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.