,5280,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PERC INTRO URETERAL NEW ACCESS WO CATH,8200533,LOCAL,50694,CPT,,,,,,Outpatient,,,,5280,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VERTEBROPLASTY ADDL THOR/LUMB,8267765,LOCAL,22512,CPT,,,,,,Outpatient,,,,5438,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VERTEBROPLASTY LUMBAR,8211170,LOCAL,22511,CPT,,,,,,Outpatient,,,,5438,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VERTEBROPLASTY THORACIC,8211160,LOCAL,22510,CPT,,,,,,Outpatient,,,,5438,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RENAL BILATERAL PLACEMENT & SI,8210560,LOCAL,36252,CPT,,,,,,Outpatient,,,,5550,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93452 Left Heart Cath,8230003,LOCAL,93452,CPT,,,,,,Outpatient,,,,5706,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TEMP SACRAL ELECTRODE WITH IMAGING,8268102,LOCAL,64561,CPT,,,,,,Outpatient,,,,5785,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
27372 FOREIGN BODY REMOVAL KNEE,13435628,LOCAL,27372,CPT,,,,,,Outpatient,,,,5815,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANT BREAST ARTOURA 455CC SMOOTH,4853890,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
75630-IR Aortogram Abdominal + Iliofemoral1,8071871,LOCAL,75630,CPT,,,,,,Outpatient,,,,4835.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AORTO ABD+ILIOFEMORAL SERIAL,8210430,LOCAL,75630,CPT,,,,,,Outpatient,,,,4835.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AORTOGRAM THORACIC S&I,8210410,LOCAL,75605,CPT,,,,,,Outpatient,,,,4835.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXTREMITY BILATERAL S&I,8210540,LOCAL,75716,CPT,,,,,,Outpatient,,,,4835.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IR Aortogram Thoracic w/ Serialography,7949377,LOCAL,75605,CPT,,,,,,Outpatient,,,,4835.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Angio Extremity in OR SI Bilat,9343676,LOCAL,75716,CPT,,,,,,Outpatient,,,,4835.33,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
20240 BIOPSY BONE EXCISIONAL SUPERFI CHARGE,8020082,LOCAL,20240,CPT,,,,,,Outpatient,,,,5961,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
20240-BIOPSY BONE EXCISIONAL SUPERFI CHARGE,8020082,LOCAL,20240,CPT,,,,,,Outpatient,,,,5961,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE ALLOX2,4850383,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE ALLOX2-15SE,4800802,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE ALLOX2-FH13E,4800497,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE ALLOX2-FH14E,4840653,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TISSUE EXPANDER ALLOX2-FH15E,4810961,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMINOFIX 7CM X 6CM,13962545,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOEXCEL PLUS  3 X 4CM,13962546,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"93451 Catheterization, Right Heart",8230000,LOCAL,93451,CPT,,,,,,Outpatient,,,,6246,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93453 Combined Left and Right Heart Cath,8230006,LOCAL,93453,CPT,,,,,,Outpatient,,,,6246,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOFIX 4X6CM,13962556,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THROMBECTOMY ARTERIAL ADDL,8210392,LOCAL,37185,CPT,,,,,,Outpatient,,,,6339,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93454 HT Left Heart Cath WO LV,8210890,LOCAL,93454,CPT,,,,,,Outpatient,,,,6392,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92973 PTC Thromebectomy Add On,8200030,LOCAL,92973,CPT,,,,,,Outpatient,,,,6395,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
NUSHIELD 6CM X 6CM,13962591,LOCAL,,,Q4160,HCPCS,,,,Outpatient,,,,1155,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TRANSCATH THER ART INFUSION FOR THROM,8210026,LOCAL,37211,CPT,,,,,,Outpatient,,,,6591,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CATH LAB IVC FILTER PLACEMENT,8210330,LOCAL,37191,CPT,,,,,,Outpatient,,,,6618,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INSERTION IVC FILTER,8267128,LOCAL,37191,CPT,,,,,,Outpatient,,,,6618,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PERC PLACE IVC FILTER S&I,8210740,LOCAL,37191,CPT,,,,,,Outpatient,,,,6618,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
leuprolide 45 mg/6 months Pow [CULL],11299002,LOCAL,J9217,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL NM Indium DTPA Per 0.5 MCI,13644937,LOCAL,,,A9548,HCPCS,,,,Outpatient,,,,6781,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - 7 X 10CM,13962581,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THROMBECTOMY ARTERIAL PRIMARY,8210391,LOCAL,37184,CPT,,,,,,Outpatient,,,,7024,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AORTOGRAM ABDOMEN S&I,8210420,LOCAL,75625,CPT,,,,,,Outpatient,,,,5844.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IR Aortogram Abdominal w/ Serialography1,8071874,LOCAL,75625,CPT,,,,,,Outpatient,,,,5844.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
XR Aorta Abdomen Catheter in OR SI,2425389,LOCAL,75625,CPT,,,,,,Outpatient,,,,5844.3,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PURAPLY AM 5 CM X 5 CM,13962602,LOCAL,,,Q4196,HCPCS,,,,Outpatient,,,,3861,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER BREAST TISSUE ARTOURA 375CC,4853226,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDER TISSUE ARTOURA SDC100UH,4803722,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EXPANDERS TISSUE 475CC SDC-130H,4852707,LOCAL,,,L8600,HCPCS,,,,Outpatient,,,,644,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TRANSCATH STENT CERV CAROTID WITH DEVICE,8210025,LOCAL,37215,CPT,,,,,,Outpatient,,,,7459,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VERTEBRAL CERVICAL/CRANIAL S&I,8201620,LOCAL,36226,CPT,,,,,,Outpatient,,,,7488,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LEAD REPLACEMENT DUAL,8210110,LOCAL,33217,CPT,,,,,,Outpatient,,,,7768,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
LEAD REPLACEMENT SGL,8210100,LOCAL,33216,CPT,,,,,,Outpatient,,,,7768,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
calcitonin 200 intl units/mL Sol [CULL],J0630,CPT,,,,,,,,Outpatient,200,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93455 HT Left Cath W Cor Inj WO LV,8230002,LOCAL,93455,CPT,,,,,,Outpatient,,,,7817,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
immune globulin intravenous and subcutaneous 10% injectable solution 200 mL [CULL],11205107,LOCAL,J1561,CPT,,,,,,Outpatient,200,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ALLOGRAFT DERMAPURE 7X10CM,4810278,LOCAL,Q4152,CPT,Q4152,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93458 HT Cath Left W LV and Cor Angio,8230004,LOCAL,93458,CPT,,,,,,Outpatient,,,,8133,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93460 HT Cath L or R W LV and Cor Angio,8230007,LOCAL,93460,CPT,,,,,,Outpatient,,,,8133,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
33210 INSERTION TEMP PACEMAKER SINGLE CHAMBER CHARGE,13707085,LOCAL,33210,CPT,,,,,,Outpatient,,,,8153,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TEMP PACEMAKER SGL CHAMBER,8210050,LOCAL,33210,CPT,,,,,,Outpatient,,,,8153,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92920 PTCA 1st Vessel,8201256,LOCAL,92920,CPT,,,,,,Outpatient,,,,8298,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PTA RENAL ARTERY (INITIAL),8267124,LOCAL,37246,CPT,,,,,,Outpatient,,,,17592,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ANGIO CPLX 1,8230034,LOCAL,37224,CPT,,,,,,Outpatient,,,,8298,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS IVT ANGIO CPLX1,8230030,LOCAL,37220,CPT,,,,,,Outpatient,,,,8298,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS TPVT ANGIO SF 1ST,8230022,LOCAL,37228,CPT,,,,,,Outpatient,,,,8298,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
THERASKIN 7.6 X 15.2 CM,13962609,LOCAL,,,Q4121,HCPCS,,,,Outpatient,,,,2431,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93459 HT Cath Left W LV and Cor Grf Angio,8230005,LOCAL,93459,CPT,,,,,,Outpatient,,,,8765,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93461 HT Cath L or R W LV Cor Grf Angio,8230008,LOCAL,93461,CPT,,,,,,Outpatient,,,,8765,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
riTUXimab pvvr 10 mg/mL Sol 50 mL [CULL],11211085,LOCAL,Q5119,CPT,,,,,,Outpatient,50,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"C1 esterase inhibitor, human 500 intl units intravenous kit [CULL]",11201256,LOCAL,J0597,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AMNIOEXCEL PLUS 4X5CM,13962550,LOCAL,,,Q4137,HCPCS,,,,Outpatient,,,,3028,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ATHERECTOMY ABD AORTA,8230043,LOCAL,0236T,CPT,,,,,,Outpatient,,,,9388,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ATHERECTOMY BRACHIOCEPHALIC & BRANCHES,8230044,LOCAL,0237T,CPT,,,,,,Outpatient,,,,9388,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ATHERECTOMY ILIAC EACH,8230045,LOCAL,0238T,CPT,,,,,,Outpatient,,,,12175,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ATHERECTOMY RENAL,8230041,LOCAL,0234T,CPT,,,,,,Outpatient,,,,9388,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ATHERECTOMY VISCERAL,8230042,LOCAL,0235T,CPT,,,,,,Outpatient,,,,9388,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
EPICORD 3 X 5,13962559,LOCAL,,,Q4187,HCPCS,,,,Outpatient,,,,3788,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INTERNAL CAROTID UNI S&I,8201636,LOCAL,36224,CPT,,,,,,Outpatient,,,,9628,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
37239 STENT ANGIO VEIN EA ADDL CHARGE,8230063,LOCAL,37239,CPT,,,,,,Outpatient,,,,10194,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ARTERY STENT ADD'L (NONCORONARY),8230061,LOCAL,37237,CPT,,,,,,Outpatient,,,,10194,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93456 Right Heart Catheterization With Angiography,8230009,LOCAL,93456,CPT,,,,,,Outpatient,,,,10413,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
33285 Implant Pt Activated Cardiac Event Recorder,8267776,LOCAL,33285,CPT,,,,,,Outpatient,,,,10419,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
92928 Trnscath Plcmnt Metal Single,8201254,LOCAL,92928,CPT,,,,,,Outpatient,,,,10803,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
CULL Octreotide,14874647,LOCAL,,,A9572,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
alteplase 50 mg intravenous injection [CULL],11201048,LOCAL,J2997,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93457 Right or Left Heart Cath with No LV Gram Charge,8230010,LOCAL,93457,CPT,,,,,,Outpatient,,,,11044,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
AV FISTULAGRAM WITH ANGIOPLASTY,8210331,LOCAL,36902,CPT,,,,,,Outpatient,,,,11107,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"C9764 Revasculation, Endovascular, With Intravascular Lithotripsy, Includes Angioplasty",8230070,LOCAL,,,C9764,HCPCS,,,,Outpatient,,,,11270,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
digoxin immune FAB 40 mg intravenous injection [CULL],11201675,LOCAL,J1162,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
KERECIS OMEGA 3 - 7 X 10,13962580,LOCAL,,,Q4158,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GENERATOR ONLY SGL CHAMBER INSERTION,8210070,LOCAL,33212,CPT,,,,,,Outpatient,,,,11691,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PACEMAKER REMOVAL SINGLE,8210171,LOCAL,33227,CPT,,,,,,Outpatient,,,,11691,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
immune globulin intravenous and subcutaneous 10% injectable solution 300 mL [CULL],11205109,LOCAL,J1561,CPT,,,,,,Outpatient,300,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
0238T Iliac Athrectomy with or without PTA,8230069,LOCAL,0238T,CPT,,,,,,Outpatient,,,,12175,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
INSERTION NEUROSTIMULATOR GENERATOR,8268101,LOCAL,64590,CPT,,,,,,Outpatient,,,,519,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
GENERATOR REMOVAL AND REPLACEMENT DUAL,8210172,LOCAL,33228,CPT,,,,,,Outpatient,,,,13640,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C9604 Revasc thru Bypass Single Vessel w DES (M'care),8201640,LOCAL,,,C9604,HCPCS,,,,Outpatient,,,,13725,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C9607 Revasc CTO Single Vessel w DES (M'care),8201642,LOCAL,,,C9607,HCPCS,,,,Outpatient,,,,13725,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PERQ BM STENT ADD ON  RAMUS,8201252,LOCAL,,,C9600,HCPCS,,,,Outpatient,,,,13725,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
TIB/PER REVASC W/ATHER ADD ON  LT,8210020,LOCAL,33206,CPT,,,,,,Outpatient,,,,13997,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C9772 Revasc Lithotrip Tibi/Peroneal Artery (Shockwave IVL),8230074,LOCAL,,,C9772,HCPCS,,,,Outpatient,,,,14403,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PTA VENOUS PERC W S&I,8267099,LOCAL,37248,CPT,,,,,,Outpatient,,,,14476,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VENTRICULAR PACEMAKER IMPLANT INS OR REP,8210030,LOCAL,33207,CPT,,,,,,Outpatient,,,,14551,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ATHRC CPLX 1,8230035,LOCAL,37225,CPT,,,,,,Outpatient,,,,15305,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ST CPLX 1ST,8230036,LOCAL,37226,CPT,,,,,,Outpatient,,,,15305,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS IVT ST CPLX 1ST,8230031,LOCAL,37221,CPT,,,,,,Outpatient,,,,15305,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS TPVT ATHRC CPLX 1,8230023,LOCAL,37229,CPT,,,,,,Outpatient,,,,15305,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VASC EMBOLIZE OCCLUDE ARTERY,8210362,LOCAL,37242,CPT,,,,,,Outpatient,,,,15482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VASC EMBOLIZE OCCLUDE BLEED,8210364,LOCAL,37244,CPT,,,,,,Outpatient,,,,15482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VASC EMBOLIZE OCCLUDE ORGAN,8210363,LOCAL,37243,CPT,,,,,,Outpatient,,,,15482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
VASC EMBOLIZE OCCLUDE VENOUS,8210361,LOCAL,37241,CPT,,,,,,Outpatient,,,,15482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
37238 STENT ANGIO VEIN INITIAL CHARGE,8230062,LOCAL,37238,CPT,,,,,,Outpatient,,,,15809,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
37236 Stent Angioplasty Artery Int,8230060,LOCAL,37236,CPT,,,,,,Outpatient,,,,15968,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SACRAL NERVE (TRANSFORAMINAL PLACEMENT),8268100,LOCAL,64581,CPT,,,,,,Outpatient,,,,1108,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SHOULDER SYSTEMHEAD DWF041,4811086,LOCAL,,,L3975,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PTA BRACHIOCEPHALIC TRUNK W S&I,8210280,LOCAL,37246,CPT,,,,,,Outpatient,,,,17592,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
A V PACEMAKER IMPLANT INS OR REPLACE,8210040,LOCAL,33208,CPT,,,,,,Outpatient,,,,18010,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
UPGRADE SGL DUAL LEAD/CHAMBER,8210090,LOCAL,33214,CPT,,,,,,Outpatient,,,,18010,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C9773 Revasc Lithotrip-Stent Tib/Peroneal Atr (Shockwave IVL),8230075,LOCAL,,,C9773,HCPCS,,,,Outpatient,,,,18430,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C9774 Revasc Lithotr-Ather Tib/Peroneal Atr (Shockwave IVL),8230076,LOCAL,,,C9774,HCPCS,,,,Outpatient,,,,18430,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
C9775 Revasc Lithotr-Stent-Ather-Peroneal Atr (Shockwave IVL),8230077,LOCAL,,,C9775,HCPCS,,,,Outpatient,,,,18430,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"C9765 Revasculation, Endovascular, With Intravascular Lithotripsy, With Stent Placement Includes Ang",8230071,LOCAL,,,C9765,HCPCS,,,,Outpatient,,,,19321,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"C9766 Revasculation, Endovascular, With Intravascular Lithotripsy, Includes Atherectomy",8230072,LOCAL,,,C9766,HCPCS,,,,Outpatient,,,,19321,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
tenecteplase 50 mg intravenous injection [CULL],11211269,LOCAL,J3101,CPT,,,,,,Outpatient,1,EA,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PTA STENT TIBPERONEAL INITIAL,8230024,LOCAL,37230,CPT,,,,,,Outpatient,,,,21279,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
REVASCULARIZATION  ENDOVASCULAR OPEN OR PERCUTANEOUS FPVT ST ATHRC CPX 1,8230037,LOCAL,37227,CPT,,,,,,Outpatient,,,,21505,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
alteplase 100 mg intravenous injection [CULL],11201042,LOCAL,J2997,CPT,,,,,,Outpatient,1,ML,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
SIMPLIDERM ACELLULAR DERMAL,13962604,LOCAL,,,Q4116,HCPCS,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"C9767 Revasculation, Endovascular, With Intravascular Lithotripsy, With Stent Placement And Atherect",8230073,LOCAL,,,C9767,HCPCS,,,,Outpatient,,,,25903,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
IMPLANTABLE STIM 2-LEAD EBI 10-1335M,4802519,LOCAL,,,E0749,HCPCS,,,,Outpatient,,,,22885,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PTA ARTHRECTOMY STENT TIBPERONEAL INITIA,8230025,LOCAL,37231,CPT,,,,,,Outpatient,,,,32867,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ICD INSERTION WITH EXISTING SINGLE LEAD,8231000,LOCAL,33240,CPT,,,,,,Outpatient,,,,33168,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ICD REMOVAL&REPLACE SINGLE,8267790,LOCAL,33262,CPT,,,,,,Outpatient,,,,42582,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ICD REMOVAL&REPLACE DUAL LEAD,8267778,LOCAL,33263,CPT,,,,,,Outpatient,,,,43882,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
ICD REMOVAL&REPLACE MULTIPLE,8267791,LOCAL,33264,CPT,,,,,,Outpatient,,,,45832,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"45300 Proctosigmoidoscopy, rigid; diagnostic, w/ or w/o collection by brushing or washing",7962380,LOCAL,45300,CPT,,,,,,Outpatient,,,,129,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,90471,CPT,,,,,,Outpatient,,,,140,CIGNA,Commercial,,50,,67.44,67.44,67.44,1 through 10,percent of total billed charges,42.18,65.07,
90471 PO IMMUNIZATION ADMIN 1 VACCINE CHARGE,9279752,LOCAL,G0010,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"25105 ARTHROTOMY, WRIST JOINT WITH SYNOVECTOMY",14130163,LOCAL,25105,CPT,,,,,,Outpatient,,,,3245,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DOPP ART BIL REST MULTIPLE/SINGLE,8230015,LOCAL,93923,CPT,,,,,26,Outpatient,,,,401,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DOPP ART W/TREADMILL,8230020,LOCAL,93924,CPT,,,,,26,Outpatient,,,,302,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DOPP LEA LIMITED,8230019,LOCAL,93922,CPT,,,,,26,Outpatient,,,,265,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP ABD RENAL COMPLETE,8200571,LOCAL,93975,CPT,,,,,26,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP ABD RENAL LIMITED,8200581,LOCAL,93976,CPT,,,,,26,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP AO IVC COMPLETE,8200570,LOCAL,93978,CPT,,,,,26,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP AO IVC LIMITED,8200580,LOCAL,93979,CPT,,,,,26,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP CAROTID BILATERAL,8200229,LOCAL,93880,CPT,,,,,26,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP CAROTID UNILATERAL,8200228,LOCAL,93882,CPT,,,,,26,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP HEMODIALYSIS ACCESS,8200582,LOCAL,93990,CPT,,,,,26,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP LEA BIL,8200577,LOCAL,93925,CPT,,,,,26,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP LEA UNI,8200576,LOCAL,93926,CPT,,,,,26,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP UPPER ART BIL,8200575,LOCAL,93930,CPT,,,,,26,Outpatient,,,,482,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP UPPER ART UNI,8200574,LOCAL,93931,CPT,,,,,26,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC DUP VENOUS BIL,8200573,LOCAL,93970,CPT,,,,,26,Outpatient,,,,482,CIGNA,Commercial,,50,,475.26,231.54,718.97,1 through 10,percent of total billed charges,220.99,245.49,
PC DUP VENOUS UNI,8200572,LOCAL,93971,CPT,,,,,26,Outpatient,,,,310,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
PC US PSEUDOANEURYSM COMPRESSION REPAIR,8200583,LOCAL,76936,CPT,,,,,26,Outpatient,,,,237.6,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97802 MEDICAL NUTRITIONAL THERAPY PROF CHARGE,13475611,LOCAL,97802,CPT,,,,,,Outpatient,,,,55,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97803 MEDICAL NUTRITIONAL RE-ASSESSMENT PROF CHARG,13481228,LOCAL,97803,CPT,,,,,,Outpatient,,,,48,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"64640 Destruction by neurolytic agent, other perip",13959658,LOCAL,64640,CPT,,,,,,Outpatient,,,,927,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
10060 PROFEE Drainage of skin abscess,13954453,LOCAL,10060,CPT,,,,,,Outpatient,,,,420,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
10061  I&D abscess complicated/multiple Profee,13769279,LOCAL,10061,CPT,,,,,,Outpatient,,,,420,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
10120 Incision & Removal Foreign Body Simp PROFEE,14006132,LOCAL,10120,CPT,,,,,,Outpatient,,,,893,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11042 PROFEE Debride subcutaneous tissue, 1st 20 s",13962336,LOCAL,11042,CPT,,,,,,Outpatient,,,,836,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11043 PROFEE DEB MUSC/FASCIA 20 SQ CM/<,13967660,LOCAL,11043,CPT,,,,,,Outpatient,,,,836,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11044 Debride bone, 1st 20 sq cm or less Pro Fee",11221020,LOCAL,11044,CPT,,,,,,Outpatient,,,,2328,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11045 Debride subq tissue, ea addl 20 sq cm Pro Fe",11221021,LOCAL,11045,CPT,,,,,,Outpatient,,,,836,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11046 PROFEE Debride muscle and/or fascia; ea addl,13954830,LOCAL,11046,CPT,,,,,,Outpatient,,,,836,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11047 PROFEE Debridement, sus tissue each add 20 s",13967661,LOCAL,11047,CPT,,,,,,Outpatient,,,,2092,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11104 Punch Biopsy of Skin; Single Lesion ProFee,8768419,LOCAL,11104,CPT,,,,,,Outpatient,,,,449,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
11106  Incisional biopsy of skin single lesion Pro,13759967,LOCAL,11106,CPT,,,,,,Outpatient,,,,800,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11400 EXCISION, BENIGN LESION INCLUDING MARGINS, E",7929974,LOCAL,11400,CPT,,,,,,Outpatient,,,,935,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11406 EXCISION, BENIGN LESION INCLUDING MARGINS, E",7929979,LOCAL,11406,CPT,,,,,,Outpatient,,,,1620,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11604 EXCISION, MALIGNANT LESION INCLUDING MARGINS",7930002,LOCAL,11604,CPT,,,,,,Outpatient,,,,704,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11730 PROFEE Avulsion nail plate simple, single",13967650,LOCAL,11730,CPT,,,,,,Outpatient,,,,228,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"11750 PROFEE Excision of nail and nail matrix, par",13954836,LOCAL,11750,CPT,,,,,,Outpatient,,,,1342,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15271 PROFEE Application of skin substitute graft,13967652,LOCAL,15271,CPT,,,,,,Outpatient,,,,1092,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
15275 PROFEE APPLICATION OF SKIN SUBSTITUTE GRAFT,13954832,LOCAL,15275,CPT,,,,,,Outpatient,,,,1092,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"28810 AMPUTATION, METATARSAL, WITH TOE, SINGLE Pro",7931853,LOCAL,28810,CPT,,,,,,Outpatient,,,,3245,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
29445 PROFEE APPLICATION OF RIGID TOTAL CONTACT LE,13962328,LOCAL,29445,CPT,,,,,,Outpatient,,,,266,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
31502 Tracheotomy tube change prior to establishme,14397259,LOCAL,31502,CPT,,,,,,Outpatient,,,,232,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"31899 UNLISTED PROCEDURE, TRACHEA, BRONCHI ProFee",7932202,LOCAL,31899,CPT,,,,,,Outpatient,,,,194,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"58573 LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTO",14831670,LOCAL,58573,CPT,,,,,,Outpatient,,,,10411,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64454 Genicular Nerve Block Profee,13911832,LOCAL,64454,CPT,,,,,,Outpatient,,,,244,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
64999 XX UNLISTED NERVOUS SYSTEM INJECTION,7939552,LOCAL,64999,CPT,,,,,,Outpatient,,,,620,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93010 EKG INTERPRETATION,7939709,LOCAL,93010,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
93451 RIGHT HEART CATHERIZATION (OR),8192212,LOCAL,93451,CPT,,,,,26,Outpatient,,,,6246,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
97597 WOUND DEBRIDEMENT ProFee,7935939,LOCAL,97597,CPT,,,,,,Outpatient,,,,395,CIGNA,Commercial,,50,,33.14,11.61,187.76,19,percent of total billed charges,181.66,863,
97598 DEBRID SELCT EA ADD20SQCM ProFee,7935940,LOCAL,97598,CPT,,,,,,Outpatient,,,,395,CIGNA,Commercial,,50,,52.63,22.71,82.55,1 through 10,percent of total billed charges,20.42,1466.58,
97605 Negative pressure wound therapy less than 50,14327888,LOCAL,97605,CPT,,,,,,Outpatient,,,,285,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99183 HBO PER SESSION ProFee,7935966,LOCAL,99183,CPT,,,,,,Outpatient,,,,,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99202 LEVEL 2 VISIT NEW PT ProFee,7935970,LOCAL,99202,CPT,,,,,,Outpatient,,,,294,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99203 LEVEL 3 VISIT NEW PT ProFee,7935971,LOCAL,99203,CPT,,,,,,Outpatient,,,,387,CIGNA,Commercial,,50,,136.33,74.13,198.52,1 through 10,percent of total billed charges,67.57,67.57,
99204 LEVEL 4 NEW PT PROF CHARGE,8700762,LOCAL,99204,CPT,,,,,,Outpatient,,,,513,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99205 PROFEE OFFICE VISIT LEV 5 NEW PT,13962366,LOCAL,99205,CPT,,,,,,Outpatient,,,,701,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99211 LEVEL 1 EST PT PROF CHARGE,8700763,LOCAL,99211,CPT,,,,,,Outpatient,,,,226,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99212 LEVEL 2 EST PT PROF CHARGE,8700764,LOCAL,99212,CPT,,,,,,Outpatient,,,,294,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99213 LEVEL 3 EST PT PROF CHARGE,8700765,LOCAL,99213,CPT,,,,,,Outpatient,,,,387,CIGNA,Commercial,,50,,80,52.18,133.96,1 through 10,percent of total billed charges,54.77,54.77,
99214 LEVEL 4 EST PT PROF CHARGE,8700766,LOCAL,99214,CPT,,,,,,Outpatient,,,,513,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
99215 LEVEL 5 EST PT PROF CHARGE,8700767,LOCAL,99215,CPT,,,,,,Outpatient,,,,701,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0108 DIABETES SERVICE 30 MIN PROF CHARGE,13484119,LOCAL,G0108,CPT,,,,,,Outpatient,,,,128,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G0109 DSMT DIABETES GROUP 30 MIN ProFee,7936084,LOCAL,G0109,CPT,,,,,,Outpatient,,,,18,CIGNA,Commercial,,50,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.